Increasing access to psychological therapies for people with a learning disability

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

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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)

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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

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access for minorities• Service

commissioning for whole community

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• Overcoming health inequality in NHS services

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• 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

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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

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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

…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

Health & Medicine

Increasing access to psychological therapies for people with a learning disability