Issues and Dilemmas for Learning Disability Community Psychiatric Services
| Published date | 01 June 2000 |
| Date | 01 June 2000 |
| DOI | https://doi.org/10.1108/13619322200000017 |
| Pages | 26-29 |
| Author | Sheila Hollins,Ken Courtenay |
| Subject Matter | Health & social care |
Issues and Dilemmas
for Learning Disability
Community Psychiatric Services
Sheila Hollins
Professor of Psychiatry of Disability
St George’s Hospital Medical School
Ken Courtenay
Specialist Registrar in Psychiatry of Disability
St George’s Hospital Medical School
Focus on…
Introduction
The issues and dilemmas facing learning disability
community services are both similar to and different
from those facing general adult psychiatry services.
They include the challenge to be faced in a
modernising NHS to ensure that the quality of health
care available to people with learning disabilities is at
least sustained, and hopefully improved; and that
organisational boundaries do not impede access to
essential expertise and support. Issues include:
■limited understanding among health service
commissioners of the complex mental health
needs of people with moderate or severe
learning disabilities
■poor recruitment and retention of specialist
learning disability mental health staff: for example,
a 15% shortfall in consultant psychiatrists
■inflexibility of providers and commissioners of
social care to meet complex, individual needs.
Dilemmas include:
■clinical practice relies on findings from research
which has excluded people with learning disabilities
■access to mainstream generic mental health
services may be more discriminatory than
developing mental health expertise among
learning disability specialist and support staff
■ethical issues about consent to treatment.
Learning disability specialist health care
Learning disability specialist health services are
usually provided in multidisciplinary community
teams, sometimes jointly with social services. They
have a wider remit than community mental health
teams, with responsibilities for providing specialist
assessment and therapeutic support to people with
learning disabilities, whether or not they have a dual
diagnosis. The disciplines employed may include
the following:
■psychology
■psychiatry
■speech therapy
■dietetics
■physiotherapy
■nursing
■social work
■occupational therapy.
Such teams were first introduced in the late
seventies to support resettlement and have undergone
diversification and change as services have become
established in community or mental health trusts, or
in separate learning disability trusts. The range of
skills within community teams has allowed a more
comprehensive approach, involving both social care
and health care workers in meeting the needs of
the person.
26 The Mental Health Review Volume 5 Issue 2 June 2000 ©Pavilion Publishing (Brighton) 2000
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