Difficulties developing evidence-based approaches in learning disabilities
- Patricia C Oliver, PhD DMS1,
- Jack Piachaud, FRCPsych MA BMBCH2,
- D John Done, PhD3,
- Adrienne Regan, FRCPsych DCH MBBS4,
- Sherva E Cooray, FRCPsych DPM MBBS5,
- Peter J Tyrer, MD FRCP FRCPsych FFPHM FMedSci6
- 1Faculty of Medicine, Imperial College London, United Kingdom
- 2Hertfordshire Partnership NHS Trust Hertfordshire, United Kingdom
- 3University of Hertfordshire Hatfield, United Kingdom
- 4Harrow Primary Care Trust Middlesex, United Kingdom
- 5Brent Primary Care Trust London, United Kingdom
- 6Faculty of Medicine, Imperial College London, United Kingdom
- Correspondence to: Patricia Oliver,Department of Psychological Medicine, Faculty of Medicine, Imperial College, London, UK. poliver{at}ic.ac.uk.
Around 2% of the population have a learning disability, categorised as ‘mental retardation’ in the ICD / DSM classification systems. Mental disorders are at least two to four times more prevalent in people with learning disability compared to the general population.1 Increasing numbers of people with learning disability access generic mental health services, due to philosophies of equity of access and normalisation. Mental health practitioners may address the problem of learning disabilities directly or help people deal with indirect outcomes, such as poor self concept or even self harm.
Learning disabilities affect both adults and children and can impact on a person’s self esteem as well as their education and competency. People with learning disabilities may also have co-morbidities. Learning disability is manifested by two components: low cognitive ability and diminished social competence. Both factors are profoundly affected by social and cultural influences. Unlike other ICD 10 mental health disorders, it is difficult to specify detailed clinical diagnostic criteria for learning disability. After considering the cultural norms of a particular individual, mental health practitioners often estimate the intelligence quotient or mental age of the individual using specified levels of cognitive abilities (table).2
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Levels of cognitive abilities
During the past 20 years, learning disability services have shifted from the hospital to specialist community services.3 Three key changes occurred with this shift: (1) the introduction of “care management;” (2) the creation of packages of social, educational and developmental care, and (3) allocating “physical care” to primary healthcare and “mental health care” to specialist health services. In the era of evidence-based medicine and clinical governance, each of these changes should be based on research evidence.4 Evidence-based strategies might lead to constructive change for people with learning disabilities, but evidence about effective interventions is limited and it may …
