1. How to Find Your Way Around 1. You can play the PowerPoint, and find the Test here EXAMPLE COURSE

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4. 22nd April 2009 Learning Disabilities Foundation Level 2012 / 2013

5. Objective & Outline  Objective – To provide a walk through learning disabilities to increase awareness and understanding of the need to support people with learning disabilities within our Trust.  By the end of this session you will be able to identify 3 areas where you can further support clients with a learning disability.  It is hoped that following this course you will feel more confident in supporting people with a LD using our services

6. Introduction to Learning Disabilities LD = learning disability/disabilities A learning disability is usually caused by the way the brain develops - before, during or soon after birth. It is lifelong and usually has a significant impact on a persons life. People with a learning disability usually find it harder than others to learn, understand and communicate. People with profound and multiple LD (PMLD) need full-time help with every aspect of their lives - including eating, drinking, washing, dressing and toileting. There are 1.5 million (2% of the population) with a LD in the UK however this is expected to increase a further 10% by 2020 (DOH, Mansell, 2008). Like all of us, they are individuals who want different things in life and need different levels of support.

7. Introduction to Learning Disabilities Cont’d LD is not a mental illness or dyslexia, but when a person has learning disabilities with another condition this often makes their needs more complex…we will be looking at this in more detail later on. The Department of Health (2001) in England defined LD as a combination of:  A significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence); with  A reduced ability to cope independently (impaired social functioning); which started before adulthood, with a lasting effect on development Remember! A learning disability is present from childhood and does not include 'learning difficulties’ like dyslexia and dyspraxia, which is are broadly defined in education legislation.

8. Introduction to Learning Disabilities Cont’d Most people with a LD are treated as 'different'. But they are individuals like the rest of the population and have their own distinct personality, characteristics, history, values and opinions. People with LD are a group of people who in law have the same rights as any other citizen, though in the past, and still today, they continue to be excluded and discriminated against. Watch the short film by clicking on the TV to show how people with learning disability can be treated differently. This film shows the worst outcomes of Diagnostic Overshadowing but it also happens in subtle ways too and we can overlook mental health illnesses. Discrimination can occur in the form of "diagnostic overshadowing" where a persons presenting problems are put down to their LD rather than seeking another potentially treatable cause.

9. Introduction to Learning Disabilities Cont’d Some facts from MENCAPMENCAP  People with a LD are 58 times more likely to die aged under 50 than other people.  Just 1 in 3 people with a LD take part in some form of education or training.  Less than 1 in 5 people with a LD work (compared with 1 in 2 disabled people generally), but at least 65% of people with a LD want to work.  Half of all families with children with a LD live in poverty.  At least half of all adults with a LD live in the family home - meaning that many don't get the same chances as other people to gain independence, learn key skills and make choices about their own lives.  Just 15% of people with a LD have a secure long-term tenancy or own their own home.

10. Communication Cont’d Whatever your role within the trust you need to be aware that you may come in contact with people with learning disability. Sometimes staff worry that they will not be understood or feel awkward when faced with someone with a LD. There are some simple things that will help with this, and remember if you feel awkward, how must the person feel? The person may not know or understand what is happening and need you to explain or guide them. For example some buildings have intercoms which could be difficult or finding the right entrance if the person cannot read. The following slides focus on communication and gives some tips on how you can communicate with someone with LD.

11. Communication The Government White Paper 'Valuing People' (2001) followed by 'Valuing People Now' (2009) says that people with LD should have: Independence, Choice, Rights and Inclusion.'Valuing People Now' (2009) Effective communication is fundamental in achieving these principles. People with LD may have difficulties with spoken and written language, coordination, attention, or self control. Some people with LD find it difficult to communicate pain or distress in an understandable way and may express this by changes in behaviour or personality. Think about the short film at the beginning. Remember! Behaviour is a method of communication so we need to understand causes of behaviour. e.g. pain, discomfort, feeling frightened or scared.

12. Communication Cont’d Communication difficulties occur to varying degrees, depending upon the type and extent of LD and the presence of an associated physical disability such as cleft palate, cerebral palsy or hearing impairment. There is an increasing recognition that difficulties with communicating over a lifetime often contribute to low self esteem, social isolation and loneliness, lack of trust, frustration and anger. Finding ways in which people with LD can communicate, and ways other people can communicate with them, can make a big difference to their quality of life. Click here to read more http://www.bild.org.uk/information/useful-resources/advocacy-to-employment/#Communication The next slide gives you some simple things you can do to help you to communicate with someone with a learning disability.

13. Remember! To plan ahead if possible and always allow extra time for the above approaches.

14. Easyread Information to use Easyread information helps the person to understand and it is important we use them whenever possible. There are lots of leaflets to help you support people with learning disability. Here are some the Trust have developed, and links to find more. Our leaflets are available on iConnect – click hereclick here More can be found on www.easyhealth.co.ukwww.easyhealth.co.uk Remember! You still need to go through the leaflet with the person.

15. Communication Cont’d  help them to feel secure and safe from harm  spend time to develop a rapport with them  ensure they have as much choice and control over their treatment as possible  encourage and support them to build social networks  support them to improve their physical health So how can we help people with LD using our services to communicate what they are thinking and feeling? The following 3 slides are key messages for clinical staff

19. Policy and Law In 2008 the Joint Committee on Human Rights stated it is still necessary to emphasise that adults with LD have the same rights as everyone else. Since 1995 it has been unlawful to discriminate against people with a disability, including those with a LD.Joint Committee on Human Rights The Equality Act 2010 requires information to be provided in an accessible format about treatment options, complaints procedures and appointments. 'Reasonable adjustments' must be made to the way that services are delivered in order to meet the needs of disabled users.Equality Act 2010 The Mental Capacity Act (2007) introduced a new criminal offence of ill treatment or neglect of a person lacking capacity. It put into statute the principle that everything must be done in the best interest of the patient.Mental Capacity Act (2007)

20. Relevance to our Trust  Equal access – Equality Act & Human Rights  CQC & Monitor Indicators  Green Light for Mental Health  Increased mental health needs

21. The Trust's Green Light Strategy Group This is a partnership meeting with stakeholders including people with a learning disability, carers, providers of specialist LD services and commissioners. This group meet and agree ways to work together to improve the mental health care and treatment for people with learning disabilities. There are Local Action Mental Health and Learning Disability Groups in each area that link into the Green Light Strategy Group to make sure staff are involved.Local Action Mental Health and Learning Disability GroupsGreen Light Strategy Group The Green Light Strategy Group reports to the Equality and Diversity Group to ensure that we are making reasonable adjustments for people with learning disability to access our service.Equality and Diversity Group

22. Services Think back to the short film we saw at the beginning. This showed how people used to be segregated in institutions. People now have the same rights to access services as any other citizen, such as using their GP, dentist and secondary services like NEPFT, our mental health service. To help us meet the mental health needs of people with learning disabilities we need to work jointly with our colleagues in learning disability services. To support you to do this we have a joint protocol called ‘Responding to people with learning disability who need mental health care and treatment’.‘Responding to people with learning disability who need mental health care and treatment’. This protocol is a reasonable adjustment to support people to access our service. It is on iConnect under ‘Policies’ ‘Clinical Policies’ ‘L’ for learning disability. Task: click here and navigate to the Joint Protocol from the home screenclick here

23. Services Cont’d Hertfordshire PFT Hertfordshire PFT provide specialist LD services across the whole of north Essex. People with a learning disability who require social care for social needs connected with their learning disability receive this from Essex County Council Essex County Council Task – click here to find out the local teams you can work with to prepare for the next time you support someone with a learning disability.the local teams Remember! HPFT only provide specialist health services, not social We provide mental health services to people with severe and enduring mental health and social needs. This includes people with a learning disability and we use the joint protocol to decide which service should be involved and who should lead the care.

24. Clinical Information System Users A ‘confirmed’ learning disability on CareBase turns the first name field yellow to tell staff to make reasonable adjustments. The criteria to confirm a learning disability is:  Learning disability not learning difficulty (educational difficulty like dyslexia)  Learning disability was diagnosed in childhood  If no diagnosis then attendance at a special school for learning disability. Additional support in mainstream school does not count unless there was a diagnosis. If you are not sure select ‘no’ – you can always go back and change to ‘confirmed’ if necessary. If in doubt discuss with a Psychiatrist or Psychologist. Our patient information system records and flags a learning disability so staff know and can plan how to support the person by making reasonable adjustments. For guidance on our current information system click here. Below is the guidance for recording a learning disability.

25. Mental Health Problems with LD Most people with LD live in the community and have the right to equal access to mainstream health services. However, specialist services are sometimes needed to provide additional support. It is important that you feel confident in supporting these vulnerable people to ensure they get the best service possible. People with LD are:  More likely than others to suffer mental ill health  Experience the same range of mental health problems but have a higher prevalence than the general population  Are more likely to have undetected and untreated mental health needs

26. Mental Health Problems with LD Cont’d It is estimated that 16-25% of the population are likely to have a mental health problem at some point in their lives. This compares with an estimated 25-40% of people with LD who experience more of the risk factors associated with mental ill health. There seem to be 4 key reasons for this….. 1. Many LD syndromes of genetic origin are associated with psychiatric disorders 2. Brain trauma often results in psychiatric problems 3.People with LD are much more likely to encounter traumatic life events that make them more vulnerable to mental health problems 4.Social restrictions experienced by people with LD may endanger their mental health

27. Mental Health Problems with LD … detection Generally the signs and symptoms of psychiatric disorders presented by adults with mild learning disability and reasonable verbal communication are similar to those presented by adults in the general population. It is more difficult to detect psychiatric disorders in adults with moderate to severe LD or autism. These individuals are likely to exhibit disturbed and regressive behaviours as presentations of psychiatric disorder. How do we detect mental health problems?  What people say they are experiencing  What others say about them  How they are seen to behave  History of the complaint  Family history  Recent trauma/traumatic events

28. Mental Health Problems with LD…Detection cont’d Carers play a central role in the identification and assessment of mental health problems in individuals with LD. Some problems can be very difficult to diagnose in people with LD and so it is important to ask and talk to the carers about the persons background and experiences, as this will give you vital clues to any diagnosis. The following 4 slides contain information on mental health for clinical staff

29. Mental Health Problems with LD…Detection Cont’d A comparison of those adults in the general population with people with LD PSYCHIATRIC DISORDER PRESENTATION IN MILD LD PRESENTATION IN SEVERE LD DementiaSimilarDifferent/ difficult to diagnose Schizophrenic psychoses Similar/may be over- diagnosed Very different/ difficult to diagnose Anxiety and related disorders Similar/under- diagnosed Very different/ difficult to diagnose Eating disordersSimilar/ under- diagnosed Different/ difficult to diagnose Personality disordersSimilarDifferent/ difficult to diagnose

30. Mental Health Detection in People with LD – Some Possible Symptoms  Social isolation or marked withdrawal (unusual for the person)  Odd/bizarre behaviour  Biological changes - sleep disturbance/poor appetite/weight loss  Anxious, worried, preoccupied, agitated or perplexed mood  Talk content preoccupied  Conversation bizarre and disjoined/disorganised  Speech changes i.e. rapid, slurred  Loss of usual interpersonal skill, social skills & ability to learn new skills  Paranoia/unusually very suspicious  Avoidance of situations & people

31. Mental Health Detection in People with LD – Some Possible Symptoms Cont’d  Aggressive/argumentative/non-compliant  Destructive to property  Low impulse control, compulsive/impulsive  Mood Swings  Feeling stressed/cannot cope/feels different  Personal hygiene poor/self neglect  Feelings of severe anxiety, despair, loneliness, unworthiness & rejection  Delusions - false belief  Self injury or increase in usual self harming behaviour  Evidence of suicidal ideas/intent/acts  Compulsion or rituals  Hallucinations (visual/auditory) & evidence of responding to these

32. Physical Health Problems for People with LD People with LD often do not seek out healthcare, and when they do they frequently face difficulties, but ironically they are more prone to a range of physical problems than others. People with LD are less likely to receive health checks and access to routine screening, e.g. cervical screening. People with learning disability should have been offered a Health Action Plan by their GP. This will tell you about their physical health needs Remember! diagnostic overshadowing happens and you need to ask if the person has a Health Action Plan

33. Risk of Abuse Individuals with a LD are at an increased risk of being abused and neglected. Research has indicated that between 8% and 58% of adults with LD have experienced sexual violence. Adults with LD are less likely to report crimes of abuse perpetrated against them, and if they do they are less likely to achieve justice. For many, the violation of their human rights is seen as a normal part of their everyday lives. As part of our roles in mental health we need to be actively aware of this and you should know what to do if you are suspicious that abuse may be occurring.

34. Risk of Abuse Cont’d  If you have concerns about the abuse or neglect of an adult (18 or over) they must complete a SETSAF1 form. Issues of capacity are essential to this domain. If you have concerns that an adult may not have capacity to consent to a referral, you must also complete an MCA2 assessment.SETSAF1 MCA2 assessment  If a young person (aged under 18) is potentially at risk a referral MUST be made using the ECC999 Interagency Referral Form.ECC999 Interagency Referral Form  Copies of all completed SETSAF1, MCA2 and ECC999 forms must be sent to the NEPFT Safeguarding Office at Birchwood, Colchester.  Click here for the Safeguarding iconnect Pages Click here for the Safeguarding iconnect Pages The following charities provide excellent information in this field:  www.respond.org.uk www.respond.org.uk  www.voiceuk.org.uk www.voiceuk.org.uk  www.anncrafttrust.org www.anncrafttrust.org

35. What you can do to Support People with LD Remember!  Be aware of any special needs, such as sensory impairment  Put information in an accessible format  Carry out assessments in familiar settings  Minimise distractions  Be aware of the persons attention span and act accordingly  Use open ended questions  Ensure your conversations are jargon/terminology free  Use concrete terms There are many ways you can help people with LD, particularly when they are using our services. Just taking more time and being more observant can make a big difference in helping the person feel more relaxed and comfortable. Also to think about the diagnosis carefully, taking into account the LD factors that can skew the information.

36. Further Support/Information for You Cont’d Internal Support - click each one for more information  Joint Protocol with learning disability health services Joint Protocol with learning disability health services  Learning Disability Iconnect pages Learning Disability Iconnect pages  The Green Light Strategy Group The Green Light Strategy Group  The Local Action MH and LD Groups The Local Action MH and LD Groups  The Equality & Diversity Group The Equality & Diversity Group  Easyread leaflets and information Easyread leaflets and information  Clinical Specialist in LD NiArmstrong@nepft.nhs.ukNiArmstrong@nepft.nhs.uk

37. External Resources  Valuing People Now - A three-year strategy for people with learning disabilities - Department of Health (2009) Valuing People Now - A three-year strategy for people with learning disabilities - Department of Health (2009)  Mental Health Nursing of Adults with LD - RCN Guidance (2007) Mental Health Nursing of Adults with LD - RCN Guidance (2007)  Equality & Human Rights Commission Equality & Human Rights Commission  MENCAP MENCAP  Foundation for people with learning disabilities Foundation for people with learning disabilities  British Institute of Learning Disability British Institute of Learning Disability  Mind learning disabilities pages Mind learning disabilities pages

38. You Have Now Finished the Learning Remember to click the ‘Home’ icon when you finish the Test to save your results Please click the ‘Test’ icon in the left column. You may need to maximise the column by clicking the top left icon.