Provision of Mental Health Services for Adults with Learning
Disabilities – CLP033
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Table of Contents
Governance of Trust Policies – PB001 ..................................................... Error! Bookmark not defined.
Why we need this Policy ..................................................................................................................... 2
What the Policy is trying to do ............................................................................................................ 4
Which stakeholders have been involved in the creation of this Policy .............................................. 4
Any required definitions/explanations ............................................................................................... 4
Key duties ............................................................................................................................................ 5

Clinical Policies Committee ..................................................................................................... 5

Service Areas ........................................................................................................................... 5

Ward Managers’...................................................................................................................... 5
Policy detail ......................................................................................................................................... 5

Eligibility for Services .............................................................................................................. 5

Implementation and Dissemination ..................................................................................... 10

Education and Training (Training Needs Analysis) ................................................................ 11
Training requirements associated with this Policy ........................................................................... 11

Mandatory Training .............................................................................................................. 11

Specific Training not covered by Mandatory Training .......................................................... 11
How this Policy will be monitored for compliance and effectiveness .............................................. 12
For further information..................................................................................................................... 12
Equality considerations ..................................................................................................................... 12
Havard Reference Guide ................................................................................................................... 13
Document control details ................................................................................................................. 14
APPENDIX 1 – EQUALITY Analysis report .......................................................................................... 14
APPENDIX 2 - Crib Card for use with Transforming Care 'At Risk Register'…………………………………..17
Why we need this Policy
The White Paper, Valuing People: A New Strategy for Learning Disability for the 21st Century (March
2001) sets out the Government’s commitment to improve life chances for people with learning
disabilities. It emphasizes that mainstream services should be accessed by people who have a
learning disability in the same way as the rest of the population. In particular it makes reference to
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the mental health needs of people with a learning disability being met within mainstream mental
health services where appropriate with or without the support of Learning Disability services.
It is therefore expected that all Mental Health Services in Northamptonshire Healthcare Foundation
NHS Trust will identify and respond to the mental health needs of people with learning disabilities, in
conjunction with specialist learning disability services where appropriate, within the context of
Valuing People and the National Service Framework for Mental Health Services. Furthermore, where
specialist learning disabilities are providing mental health services, they will deliver the standards of
care set out in the NSF for Mental Health and New Horizons
When in need of mental health services it is important that people with learning disabilities are able
to access appropriately skilled and knowledgeable professionals who are able to undertake
assessment, intervention, support and monitoring, and wherever possible enable people to remain
in their communities, only accessing in-patient services when required. It will require mental health
services and learning disability services to work in partnership to achieve this.
The Trust is committed to the following principles:

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People with learning disabilities have the same right of access to specialist Mental Health
Services as the rest of the population.
Every effort should be made to ensure that where possible the mental health needs of
people with learning disabilities are met within mainstream services, either with them as the
sole provider or in partnership with learning disability services.
Services will be able to evidence that reasonable adjustments have been made to
accommodate individuals accessing the service
There will be a number of people with learning disabilities whose mental health needs
cannot be met within mainstream mental health services even with the provision of
specialist learning disability support. In these situations the provision of specialist learning
disability services will be required to meet the needs of this client group.
Access to services should be based upon needs not upon diagnostic category.
Service users and their families/ carers should be fully involved as far as possible in making
decisions that affect their lives.
Often the needs of the service users require a multiagency approach; co-operation and
flexibility should characterise approaches in meeting people’s needs.
The approach should be consistent with the principles of recovery using the care programme
approach alongside person centred planning and WRAP (Wellness Recovery Action Plan).
A person physical health needs will be identified via a health check and health action plan
that identifies key professionals involved in meeting both physical and mental health needs
Expected Outcomes of Policy Implementation


