Sir: The reconfiguration of mental health and learning disabilities NHS trusts has highlighted once more the lack of clarity for the provision of mental health services for people with learning disabilities. The prevailing view is that the mental health needs of people with learning disabilities should be provided by mental health trusts through specialist services (Hassiotis et al, 2000).
Psychiatrists for people with learning disabilities are not seen to have an extended medical responsibility for other health needs, i.e. primary care, epilepsy etc. (Doody & Neville, 2001). Primary care teams are now the principal providers of primary clinical care to people with learning disabilities (Lindsey, 1998). They act in cooperation with multi-disciplinary and often multi-agency community learning disability teams.
The role of the psychiatrist specialising in the care of people with learning disabilities should not be diluted and confused by these other service requirements. This is compatible with the practice of other psychiatric specialities; for instance child and adolescent mental health teams focus on mental health problems, while child development teams address developmental issues. Similarly, for elderly people there are the specialist multi-disciplinary teams and mental health teams.
The White Paper Valuing People: A New Strategy for Learning Disability for the 21st Century (Department of Health, 2001) reiterates that people with learning disabilities should have access to mainstream mental health services and that the National Service Framework for Mental Health applies to people with learning disabilities and mental health problems. Although it proposes clear protocols for collaboration between specialist learning disability services and mental health services, it does not offer any clarification about the organisational and funding implications. It emphasises that alternatives to in-patient treatment should be sought whenever possible for people with learning disabilities and mental health problems. However, each local service should have access to an acute assessment and treatment resource for those who cannot appropriately be admitted to general psychiatric services, even with specialist support.
The consequences are that a distinct mental health service is needed for people with learning disabilities and that the general psychiatric services will have increasing responsibilities for this population in terms of admissions, forensic cases and for people with mild learning disabilities and borderline cognitive impairment.
We are interested to hear the views of our colleagues in general psychiatry on these issues.
We believe that the specialist mental health service for people with learning disabilities is a tertiary psychiatric service, which has a service interface with the developmental aspects of other learning disability services. It should predominately function as part of an overall mental health service including general psychiatry and the other psychiatric specialities. A consensus opinion should emerge as to what are the necessary components and responsibilities of the specialist mental health service for people with learning disabilities.