Supporting Patients with a Learning Difficulty


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




Life on a Mental Health Mixed Acute Ward

It’s a roller coaster ride


Some people like them some people don’t but life on an acute ward is often up and down. Some days are busy some days are – dare I say the word…. Quiet!


But no two days are the same, which for some people is what attracts them to work the acute life.

Acute wards in mental health are designed to be a place for assessment and or treatment for people experiencing a severe episode of mental illness. Admissions can come at any time in the 24 hour period and with varying degrees on urgency.

Some patients are informal and choose to be admitted as they may recognise they are unwell, others are brought in on a 136 section from police custody due to concerns for their welfare or that of others. All will need risk assessing and care plans put into action straight away.

On top of the new admissions there are the often another 20 or so patients on the team-upward (depending on the size of the units). These patient’s presentations may vary day to day depending on how their treatment is going and how they feel it is going. Whilst mentally unwell, patients may have little or no regards for others on the ward so balancing out everyone’s needs can be hard. Team work is essential.

Some patients may be restless all night so keeping the disturbance for others to a minimum is another challenge. Flexibility and thinking on your feet for solutions is another necessity for a mental health nurse.

However there is nothing more rewarding than escorting a discharged patient calmly off the ward knowing they are now thinking  and feeling a lot more clearly and will hopefully be able to manage their illness out in the community and regain their place as part of  their family or community.

As a student nurse a mental health ward is one of the best places to really understand what someone experiencing a mental health illness can be like. Every kind of illness could be admitted, from depressive or manic behaviour, thought disorders and post-partum psychosis to severe self-harm and aggressive behaviours. To match the variety of illnesses you may encounter there are the medications to match.

The medication trolley will be your nemesis as a student nurse. Trying to remember your anti-depressants from your mood stabilisers and your anti-psychotics becomes stressful as you are under the watchful eye of your mentor as well as the patient themselves. You probably won’t remember them all so don’t try too.

Always ask if you are unsure – the patient is an expert in their own medication usually as well so there is no harm in asking them if they are stable in their presentation to assist you. This also helps to check the patients understanding of what they are taking their medication for; which is part of the NMC Code.

Talking to the patients can seem daunting at first but just being around canbe helpful for some as a piece of mind that someone is there is they need them. As a student nurse you may often find during your shift you have more free time than the qualified nurses so you can become extra support and provide more vital one to one time with a patient. Just don’t forget to document it afterwards.

Love it or loathe it acute wards can throw anything at you at any time of your shift they really are a roller coaster!


Blue Monday?

Its Blue Monday today! Apparently the third Monday in January is supposed to be the most depressing day of the year. So are you feeling depressed? How do you know? 

What does it mean to be depressed?         Feeling sad, miserable, fed up?      

How can you tell if you are depressed or just a bit down in the dumps – a bit blue?

Depression can mean different things to different people. What may seem simple and straightforward to one person may just have been the straw that broke the camel’s back for another. People often carry on with daily life often hiding the struggle they face. This can make things harder to cope with and accept or spot. Depression can affect anyone at any time it is not exclusive or discriminative.


There are many different types of depression such as seasonal affective disorder (SAD), postnatal depression and bipolar disorder (manic depression).  Symptoms can range from low spirits, feeling numb, helplessness or isolation to name but a few. You may find you’re not enjoying activities you usually would. You could be funding it hard to concentrate on things, difficulty sleeping or have lost your appetite. Again symptoms may vary from person to person and you may not even realise yourself. It could be that they reoccur or are just persistent.

The cause of these feeling may not be transparent, it could stem from a loss you may have experienced, life changes that are everyday occurrences in general but may have just impacted on you significantly. It may be something that happened a long time ago but feelings have only just resurfaced.

So what can you do if you feel this way or you think someone you know may be suffering with depression?

Self-help – reconnecting with people and talk to someone if possible, you’d be surprised how many people out there are ready to listen and help you if they can.  As they say …

timetotalkttclogo       It is good to talk!

As a friend you can help encourage your friend to seek the right kind of help for them.  Show them you care and be there for them when they need you. Again little things can make a big difference and being patient with them can be important. As a friend or carer you too can seek support and advice from a GP or other appropriate organisations (some of which are listed below). 

Keeping busy is important as breaking the negativity cycle and keeps your mind occupied on other more positive things. Take time to care for yourself. Every little helps and each step no matter how big or small can be a step in the right direction.

Alternative therapies are recommended to medication such as mindfulness or talking therapies. These can be accessed via your local health authority or via your GP or often at community/library centres.  Art or music groups, community volunteering or the new popular colouring books are a great way to help you focus on the here and now.

It is important you seek advice from your GP if possible, they can help you monitor your situation and support your recovery. They may also discuss medication if they or you feel it is necessary. 

For more information please seek professional help, below are some organisations that can also help;

Useful YouTube

Have you checked out Manchester University on YouTube? Subscribe to their channel and find out from the staff and students direct what life is like.

There is always something going on in different departments too so you can enhance your social awareness of what everyone else attached to the university is up to. This can provide extra learning opportunities and ideas, encourage a wider social involvement and a better understanding of university life outside that of the school of nursing.
The school of nursing has some great collaborations with outside agencies and generate ways to aid public awareness of topics and promotions going on in the area. A recent example is;

Use these ideas to be creative during your time here at Manchester University and beyond into your nursing career and stay involved with those around you.

Spokes – Its a State of Mind!

I attended the 10th annual ‘Mental Health Student Nurse Conference’ held by the University of Manchester yesterday. This was a great event organised by staff here at the University where students got a chance to debate the 6Cs with a panel of professionals. Workshops were held to focus on specific areas such as OCD or Dementia. We were also lucky enough to have a presentation from State of Mind. They are an award winning charity that challenges attitudes and stigma and helps to raise awareness of mental health within the Rugby profession and community groups. The guys were truly inspirational. Lead by a mental health nurse the guest speakers, all of whom were ex-professional rugby players, told us their experiences of mental health following life changing injuries sustained in the sport they love. Click on the link to the charities website to find out more of the fantastic work they do at both professional and amateur level. state-of-mind-logo I am writing about this to show how creative mental health work can be. Using this charity as a starting point, you can be as creative with your spokes as is relative when on placement. Look outside the box and see what amazing things mental health nurses are involved with out there.  Link up to your portfolio requirements as well and discuss possibilities with your mentor to help discover other ideas for learning opportunities. Physical health plays a large part in mental health both as a cause and an intervention. Use your spokes to come up with ideas or suggestions to help improve the care of those being looked after on your placement.  Discuss ideas with your colleagues, peers and AA and bounce ideas around.  Attending conferences and events in and around the university and NHS trusts can help spark your imagination and develop your skills and knowledge in just what mental health nursing incorporates.