Child and Adolescent Mental Health Services: inpatient report

A4.20 Clinicians' views on the potential advantages to their patients of specialist mental health inpatient provision in Scotland for children and young people with a learning disability

Where clinicians indicated that their patient ideally required an LD CAMH specialist inpatient unit, they were asked during telephone interviews what they thought that patient would have gained from such a unit in Scotland. The same was asked for the very small number who they thought required a specialist ASD (non- LD unit). Many clinicians independently gave similar answers, which are summarised in this section.

A4.20.1 Earlier, more effective treatment

A number of patients would have benefitted from an earlier, more planned specialist inpatient assessment, preventing escalation of difficulties over months or years. The child or young person could get 'back on track' quicker to benefit from education and community services and make developmental progress. Access to a Scottish specialist unit could have prevented long periods of illness and distress at home, or whilst being 'contained' with limited treatment on non-specialist wards. Patients with certain illnesses ( e.g. bipolar disorder) could have had a less serious prognosis and course of illness with quicker treatment. Patients with learning disability and autism spectrum disorder struggle with transition, so admission straight to a specialist ward, rather than one or more move along the way would have been particularly helpful.

A4.20.2 A safer, more appropriate physical environment

A specialist unit would have had a safer and more appropriate physical environment, quieter and less over stimulating from a sensory perspective. Vulnerable children and young people would not be exposed to adult patients. Some with highly destructive behaviour would have required a particularly robust part of a unit, segregated from other young people, but with access to education and activities. A few of those with autism spectrum disorder and mild or no learning disability with forensic/secure needs would also have benefited from this type of environment. Some level of security would be helpful for the majority, due to either their vulnerability and lack of understanding of common dangers, or the risk they pose to others.

A4.20.3 Thorough assessment and treatment from a specialist multidisciplinary team

Thorough assessment and treatment from a specialist, well-functioning multidisciplinary team of professionals experienced in working with children and young people with learning disability and autism spectrum disorder and their families would have been a significant advantage for these patients. Professional groups indicated included nursing, psychiatry, clinical psychology, speech and language therapy, occupational therapy, pediatrics and teaching. Staff experienced and confident in working with this patient group would be able to more quickly and effectively assess and manage complex presentations, due to their ability to:

• assess mental state and role of any mental illness in their presentation
• assess communication level and needs and use a variety of appropriate forms of communication, engaging more effectively with young people and better understanding the role of challenging behaviour in those who cannot verbalise distress
• carry out functional analysis of behaviour, plan and implement behavioural interventions
• assess sensory processing issues and implement effective strategies
• manage aggression, self-injurious and destructive behaviours
• assess the need for psychotropic medication, understand medication effects, side-effects and dosages in this population
• safely monitor medication impact and side effects
• exclude and manage physical health problems, including epilepsy
• understand the impact of puberty in children and young people with learning disability.

Staff on a specialist unit would have a better understanding of patient needs from a developmental perspective. Assessment of level of learning disability and autism spectrum disorder assessment would be available where this was not already clear. Occupational therapy and nursing input would improve patients' functioning. Staff would also have more experience and expertise in attachment and family systems issues for children and young people with learning disability. Better and more effective relationships with families would be facilitated. Families would be able to be more confident in the care their children would receive.

A4 20.4 Other advantages

Specialist nursing staff would be able to provide a better structure to patients' days, with clear rules routines. There would be an age appropriate peer group and the type of structured and purposeful developmentally appropriate education and activity required for recovery. Young people would be less vulnerable in an age-appropriate setting.

A specialist unit would also be helpful in identifying patients' long term needs and facilitating more effective discharge planning to home, or alternative placement and education.

For some patients, where a short-term crisis admission to a local non-specialist ward was all that was required, consultation advice and support from a national specialist centre would have been helpful.