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Service innovations: risk assessment in learning disability

  • S. Bhaumik (a1), S. S. Nadkarni (a2), A. B. Biswas (a2) and J. M. Watson (a3)
Abstract
Aims and Method

The aim of the study was to evaluate the effectiveness of the care programme approach (CPA) in adults with learning disabilities in a specialist treatment unit by auditing all in-patient records over a 6-month period. A multidisciplinary team set CPA standards. Staff on the unit completed questionnaires about patients, including CPA screening and risk assessment/management, and carers completed questionnaires about their perceptions of risk and information sharing.

Results

Of the 15 patients whose records were reviewed, 13 had CPA screening on admission and 12 on discharge. Before discharge, 9 patients had a CPA planning meeting and only 4 patients had a demonstrable risk management plan. Carers of 9 patients perceived that information was shared.

Clinical Implications

Major deficiencies identified in risk assessment and management and in information sharing may potentially jeopardise successful treatment and after-care.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Bhaumik, S., Collacott, R. A., Gandhi, D., et al (1995) A naturalistic study in the use of antidepressants in adults with learning disabilities and affective disorders. Human Psychopharmacology, 10, 283288.
Corbett, J. A. (1979) Psychiatric morbidity and mental retardation. In Psychiatric Illness and Mental Handicap (eds James, F. E. & Smith, R. P.), pp.1125. London: Gaskell.
Department of Health (1990) The Care Programme Approach for People with Mental Illness Referred to the Specialist Psychiatric Services. HC(90)23. London: Department of Health.
Department of Health (1998a) A First Class Service. Quality in the New NHS. London: Department of Health.
Department of Health (1998b) Signposts for Success in Commissioning and Providing Health Services for People with Learning Disabilities. London: Department of Health.
Department of Health (1999a) Clinical Governance – Quality in the New NHS. HSC 1999/065. London: Department of Health.
Department of Health (1999b) Effective Care Co-ordination in Mental Health Services. Modernising the Care Programme Approach. DH16736. London: Department of Health.
Department of Health (2001) An Audit Pack for Monitoring the Care Programme Approach. London: Department of Health.
Lund, J. (1985) The prevalence of psychiatric morbidity in mentally retarded adults. Acta Psychiatrica Scandinavica, 72, 563570.
Mcgrother, C.W., Bhaumik, S., Thorp, C. F., et al (2002) Prevalence, morbidity and service needs among South Asian and white adults with intellectual disability in Leicestershire, UK. Journal of Intellectual Disability Research, 46, 299309.
Roy, A. (2000) The Care Programme Approach in learning disability psychiatry. Advances in Psychiatric Treatment, 6, 380387.
Royal College of Psychiatrists Special Working Party on Clinical Assessment and Management of Risk (1996) Assessment and Clinical Management of Risk of Harm to Other People. Council Report CR 53. London: Royal College of Psychiatrists.
Saunders, M. (1998) Risk management. In Standards and Learning Disability (eds Thompson, T. & Mathias, P.), pp.249259. London: Baillière Tindall.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Service innovations: risk assessment in learning disability

  • S. Bhaumik (a1), S. S. Nadkarni (a2), A. B. Biswas (a2) and J. M. Watson (a3)
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eLetters

CPA for people with learning disabilities

Colin P Hemmings, Consultant Psychiatrist in Learning Disabilities
28 April 2005

Bhaumik et al’s (Psychiatric Bulletin, January 2005, 29, 28-31) recent implementation of the Care Programme Approach (CPA) in Leicester iswelcome. Given the increased prevalence of mental disorders in people withlearning disabilities (PWLD), it is unsatisfactory that services nationwide have been so slow in implementing CPA for this patient group (Roy, 2000). There have been clear guidelines from the DoH that CPA shouldapply to all those who receive a specialist mental health service, including those with LD in the community (DoH, 1995).

It was surprising however to see risk assessment for PWLD and mental disorders described as a “service innovation”. Our service here in South London has been using CPA and risk assessment for several years, includingfor those admitted to our Weston inpatient unit. CPA has provided the framework necessary to co-ordinate care for our patients who invariably have complex needs requiring multidisciplinary input. It has also highlighted the difficulties in providing holistic and effective care to PWLD and mental disorders when generic LD services so often do not recognise and/or meet their additional needs.

An audit has been recently completed of the implementation of CPA andrisk assessment in services for PWLD and mental disorders across the SouthThames region (Brooks et al, in preparation). The recommendations generated should help to improve patient care, communication and collaboration between clinical teams. The forthcoming report should be essential reading for those who still have yet to implement CPA and risk assessment for PWLD and mental disorders.

References

Department of Health (1995) Building Bridges. London: DoH

Roy, A. (2000) The Care Programme Approach in learning disability psychiatry. Advances in Psychiatric treatment 6, 380-387.

Brooks, D. et al (in preparation). The South Thames Regional Audit ofthe Care Programme Approach (CPA) and Risk Assessment/ Management Implementation in Services for people with Learning Disabilities and Mental Disorders.

Author:Dr. Colin Hemmings B.Sc. MB BS M.Sc. MA MRCPsychConsultant Psychiatrist in Learning DisabilitiesSouth London and Maudsley NHS Trust,Guy's Hospital,47 Weston Street, London SE1 3RR

Tel: 0207 188 3483Fax: 0207 188 3479

I declare no conflict of interest.
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Conflict of interest: None Declared

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