rcpsychSpecialist mental health in-patient services for people with learning disabilities still need to improve, according to a report by the Royal College of Psychiatrists.

The report, People with learning disability and mental health, behavioural or forensic problems: the role of in-patient services, was commissioned by the College’s Faculty of Psychiatry of Intellectual Disability as a result of the abuse scandal at Winterbourne View Hospital and makes recommendations to improve care.

People with learning disabilities who come into contact with specialist learning disability mental health services often have a complex mix of learning disability, other developmental disorders, mental illnesses, personality disorders, substance misuse and physical disorders including epilepsy. Sometimes this is associated with challenging behaviour, other times not. Most people can be supported in community settings, especially when these are provided in a person-centred, flexible way. But where there are major risks to the person themselves, or to others, compulsory treatment under the Mental Health Act can sometimes be required. As such, specialist in-patient services can form an essential component of an overall integrated care pathway. 

Key recommendations
The report sets out the different types of specialist in-patient services that are currently provided for people with learning disabilities, and makes a series of key recommendations, including:
• A choice of generic mental health and specialist learning disability mental health beds should be available for people with learning disability and mental health or behavioural problems who require acute in-patient treatment
• Commissioners and service providers should plan from day one of admission to in-patient services for the person with learning disability to move back to community services
• Good in-patient unit facilities should have multidisciplinary therapeutic input. There should be regular monitoring of this availability
• All in-patient units should be able to show evidence of going through an external accreditation process, such as those run by the Royal College of Psychiatrists or an equivalent
• All in-patient units should be able to show evidence of a minimum data-set of treatment outcomes, including descriptions of quality of care, measures for effective treatments, appropriate use of medication, patient safety, compliance with the Mental Capacity Act, and patient experience.

Dr Ian Hall, chair of the Royal College of Psychiatrists’ Faculty of Psychiatry of Intellectual Disability, said: “In Winterbourne View Hospital, there was an appalling standard of care that no one would condone. Since that time, there has been much debate about the place of specialist in-patient care for people with intellectual disabilities.

“Most people with learning disability will never need to use specialist inpatient services, and improvements in community services will mean that fewer do in the future. The

Royal College of Psychiatrists wholeheartedly support the development of better community services, particularly for those with challenging behaviour and other major mental health needs. However, for those people who do require inpatient treatment because of the severity of their mental health, behavioural or forensic problems, it is crucial that they have services of the highest quality with clear treatment goals and outcomes. Care pathways and support must be in place so that people can move safely to community settings promptly as soon as their risk profile allows.”