Consistent access and appropriate use of mental health services by people with learning
disabilities and mental health needs, with them receiving the best possible support.
Roles and responsibility for meeting the mental health needs of people with learning
disabilities will be explicit across all services.
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Collaboration between Mental Health and Learning Disabilities services will ensure that
people with mental health needs do not fall between services.
Generation of data on use of mental health services, by people with learning disability with
mental health needs will be available. This will be used to further develop services based on
need, monitor accessibility of services and provide evidence to inform policy and protocol.
The Trust is committed to treating people with dignity and respect in accordance with the
Equality Act 2010 and Human Rights Act 1998. Throughout the production of this policy due
regard has been given to the elimination of unlawful discrimination, harassment and
victimisation (as cited in the Equality Act 2010)
What the Policy is trying to do
This policy concentrates on service provision to meet the mental health needs of people with
learning disabilities. It sets out the operational arrangements between secondary mental health and
learning disability services which will enable people with learning disabilities to have their mental
health needs met by the most appropriate directorate and service.
The fundamental principles of this policy are to direct resources as appropriate to the mental health
needs of people with learning disabilities within the context of: 

st
Valuing People-A New Strategy for Learning Disability for the 21 Century
New Horizons- A Shared Vision for Mental Health
Which stakeholders have been involved in the creation of this Policy


Consultation with Service Managers, Medical Staff, Clinicians in both directorates
Trust Policy Board
Any required definitions/explanations

Learning Disability
Includes the presence of a significantly reduced ability to understand new or complex
information, to learn new skills (impaired intelligence) with a reduced ability to cope
independently (impaired social functioning) which started before adulthood, with a
lasting effect on development.

Mental Health Issues
The Government defines mental illness as “A term generally used to refer to more serious
mental health problems that often require treatment by specialist services. Such illnesses
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include depression and anxiety (which may also be referred to as common mental health
problems) as well as schizophrenia and bipolar disorder (also sometimes referred to as
severe mental illness).” In this report, we refer to mental health issues rather than mental
illness.

Reasonable Adjustments
The term reasonable adjustments was first used in the Disability Discrimination Act 1995 and
refers to the duty on those providing goods, services and employment opportunities to
ensure that their arrangements do not discriminate against disabled people
NHFT
Northamptonshire Healthcare NHS Foundation Trust
Key duties

Clinical Policies Committee
Will approve the policy and ensure that current policy versions are placed on the intranet via
CGST. This will enable it to be held on a central register.

Service Areas
The Service Managers / Senior Matrons are responsible for monitoring and ensuring that
the policy is implemented in clinical practice by all professionals involved, reporting any
deficits to the Quality Team.

Ward Matrons
Responsibility is to ensure all professionals on their ward have access to the policy. This
involves doctors, therapists, nurses etc.
Policy detail

Eligibility for Services
Services from the Mental Health and Learning Disability Directorate will have clear and
transparent eligibility criteria for the services they provide. These will be equality impact
assessed. Under no circumstance will service eligibility criteria exclude people with learning
disabilities based on diagnosis alone.
o
Referral Route and Initial Assessment
In both mental health and learning disability services, the Community Teams provide the
single point of entry to services in their the team receiving the referral will:

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Establish eligibility for their service
Carry out the initial screening assessment/single assessment process
At this point there are 3 pathways for the referral/service user
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o
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The receiving team accepts the referral and commences work with the
service user. If a joint assessment/intervention becomes necessary in the
future a referral can be made to the appropriate service.

The receiving team deem that their service is not the most appropriate or
they cannot solely meet the service users’ needs. It is then their
responsibility to initiate discussion with other services and arrange a joint
assessment to identify how the needs of the service user are best met and
by whom.

