1. Network of care for intellectually disabled individuals with mental illness in the UK Professor Iqbal Singh

2. Network of care People with learning disabilities & mental health problems have the same right to high standards of assessment and treatment, and as good a quality of life as other people Historically, these people’s mental health needs have been given low priority, which is further compounded by Their often very complex mental health needs Difficulties in diagnosis of mental health problems Requirement for specialist multi-professional involvement

3. Network of care In recent times the care for people with learning disabilities and mental health problems has been improved greatly as these people are viewed much more favourably, and we have better understanding of psychological processes, neurosciences, genetics and neuro-imaging. There are also more effective treatments based on biopsychosocial models.

4. Network of care There is wide variation in the development of services between different countries of the world, with services in their infancy in most of the third world countries. There is a now a general trend towards a more humane form of treatment and a move away from large institutional care to community-based care.

5. Network of care Most writers date the Western history of learning disability from 1790 Modern developments were inspired by Philippe Pinel, who is credited with removing chains and other abusive treatments The publication of The Wild Boy of Aveyron, by Jean-Marc Itard

6. Network of care Industrialisation led to major changes in population centres and saw the growth of large institutions. These became total institutions.

7. The Eugenics Movement The Eugenics Movement, promoted by Sir Francis Galton, played a significant part in the growth of these institutions Survival of the race was seen in keeping imbeciles locked away from the general population

8. The Eugenics Movement The quality of care for such people consequently suffered : Diverse physical & mental health needs not assessed No effective treatments Research was limited After 1945 the Eugenics Movement was discredited and human rights extended to people with learning disabilities

9. Network of care Over some decades the process of de- institutionalisation gathered pace and most of the larger hospitals have been closed and replaced by purpose-built small specialist units, or the facilities have been merged with generic services.

10. Normalisation The UK King’s Fund Report ‘An Ordinary Life’ (1981) was influential in speeding up the process of normalisation Changes in Social Security regulation provided massive expansion of public funds for resettling people from large hospitals

11. Normalisation Between 1971-2000 the number of hospital beds fell from 50,000 to less than 2,000 (DH 2001) A down-side to this rapid move meant that some clients were not properly prepared for their move and others’ complex needs were not properly assessed or reprovided

12. Network of care Eventually the DoH and the Dept of Social Security agreed that there are 3 overlapping groups of people with learning disabilities whose special needs require specialist attention: Those with mental illness Those with severe antisocial behaviours Those who commit crimes

13. Network of care This has led to an uneven pattern of specialist services throughout the country, including Specialist acute mental illness services A small number of inpatient forensic units A diverse range of challenging behaviour services

14. Services in a typical district Population around 200,000 Number of LD clients on register: 600-700 Number of LD clients with mental health problems: 200-300 A Partnership Board, Social Services and National Health Services Pooled budgets

15. Services in a typical district Community Team for People with Learning Disabilities consists of: Manager Senior nurse and other nurses Psychologists Speech & Language Therapist Occupational Therapist Challenging Behaviour specialist Epilepsy Specialist Nurse Consultant Psychiatrist

16. Services in a typical district Most clients live at home Some live in supported accommodation Others live in specialist accommodation Small in-patient facilities (generic vs. specialist)

17. Services in a typical district Other specialist services Tertiary assessment and treatment services Medium secure services Private sector

18. Provision of healthcare for people with learning disabilities Jointly funded across the region Integrated clinical information systems Evidence-based practice Identifiable pathways to care

19. Provision of healthcare for people with learning disabilities (2) Clear responsibilities/accountabilities Comprehensive services for all ages & abilities Regional Codes of Practice and Standards for Professional Carers Regional planning for workforce and training

20. Provision of healthcare for people with learning disabilities (3) In-patient facilities: Assessment and treatment Rehabilitation Slow stream rehab 24-hour nursing care (residential) Neuropsychiatric disorders

21. Network of care

22. Traditional Role versus New Role Traditional role Seeking aetiology of mental retardation General health care Administration of health facilities Unit-based service New role Focus on diagnosis, treatment and prevention of mental illness Community-based service

23. Generic vs. Specialised Services Generic services by default Generic services by design Specialised Psychiatric Services