Meeting patient need comes first

As a general principle, if it is unclear which service would best meet the patient’s needs then a joint assessment should be arranged. This enables clinicians from both services to think together about what each service might be able to offer, and decide which could best meet the patient’s needs; following Valuing People guidance, in line with the Green Light Toolkit.

Following a joint appointment, if it is established that a patient can access mainstream services, then MHLD could offer formulation to the staff involved, and make suggestions around the specific reasonable adjustments to be made. MHLD could also offer consultation to staff who are working with patients who appear to have an intellectual disability.

From the information presented we would expect that Mary’s needs would be best met by a CMHT. She is able to communicate her needs, and with Reasonable Adjustments (eg. simplifying language, and checking back that she has understood) the clinical team are able to communicate effectively with her about her care needs. The CMHT has specialist knowledge and skills to meet Mary’s needs in relation to her Personality Disorder, if indeed it is decided that this is the most appropriate diagnosis.

However Sanjit’s needs are maybe better met by the MHLD. His communication difficulties are more pronounced, and exacerbated by his Autistic Spectrum Condition. The MHLD have specialist knowledge of intellectual disability and ASC to meet Sanjit’s needs.

It is impossible to make hard and fast rules about eligibility, other than to say that Valuing People clearly states that if the patient’s needs can be met within mainstream services, with Reasonable Adjustments then this should be offered. This is in line with the Equality Act.

Other Reasonable Adjustments might include:

• Slower pace of the appointment
• Shorter sessions
• Seen with a family member/carer
• Checking the person has understood
• Simplifying language, reduce use of jargon, repeating or rephrasing to add clarity.
• Aim to keep communication, whether written or verbal, as basic and concise as possible. Learning Disability organisations, such as Mencap, have produced guides on accessible information (‘Am I Making Myself Clear?’)
• Use of written information in addition to verbal, e.g. writing down plans made at the end of sessions (consider printing on different colours for people with specific learning difficulties), making homework tasks more practical and specific
• Consideration of the environment (noise/light etc.)
• Support with completing forms and outcome measures
• Consideration of client’s concept of time – reporting accurately may be difficult so specific questions, such as ‘before Christmas or after Christmas’ may be helpful.
• Liaising with support system around the person, e.g. LD nurses, carers, social workers