Transcript In Business

Promoting Access To Mainstream
Psychological Services For All:
Including people with mild to moderate
learning disabilities
Christine Burke
Jill Davies
About FPLD
Our vision is that people with learning
disabilities continue to get better lives and
that our work contributes to this through
the development of knowledge, the
improvement of practice and the influence
of policy
About FPLD – how we do it
www.learningdisabilities.org.uk
“An estimated 25-40% of people with learning disabilities
have mental health problems… Commissioners and
service providers will need to continue to ensure that
mental health services are accessible to all disabled
people…. The improvement of mental health services for
people with learning disabilities [requires] inclusivity of
mainstream mental health services for people with learning
disabilities who have mental health problems”.
No health without mental health, Department of Health
(2011)
“The IAPT programme will consider that equitable
access has been achieve when the proportion of
patients using IAPT services is in line with both
prevalence and the community profile”
(IAPT three-year report. DH 2012)
Prevalence of mental health problems in
people with learning disabilities
People with learning disabilities are more likely to develop
mental health problems as compared to the general
population.
1 in 4 people experience a mental health problem at some
point in their life (Singleton et al, 2001)
Estimates range from 20 – 40% for people with a learning
disability
Prevalence
3% for schizophrenia (three times greater
than for the general population), with higher
rates for people of South Asian origin (Public
Health Observatory for Learning Disability)
Risk Factors for Mental Health Problems for
people with learning disabilities
• more likely to:
– live in poverty,
– have few friends
– to have other long term health problems and
disabilities such as epilepsy and sensory
impairments. (Emerson and Hatton, 2007)
– have fewer psychological and material resources to
deal with adversity (Jahoda et al, 2006)
– experience social exclusion, poverty and abuse
(Gravell, 2012).
Risk Factors for Mental Health Problems for
people with learning disabilities
− risk-averse service cultures contribute to restrictive
environments with fewer opportunities to build selfefficacy and develop problem-solving skills (Dagnan &
Jahoda, 2006)
− encountered discrimination by not being given
opportunities to get a job, socialise, have relationships
developing low expectations. (FPLD, ‘Count us in’, 2002)
• lack of meaningful activity can increase vulnerability for
mental health difficulties such as depression (Stancliffe
et al, 2011).
• People with learning disabilities have increased health
needs compared to the wider population. Physical and
mental health has a direct impact on one another.
(Hardy, 2011)
• Communication and language – it can be difficult to
communicate or articulate the symptoms of mental
health. (The Count us in inquiry, FPLD, 2002)
Barriers early identification and diagnosis
• Diagnostic overshadowing. ‘Its because of your learning disability’
• Lack of knowledge by parents and professionals about the range of
mental health problems people experience, and about who to go to
for advice.
• Not being listened to.
• Referrals passed from service to service, particularly if the person
had mild/moderate level needs.
Range of mental health problems
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Anxiety
Obsessive-compulsive
Depression/bi-polar disorders
Schizophrenia
Eating and elimination disorders
Sleep disorders
Attachment disorders
Personality disorders
The Access to Mainstream
Psychological Therapies Project
• Funded by DoH and run by the Foundation for People
with Learning Disabilities in partnership with Kings
College.
• Raise awareness about barriers to IAPT services.
• Provide evidence to make recommendations about
effective strategies for service development.
• Explore ways in which Improving Access to
Psychological Therapies (IAPT) services can better
support people with learning disabilities and mental
health needs.
What we hope to achieve
• IAPT staff have increased confidence and knowledge
around the needs of people with learning disabilities
and social communication disorders.
• Development of clear pathways to access services for
all.
• People with learning disabilities and social
communication disorders successfully accessing IAPT
services.
• Joint working between IAPT and health and social
care through involvement in the learning sets.
Insights from mapping
X Borough
Y Borough
Good links between psychologists in
different specialties
No forum for meetings between
psychologists between different
specialties
Opportunities for consultation and
training
Referral pathways between CLDT and
IAPT
Joint working
Both offering variety of therapies
IAPT services provided by a different
trust to LD psychology
Different service lines based on
“payment by results”
“We don’t work with people with
learning disabilities”
What we found
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Out of 25 respondents 4 were from IAPT
7 areas confirmed
Rest no engagement – not priority/IQ
No way of recording learning disability in national data base and no
indication of priority.
No commitment from IAPT in North England for ALS
Workshops and development of IAPT champions developed
Training on working with people with learning disabilities
Follow up with local support to encourage joint work IAPT/LDT
Project outcomes to date
• Joint working between IAPT/LDT
• Reference/implementation groups set up in some areas successfully
this has resulted in the involvement of commissioners and local
plans.
• Clearer statements of inclusion in IAPT services for people with
learning disabilities.
• Recording systems that allow for monitoring of people with learning
disabilities’ access to IAPT. (As in the Cumbria model)
• Training for PWPs and other IAPT therapists from LDT
• Pathways for joint working between IAPT services and local
specialist learning disability services.
Project results
• Clear goals and targets regarding use of IAPT by people
with learning disabilities specified by commissioners and
funded appropriately
• Different models of delivering good psychological
therapies for people with learning disabilities developed
• Joint development of Good Practice Guide for IAPT
• Training modules developed
• Work with National IAPT for change in data sets
• Dissemination of positive practice, conference, articles
etc.
IAPT & Learning Disability Research
• This study, funded by BUPA, explored the relationships between the
Improving Access to Psychological Therapies (IAPT) programme in
England and people with learning disabilities and the people and
services that support these service users. (Dr Deborah Chinn et al 2014)
It sets out to answer the following questions:
• What are the barriers and facilitators facing people with learning
disabilities in accessing IAPT?