The referral does not meet the service eligibility criteria of any specialist
services; the receiving team will inform the referrer and signpost to
alternative services outside of the Trust and ask for confirmation that this
has been offered
Cases Requiring Joint Assessment and Joint Intervention
In the case where a joint assessment is required, the initial receiving service will hold the
case until this is carried out.
The Mental Health and Learning Disability Community Teams will each appoint a worker
who will coordinate the assessment. They will jointly contribute to the assessment of
need with the relevant Consultants and professionals involved.
The outcome of the joint assessment will be discussed at a Multi-disciplinary meeting.
This would result in 3 potential pathways for the referral/service user:
o
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One service accepts the referral and proceeds as per their operational policy
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Joint working is agreed, with one service appointed as case holder and
takes responsibility for leading the joint work
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The referral is directed to another service outside the trust and after follow
up the case is closed.
Cases Requiring Urgent Assessment in Relation to their Mental Health
A Care and Treatment Risk register (CTR) has been developed across the services to ensure
that anybody (adult, child or young person) with a learning disability and/or Autism who is at
risk of being admitted to a specialist learning disability unit or generic mental health
inpatient bed because of their mental health or behaviour that challenges, is flagged at the
earliest opportunity if they are at risk of a crisis that could result in hospital admission. This
will enable contingency plans and early identification, including joint organisational
discussions to occur with the aim of preventing an admission to hospital.
If an individual becomes red rated, they will be required to receive a Community CTR if they
are at imminent risk of admission to hospital. The lead clinician/social worker will contact
the CCGs learning disability commissioners to arrange a community CTR where all parties
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will attend. (Commissioners will endeavour to arrange the CTR as a matter of urgent
priority)
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If a person is rated at BLUE which is where the person is in crisis or a crisis has occurred and
the individual is at the point of being admitted to hospital. All blue light ratings will have a
‘Blue Light’ conference call with all those involved/available.
The Commissioner (or their representative) will need to agree the admission
Should admission occur (or if the person is admitted without prior knowledge) a Care and
Treatment Review will take place within ten working days of the admission
(See appendix 2 for further information on Care treatment review risk register)
o
Within Working Hours
The Crisis Resolution Home Treatment Team (CRHTT) and the Intensive Support
Service (ISS) will respond to urgent referrals for people who are experiencing an
acute mental health crisis in accordance with their operational policies. In
addition the Intensive Support Team (IST) has a duty clinician whom the Mental
Health service can refer to directly for advice and guidance.
It is the responsibility of the team receiving the referral to clarify eligibility, carry
out initial assessment and initiate local discussion between other services and
contact CCG commissioners if there is a risk of admission.
o
Out of Normal Working Hours
The CRHTT responds to urgent referrals for people who are experiencing an
acute mental health crisis in accordance with their operational policy
Psychiatry provides an out-of-hour’s on-call psychiatrist who can be contacted
through Berrywood Hospital switchboard.
Northamptonshire County Council out-of-hours team will respond to urgent
situations relating to mental health crisis and work in conjunction with other
services to co-ordinate mental health act assessments.
o
Access to In-Patient Services
Wherever possible assessment and intervention should be provided within the
community. Admission to in-patient areas should only be considered when there
is an acute clinical need requiring assessment and treatment and the individual
cannot be safely supported within the community. Support must take place in
the least restrictive environment
o
Planned Admission/Admission with Notice
The individual referring for an inpatient admission should ensure that joint
assessment/discussion is facilitated between LD and MH inpatient services to
identify which is the most appropriate service to meet the needs of the
individual and to agree what, if any, additional support may be required.
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o
Emergency Admission – Admission on Day of Request
In emergency situations, where it is not possible for the receiving service to
facilitate a joint assessment or discussion, a clinical judgement should be made
as to which service would be in the best position to meet the needs of the
individual. A decision should be made by the service receiving the admission to
review the situation and to request a joint assessment if a transfer to the other
directorate may be appropriate.
o
Medical Responsibility
Where the service user is under the active care of a Learning Disability
Consultant Psychiatrist, they will continue to take medical responsibility when
the service user is admitted to a Mental Health in-patient service. Where the
service user is not under the active care of the Learning Disability Consultant
Psychiatrist, the admitting team will involve them in the MDT decision making
process.
Whilst maintaining medical responsibility the Learning Disability Consultant
Psychiatrist will work in partnership with the inpatient team, including medical
staff. In situations where the inpatient team need to act urgently and the
Learning Disability Consultant Psychiatrist cannot be contacted the appropriate
Mental Health Psychiatrist will intervene, acting in the service users best
interests.
The exception to this is when a service user who is under the care of the
Learning Disability Consultant Psychiatrist is admitted to the Psychiatric
Intensive Care Unit (PICU). In this situation the PICU Psychiatrist will take on
