According to the Health and Social Care Information Centre (HSCIC July 2015) there are approximately 1.84 million individuals who are recorded as being users of Adult Mental Health and/or Learning Disability services.
It is well recognised that the emotional needs of people with learning disabilities can be overlooked, particularly given the prevalence of co-morbidities and complexities of an individual’s condition.
Parity between physical health and mental health was highlighted as an area for improvement by NHS England in 2014 and continues to be recognised within the Shape of Caring review (Willis 2015).
The authors of this paper recognise how the mental health and well being needs of people with learning disabilities have been neglected in the past and make a specific link to Valuing People (2001) which recognised the need for access to mainstream service in the promotion of rights, choice, inclusion and independence as essential to equality for people with learning disabilities.
A search question was developed using PEO (population, exposure, outcome): How are mental health nurses prepared to care for people with learning disabilities in mainstream mental health settings?
A systematic approach was adopted, relevant websites pertinent to research, nursing and political contexts were scoped, prior to a search through five relevant databases.
Inclusion criteria are listed:
- available in English language
- published since 2001
- related to the adult population
A list of key words/synonyms is presented which the authors used within the search.
Following the search, the authors read the titles, matching to inclusion criteria to assess suitability for inclusion. There were 13 articles included in the final review.
Three key themes are highlighted. However, little discussion is presented in terms of how these categories were devised.
Three studies looked at the attitudes of health care staff, qualified staff and student nurses towards those with learning disabilities. The impact of a negative attitude from health professionals towards those with learning disabilities is linked to negative outcomes in terms of access to services, recovery, rehabilitation and self esteem. Increased positive attitude is reported if the individual has a friend or relative with a learning disability and nursing students were found to have more positive attitudes than non-nursing peers.
Practice issues were themes within four papers according to the authors, highlighting that staff do not have the necessary skills to meet the mental health needs of individuals with learning disabilities. Role confusion and poor coordination are reported as factors related to this.
The remaining 6 papers were grouped into education and training, highlighting that there is little or no education around the needs of those with learning disabilities outside of the specialist field delivered at pre-registration level.
The authors conclude that the question remains unanswered as there is little evidence to inform the research question. They also highlight that few countries have contributed to the literature, with most evidence being from the UK.
The authors do report that qualified nurses are ‘shown to lack knowledge, understanding and relevant skills’ in meeting the needs of people with learning disabilities due to limited experience of interactions with the user group.
A range of implications for practice are highlighted, acquiring and maintaining competence in meeting the needs of people with learning disabilities must be a priority at pre and post reg levels. Recommendations around service users being involved in teaching and assessing students are made, however the difficulties in making this a reality are also identified. The question of how best to ensure competence across all fields of practice when working with learning disabilities is recognised within Strengthening the Commitment (2015) and this also supports the inclusion of people with learning disabilities and their families in curriculum development.
Strengths and limitations
The authors have not presented a critique of their own work and the assertion that most evidence is from the UK could be linked to the significance of the date utilised for limiting inclusion.
2001 was selected as this relates to Valuing people, a significant key document influencing outcomes for people with learning disabilities in the United Kingdom.
The data extraction tool or method is not referred to and so the themes highlighted are not well contextualised, there is little information as to what has not been included from the review of the papers.
One methodological weakness which is evident relates to the limited synonyms for learning disabilities utilised within the search. There are only two other alternatives presented (intellectual disabilities and mental retardation). There might have been relative terms utilised in other cultures or specific syndrome terminology which might have increased the results. A similar criticism is that no alternatives to ‘care’ as a search term were used. There might have been articles highlighted by other terms such as ‘treatment’, ‘support’, or ‘intervention’.
The paper adds to the literature highlighting an area for further research, but the authors are clear that the research question remains unanswered. They suggest this is due to the paucity of research in this area, however, do not acknowledge the limited structure of the research question and the limited range of search terms employed.
In terms of further research there are recommendations from the authors, particularly with regard to the experiences of mental health nurses caring for people with learning disabilities.
The suggestion that service users can be included in the delivery of new initiatives is made, positive outcomes from receiving education from individuals with learning disabilities are highlighted .
This also links to a point made with regard to practice issues, recognising that the contribution care givers, particularly family and friends make to highlighting the needs of the individual can be ignored.
Recommendations for nurse education are made, looking for initiatives to promote the needs of people with mental health difficulties and learning disabilities to non learning disability specialists, both pre-registration and post qualifying. Changes to nurse education are ahead, the shape of caring review identifies how with the exception of the mental health speciality, mental health is marginalised within existing nurse training.
There are also suggestions with regard to practice development for example with assessment tools and other frameworks, this could link to pathways and processes.
The relevance of this review links to the current government agenda with regard to Improving Access to Psychological Therapies (IAPT) and generally raising awareness of the mental health needs of the population.
The need to develop a more generalised approach to practice is clear and the holistic focus must be reinforced. All nurses must be equipped to meet the needs of all individuals. Good mental health is important for everyone and poor mental health has far reaching consequences, health professionals have a responsibility to recognise the scope of their practice and develop skills to meet the needs of service users.
Adshead, S., Collier, E. and Kennedy. S. (2015) ‘A literature review exploring the preperation of mental health nurses for working with people with learning disability and mental illness Nurse Education in Practice’, Nurse Education in Practice vol. 15 (2) p. 103-107 [Abstract]
Raising the Bar. Shape of Caring: A Review of the Future Education and Training of Registered Nurses and Care Assistants, Lord Willis, Independent Chair – Shape of Caring review, Health Education England
Strengthening the Commitment: Living the commitment, UK Strengthening the Commitment Steering Group June 2015
HES-MHLDDS Data Linkage Report, Summary Statistics – Mar 15 Publication date: July 03, 2015
Valuing people: A New Strategy for Learning Disability for the 21st Century, Department of Health, 2001