Improving access to mental health services for people with learning disabilities

Two colleagues at our trust are working to improve access to mental health services for people with learning disabilities, following research that explored the challenges faced by both patients and the teams supporting them.

The project, led by trainee clinical psychologist, Freya Gomes, clinical associate psychologist, Maisie Knight-Davies, and former colleague Jo Doherty, who were all in clinical associate psychologist roles at the time of the project, focused on understanding how people with learning disabilities experience mainstream mental health services, and what could be done to improve access.

For the team, the work was driven by a simple but important principle. “Our aim underpinning everything is to ensure access,” says Freya. “People with learning disabilities in Somerset should be able to access any service that anybody else can access.”

The project began during their clinical associate psychologist training, building on an initial research proposal developed by Jo. While there was no requirement to take the work further, the team felt strongly that it was an area worth exploring in more depth.

Maisie explains that their early findings highlighted a gap between expectations and reality. “Eligibility for specialist services like ours is when all other reasonable adjustments have been tried in mainstream services but haven’t worked,” she says.

“But we know that doesn’t always happen in practice, so we wanted to understand what was actually taking place for people with learning disabilities accessing those services.”

To explore this further, the team carried out an initial audit looking at a small number of patients and their experiences of accessing mainstream mental health support.

“The results of our audit weren’t great,” says Maisie. “That’s what led us to move forward with the project and really look at the barriers in more detail, from the perspective of colleagues working in those services.”

The team went on to run a series of focus groups with colleagues from both learning disability services and mainstream mental health teams, asking them to reflect on what was working well, what wasn’t, and what changes they would like to see.

Freya says this approach helped build a clear picture of the challenges. “We asked colleagues to think about their experiences, including what people definitely didn’t want to happen and what they did want to happen,” she says.

“We then analysed the themes from those discussions and used that to identify areas where changes could make a real difference.”

One of the key findings was that, in many cases, colleagues already had the knowledge needed to support people with learning disabilities, but lacked confidence in how to apply it in practice.

“A lot of the time people had the knowledge, but were perhaps unsure whether they should be applying it, or how to do that,” Freya continues.

“So a big part of the work is about building that confidence, as well as making sure people feel supported.”

The research also highlights wider organisational challenges, including services not always being set up in a way that enables reasonable adjustments to be made easily.

“There are clinical service barriers, where colleagues feel their service isn’t designed to make the adjustments that might be needed,” says Maisie.

“Those are bigger, system-level changes, but it’s important that they’re recognised and fed into wider discussions so that improvements can be made.”

Alongside identifying the barriers, the team also focused on potential solutions, many of which are already being explored across Somerset.

These include clearer care pathways, improved training and the development of a “reasonable adjustments” resource pack to support colleagues in making practical changes.

“We’ve already delivered a number of presentations around reasonable adjustments for different teams,” Freya says.

“That’s about helping colleagues understand what adjustments might look like in practice, but also building their confidence to use them.”

Another key idea is the development of a network of “intellectual disability champions” within mainstream services, giving teams a clear point of contact for advice and support.

“The idea is to have someone within each service who has a particular interest or experience in this area,” explains Maisie.

“They can help share knowledge, support colleagues and make sure people know where to go for advice.”

While the project is still developing, both Freya and Maisie say it has already helped strengthen relationships between teams and opened up conversations about how services can work more closely together.

“One of the biggest benefits has been the relationships we’ve built with colleagues in mainstream services,” continues Maisie.

“We’ve always had good working relationships, but this has helped us become even more open, with colleagues asking for advice, support and resources.”

Looking ahead, the team is keen to build on the work and continue improving access for patients, including involving people with lived experience more directly in future projects.

“One of the things we would have liked to include is the voices of people with intellectual disabilities themselves,” says Freya.

“That’s definitely something we’d want to build into future work, to make sure their experiences are shaping what we do.”

For now, the focus remains on continuing to raise awareness and support colleagues across services to feel more confident in making adjustments.

“Our main message is that people who are entitled to a service should be offered that service wherever possible,” adds Freya.

“Often, it’s about small, simple changes – things that colleagues are already doing for other patients – but there can be a lack of confidence when working with people with learning disabilities, especially if it’s not something they do regularly.

“If we can support colleagues with that, we can make a real difference to patients’ experiences and ensure more people are able to access the care they need.”