Royal College of Psychiatrists, 2013

People with a learning disability who come into contact with specialist learning disability mental health services often have a complex mix of learning disability, other developmental disorders, mental illnesses, personality disorders, substance misuse, and physical disorders including epilepsy. Some of these conditions present with challenging behaviours, others do not.

Describing all types of specialist in-patient services for people with learning disability as ‘assessment and treatment units for challenging behaviour’ does not capture the spectrum of in-patient services and their different functions in meeting the needs of those with complex presentations. When this approach is used by governments, regulatory authorities and some service providers, it results in mixing up categories of beds that serve completely different functions. As a consequence, targets that aim solely on cutting the numbers of ‘assessment and treatment units for challenging behaviour’ will result in significant gaps in service provision that will disadvantage the very patients it is meant to help.

This report sets out, with representative case examples, six categories of in-patient beds and their close relationship with each other. Although all these categories do involve some assessment and treatment, they serve different functions. They can be best understood within the context of the tiered model, where tier 4 constitutes the in-patient part of a specialist learning disability service provision:

  • Category 1: high, medium and low secure forensic beds
  • Category 2: acute admission beds within specialised learning disability
  • Category 3: acute admission beds within generic mental health settings
  • Category 4: forensic rehabilitation beds
  • Category 5: complex continuing care and rehabilitation beds
  • Category 6: other beds including those for specialist neuropsychiatric conditions