Bernard Sarah - Mental Health Needs of Children and Young People with Learning Disabilities

Pavilion Publishing and Media

The authors have asserted their rights in accordance with the Copyright, Designs and Patents Act (1988) to be identified as the authors of this work.

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First published 2010. Reprinted 2012

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A catalogue record for this book is available from the British Library.

ISBN: 978-1-908993-79-3

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Editors: Raghu Raghavan, Sarah H Bernard and Jane McCarthy
Editor: Catherine Jones, Pavilion
Cover design: Emma Garbutt, Pavilion
Page layout and typesetting: Katherine Jones, Pavilion
Printing: Ashford Press

Contents

Sarah H Bernard

Sarah H Bernard, Muthukumar Kannabiran and Neil Philips

Jane McCarthy

Chantal Homan

Suzannah Gratton

Alison Dunkerley

Raghu Raghavan

Raghu Raghavan and Nicole Pawson

Jill Davies and Kate Baxter

Richard Barker

Lisa Rippon

We wish to thank all the children and young people with learning disabilities, their families, carers and professionals who have helped us to conceptualise the theme of this book through our practice and research. We wish to acknowledge the help and support of all the chapter contributors to this book. The help of Hugh Firth, consultant clinical psychologist, Northgate Tyne and Wear Trust, for the formulation of the psychological interventions chapter is greatly acknowledged. Our thanks also go to Dr David Sims and Kate Dutton from Bradford District Care Trust for their contribution on family carers perspectives. We are grateful to Jan Alcoe and Sanaz Nazemi from Pavilion Publishing for commissioning this book and for their support and patience.

Sarah H Bernard MB ChB, MD, FRCpsych, DRCOG, Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust, National and Specialist CAMHS Learning Disability Team Mental, The Michael Rutter Centre, London

Jane McCarthy MB, ChB, MD, MRCGP, FRCPsych, Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust, Mental Health in Learning Disabilities, York Clinic, Guys Hospital, London

Raghu Raghavan BA, MSc, RNLD, PGCE, PhD, Reader in Disability and Mental Health, School of Health Community and Education, Northumbria University, Newcastle upon Tyne

Richard Barker BA (Hons), MA, PhD, CQSW, CASS, PGCE, RSW, Professor of Child Welfare, School of Health Community and Education Studies, Northumbria University, Newcastle upon Tyne

Kate Baxter BA, MA, MBBS, MRCPsych, Locum Consultant Psychiatrist, Harper House Childrens Service, CAMHS, Hertfordshire Partnership NHS Foundation Trust

Jill Davies BSc, RNLD, Research Programme Manager, Foundations for People with Learning Disabilities, 9th Floor Sea Containers House, 20 Upper Ground, London

Alison Dunkerley MB, ChB, MRCPsych, PGCTLCP, Bolton CAMHS, Royal Bolton Hospital NHS Foundation Trust, Bolton

Suzannah Gratton BSc (Hons), MSc, PsychD, Chartered Clinical Psychologist, South London and Maudsley NHS Foundation Trust, National and Specialist CAMHS Learning Disability Team, Michael Rutter Centre, Maudsley Hospital, Denmark Hill, London

Chantal Homan Clinical Nurse Specialist (Learning Disabilities and Mental Health), Southampton City Primary Care Trust, Southampton

Muthukumar Kannabiran MBBS, DPM, MRCPsych, Consultant Psychiatrist, Kent and Medway NHS and Social Care Partnership Trust, Sittingbourne, Kent

Nicole Pawson PhD Senior Research Fellow, School of Health Studies, University of Bradford, Bradford

Neil Phillips ClinPsyD, MSc, PGDip, BSc (Hons), Clinical Psychologist, Worcestershire PCT, Worcestershire

Lisa Rippon Consultant Psychiatrist, Prudoe Hospital, Northgate Tyne and Wear NHS Trust, Morpeth, Northumberland

It gives me great pleasure to provide the foreword for this book. The last decade has seen major changes and developments in provision for children with learning disabilities and their families. The Aiming High for Disabled Children programme has raised expectations in terms of life chances, educational outcomes and social inclusion, and parents are now seen as key and expert partners in their childs development. But we also know that provision can be variable and as this book shows we also know that concerns about the mental health of all children are growing.

In the UK there are approximately a third of a million children with a learning disability. Of these, 40% are likely to develop mental health problems. For many families, the mental health problems associated with challenging behaviour and sleep and eating problems will constitute a major challenge. As one mother notes:

Friendships and family contacts dwindle when your child behaves differently. You are so tired you can hardly cope. So often services just dismiss mental health problems as part of the learning disability. They are not and if they are not addressed at home, at school and in the community, the whole family is affected.

Children and young people with a learning disability and an associated mental health problem (and their families and those working with them in education and other settings) will require proactive, positive and well integrated support at every level. We know that many families with a child with a learning disability experience multiple challenges in ensuring that their child develops the resilience and emotional and physical well-being essential for good outcomes in education and later life.

A study from Contact a Family (2010) noted that, Many families with disabled children are in dire financial straits, having to cope with a harsh combination of extra living costs, the difficulty of holding down a job and the challenges of caring day to day.

For these families, there are often additional barriers due to lack of information, poor access to health care and in some cases, negative reactions and stigma about their childs disability and behaviours. As Lord Darzi (2008) commented:

People live out their lives in their own homes and communities. It is here that their health and well-being is shaped by the circumstances in which they find themselves and it is here that we need to deliver more vibrant, family-focused services, focusing more on emotional as well as health outcomes and life chances rather than crisis intervention.

This book offers the Darzi vision of integrated, informed and evidence- based identification, management and interventions when a child or young person has the dual diagnosis of learning disability and mental health problems. It is vital that parents, teachers, childcare and other workers and professionals have high expectations and receive early information, advice and support appropriate to the child or young persons developmental and chronological ages. If children and young people with learning disabilities are six times more likely to have a psychiatric diagnosis compared to their non-disabled peers, then a wide range of services working with children with disabilities or special educational needs will need an enhanced understanding of the interface between mental health and learning disability. As a parent at the Aiming High for Disabled Children consultation conference said: