This reflective account will focus on time spent with the Learning Disability (LD)/ Autism Professional Lead for a mental health service.
The very core of this role is being a LD nurse in a mental health service, advocating the needs of people with LD and/or Autism Spectrum Conditions (ASC) in an environment where they are not always a forefront priority. What makes this role specialist is that the skills and knowledge that are required to carry it out effectively have to be transferrable; to be able to work with people with LD and/or ASC who use the service, with the staff within mental health services giving the service and with higher management who implement new services. The cornerstone of this role is the implementation of The Green Light Toolkit Audit, which is the responsibility of the LD/Autism lead to develop, roll out and monitor, using results to ensure a responsive and adaptive approach is taken to support the needs of people with LD and/or ASC using mental health services.
In Valuing People Now (2009) The Department of Health highlighted concerns around a lack of understanding in health services about the need of people with learning disabilities, how to communicate effectively and how to make reasonable adjustments (DOH, 2009, p30). As a result, implementations such as The Green Light Toolkit (NDTi, 2013) were developed to help services become more inclusive of all their service users’ needs. It is the responsibility of the LD/Autism Professional Lead to develop the guidance set by the National Development Team for Inclusion (NDTi) and ensure teams are meeting the fundamental standards.
NDTi first developed Green Light Toolkit in 2004 in an effort to support mental health services to include people with a learning disability. Following on from this, the report ‘Reasonably Adjusted?’ (2012) looked at how effectively services were supporting these adjustments. They found that not many trusts had made enough reasonable adjustments to allow fair access into services or effective treatments for people with LD and also those with Autism Spectrum Conditions (NDTi, 2013). The Green Light Toolkit Audit (2013) set 27 fundamental standards to be assessed by each service; carried out by a Green Light Champion who is team member who acts as a link between the LD/ ASC Lead and the teams delivering the service and advocating the needs of those with LD/ ASC. The Green Light Toolkit Audit is carried out across trusts annually, results are then sent to NDTi who create a benchmark for all services to aim to achieve. Alongside this NDTi also provide guidance for improvement and a database of good practice example and ideas allowing for peer-to-peer sharing and learning across teams and trust (NDTi, 2013).
There is a longstanding ignorance in mental health services to widely accept that people with LD and/or Autism require input from mental health services. The 1913 Mental Deficiency Act’s acknowledgement of people with learning disabilities need to have a care provision was to segregate them from society (O’Driscoll, 2013). Although this marked a change in service provisions for people with learning disabilities as specialist services had to be created to support this population, these setting were often kept away from mainstream society and housed large numbers of people with LD and/or ASC, who were not only kept away from communities but also from each other as males and females were strictly kept apart (O’Driscoll, 2013). It could be inferred from this that this change in care set the scene for the ‘out of sight, out of mind’ approach that mental health services appear to have adopted towards supporting people with LD and/or ASC.
Over the last 50 years there has been a shift towards mainstream care for people with LD and /or ASC, from delivering care to this population in large isolated institutions to supporting people to live within the community (Sheehan & Paschos, 2013,). More recently; supported by evidence that not only do people with LD and/ or ASC suffer the same mental health difficulties as the general population but also higher rates of these difficulties (Sheehan & Paschos, 2013; McNally & McMurray, 2015); there has also been recognition that those with co-existing mental health difficulties should receive care from mental health services. Despite this, some modern day mental health services explicitly exclude anyone with a diagnosis of LD and/or ASC from their service, regardless of if their primary need is mental health related. It is from barriers such as these that recommendations, such as from The Green Light Toolkit (2004) have arisen in an effort to provide standards and guidance for mental health and learning disabilities services to work together to provide a mainstream service that is inclusive of all service user needs (McNally & McMurray, 2015).
During time spent shadowing the LD/ Autism Professional Lead, I have seen the work going on ‘behind the scene’ of the mental health service to create an inclusive service. From being part of Green Light Champion events that bring together both experts by experience and staff to work collaboratively to create achievable and obtainable goals, to attending Transforming Care meetings where the NHS and Local Authorities attempt to identify gaps within services and local provisions that need to be created to assist the delivery of care and support. Another important aspect of the LD/ Autism Professional Lead is to ensure the mental health trust is compliant with NICE guidelines in preventing, assessing and managing mental health problems in learning disabilities and autism (NICE, 2016). As a mental health student nurse, the most important outcome taken away from this experience working with the LD/ Autism Professional Lead and talking to experts by experience is that there is an acknowledgement that things need to change, however mental health staff that are often responding do not have the specific experience or training in working with this population (Hemmings et al, 2013) to meet their needs.
From shadowing the LD/ Autism Professional Lead it has become obvious that similar to a pebble being dropped into a lake, appreciation of the needs of people in mental distress with co-existing LD and/or ASC are slowing making ripples through the mental health system.
Moving through training and once a qualified mental health nurse this experience has highlight that to be an effective mental health nurse, fulfilling NMC code of conduct to treat people as individuals and deliver the fundamentals of care (NMC, 2015) It is imperative to ensure that therapeutic interventions are not only transferable but also effective to those who may also have LD and/or ASC. Whilst implementations such as The Green Light Toolkit work on a many levels to create reasonable adjustments within the mental health service on an individual level I can develop my own practice by utilising training opportunities and keeping up to date with current evidence.
Mental Health Student Nurse
University of East Anglia
Department of Health (2009) Valuing People Now: Summary Report for March 2009 to September 2010, London: Department of Health; p30
Hemmings. C, Obousy. S and Craig. T (2013) Mental Health Crisis information for people with intellectual disabilities, Advances in Mental Health and Intellectual Disabilities, 7 (3) pp.135-142
McNally. P and McMurray. K (2015) Exploration of the dynamic barriers to adults with intellectual disabilities accessing mainstream mental health services, Advances in Mental Health and Intellectual Disabilities, 9 (6) pp.352-362
National Development Team for Inclusion (2012) Reasonable Adjusted? Mental Health Services and Support for People with Autism and People with Learning Disabilities, Bath: National Development Team for Inclusion
National Development Team for Inclusion (2013; revised 2017) Green Light Toolkit: A guide to auditing and improving your mental health service so that it is effective in supporting people with autism and people with learning disabilities, Bath: National Development Team for Inclusion
National Institute for Health and Care Excellence (2016) Mental Health problems in people with learning disabilities: prevention, assessment and management [online] available at: https://www.nice.org.uk/guidance/ng54
Nursing and Midwifery Council, 2015, The Code, London, NMC, Available at: http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf
O’Driscoll. D (2013) Happy Anniversary, Learning Disability Practice, 16 (9) p.11
Sheehan. R and Paschos. D (2013) A comparison of different models to meet the mental health needs of adults with intellectual disabilities, Advances in Mental Health & Intellectual Disabilities, 7 (3), pp.161 – 168