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Welfare Reform on the Web (August 2009): Mental health services - UK

Architects of reform?

A. Kaehne

Learning Disability Today, July 2009, p. 34-36

Despite vast improvements over the past 30 years, and current policies focusing on the promotion of inclusion, autonomy and choice, people with learning disabilities still experience discrimination, lack of access to services and opportunities, and unequal treatment in society. This article highlights key themes from a roundtable summit looking at what would improve their lives.

A Better life for Laura

E. Hughes

Learning Disability Today, July 2009, p. 28-29

A mother explains how access to an individual budget has benefitted her daughter Laura, who has learning disabilities. All that has been achieved for Laura has been managed by her family with no input from professionals.

(For a further personal testimony to the benefits of personal budgets, see Learning Disability Today, Aug./Sept. 2009, p. 32-33)

Broadmoor report warns on mental health funding

N. Timmins

Financial Times, July 21st 2009, p. 4

The Care Quality Commission's report on West London Mental Health Trust says patients have been put at risk by the failure to learn from suicides and other incidents. Staff shortages and overcrowding contributed to the problems. The report warns that spending pressures on the NHS must not lead to mental health again becoming a 'Cinderella service'.

Fifty years on: the legacy of the Percy report

J. Rapaport and J. Manthorpe

Journal of Social Work, vol. 9, 2009, p. 251-267

The Royal Commission on the Law Relating to Mental Illness and Mental Deficiency undertook a major review of lunacy, mental treatment and mental deficiency laws in England and Wales and made a series of recommendations that were subsequently incorporated into the Mental Health Act 1959. This article draws on parliamentary records and debates of the time to consider the context of the Royal Commission. It then discusses the report's legacy in respect of social work services in mental health provision and social care, structuring this around two main themes:

  1. the Report's proposals for involuntary hospital admission
  2. its recommendations for community care.

Intellectual disability and social inclusion: a critical review

M. Bollard (editor)

Edinburgh: Churchill Livingstone Elsevier, 2009

This book provides a unique insight into the challenges faced by people with learning disabilities trying to access mainstream health and social services and by the professionals who are trying to help them. The combination of professional perspectives and viewpoints of people with learning disabilities themselves creates an authoritative explanation of why this group of people face the barriers they do. The book includes comprehensive coverage of UK policy and tackles the effects of day-to-day issues on the lives of people with intellectual disabilities.

The Job challenges

L. Wardrop

Learning Disability Today, Aug./Sept. 2009, p. 14-16

Partners for Inclusion supports many people with severe learning disabilities and challenging behaviour who want to work. Such people can find employment, provided that a job is carved out specifically for them, matching their unique gifts and talents.

The key to progress

D. Moore

Learning Disability Today, July 2009, p. 32-33

It is clear from recent reports and inquiries that the health needs of people with learning disabilities are of concern and should be a priority area for health and social care organisations. Health action plans and health facilitation are useful tools to promote better health, but should be seen as part of a wider strategy across health and social care to reduce inequalities and improve NHS access.

Mind the healthcare gap

D. Moore

Learning Disability Today, July 2009, p. 30-31

It is well documented that people with learning disabilities have poorer health and die younger than the general population. This is due to poor access to healthcare arising from negative stereotyping by staff, communication difficulties, and diagnostic shadowing. Access could be improved by staff training, targeted health promotion initiatives, and the use of health facilitators.

New horizons: towards a shared vision for mental health: consultation

Department of Health


This draft strategy replaces the 1999 national service framework for mental health. This was backed up by extra investment of 1.7bn a year, but new service improvements now envisaged must be self-financing. The new strategy calls for a greater focus on prevention and for mental health to be prioritised alongside physical problems. It envisages more collaboration between central government and local organisations such as schools and councils. It also presents proposals for tackling the stigma attached to mental illness and promises that psychological therapies will be made available to all who could benefit from them by 2020.

A silver lining

A. Tyson

Learning Disability Today, Aug./Sept. 2009, p. 18-20

The advent of personalisation has raised questions about the future of social work. This article explores the positive roles that social workers could play at all stages in the transfer of a client to self-directed support.

Support for family carers of children and young people with developmental disabilities and challenging behaviour: what stops it being helpful?

G. Wodehouse and P. McGill

Journal of Intellectual Disability Research, vol. 53, 2009, p. 644-653

Many family carers find the support they receive in respect of their child's challenging behaviour unhelpful. This study sought to identify carer perceptions of ways in which support is unhelpful and how it could be more helpful through interviews with 13 mothers. Parents reported problems with generic disability services including difficulties gaining access to them and obtaining relevant information, poor working relationships with professionals, and issues with respite provision. Concerns were also expressed about challenging behaviour-specific provision, including ineffective strategies being suggested, an apparent lack of expertise, insufficient input and their child's exclusion from services.

Supporting people with autism through adulthood

National Audit Office

London: TSO, 2009 (House of Commons papers, session 2008/09; HC 556)

This report examines the range of services for adults with autism and their carers in England, including health and social care, education, benefits and employment support. It suggests that there are two key areas where the effectiveness of existing services can be improved: better strategy and planning, based on good information, and raising levels of knowledge and awareness of the nature of autism and the potential needs of autistic people. Addressing these two issues could improve outcomes for this group by making better use of existing resources. There is also scope for better targeted support for people with high-functioning autism/Asperger Syndrome. The report also looks at the possible impacts of providing specialised health, social care and employment support for adults with high-functioning autism. Wider implementation of such services would require additional expenditure, for example an estimated 40 million per year by Primary Care Trusts and Local Authorities to provide specialised health and social care teams across the whole of England. Evidence from existing specialised services does however indicate that they can improve outcomes for service users, and the model suggests that the costs could over time be outweighed by overall public expenditure savings.

The treatment of challenging behaviour in intellectual disabilities: cost-effectiveness analysis

R. Romeo and others

Journal of Intellectual Disability Research, vol. 53, 2009, p. 633-643

Antipsychotic drugs are widely used in the UK for the routine treatment of adults with intellectual disabilities who exhibit challenging behaviour. However, there are doubts about the effectiveness of these drugs and there is a lack of evidence of their cost-effectiveness. This paper reports on the relative cost-effectiveness of risperidone, haloperidol and placebo in treating individuals with intellectual disabilities and challenging behaviour using data from a 26-week, double-blind, randomised controlled trial. The economic analyses suggest that risperidone and haloperidol do not offer good value for money over placebo when service implications, costs, and effects on aggression and quality of life associated with treatment are considered.

Trying to get it right with campus closure

R. Mair

Learning Disability Today. Aug./Sept 2009, p. 10-11

Hundreds of people with learning disabilities still live in NHS campus accommodation, often stuck in grim surroundings and deprived of many of the liberties enjoyed by their counterparts in independent living. Government has set a goal of April 2010 to close all NHS campuses, and move residents into their own homes, but this deadline is highly likely to be missed.

Valuing employment now: real jobs for people with learning disabilities

HM Government

Department of Health: 2009

This report sets out the government's commitment to closing the gap between the employment rate for disabled people generally and the rate for people with learning disabilities. This amounts to a pledge to find jobs for around 45,000 people with moderate and severe learning disabilities. Key priorities include:

  • Promoting the Getting a Life programme and adding two more sites
  • A new employability hub in Kent for people with complex needs
  • A campaign among parents of children with learning disabilities to raise their aspirations about work
  • A new resource pack for local areas
  • A focus on finding jobs for people leaving school, college and work-based learning
  • A campaign to show people that they would be better off in paid work of 16 hours a week or more than on benefits.
  • Improving access for people with learning disabilities to mainstream disability employment programmes

What makes a good life?

J. Snell

Learning Disability Today, July 2009, p. 18-20

The Camphill movement runs 11 communities across England and Wales where adults with learning disabilities live and work alongside staff and volunteers without disabilities. This article describes life in two of these communities. Taurus Crafts in Gloucestershire is a social enterprise combining a craft centre with a supported housing scheme. The Grange is a rural community made up of a series of houses, each with a handful of residents and a coordinator.

Which way now for human rights?

B. Hudson

Learning Disability Today, Aug./Sept 2009, p. 24-25

Despite a steady stream of reports and policy initiatives, people with learning disabilities are still second class citizens in the UK. The Disability Discrimination Act 1995 and the Human Rights Act 1998 should assure the rights of people with learning disabilities, but evidence suggests that their provisions are routinely ignored. There is little hope for improvement if a Conservative government is elected in 2010, especially as David Cameron has pledged to repeal the Human Rights Act.

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