Mental Health Needs/Service
Provision for Children and
Adolescents with Challenging
Behaviour/Learning Disability
Dr Sarah Bernard
Consultant Psychiatrist
The Michael Rutter Centre
Background
 Children with LD are a seriously neglected
group.
 High risk of behavioural/mental health
problems (50-95%)
 Morbidity impacts on child, family, school.
 Input can, AND DOES, make a difference
 DoH has been addressing the gaps in
service provision
Current Situation
 Varies according to district
 CAMHS vs LD psychiatry services
 Variety of models – CAMHS, child
neuropsych., lifespan, paediatric and others
 Promotion of child 1st model – this
supported by NSF
 Training is a priority
What is needed - assessment
 MDT approach
 Understanding of child psychopathology
 Understanding of disability
 Flexible approach – community based
 Multiagency working
 Cultural sensitivity
 Understanding of safeguarding
What is needed - management
 MDT/multiagency approach
 Behavioural interventions – not short term
 Role of medication
 Impact of environment – education
 Respite
 Emergency protocol
 Ongoing review and monitoring
The MDT
 Psychiatry
 Psychology
 Behavioural Therapy
 SALT
 Social Services
 OT
 Other……..
The Future
 A comprehensive CAMHS for all
 Appropriate provision – local and
national/specialist
 More research/evidence based practice
Discussion points
What is challenging behaviour? How does the
definition fit into a CAMHS service model?
Current financial constraints (new services not
likely to be developed)
Motivation and interest