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22nd April 2009
Learning Disabilities
Foundation Level
2012 / 2013
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.
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By the end of this session you will be
able to identify 3 areas where you
can further support clients with a
learning disability.
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It is hoped that following this course
you will feel more confident in
supporting people with a LD using
our services
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.
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.
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.
Introduction to Learning Disabilities Cont’d
Some facts from MENCAP
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People with a LD are 58 times more likely
to die aged under 50 than other people.
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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.
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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.
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.
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.
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.
Remember! To plan ahead if possible and always allow extra time for the above
approaches.
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 here
More can be found on www.easyhealth.co.uk
Remember! You still need to go through the leaflet
with the person.
Communication Cont’d
So how can we help people with LD using our services to
communicate what they are thinking and feeling?

help them to feel secure and safe from harm
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spend time to develop a rapport with them
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ensure they have as much choice and control over their
treatment as possible
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encourage and support them to build social networks

support them to improve their physical health
The following 3 slides are key messages for clinical staff
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.
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.
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.
Relevance to our Trust
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Equal access – Equality Act & Human
Rights
CQC & Monitor Indicators
Green Light for Mental Health
Increased mental health needs
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.
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.
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’.
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 screen
Services Cont’d
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.
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
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.
Remember! HPFT only provide specialist health services, not social
Clinical Information System Users
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.
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:
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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.
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
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
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?
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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
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
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
Dementia
Similar
Different/
difficult to diagnose
Schizophrenic
psychoses
Similar/may be overdiagnosed
Very different/
difficult to diagnose
Anxiety and related
disorders
Similar/underdiagnosed
Very different/
difficult to diagnose
Eating disorders
Similar/ underdiagnosed
Different/
difficult to diagnose
Personality disorders
Similar
Different/
difficult to diagnose
Mental Health Detection in People with LD –
Some Possible Symptoms
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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
Mental Health Detection in People with LD –
Some Possible Symptoms Cont’d
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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
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
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.
Risk of Abuse Cont’d
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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.
If a young person (aged under 18) is potentially at risk a referral
MUST be made using the 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
The following charities provide excellent information in this field:
 www.respond.org.uk
 www.voiceuk.org.uk
 www.anncrafttrust.org
What you can do to Support People
with LD
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.
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
Further Support/Information for You Cont’d
Internal Support - click each one for more information

Joint Protocol with learning disability health services
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Learning Disability Iconnect pages
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The Green Light Strategy Group
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The Local Action MH and LD Groups
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The Equality & Diversity Group
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Easyread leaflets and information
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Clinical Specialist in LD NiArmstrong@nepft.nhs.uk
External Resources
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Valuing People Now - A three-year strategy for people with
learning disabilities - Department of Health (2009)
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Mental Health Nursing of Adults with LD - RCN Guidance (2007)
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Equality & Human Rights Commission
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MENCAP
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Foundation for people with learning disabilities
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British Institute of Learning Disability
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Mind learning disabilities pages
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