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News and updates from today's 'Implementing the NICE guidance for improving Mental Health Services For People with Learning Disabilities' conference

Professor Sally-Ann Cooper speaks at today's conferenceProfessor Sally-Ann Cooper speaks at today's conference

Following the chair's introductions and discussion on the response to the NICE guidelines,  Professor Sally-Ann Cooper Chair Guideline Development Group for Mental health problems in people with learning disabilities NICE & Professor of Learning Disabilities & Honorary Consultant Psychiatrist University of Glasgow, opens the conference with a session on 'Implementing the January 2017 NICE Quality Standard: Learning disabilities: identifying and managing mental health problem' covering: 

• the 5 quality statements for your service
• what the new standard means for you
• what you need to know: changes to documentation, medication and intervention 

Professor Cooper cooments:

"There's under recognition of Mental Health with learning disabilities 
Some people dont get the efective interventions they need, provisions of ineffective / or harmfull interventions 

The reason for the Quality standard - The describe high quality areas for quality improvement in a defined care or service area.
They are annually reviewed.  NHS england has commited to the standards.

Populations included: children, young people and adults wth LD and mental health problems.
Settings covered : All settings in which care is provided.

Guideline published September 2016.  Easy read version also avaiaible. Nice pathway created - covers overview, assessment, interventions.

The quality statements are explicit.
The guidelines are evidence based. "

Professor Cooper's Abstract:

The National Institute of Health and Care Excellence (NICE), provides national evidence-based guidance and advice to improve health and social care. It was established in 1999 to explicitly reduce variation in availability and quality of NHS treatments and care, and in 2012 it was also given responsibility for developing Guidance and Quality Standards in social care as well as health care. Geographic variation in care is clearly an issue in services for people with learning disabilities, and in recognition of this, poor access to care, and under-recognition/misattribution of mental health problems, NICE were asked to produce a Guideline on preventing, assessing and managing mental health problems for people with learning disabilities. The Guideline was published in September 2016, and the associated Quality Standard in January 2017. The Quality Standard describes high priority areas for quality improvements. It includes five quality statements, which are clear, measurable, and concise. Measures are provided for each of the five statements to assess the quality of care/service specified in the Quality Standard. The Quality Standard provides organisations information on best practice, allows benchmarking of current performance, and identification of priorities for improvement, and allows services to monitor improvements. They can also be used by service-users, carers and the public, practitioners, and commissioners. This talk will outline the background to the Guideline and the Quality Standard, its coverage, uses, and what it might mean for you and your service.

Professor Cooper's biography:

Professor Cooper was appointed to the University of Glasgow in 1999 to its foundation Chair of Learning Disabilities.  She is Deputy Director of the Institute of Health and Wellbeing at the University, works as an Honorary Consultant Psychiatrist within NHS Greater Glasgow and Clyde, and is Director of the Scottish Learning Disabilities Observatory.  She has published extensively on the epidemiology of health and health inequalities in adults with intellectual disabilities, and trials of complex interventions to improve their health.  She recently chaired the NICE Guideline Development Group on mental health problems and people with intellectual disabilities, published September 2016, from which the new Quality Standard was developed and published in January 2017.

Dr John Devapriam Committee Member GDG Service Models for People with Learning Disabilities Chair Quality Network for Learning Disabilities Clinical Director Acute & Low Secure Mental Health Services & Consultant Psychiatrist Leicestershire Partnership NHS Trust, continues the morning sessions with an update from The Royal College of Psychiatrists on Psychotropic drug prescribing for people with intellectual disability, mental health problems and behaviours that challenge.  The session covers:

• approaches to prescribing for people with intellectual disability and mental health problems
• Prescribing standards and recommendations

Dr Devapriam's Abstract

Challenging behaviour is a socially constructed descriptive concept that has no diagnostic significance and makes no inferences about the aetiology of the behaviour. The presence of communication difficulties, autism, sensory impairments, sensory processing difficulties and physical or mental health problems (including dementia) increases the likelihood of challenging behaviour in people with intellectual disabilities.