medical responsibility. Medical support can be requested from the Learning
Disability Consultant to enable joint working as necessary.
o
Transfer Between Services
On occasions, it may be necessary to transfer a service user to another
directorate to enable their needs to be met by the most appropriate service, this
relates to both community and in-patient settings.
A discussion will be coordinated by the service that is already supporting the
service user. This will involve the individual, family, advocates, consultants, team
and service managers from relevant services who will identify and agree which
service would be most appropriate to meet the service user’s needs.
Any transfer of care should be carried out in the best interests of the service
user with the minimal of disruption and upset to them. This should be carefully
planned between the two services. Transfer should occur during normal working
hours unless there is a valid justification to do otherwise.
Documentation should clearly describe the reasons why the transfer was
required and how this was carried out. Under no circumstances should diagnosis
of learning disability alone be used as a reason for transfer.
Prior to transfer a full hand over should take place including relevant history,
reason for admission, current treatment and intervention, physical and mental
health status and person centred information. It is the referring services
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responsibility to ensure adequate information and support is provided. It is the
receiving services responsibility to ensure they are fully informed of the care
plan and needs of the patient before accepting responsibility.
o
Complex Developmental Needs in Addition to Mental Health
Where there are complex developmental needs such as autism and ADHD, the
service receiving the referral or case holder will consider the need to request an
assessment from the Autism, Asperger’s and ADHD team. This will enable a
review of the care planned and will recommend and/or provide:
o Further intervention strategies
o Advice/training on management of needs
o Recommendations about appropriate care setting and
support/treatment needs.
o
Care Programme Approach / Care Planning
The majority of service users to whom this policy applies will be supported
within the framework of the CPA. For those that do not meet the criteria for CPA
the same best practice principles will apply under the care planning process.
After the initial assessment has taken place a CPA meeting will be held to
identify support required and develop a care plan based on need. The most
appropriate professional involved from the team holding the case will be
allocated as the CPA or case care co-ordinator, and will oversee the
implementation, monitoring, reviewing and evaluation of the agreed plan of
care.
Additional support from either Mental Health or Learning Disabilities services
will be identified and negotiated within the meeting. The role of services
providing the additional support will be clearly identified in the CPA action plan.
This will vary from the provision of support workers to specialist advice and
consultation. The levels of support may vary dependent on resources available.
The GP will be asked whether the person is in receipt of an annual health check
and health action plan. Where this has not taken place the clinician will support
the initiation of one. The mental health needs will be documented alongside
actions and clinicians responsible as well as consideration for any physical health
needs that may be identified.
o
Information and Involvement
All services will have easy read materials in relation to the service provided,
ward rounds and/ or reviews, Advocacy, medication and treatments prescribed,
Mental Health Act and Mental Capacity Act These resources can usually be
found on the internet or by approaching CTPLD’s and/ or requesting support to
develop materials via the Learning Disability Speech and Language Therapy
Service based in CTPLD’s.
It is essential that the person and/ or family are invited and supported to attend
ward rounds/ reviews and involved in their care planning. It is also essential that
they are offered an advocate to support where applicable.
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o
Discharge
Discharge will be planned from the day of admission. Admission documentation
should clearly identify reason for admission, actions required and anticipated
length of stay required. This will be regularly reviewed and updated as
appropriate. Discharge planning will follow the Trust discharge and CPA policies.
Discharge plans must take into account individual need and be at a pace that
supports their needs. The CPA discharge meeting will include all agencies
involved and will clearly identify discharge arrangements and follow up.
Any concerns of potential or actual delays in discharge should be reported to the
LD IPC Team who will support discharge in liaison with the local authority care
management team..
o
Outcome Measures
All people accessing services will have outcomes measured via HoNOS LD and
three changes checklist.
o
Agreement of Funding
Where cases require additional funding e.g. for additional staffing to enable use
of mainstream services, or for an out of county placement, these will be
resolved between the nominated budget holders. This may include sums due or
requested from the County Council and/ or CCG.
The appropriate contact in LD/MH commissioning should be informed at the
earliest opportunity within working hours.
Funding should never be a barrier to urgent provision of health care as required.
o
Dispute Resolution
The case holder will liaise with the relevant Consultant Psychiatrists and Service
Managers where a dispute is raised. Where these cannot be immediately
resolved, a multi-disciplinary meeting between the services will be arranged by
the case holder in order to reach agreement.
Where an agreement cannot be reached by clinicians who are directly involved
the case will be referred to the Head of hospitals or general manager as
appropriate. Where the dispute is still unresolved the Medical Director should
be contacted for advice.
Out of hours a reasonable compromise should be sought, seeking advice from
on-call managers as appropriate. If a solution cannot be reached the Director on
Call
should
be
contacted
for
guidance.

