NICE quality standard for people with mental health problems and learning disabilities

NICE is consulting on a new quality standard for people with mental health problems and learning disabilities that will apply to work across health and social care. The standard was created through an earlier engagement exercise, and the formal consultation period is very short, so it seems unlikely there will be substantial changes in its requirements. Our briefing summarises its main content.

This quality standard covers the prevention, assessment and management of mental health problems in people with learning disabilities in health, social care, educational, forensic and criminal justice settings.

NICE say the standard is also intended to cover family members, carers and care workers. I don’t know why care workers are not simply seen as important members of the settings listed….and I don’t quite understand how carers and family members can be ‘covered’ by NICE standards.

Problem behaviours are not addressed in the quality standard. They are covered by the NICE quality standard on challenging behaviour and learning disabilities.

People with learning disabilities are more likely to experience mental health problems

The new quality standard is seen to be needed because of the benefits that will arise from earlier identification of dual problems – an identification that is sometimes difficult because people’s learning disabilities may cloak underlying mental health problems.

The standard is also important because of what is known about the higher rate of mental health problems amongst people with a learning disability. The background paper for the standard says these include schizophrenia, bipolar disorder, dementia, and ADHD. Autism is also considerably more common in people with learning disabilities.

Quoted prevalence rates of mental health problems for children and young people with learning disabilities have been reported to be higher than for other children and young people for 27 out of 28 specified diagnostic categories, and statistically significantly so for 20 of these 28 comparisons.

The standard notes that the physical health state of people with learning disabilities can contribute to mental ill health, as can the degree and cause of their learning disabilities, biological factors, psychological factors such as trauma, and social factors such as neglect, poverty and lack of social networks.

Estimates in the standard suggest that in the UK population, 28% (excluding those with problem behaviour) of adults with learning disabilities experience mental health problems at any point in time. An estimated 24% (again excluding problem behaviours) of children and young people with learning disabilities experience mental health problems at any point in time. These rates are much higher than for people who do not have learning disabilities.

The quality standard is expected to improve the identification of mental health needs, reduce psychiatric hospital admissions, and improve patients’ experience of primary and secondary care, and the quality of life of people with learning disabilities and carers.

NICE says annual health checks must include mental health

The standard provides tables showing how it is intended to contribute to the achievement of outcomes in the:

• Adult Social Care Outcomes Framework 2015–16
• NHS Outcomes Framework 2016–17
• Public Health Outcomes Framework for England 2016–19

Before going on to set out its specific requirements, the standard makes a number of overarching points. Expectations are that:

• The care system should consider NICE quality standards in planning and delivering services as required by the Health and Social Care Act 2012
• Services should be coordinated and commissioned in line with care pathways
• There should be a person-centred, integrated approach to care across the whole system
• All health and social care practitioners – across the system – involved in assessing, caring for and treating mental health problems in people with learning disabilities should have sufficient and appropriate training and competencies to deliver the interventions described in the quality standard.

The quality statements are that:

• People with learning disabilities are offered an annual health check that includes a review of mental health problems. This will mean service providers ensuring that people with learning disabilities are offered an annual health check that includes a review of mental health problems, and that a family member or carer (as appropriate) is involved. Commissioners will specify this requirement to providers. And, relevant healthcare professionals will, in any event, offer such an appointment
• People with learning disabilities and identified mental health needs have a mental health assessment conducted by a professional with expertise in mental health problems in people with learning disabilities. The statement has similar implications for providers, commissioners and health care professionals as describe above
• People with learning disabilities and a serious mental illness have a key worker. Again, the statement has similar implications for providers and commissioners and says that keyworkers must ensure that they coordinate all aspects of care and communication, and monitor the implementation of the care plan and its outcomes
• People with learning disabilities who are taking antipsychotic drugs long-term and are not experiencing psychotic symptoms have their prescriptions reduced or discontinued. In addition to the usual implications for providers and commissioners, the standard specifically says that healthcare professionals including GPs should reduce or discontinue long-term prescriptions of antipsychotic drugs in people with learning disabilities who are not experiencing psychotic symptoms
• Health and social care provider organisations provide parent training programmes for parents and carers of children with learning disabilities. Under this statement, providers are expected to ensure that programmes are designed and delivered in groups of parents or carers. There is also a separate table setting out how such training should be delivered. CareKnowledge readers may want to note that, alongside its specific requirements, the standard provides a wealth of links to other relevant NICE material, and policy documents.