To be able to inform the type(s) of interventions (pharmacological and non-pharmacological), it is important to have a conceptual framework to understand challenging behaviour to support rational prescribing where appropriate. This framework can form the theoretical basis which informs formulation and intervention plans. Diagnoses (where applicable) of mental illnesses are a crucial element of any multidisciplinary formulation especially where prescribing of psychotropic drugs is to be one of the interventions.  The recording of diagnoses can be particularly problematic in those patients with intellectual disability who are unable to give a clear verbal account of their psychopathology. This dynamic means that in rationalising prescribing practice, one has to carefully balance the need to stop unnecessary treatment with the risk of under-treatment (RCPsych 2016, NICE 2016). 

The standards for good prescribing are described by the Royal College of Psychiatrists (2016):

  • The indication(s) and rationale for prescribing the psychotropic drug should be clearly stated, including whether the prescribing is off-label, polypharmacy or high dose.
  • Consent-to-treatment procedures (or best-interests decision-making processes) should be followed and documented.
  • There should be regular monitoring of treatment response and side-effects (preferably every 3 months or less, at a minimum every 6 months).
  • Review and evaluation of the need for continuation or discontinuation of the psychotropic drug should be undertaken on a regular basis (preferably every 3 months or less, at a minimum every 6 months) or whenever there is a request from patients, carers or other professionals.


Dr Devapriam's biography:

Dr John Devapriam works as a Consultant Psychiatrist and is the Clinical Director for the Adult Mental Health and Learning Disability Directorate at Leicestershire Partnership NHS Trust.

Nationally, he is the National Professional Advisor for Learning Disability at the Care Quality Commission and Chair of the Quality Network for Learning Disability, Royal College of Psychiatrists. He is a GDG committee member at NICE for the guideline on service models for people with learning disability and behaviour that challenges.

Dr Ashok Roy Consultant Psychiatrist Coventry and Warwickshire Partnership NHS Trust Chair Intellectual Disability Faculty, Royal College of Psychiatrists,  continues with a keynote address on 'intellectual disability and mental health priorities' covering:

• ten key messages for commissioners
• what do we know about the current provision of mental health services for people with learning disabilities?
• what would good mental health services for people with learning disabilities look like?

Dr Roy's abstract

This presentation summarises the overlapping nature of mental health problems, the population distribution in the community and the nature and prevalence of coexisting conditions. This is followed by a description of what good looks like based on the national service model published by NHS England in 2015 and the service specifications of key services published in 2017.

This is followed by examples of good practice in a large community service hosting some inpatient facilities.

The first describes the components of a strategy to reduce restrictive practice typified by the number of physical restraints and the number of prn (as required) medication. A combination of improved incident monitoring, autism awareness training, medication audits and the implementation of Positive Behaviour Support led to positive change.

The second example is of a medication reduction clinic set up in response to the STOMP (Stopping Overmedication in People with Learning Disabilities) initiative.

The third example is the development of a Carer and Family leaflet specifically designed for use when medication was not being considered in the context of challenging behaviour.

The next example is of a Behaviour clinic set up to generate evidence based advice and support for people who were known to services and where there was pressure to prescribe medication in response to exacerbation of behaviour problems. The clinic process is described.

Finally there is a description of the pathway through an assessment and treatment in patient service followed by key issues regarding the workforce needed to sustain person centred services for the future.

Dr Roy's biography:

Dr Ashok Roy is a consultant psychiatrist for adults and young people with Learning Disabilities in Solihull Community Services and in Brooklands Hospital employed by Coventry and Warwickshire Partnership Trust. He is Chair of the Intellectual Disability Faculty at the Royal College of Psychiatrists and Clinical Advisor in Learning Disability for Health Education England. He is the Chair of the Birmingham Autism Partnership Board and a Trustee of Autism West Midlands and for BILD (British Institute of Learning Disabilities). He is also the Co-Chair of the Learning Disability Professional Senate.

Also of interest:

The Mental Capacity Act Masterclass
Monday 10 July 2017 
De Vere West One Conference Centre, London

Learning from Outstanding Mental Health Services
Monday 17 July 2017 
De Vere West One Conference Centre, London

Delivering Excellence in Recovery Oriented Services in Mental Health
Monday 2 October 2017 
De Vere West One Conference Centre, London

Improving Physical Health Outcomes for people with Mental Health Conditions
Monday 6 November 2017 
De Vere West One Conference Centre, London

26 June 2017


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