• How do these relate to the views, practices and service delivery
models described by IAPT and specialist learning disability staff in
England?
• What are the strategies and practices that staff employ to support
people with learning disabilities to make good use of IAPT services?
• What advances are needed at the level of individual staff capabilities,
service delivery models, management, commissioning and policy
development to ensure equitable access to IAPT for people with
learning disabilities?
Results
• Staff in IAPT services do come across people with learning
disabilities as clients.
• The IAPT programme as a whole has not adequately addressed
access issues for people with learning disabilities
• Some IAPT services exclude people with learning disabilities from
the outset, by specifying eligibility criteria that rule them out.
Results
• a number of IAPT staff feel that their service, as a mainstream,
community-based service for people experiencing common
mental health problems, should be available to people with
learning disabilities and can offer treatments that they will find
helpful.
• The Psychological Wellbeing Practitioners (PWPs) seem most
optimistic about people with learning disabilities making good use
of IAPT.
( PWPs provide shorter, more practical interventions focusing on
self-management and education about mental health.)
Learning disability staff
Some specialist learning disability staff :
• Are actively involved in promoting IAPT for people with learning
disabilities.
• have either limited knowledge of IAPT services have had negative
experiences in trying to support their service users to get treatment
from IAPT.
• Felt that Iapt staff lacked confidence and understanding of the
needs of people with learning disabilities.
• Felt that specialist input from learning disability staff is more helpful
and appropriate, particularly for people with more complex
.
presentations
Figure 2. To your knowledge does your local IAPT service work with people who need help
with the following conditions?
Results
From the perspective of IAPT staff: majority of people with learning disabilities
they saw had been referred by GP (58.3% N137), 14% self referring, but only
8.1% CTLD.
In your opinion should ALL psychological therapies for people with learning disabilities
be provided by specialist learning disability services?
consensus among the IAPT staff and the learning disability staff, with very similar
proportions of each group (73.8% of the IAPT staff, N=138 and 73.5% of the learning
disability staff, N=175) answering No to this question
Both teams agreed that IAPT should be supporting people with learning
disabilities with common mental health problems.(anxiety and
depression)
Figure 8 What do you think makes an impact on whether someone with learning disabilities
would benefit from IAPT input? (IAPT staff responses)
(Learning disability staff responses)
The researchers found a similar response from IAPT and LD staff.
With an emphasis on support from carers and the individuals
capacity to understand the model of change underpinning IAPT
therapies.
Neither group felt that reading and writing would be a major barrier.
Communication issues highlighted as a possible barrier
Figure 10. To your knowledge, what has been the impact of this training?
Similarly there was an increase in IAPT staff confidence in
supporting people with learning disabilities
What helps.
IAPT services work best for people for learning disabilities when:
• IAPT staff and learning disability staff have developed good working
relationships and can co-ordinate their input.
• have prior experience of the needs of people with learning
disabilities
• are adapting their materials and their work practices for this client
group.
• involve family and carers in their work.
• their managers are happy to support them to work more flexibly and
at a slower place.
•
access training and consultation from local learning disability
specialists.
What hindered
Piecemeal support for work with people with learning disabilities
within IAPT, and initiatives vulnerable to service cuts.
This work does not appear to be a priority for commissioners, who
generally do not set local goals regarding access to IAPT for
people with learning disabilities.
People with learning disabilities can struggle to see themselves, and
be viewed by service systems, as legitimate candidates for IAPT
services.
What is needed
Clearer statements of inclusion in IAPT services for people with
learning disabilities.
Recording systems that allow for monitoring of people with learning
disabilities’ access to IAPT.
Training for qualification of PWPs and other IAPT therapists to include
material on working with people with learning disabilities, where
possible delivered with the involvement of people with learning
disabilities.
Pathways for joint working between IAPT services and local specialist
learning disability services.
Clear goals and targets regarding use of IAPT by people with learning
disabilities specified by commissioners and funded appropriately.
Next steps for project
• Update the IAPT Good Practice
Guidance
• Influence inclusion of ld in
National data set
• Develop ld champions in IAPT
north of England
• Evaluation report and research
report Disseminate nationally
• Influence policy and practice
Visit www.learningdisabilities.org.uk
IAPT Report
King’s College, London and the Foundation have been involved in a project looking at the experiences of
people with learning disabilities when using IAPT and have written a report and easy read executive
summary about this.
Download this report and easy read executive summary from our website.
http://www.fpld.org.uk/content/assets/pdf/publications/iapt-and-learning-disabilities-report.PDF
http://www.fpld.org.uk/content/assets/pdf/publications/easy-read-iapt-research-report.PDF
MHLD Report and Easy Read Guide
The mental health of people with learning disabilities is often overlooked and if recognised, services do not
adapt to meet their needs. We did a survey of people with learning disabilities, their families and p eople who
work in mental health services to see how well these services were supporting people with learning disabilities.
We have produced a report, Feeling Down improving the mental health of people with learning disabilities, with
recommendations about how these services can better meet people’s needs.
We have also produced an easy read guide, Feeling Down: looking after my mental health, to help people with
learning disabilities think about their mental health needs and support them to prepare for their visit to their
doctor to talk about their feelings.
http://www.fpld.org.uk/content/assets/pdf/publications/feeling -down-report-2014.pdf
http://www.fpld.org.uk/content/assets/pdf/publications/feeling -down-guide.pdf
Contact
Christine Burke
Foundation for People with Learning Disabilities
Colechurch House
1 London Bridge Walk
London SE1 2SX
Tel: 07985417808
[email protected]