People with learning disabilities-meeting complex needs

Abstract

Meeting the needs of people within the community who have learning disabilities and exhibit challenging behaviour and who may have an associated mental health problem raises particular policy questions. The provision of effective community services for people with this particular combination of complex needs requires a skilled workforce. Issues of definition, of assessment and diagnosis, of therapeutic interventions and service models should be addressed and resolved in order to plan and implement a strategy for meeting both health and social care needs of this client group. This paper aims to provide a general overview of these issues, bringing together material on the four separate concerns, and to draw the American literature to the attention of a wider audience. This work was originally carried out as part of a wider project on staff training provision and training standards in 1992. The objectives are to identify: (1) definitions of challenging behaviour and mental health problems in relation to people with learning disabilities; (2) therapeutic interventions for meeting these needs; (3) models of service provision for people with these needs; (4) the implications for developing a skilled workforce to meet this particular combination of needs. Definitions of challenging behaviour are varied and general, and the diagnosis of mental illness in people with learning disabilities appears to be less well developed in the UK than in the USA. Those whose needs include both learning disability and mental health problems are at risk of losing out in the provision of services for either category. There is a wide variety of theoretical and practical responses to behavioural problems in the context of two differing models of service provision for people with these needs-the‘compus’ model and the‘ordinary life’ model. Professional tensions with regard to both therapeutic responses and service models must be resolved if people with this particular combination of complex needs are to receive a comprehensive, needs-led service provided by an appropriately skilled workforce.