A Drop in the Ocean

1
A Drop in the Ocean

• Exploring the need for
• Medium Secure Mental Health Provision
• for
• Adolescents with Learning Disabilities

2

• Tim Docking
• (Divisional Manager)
• Dr Ruth Andrews
• (Consultant Clinical Psychologist)
• Child and Adolescent and Autism Division,
  Northgate Prudhoe NHS Trust

3
Northgate and Prudhoe

• Large specialist LD provider
• Well established adult forensic service
• Specialist Child and Adolescent Tier 4
  service
• Stephenson House-8 beds low secure, Adolescent
  Forensic

4
Background

• Significant pressure on inpatient service-high
  referral rates
• Springhill,St.Andrews-30 beds
• Adolescent MSU referral criteria
• No learning disability as primary diagnosis
• Small number being admitted with limited success

5
Background(cont)

• Young People with learning disability
• Learning disability not being identified within
  youth justice system
• Held for lengthy periods in secure estate
• In specialist social care packages
• Admitted to adult services
• Being held in higher levels of security
• Remain in community or at home
• Risk too high for local teams

6
Background(cont)

• Issues raised with NSCAG-asked for more
  information
• The outline brief
• Is there a need for a specialised LD adolescent
  medium secure provision ?
• What is the unmet need ?
• If needed, what should service look like?

7
The NSF for Children

• The Mental Health and Psychological Well Being
  of Children and Young People (CAMHS module).
• The external working group had an LD sub
  group. The Key messages are
• Inclusion
• Early intervention
• Training and Support to professionals

8
NSF(cont)

• Adequately resourced Tiers 2 and 3 specialist LD
  CAMHS
• Access to Tier 4 CAMHS providing inpatient,day
  patient and outreach
• Joint agency planning
• Comprehensive CAMHS-Performance managed

9
Background (cont)

• Minding the Gap
• 2004 conference involving speakers from
  Department of Health, Commissioners, other
  providers, social services and Home Office.
• Recognising young people with learning
  disabilities falling between services
• Count us In
• Recommends inclusion alongside specialist
  provision and further investment in learning
  disability services

10
What we did

• Explored the existing literature relating to this
  group
• Consulted lead clinicians from the existing
  adolescent MSUs
• Consulted clinicians and commissioners from areas
  of the country where there is currently no such
  provision
• Audited the existing adolescent MSU referral data
  base to establish the number of young people
  fulfilling the diagnostic criteria for learning
  disability
• Accessed referral data bases held at Northgate
  and Prudhoe NHS Trust to identify young people
  requiring medium secure provision.

11
Studies in the North East

• YOT 26 had IQ less than 70
• STC 32 had IQ less than 70
• Kolvin Clinic 20 had IQ less than 70
• Most figures indicate verbal skills more impaired
  than abstract reasoning skills

12

• One US study estimates for all juvenile
  offenders
• 35.6 would be considered learning disabled (ie
  have specific learning difficulties in the UK)
• 12.6 would be considered mentally retarded (ie
  meet diagnosis for learning disability in the UK)
• (Casey Leilitz, 1990)

13
Study limitations

• Unclear definition of learning disability
• Unclear definition of MSU
• Time involved in collecting information
• Could not consult all agencies
• Screening practices variable
• Data bases still under development
• Data bases not designed with audit questions in
  mind.

14
Findings

• 15 to 33 of referrals to current adolescent MSU
  have intellectual disability-this equates to
  between 8 and 17 referrals per year
• Northgate and Prudhoe had 9 referrals per year
  thought to require MSU
• Annual range is 17-26 referrals with 1 in 3 or 4
  female.

15
Findings

• Lack of clarity around MSU referral criteria
• Learning disability is not routinely screened
• Learning disabled adolescents have difficulty
  accessing therapies in mainstream services
• Difficulty in accessing education
• Discharge can be delayed and young people can
  become stuck in the system

16
Findings (cont)

• Clinical teams have skills but require further
  training
• MSUs work with young people with complex needs.
  Adding needs associated with LD makes offering
  treatment very difficult
• Adolescents with learning disability can be
  vulnerable within mainstream peer group
• Adolescents with learning disability require
  specialist services and expertise
• Current provision is a drop in the ocean of
  need

17
Recommendations

• Systematic screening should be established
• A comprehensive national database is needed
• A further more detailed study should be
  considered
• Consideration should be given to the
  commissioning of medium secure services for
  adolescents with learning disabilities.

18
The options

• Widening access to current MSUs to individuals
  who have learning disability
• Develop a specialist service within an existing
  service
• Develop a specialist learning disability MSU.

19
Where Next

• Draft report received by NSCAG
• Under consideration
• Specialist commissioning ?
• Currently leading needs assessment within
  Regional Youth Justice System
• YOUR QUESTIONS ??