Improving Access to Psychological Therapies for people with learning disabilities

Abstract

Purpose -This paper considers the applicability of the Improving Access to Psychological Therapies (IAPT) initiative in meeting the mental health needs of people with learning disabilities.Design/methodology/approach -The author considers the nature of the IAPT service, the potential benefits, the potential barriers and how local services could be better adapted to meet the needs of people with learning disabilities.Findings -Although the IAPT service is well established for the mainstream population, for people with learning disabilities there are deficits and barriers at many levels. Increased attention should be given to removing barriers to access; the provision of ''reasonable adjustments'' in treatment; and to the monitoring of uptake and outcomes. Even with these issues addressed, the service will not meet the mental health needs of all people with learning disabilities.Originality/value -Whilst acknowledging the potential value of IAPT, without specific consideration being given, mainstream approaches to mental health will not be applicable to all people with learning disabilities: ''reasonable adjustments'' need to be made not only at the direct clinical level but also throughout the system, from service commissioning to outcomes.

A cluster randomised controlled trial of a manualised cognitive behavioural anger management intervention delivered by supervised lay therapists to people with intellectual disabilities

“…87 Median MOAS scores were a little lower than those recorded in a trial of neuroleptic drug treatment for aggressive behaviour in people with intellectual disabilities, which reported a median [interquartile range (IQR)] MOAS score of 12 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) at baseline in the placebo-treated group, and a dramatic fall (to a median score of ~3: considerably lower than the present participants) during subsequent weekly assessments under placebo treatment. 115 There is a limit to the extent of challenging behaviour that could in principle be observed in this study because most of the services from which participants were recruited would often exclude individuals who are overtly challenging.…”

“…7 There are many barriers that limit access to psychological therapies for people with intellectual disabilities, including social restrictions, communication problems, challenging behaviours, a failure of general practitioners to recognise mental health problems, and exclusion criteria operated by specialist mental health services. 7,8 However, a further problem is that the necessary research on effectiveness of psychological therapies for this population is still at a rudimentary stage. It is only recently that CBT has been adapted for people with intellectual disabilities.…”

“…The fact that the work was carried out by untrained staff, albeit under the supervision of clinical psychologists, fits well with the need to increase access to psychological therapies for disadvantaged groups such as people with intellectual disabilities, who suffer from health inequalities. 7,8,179 Several of the managers interviewed suggested that further training, accessible to more staff, would be of benefit to any service where one or more service user presents with challenging behaviours due to anger problems.…”

The experiences of high intensity therapists delivering cognitive behavioural therapy to people with intellectual disabilities

“…However, whilst these are all indications of positive local service developments, rather than a national drive, service developments for this client group appear dependant on the commitment of local IAPT services and commissioning bodies (Leyin, 2011). A recent large scale study indicated that some IAPT services may even explicitly exclude this client group (Chinn et al, 2014).…”

Mindfulness‐based cognitive therapy for adults with intellectual disabilities: an evaluation of the effectiveness of mindfulness in reducing symptoms of depression and anxiety

“…Prout & Browning () in their review of the effectiveness of therapies for this population conclude that both individual and group psychotherapeutic interventions such as CBT, imagery rehearsal therapy and anger management offer some degree of benefit as long as reasonable adaptations/adjustments are made to make the therapy accessible. The issue of ‘reasonable adjustment’ remains unclear as in our opinion, modifying an intervention to a large degree questions the evidence base for the intervention, an argument highlighted by Leyin (). It must also be noted that approaches such as CBT may not be suitable for all people with ID, particularly those with little or no language and have severe disabilities and high support needs (Sturmey ).…”