Abstract

Aims: To highlight the vital contributions of mental health and learning disability nurses (LDNs), who render direct care services and support to those with complex needs and their family caregivers as well as collaborate with other health and social care workers for prompt and appropriate responses.

Background: Mental health and learning disabilities nursing practice, through an evidence-based perspective on care services, examines the hypothesis that about 40% of people with learning disabilities will suffer mental health disorders in their lifetime. The study also critiques testimonials that a large number of mental health and learning disability nurses, who relate with patients on daily basis, lack awareness of this group’s complex needs.

Design: This research provides us with a biopsychosocial framework through which we can easily understand people with severe learning problems together with their associated complex and emotional needs. It presents a list of relevant issues encountered by healthcare professionals in presenting and identifying mental health needs in this particular group, including the basic skills and knowledge required by nurses as key stakeholders for coordinated assessment and effective care management.

Findings: [/b]An approximated 1.85 million people around the world were registered as users of Adult Mental Health and/or Learning Disability services, according to a 2015 report by the UK Health and Social Care Information Centre (HSCIC). However, the commonness of co-morbidities and complex nature of individual sufferer’s condition are responsible for their emotional needs being downplayed or ignored. In pursuance of a balanced mental and physical health as an area that demands attention and urgent improvement, Willis (2015) confirmed that NHS England included it in the agency’s Shape of Caring review.

[b]1. Introduction
Records from the healthcare sector prove that people with learning disabilities have not been directly involved in studies and, as a result, the applied research processes as well as the available statistics and policies framed with the sketchy evidence have been questioned by scholars. These denunciations and factual academic discussions influenced a new approach in the study of people with learning disabilities (Durell., 2016) thanks to huge efforts from self-advocacy groups and teams of quality researchers who collaborate with them (Johnson., 2009).

Some inclusive and extensive evaluations have explored learning disability, outlined its background and stimuli, identified its core characteristics, and underscored possible setbacks facing users of the findings. This study therefore provides an insight on the effectiveness of these inclusive researches aimed at giving people with learning disabilities the right of speech which resultantly enhances nursing practice.
In partnership with other healthcare agencies, interprofessional teams and representatives of service users, the invaluable contributions from learning disability nurses directed at helping affected individuals lead quality lives with as much independence as possible cannot be overemphasized in this research. However, it is worth noting that while the number of nurses has been decreasing, there’s a lot of work to be done through workforce planning if a successful balance of care is to be achieved in light of the unique individual needs.

2. Background
The challenges encountered by people with learning disabilities who also have mental health issues is a matter that requires urgent attention through special health services but in spite of the central role played by nurses, critics believe disability nursing has functioned with a comprehensible model of mental health. To improve or sustain physical and mental health of service users whose health needs are dependent on medical technology, there’s need for a common ground to be established between arguments on achievements recorded by psychiatric nursing and learning disability nursing in relation to patients’ wellbeing and social inclusion.

Disability Rights Commission in the UK suggested increased access to mainstream health services and timely provision of direct specialist support in both community and in-patient settings, including multi-professional teams and multi-agency settings, as some of the ways through which disability nurses can eliminate health inequalities of sufferers and support them to live a satisfying life (DH., 2007).

This discourse will explore some factors stifling effective solutions to the mental health needs of those with learning disabilities and explain how an applied approach can provide scholars and professionals with a logical theory that identifies links between mental health nursing, normalization and developmental psychiatry. It will assess applied behavioural theory as a dynamic and essential structure upon which further meaningful solutions can be deducted. In addition, recommendations will be made on how LDNs, educators, commissioners and health/social care providers can offer more effective contributions in the future.

2.1. Importance of the Study
This research examines the current theory and practice applied by LDNs in supporting people with learning disabilities and tending to their mental health needs. It evaluates the quality of contributions offered by learning disability and mental health nurses as well as other health professionals and identifies the major skills or knowledge they are required to possess for a high-level competence that addresses problems in modern-day nursing practice. In furtherance, it studies how effective assessment of needs can be conducted to provide needs-led assistance to those with autism and challenging or offending behaviours.

2.2. Study Objectives
This research provides useful information for nurses, HCAs and nursing students who render support services to both children and adults with learning disabilities. Its contents are also valuable for those in new professional roles such as mental health workers (DH., op cit.) The aims include:
• to give an insight on how LDNs can personalize their services and effectively handle mental health care plans for people with learning disabilities
• to offer clear explanations of the mental health needs of people with learning disabilities
• to highlight the need for a better understanding of their communication needs
• to enhance the ability of LDNs to properly use mental health assessments specially planned to address patients’ needs
• to expound government care policies for people with learning disabilities
• to promote collaborations and information-sharing between health professionals and services.

3. Method
Through and inclusive approach (Walmsley., 2004), this study was conducted using questionnaires developed with population, exposure and outcome (PEO): Are mental health and learning disability nurses adequately equipped for their challenging roles in mainstream mental health settings?

Using a systematic approach, some relevant websites with reliable information on research, nursing and legal/administrative contexts were visited before an extensive search through major UK health databases and healthcare literature was conducted. The search criteria are as follows: available in English language; published after 2001; and inclusive of both adults and children.

