Between 25 and 40% of people with learning disabilities also suffer from mental health problems, with dementia and schizophrenia showing a higher prevalence. Standards of care for those with an identified learning disability have been under the spotlight since appalling levels of care were highlighted in the media relating to a specialist care home – somewhere that should have been a safe haven for those in need of support. Questions were raised about in-patient services for those with a combination of a learning difficulty and a mental illness who presented with behaviours that were challenging and what care options should be provided. It must be highlighted that not everyone presenting with these combination of diagnoses will present with challenging behaviours. Everyone is different but we all deserve the same level of care.
In placement as a mental health student I have observed patients being brought onto a general mental health acute ward who have a diagnosed learning difficulty. I have seen both good and poor practice observed. I have seen staff gain a real understanding of a patient’s condition and how the patient see’s and understands the world. I have seen other patients on ward stand up for and support a patient with learning difficulties and sadly seen others exacerbate the patients current mental state. Knowing how to support and care for the patient as an individual in this situation is crucial as well as manage the others in your care in the same way.
Learn more about the patient’s condition just as you would a standard mental health patient. Asking the patient directly can also be a great way to gain understanding of they view their situation. Asking a carer or family for advice, again in the same manner you would with other admissions helps to promote equality and improves the care you can provide. Find out if they have any extra physical or communication needs that need support as it can help relieve some stress and anxiety about settling into the new environment.
Providing an individualised person centred approach to care during an admission is vital. The Royal College of Psychiatrists (2013) recognise the complexities involved in service provision of this kind and confirm the importance that communication between a multi-disciplinary team plays. Some hospitals have a learning disability liaison nurse so it’s worthwhile finding this out too. It maybe that a learning difficulty is undiagnosed in a patient as cognitive impairment is often found in those with schizophrenia; the consultant should be able to provide support on this when made aware. Either way, care provision should be treated with the same respect, care and dignity as it is to all.
The Royal College of Psychiatrists (2013). People with learning disability. London: Royal College of Psychiatrists