Implementation and Dissemination
Head of hospitals and general managers are responsible for the dissemination and
implementation of this policy to their teams via the identified line management structure
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All professionals are responsible for ensuring their actions fit within the requirements of this
policy and to identify any deficit or difficulty in implementation.

Education and Training (Training Needs Analysis)
The appraisal systems will be used across all staff groups to identify training and
developmental needs, particularly in relation to meeting the mental health needs of people
with learning disabilities. Identified training needs that cannot be met within current training
provision will be forwarded to the Head of learning and development so that where
possible, resources to meet these needs are identified.
Multifaceted learning opportunities will be developed that will enable staff in all services to
develop their knowledge and skills in relation to meeting the mental health needs of people
with learning disabilities. This may include e-learning and availability of intranet resources,
action learning sets and access to classroom based training including appropriate further
education courses.
Team based training, e.g. within staff meetings, and developing individuals, e.g. staff
shadowing opportunities, in both directorates should be considered as a way of improving
knowledge and skills
Multi-professional and multi-agency training/learning opportunities should be developed to
improve collaborative work between services and enable effective service delivery.
As a minimum staff will receive:
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Learning Disability Awareness training, including values base.
Identification of mental illness/atypical presentations in people with learning disabilities
Mental Capacity Act and Human Rights Act awareness
Adaptation of psychological therapies and Positive Behaviour Support
Use of alternative communication methods
Equality Act, including reasonable adjustments
Training requirements associated with this Policy

Mandatory Training
Training required to fulfil this policy will be provided in accordance with the Trust’s Training
Needs Analysis. Management of training will be in accordance with the Trust’s Statutory and
Mandatory Training Policy’

Specific Training not covered by Mandatory Training
Ad hoc training sessions based on an individual’s training needs as defined within their
annual appraisal or job description.
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How this Policy will be monitored for compliance and effectiveness
Data will be collated, monitored and reviewed to enable the services to understand indicators of
quality ascribed to the service. Where the data indicates that services are not performing to the
described benchmark action plans will be drafted to improve the situation. The audit process assures
users and the Trust that the service understands its commitment to equality and quality of patient
outcomes.
All services will provide information based on the Learning Disability Minimum Dataset, including the
numbers of people who have a learning disability that are referred to their service with mental
health needs, including the individual’s age, estimated level of learning disability and cultural
background. The outcome of the referral will also be documented. This will be entered onto the
patient’s electronic record.
There will be a patient experience survey made available to clients and /or carers during their
admission and at discharge. This will be made available in easy read if required. End of year reports
on the experiences of people with learning disabilities will be compiled by each service and
forwarded to Quality Assurance Team, Nurse Director and Chief operating officer and shared with
the teams
Where it has been identified and flagged up that the policy has failed to be implemented
satisfactorily the case holder should facilitate a clinical review in order to learn from the experience
and any actions including amendments required to the policy will be identified. Outcomes should be
fed back to the Mental Health Green Light Project Lead.
Where available, data will also be gathered from complaints and compliments received by the Trust.
For further information
Please contact the Service Managers, Meidcal Staff and clinicians in both directorates.
Equality considerations
The Trust has a duty under the Equality Act and the Public Sector Equality Duty to assess the impact
of Policy changes for different groups within the community. In particular, the Trust is required to
assess the impact (both positive and negative) for a number of ‘protected characteristics’ including:

