Mansell 2 Services for people with learning disabilities whose behaviour presents a challenge

1. Mansell 2Services for people with learning disabilities whose behaviour presents a challenge Jim Mansell

2. Overview Analysis Service models Commissioning Conclusion

3. Analysis

4. Typical problems • Community placements break down • Out-of-area placements increasingly used • Poor quality institutional solutions persist • Care planning overwhelmed by crises • Costs increase while quality declines

5. Reasons for these problems • Amount of challenging behaviour depends on service competence • Most placements can only support people without problems • There is not enough planning ahead for individuals

6. Action needed now • Increase capacity of local services to understand and respond to challenging behaviour • Provide specialist services locally which can support good mainstream practice as well as directly serve a small number of people with the most challenging needs • Replace low-value high-cost services with better alternatives • Avoid increasing the burden on family carers by reducing levels of service

7. Service models

8. Service models • Supporting people living with their family • Supporting people in other accommodation • Education, work and day opportunities • Access to other health and social services • Specialist support to services

9. Supporting people living with their family • Re-examine use of residential schools away from people’s homes • Provide practical support • Equipment • Advice and training • Staff support to work with the individual • Short breaks available to every family

10. Supporting people in other accommodation • Best model likely to be support to enable people to live in ordinary housing • Direct payments and individual budgets should be more widely available • Stop using services which are too large to provide individualised support; serve people too far from their homes; and do not provide people with a good quality life in the home or as part of the local community

11. Education, work and day opportunities • Everyone should have access to innovative day opportunities, further education, supported employment and other day opportunities • Commissioners should take the lead in developing a much wider range of alternatives to day centres

12. Access to other health and social services • People have the same right of access to mainstream health services as the rest of the population • Mental health services available to the whole community should increase their ability to meet the needs of people whose behaviour presents challenges and who have a diagnosed mental illness • Psychiatric hospital admission only for short-term, highly focused assessment and treatment of mental illness

13. Specialist support to services • Specialist multi-disciplinary challenging behaviour support teams are essential • Make commissioners, managers and professionals work together to ensure that advice is both practicable and is acted upon • Emergency support available 24 hours a day, seven days a week • Budgets to fund a much wider variety of interventions as an alternative to placement in special units

14. Commissioning

15. Commissioning • Commitment • Agency responsibility • Value for money • Service development • NHS role

16. Commitment • Cornwall demonstrates importance of focus and commitment • Reasons why this should be a priority • These individuals have the greatest needs for services • Quality services achieve marked improvement • Failure to develop local services threatens the policy of community care

17. Agency responsibility • Partnership working established in some areas • Problems remain: • Unilateral withdrawal of NHS finance • Reduction of Supporting People finance for individuals with relatively high needs for support • Continued use of residential special schools a long way from home • Government improving coordination between departments

18. Value for money • Need a person-centred, comprehensive view of benefits and costs • Take account of hidden costs of failure to develop local services

19. Service development • Make sure every person whose behaviour presents serious challenges has a proper person-centred plan • Build capacity in the local system, rather than waiting until crises occur • Strengthen commissioning to combine expertise about challenging behaviour with the ability to actually develop the services needed

20. NHS role • Keep contributing the money needed for joint work • Not undermine strategy by commissioning poor-quality services themselves • Continue to provide professional support to sustain good practice in community • Provide short-term psychiatric assessment and treatment, but only as part of an integrated pathway of care for the individual that gets them back into the community • Enable fair access to health services for people with learning disabilities whose behaviour presents a challenge to services

21. Conclusion

22. The right strategy • Only commission services that prevent challenging behaviour developing or getting worse • Develop effective local services for people presenting the most severe challenges • Replace low-value high-cost services with better alternatives • Avoid increasing the burden on family carers by reducing levels of service

23. What should councils do now? • Replace procurement with service development • Combine expertise with authority to actually develop services • Think about people not units

24. Two examples • 4 young men with mild learning disabilities, mental health needs and substance abuse problems • From out-of-county placements in 2007 to individual flats supported by voluntary sector outreach support • Cost in first week £7400; cost 2009 £3970 • 2 young men with severe learning disabilities and serious challenging behaviour • Secure units in 2001 at c£2900 per week each • Now sharing a house with skilled staff support • Costs now £1175 per week

25. What works? • Building support and accommodation around people, not setting up ‘units’ • Working with individual, family, service provider • Sticking at it over the long haul (working through difficulties) • Focusing on the quality of day-to-day support from well-matched and skilled staff

26. Conclusion • Critical factor is to change commissioning to build and sustain the capacity to meet the needs of people in each area