Learning Disabilities: Positive Practice Guide
It is estimated that 1,068,000 people in England have a learning disability (2% of the population) and that 145,000 have severe or profound learning disabilities (Hatton et al, 2014). (For up-to-date statistical information on people with learning disabilities visit the Improving Health and Lives Learning Disabilities Observatory http://www. improvinghealthandlives.org.uk/numbers/).
Most people with learning disabilities have poorer health than the rest of the population, yet despite this their access to the NHS is often limited. The 2013 Confidential Inquiry into Premature Deaths of People with Learning Disabilities found that people with a learning disability have a shorter life expectancy than those without: a difference of 13 years for men and 20 for women. People with a learning disability are four times more likely to die of preventable causes than the general population (Heslop et al, 2013).
People with learning disabilities are more likely to develop mental health problems than the general population. Studies screening for psychiatric symptoms in people with learning disabilities report prevalence rates of between 20.1 and 40.9% (e.g. Taylor et al, 2004), and studies using psychiatric evaluation to identify cases found a similar prevalence (e.g. Cooper et al, 2007). People with learning disabilities are a disadvantaged and vulnerable group who are likely to encounter increased psychosocial threats and also barriers to accessing healthcare, including mental healthcare. Access to the full range of treatments offered by IAPT services will enhance health outcomes for people with learning disabilities and improve the competencies of IAPT workers. The ‘No Health Without Mental Health’ strategy (Department of Health, 2011) and implementation framework (Department of Health, 2012) set out a vision for improving mental health and wellbeing in England and highlighted the need to ensure that mainstream services were able to include people with learning disabilities and autism and that staff in these services had appropriate skills and could provide reasonable adjustments to meet the individual needs of this group of people (NHS England, 2015).
Reasonable adjustments are a cornerstone of the Disability Discrimination Act (2005) and the Disability Equality Duty (2006). A person is disabled under the Equality Act (2010) if they have a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on their ability to do normal daily activities. Reasonable
adjustments are a legal requirement, not a choice, and the Equality Act (2010) places a duty on all service providers to take steps or make reasonable adjustments to avoid putting a disabled person at a substantial disadvantage when compared to a person who is not disabled. This means making adaptations to the organisation of a work environment, an educational establishment, a healthcare facility or transport service in order to remove the barriers that prevent a person with a disability from participating in an activity or receiving services on an equal basis with others.
The IAPT three-year report (Department of Health, 2012) stated: “The IAPT programme will consider that equitable access has been achieved when the proportion of patients using IAPT services is in line with both prevalence and the community profile.”
This was reiterated in the Learning Disabilities Mental Health Outcomes Charter (NHS, 2013), which stated: “It is imperative that people with learning disabilities who have mental health needs have the same access to generic mental health services as the general population using reasonable adjustments where needed. People with mental health needs can often live normal lives if they get the right treatment and support.” The Green Light Toolkit (Turner and Bates, 2013) is a guide aimed at improving mental health services so that they are effective in supporting people with learning disabilities. It helps services review their own quality and share and replicate good practice through a database of examples of successful reasonable adjustments made by services around the UK; the toolkit has been used by numerous IAPT services.