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Age;
Disability;
Gender reassignment;
Marriage and civil partnership;
Race;
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
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Religion or belief;
Sexual orientation;
Pregnancy and maternity; and
Other excluded groups and/or those with multiple and social deprivation (for example
carers, transient communities, ex-offenders, asylum seekers, sex-workers and homeless
people).
The equality report is contained in appendix 1
Reference Guide
Department of Health, (1999) National Service Framework for Mental Health: Modern Standards
and Service Models HMSO London
Department of Health, (2001) Valuing People: A New Strategy for Learning Disability for 21
Century HMSO London
st
Department of Health (2009) New Horizons: A Shared Vision for Mental Health. HMSO London.
Department of Health (2012) Transforming care: A national response to Winterbourne View
Hospital, Department of Health Review, Final report HMSO:London
Foundation for People with Learning Disabilities, Valuing People Support Team, National Institute for
Mental Health in England, (2004) Green Light for Mental Health: How good are you services for
people with learning disabilities? A Service Improvement Toolkit Foundation for people with
Learning Disabilities London
National Development Team for inclusion (NDTi) (2013) The Green Light Toolkit
Royal College of Psychiatrists (2012) Enabling people with mild learning disabilities and mental
health problems to access healthcare services (CR175 College Report November 12
Royal College of Psychiatrists (2013) People with learning disabilities and mental health, behavioural
and forensic problems: the role of inpatient services FR/ID/O3 Faculty Report July 13
US Department of Health and Human Services (1999). Mental Health: a report of the surgeon
general. Rockville MD: U.S. Department of Health and Human Services, Centre for Mental Health
Services, National Institutes of Health cited in Varcarolis E.M and Jordan Halter M (2009). Essentials
of Psychiatric Mental Health Nursing: a Communication Approach to Evidence-Based Care.
Saunders Elsevier. Missouri
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Document control details
Author:
Approved by and date:
Responsible Committee:
Any other linked Policies:
Policy number:
Version control:
Version
No.
1.0
Date
Ratified/
Amended
12.04.2016
Nurse Consultant, Mental Health, Consultant Psychiatrist, Service
Manager, Project Manager
Trust Policy Board, 12.04.2016
Clinical Exec.
CLP010 - Care Programme Approach Policy
CLP060 - Physical Interventions Policy
CLP056 - Admission and Discharge Policy
PB002 - Equality Policy
CLP033
Version 1:
Date of
Next
Implementation Review
Date
12.04.2016
12.04.2019
Reason for Change (eg. full rewrite,
amendment to reflect new legislation,
updated flowchart, minor amendments, etc.)
New governance of trust policies
template.
APPENDIX 1 – EQUALITY Analysis report
Equality Analysis Report
Name of function:
Policy for the Provision of Mental Health Services for Adults with Learning
Disabilities
Date:
Assessing officers:
Sue Freeman – Nurse Consultant
Description of policy including the aims and objectives of proposed: (service review/redesign, strategy, procedure,
project, programme, budget, or work being undertaken):
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Equality Analysis Report
Name of function:
Policy for the Provision of Mental Health Services for Adults with Learning
Disabilities
Date:
The aim of this policy is to provide guidance on operational arrangements to ensure that people with learning
disabilities, when in need of intervention for their mental health are able to access the most appropriate service
to meet their needs. This will include access to and support from mainstream adult mental health services.
Evidence and Impact – provide details data community, service data, workforce information and data relating specific
protected groups. Include details consultation and engagement with protected groups.
Evidence base:
 NHFT Equality Information Report August 2012
 Northampton County Council :Northamptonshire Results: 2011 Census Data Summary
2001
2011
%
rise
Corby
Daventry
East
Northants
Kettering
Northampton
South
Northants
Wellingborough
Northants
England
53,400
72,100
76,600
82,200
194,200
79,400
72,500
630,400
49,449,700
61,100
14.4%
77,700
7.8%
86,800
13.3%
93,500
13.7%
212,100
9.2%
85,200
7.3%
75,400
4.0%
691,900
9.8%
53,012,500
7.2%

Ethnicity: 85.7% (White) and 14.3% (BME )- 1.75% (dual heritage); 4.01% (Asian); 2.5%(Black including British,
African and Caribbean) ; 0.85 % (Chinese) ; 6.05 % (white other EEA, polish, Gypsy & Traveller)