3.1 Keywords used or generalized in the research
People with learning disabilities: Members of this diverse group are like every other person. They possess different personality traits, individual history, perspectives and principles. These vulnerable people have the same legal rights as other citizens although findings from past and recent trends prove they often suffer discrimination and exclusion.

Learning disability as a life-long condition is considered as one of UK’s prevalent forms of deformity affecting over 2% of the population. Its sufferers exhibit difficulty in learning, communicating or handling of daily tasks. They also vary widely in their abilities thus requiring special support plans (Deb S. et al, 2001).

The World Health Organization (1992) in its “The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines" and Diagnostic Statistical Manual -IV (APA., 1994) defines, through a higher-level medical and psychologically based yardstick, when an individual is eligible to use professional services provided to those with learning disability. To determine need-based qualifications rather than eligibility based on individual ability, the current evaluation methods aim at improving assessments through:
a) level of intelligence handled by clinical psychologists in the health sector. An IQ (Intelligence Quotient) test score below 70% is considered as a proof of learning disability
b) an individual’s budgeting/expenditure, social activities, personal hygiene and communication
c) a check on the person’s history to know if disability was noticed before the age of 18 for conclusions to be made on their admissibility for the Department of Health’s last factors.

From a medical perspective, the degree of learning disability is often classified as mild, moderate and severe or profound.

[b]Autism: [/b]About 25% of people with autism (a life-long, persistent developmental ailment) are prone to having learning disabilities. The disorder is referred to as a “spectrum condition” because the effects vary according to individuals although it has three core signs which are found in every individual patient’s life such as impairment of communication, withdrawal from social activities, and lack of imaginative skills (Chakraberti and Fombonne., 2001). People with autism are prone to suffering mental health problems, including anxiety disorders and depression (Copper., 1997), however, those autistic patients who do not show signs of learning difficulties are believed to have either Asperger’s syndrome or “high functioning autism.”

[b]Challenging Behaviour: [/b]This term is relative to learning disabilities but marginally different to that used in services for people with mental health needs. According to Emerson (1997), challenging behaviour includes self-harm, aggressiveness and anti-social behaviours; it refers to some culturally unacceptable behaviours which present threats to people’s life, property, and may lead to restrictions from use of community facilities. These groups often use higher support services. Causes include communication needs, physical discomfort, poor environment or an underlying mental health issue.

To achieve lasting positive change in people who showcase challenging behaviour, a person-centred active support (PCAS) is necessary. The model encourages individuals in this group to participate in meaningful activities and forge relationships with others throughout the day, and immediately this is achieved, an all-encompassing functional assessment is conducted on their behaviours by health experts who apply the results to form and implement effective intervention strategies. These methods include: changing of environments where the behaviours occur; skills acquisition or positive programming; direct treatments to control profound behaviour; and application of spontaneous approaches that guarantee continuous and productive support whenever challenging behaviour is noticed.

Offending Behaviour: The criminal justice system categorises law breakers who are found to have learning difficulties, behavioural issues or mental health problems, under the same legislation as retard offenders. This group of people require assistance from professional mental health teams to protect their individual rights and well-being. Where necessary, these vulnerable people are identified at the police station and included in adult schemes managed by knowledgeable adults who offer legal representations to ensure fairness.

To assess and treat this group of people, efforts from professionals are required to avoid misinterpreting the threats and thereby compromising public safety or erroneously suppressing an individual’s liberty. Examples of the ways to observe differences in people’s intent are:
a) acquiescence, which presents individuals with questions that are mostly answered in the affirmative and with less chances of protests. This may, however, permit examiners to them to seek praise/approval and withhold information on limitations
b) diagnostic overshadowing, where assumptions are made on the person’s behaviour to describe it as an outcome of his/her learning disability and hence their normal characteristic
c) suggestibility, when the respondents are more responsive and positive to suggestions. This is most likely to have negative outcomes if the individual is under formal interrogations
d) Psychosocial masking, which limits expression of psychiatric symptoms due to restricted lifestyles and presents individuals with symptoms such as childish imaginations or unsophisticated acts which may conceal serious symptoms during questioning.

Vulnerable People: People with learning disabilities are considered as vulnerable members of the society because they have high chances of suffering neglect and abuse by the government agencies, individuals and private organizations. Abuse incidents are, however, unreported and thus unrecognized since members of this group are most likely to have communication problems which makes it difficult for proper recounting of ill-treatments. In some cases, they may not consider the cruel behaviours as abusive acts.

The Department of Health, in its No Secrets Guidance which is currently under review, calls for the local authority and other involved agencies to collaborate in their efforts to control, prevent and protect adults and children with learning disabilities. The parties are also encouraged to ensure that staff members are regularly enrolled for proper training on safeguarding this group.

3.2 Ethical Considerations

With emphasis on countries in the UK, governments have different policies, interpretations and structures for implementing decisions on how needs of people with learning disabilities are catered for. Nonetheless, some common themes in all four nations include that:
• people with learning disabilities share the same rights with other citizens and should be seen as equal
• they have the right to be independent
• they should be supported to take charge of their lives and make personal choices
• they deserve same opportunities as others
• citizens should unanimously empower people with learning disabilities through social inclusion

Read more: https://meziesblog.com/a-critique-of-mental-health-and-learning-disabilities-nursing-practice/