increasing access to psychological therapies for people with a learning disability
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Increasing access to psychological therapies for people with a learning disability
Fleur-Michelle CoiffaitUniversity of Edinburgh & NHS Lothian
Monday, 14 May 2012
Overview of presentation
Monday, 14 May 2012
LD and mental health• MH problems and ψ distress
more common in this group (Dosen & Day, 2001; Haddock & Jones, 2006; Brown & Marshall, 2006)
• Estimated prevalence 30-50% (Smiley, 2005)
• MH needs continue to be unrecognised and unmet
• LD services need to follow mainstream mental health services (Hatton & Taylor, 2005)
Monday, 14 May 2012
Key Scottish policy documentsMonday, 14 May 2012
Key Scottish policy documentsMonday, 14 May 2012
Key Scottish policy documentsMonday, 14 May 2012
Key Scottish policy documentsMonday, 14 May 2012
Key Scottish policy documentsMonday, 14 May 2012
Key Scottish policy documentsMonday, 14 May 2012
Key Scottish policy documentsMonday, 14 May 2012
Key Scottish policy documentsMonday, 14 May 2012
• £173 million invested 2007 - 2011
• IAPT primary care services
• Low / high intensity therapists
• Work at defined steps
IAPT south of the border
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IAPT and learning disabilities
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IAPT and learning disabilities• Inclusion, improving
access for minorities
Monday, 14 May 2012
IAPT and learning disabilities• Inclusion, improving
access for minorities• Service
commissioning for whole community
Monday, 14 May 2012
IAPT and learning disabilities• Inclusion, improving
access for minorities• Service
commissioning for whole community
• Overcoming health inequality in NHS services
Monday, 14 May 2012
IAPT and learning disabilities• Inclusion, improving
access for minorities• Service
commissioning for whole community
• Overcoming health inequality in NHS services
…the reality?
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Scottish policy contextDelivering for Mental Health (2006)‘The Matrix’ (2008)• Adults• Children, young people, families• Long-term conditions• Physical health
Monday, 14 May 2012
Scottish policy contextDelivering for Mental Health (2006)‘The Matrix’ (2008)• Adults• Children, young people, families• Long-term conditions• Physical health
…where is LD?
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Psychological therapies for people with LD
• The ‘unoffered chair’ (Bender, 1993)
• Growing evidence base for CBT (Beail, 2003)
• Multidisciplinary biopsychosocial formulation (Ingham et al., 2008)
• Behavioural family therapy
Monday, 14 May 2012
Psychological therapies for people with LD
• The ‘unoffered chair’ (Bender, 1993)
• Growing evidence base for CBT (Beail, 2003)
• Multidisciplinary biopsychosocial formulation (Ingham et al., 2008)
• Behavioural family therapy
…why not?Monday, 14 May 2012
Stepped care in LD services• Already used?• Feasible?• How would it work?• How would it look?• Skills gaps?• Training / supervision
needs?• Alternatives?
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Methodology• 2 x 45 min focus
groups• P’s – CLDT:
psychiatrist, 4 x nurses, SLT, OT, physio, team secretary
• Audio recorded and transcribed verbatim
• Process notes• Stimulus material and
topic guideMonday, 14 May 2012
Topic guide• Recognition/
assessment of MH / ψ needs • How these needs are
met• Understanding / use of ψ approaches
• Supervision, training• Stepped care
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Data and analysis
• 90 mins discussion, >16,000 words
• Transcribed in full• NVivo 8 used for
coding and organising thoughts
• Thematic analysis
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Thematic map
Barriers to meeting
mental health needs
Barriers to recognising
mental health needs
Varying levels of knowledge and trainingLack of
standardised procedure /
tool
Lack of standard
assessment protocol / tool
Supervision issues Firefighting
Time constraints
Not enough people to do it
Lack of structured, evidence-
based approaches
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Conclusions• Differing levels of MH / ψ knowledge, training, experience and confidence
• Lack of standardised assessment tools/protocols
• Limited evidence base → limited training/guidelines/ policy available
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Acknowledgements
North East Edinburgh CLDT
Keith Marshall, CBT Therapist in LD
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Thanks for listening
© Luc Coiffait Photographykindly provided by www.luccoiffait.com
Monday, 14 May 2012