Gender: 49.6% males; 50.4% females (including 1% transgender)

Disabled people: 19% (including 3.5 % < aged under 18)

Faith communities: 71% Christian; 29% minority faith: (includes Hindu, Muslim, Sikh, atheists, non-belief)

Sexual orientation (gay, lesbian or bisexual): 5 - 7% (Stonewall estimate)
Service Information: provide any relevant service data or information to inform the Equality Analysis including service
user feedback, external consultation and engagements or research.
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Equality Analysis Report
Name of function:
Date:
Protected Groups
(Equality Act 2010)
Policy for the Provision of Mental Health Services for Adults with Learning
Disabilities
STAGE 3: Consider the effect of our actions on people in terms of their protected
status?
The law requires us to take active steps to consider the need to:



Eliminate unlawful discrimination, harassment and victimisation.
Advance equality of opportunity
Foster good relations with people with and with protected characteristic
Identify the specific adverse impacts that may occur due to this policy, project or
strategy on different groups of people. Provide an explanation for your given
response.
Age
There will be no impact on people over the age of 18 years old who have a learning
disability
Disability
Gender (male, female and
transsexual, inclu.
Pregnancy and maternity)
There will be a positive impact on the small population of people with mild
learning disabilities in being able to access mental health services.
This policy helps reduce the risk of discrimination againt people with learning
disability
There will be no impact on gender
Gender reassignment
There will be no impact on gender reassignment
Sexual Orientation (incl. Marriage
& civil partnerships
There will be no impact on sexual orientation
Race
There will be no impact on race
Religion or Belief (including non
belief)
There will be no impact on religion or belief
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Equality Analysis Report
Name of function:
Policy for the Provision of Mental Health Services for Adults with Learning
Disabilities
Date:
Equality Analysis outcome: Having considered the potential or actual effect of your project, policy etc, what changes
will take place?
The policy promotes positive change in promoting equity of access to mental health services for people with learning
disabilities.
Action Plan
Issue to be addressed
Action
Who
Date to be completed
Ratification – a completed copy of the Equality Analysis form must be sent to Equality and Inclusion Officer to be
approved.
Approving Officers
Tendai Ndongwe
Date of completion:
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Appendix 2
Crib Card for use with Transforming Care 'At Risk Register'
The aim
The aim of the at risk register is to ensure that anybody (adult, child or young person) with a
learning disability and/or Autism who is at risk of being admitted to a specialist learning
disability unit or generic mental health inpatient bed because of their mental health or
behaviour that challenges, is flagged at the earliest opportunity if they are at risk of a crisis
that could result in hospital admission. This will enable contingency plans and early
identification, including joint organisational discussions to occur with the aim of preventing an
admission to hospital.
Best Practice
It is already expected as best practice that people who are at risk of hospital admission will
be assessed as to whether they meet the criteria for the Care Programme Approach (CPA)
and this is initiated where appropriate. There is also an expectation that the relevant
specialist health services be referred to in an attempt to proactively work with the individual
to reduce the likelihood of a crisis occurring. In addition, there should be a discussion with
direct carers as to current management plans, including a contingency plan, if at any point
they should cease being able to provide support due to situations such as illness or level of
risk. This will include a pen portrait of need and a description of the support that would be
required in such an event.
Any professional who identifies someone at risk of requiring hospital admission should
ensure best practice is adhered to.
Consent
Where the risk is increasing and concerns have begun to be raised in relation to the level of
support required, then it is the professional’s duty to ensure that consent (or MCA best
interest decision) is established to enable details of the person and their risk, to be entered
onto the At Risk Register. It is important that individuals (and/or their family members where
appropriate) are made aware that their details will be passed to the relevant commissioner
should the risk of admission to hospital reach such a level that a Community Care and
Treatment Review (or in some cases a ‘blue light’ conference call) needs to occur. NHS
England also require consent for an individual’s details to remain on the register once an
admission to hospital/discharge has occurred.
(NB-NHS England has produced information leaflets and consent forms for this process)
Completing the risk register
