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Guidance for commissioners of mental health services for people with learning disabilities

Many people with learning disabilities live full and rewarding lives as part of their local communities. In order to do this, they need support to have good mental health and wellbeing. Commissioners need to think about the following:

1 The prevalence of mental health problems in people with learning disabilities is considerably higher than the general population (see page 7)
• commissioning for mental health problems must therefore be informed by a Joint Strategic Needs Assessment (JSNA) which takes into account the needs of people with learning disabilities (see page 13).

2 In addition to mental illness, people with learning disabilities often have coexisting autistic spectrum disorders, behaviours that challenge services, offending behaviour, or physical health conditions (see page 7). It is often hard to distinguish between these conditions especially when people have more severe intellectual impairments.
• the JSNA must therefore provide detail about the number and needs of people with learning disabilities who have mental illnesses, as well as autism and behaviours that challenge services.

3 While there is no universally agreed commissioning model for mental health services supporting people with learning disabilities, the NHS Mandate1 states that an NHS England objective is to:
• ensure that Clinical Commissioning Groups (CCGs) work with local authorities to ensure that vulnerable people, particularly those with learning disabilities and autism, receive safe, appropriate, high quality care. The presumption should always be that services are local and that people remain in their communities, and that a substantial reduction should occur in the reliance on inpatient care for these groups of people.

4 It is often difficult for people with learning disabilities to access generic and specialised mental health services. Consequently:
• reasonable adjustments are a legal requirement and should be put in place to enable access to all mainstream services where appropriate
• learning disability services should be provided alongside mainstream mental health services so that the skills and expertise from both services can be utilised in order to respond to individual need (see page 14)
• there should be clarity with regard to commissioning arrangements between learning disability and mental health commissioners, with a presumption of accessing generic services wherever possible and there should be protocols setting out clear pathways between mainstream and specialist services.

5 The quality of mental health services should be measured from the perspective of the individual with learning disabilities and their family. Clinical effectiveness and outcomes, and patient safety, are also key (see page 18).

6 A positive experience for the individual with learning disabilities and their family is achieved by building a partnership through early involvement in service planning, delivery and evaluation as well as the provision of timely and seamless advice and support especially during periods of transition. Involving people with learning disabilities, their families and advocates in service planning, enables the provision of individualised services, one of the key characteristics of exemplary care or support

7 Successful services provide individualised pathways of care, based on a thorough understanding of the individual and their experience. It should be person-centred and consist of a coordinated assessment of need, agreement of expected outcomes, provision of care and treatment, followed by a joint review of achieved outcomes with the people receiving services and their carers

8 Commissioners should work in partnership with provider services in primary and acute care, and with local authorities including public health. This is a crucial first step to a better understanding of the needs of the population with learning disabilities and achieving an improvement in overall health and well being.
• It is important to remember that NHS England should be promoting and facilitating joint and collaborative commissioning by local authorities and CCGs to support the development of better services.

9 Commissioning of mental health services should support the development of local, person-centred services, leading to the development of skilled local providers (see page 13).

10 Commissioners should evaluate the outcomes of the service models they are providing, checking for evidence of effectiveness, safety and user satisfaction. They should use this to agree priorities for investment as the commissioning landscape changes and personal budgets become more popular
(see page 18).