Most of the register is self-explanatory however some sections require explanation. This crib
sheet will act as a guide.
Client Initials/ NHS Number– It is important that both the NHS number and individuals
initials are entered in these boxes. Please provide initials only as commissioners are not
allowed to be given full names
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Under CPA Framework/Details of CPA Co-ordinator/Lead professional including
contact details and phone number –Where the person is on CPA this will be the CPA coordinator. In cases where they are not on CPA the lead professional will be named. At this
point the professional should consider whether they meet the criteria to be on CPA and take
action if required.
Last review of any review of person’s care plan/needs – this includes where people are
receiving a Direct Payment for a personal assistant, Personal Health Budget etc…
Type of residence – This will be one of the following: residential/nursing home, residential
bespoke individual home, family home, own tenancy/house with 24 hour support, own
tenancy/house with flexible support, supported accommodation, address of 52 week
residential school etc….
Name of provider – This will be the name and address of the provider in the persons place
of residence including parents/ informal carers and contact details
Funding Stream – If there is a current support package in place which commissioning
team/s are funding this- name and contact details
Secondary Health Service Involvement – Please give brief details of current involvement,
including LD and MH services- name and contact details.
Is there a plan of care, risk assessment/management and contingency plan in place –
This will be a yes where the plans are in place and detail the current situation. Where no is
recorded the professional should ensure actions take place to address this need.
Current level of risk:Green rating (for example)
 Where the person has been at risk (i.e. has been an inpatient because of their mental
health/behaviour that challenges but successfully discharged
 where intensive support has prevented a crisis admission because of intervention
etc…)
 there are concerns but no crisis presently (This may be where these are being
managed or there is a high reliance on the family and/ or ageing parents)
 If a young person is approaching transition and risks could quickly escalate (must
include young people in transition/out of county schools known to have CB/MH)
All green rating will go on the risk register and the case manager will monitor and
inform others on a need to know basis
Amber rating (for example)
 Where the risk is rising- health interventions increasing or requests for a significant
increase in the care package
 Where providers/families are stating that they are having difficulty in supporting the
individual
 Where an individual has stepped down from a red rating (i.e. that a community CTR
has taken place and an admission has been avoided) but sufficient concern and/or
activity remains with current presentation
All amber rating – a contingency planning meeting (arranged by the lead-coordinator)
should take place to ensure that crisis avoidance is at the forefront
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Red rating
 Where the lead clinician/social worker has assessed the individual as at significantly
high risk and a crisis is imminent with a highly likely inpatient admission
and/or
 Where there is a planned admission to hospital
An individual who is red rated will be required to receive a Community CTR if they are at
imminent risk of admission to hospital. The lead clinician/social worker will contact the CCGs
learning disability commissioners to arrange a community CTR where all parties will attend.
(Commissioners will endeavour to arrange the CTR as a matter of urgent priority)
Blue Light
 Where the person is in crisis or a crisis has occurred and the individual is at the point
of being admitted to hospital
 All blue light ratings will have a ‘Blue Light’ conference call with all those
involved/available.
 The Commissioner (or their representative) will need to agree the admission
 Should admission occur (or if the person is admitted without prior knowledge) a Care
and Treatment Review will take place within ten working days of the admission.
Commissioner contact details are as follows:
Learning Disabilities
Sue Freeman-Commissioning Manager
Tel: 01604 651283 M:07787006192
[email protected]
Claira Ferreira- Commissioning Lead
Tel: 01604 651207 M:07787006198
[email protected]
Children and Young People
Sian Heale-Commissioning Manager
Tel: 01604 651723 M:07919697986
[email protected]
Helen Adams-Commissioning Manager
Tel: 01604 651627 M: 07824-608158
[email protected]
Mental Health (Asperger’s)
Rachel Douglas-Clark- Commissioning
Manager
Tel: 01604 651275 M:
[email protected]
Rachel Conlon- Commissioning Lead
Tel: 01604 651133 M:
[email protected]
Senior Managers -Joint Commissioning Team
Catherine O’Rourke –Deputy Head (adults)
Tel: 01604 651263 M:
catherine.o’[email protected]
Richard Bailey - Deputy Head (children)
Tel: 01604 651851 M:
[email protected]
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