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Learning disability in psychiatry — the future of services

Department of Psychiatry of Disability, St George's Hospital Medical School, London SW17 ORE (e-mail: kcourtenay{at}sghms.ac.uk)

Sir: I support what O'Dwyer (Psychiatric Bulletin, July 2000, 24, 247-250) describes of her experiences as a consultant psychiatrist in learning disability. Her difficulties were recognised by other psychiatrists in the UK. Of fundamental influence on the workload of community teams in learning disability are the number of independent care homes in a catchment area rather than the size of the general population. Poor training and a high turnover of care staff compound the difficulties inherent in the workload that the psychiatrist and the mental health team can expect.

With the move to ‘normalisation’ of learning disability services since the closure of the institutions and the ‘demedicalisation’ of care, I believe services have been hijacked by well-meaning professionals and carers who choose not to recognise, or remain ignorant of, mental illness in this group of people. Ultimately they do a disservice to their clients, which in many cases results in eviction from homes because of difficult behaviour or the inappropriate prescription of potent drugs by general practitioners and general psychiatrists. Unfortunately they too can hold society's prejudice towards the learning disabled and thus further stigmatise their patients.

In planning services, the importance of well-resourced mental health teams in learning disability cannot be ignored because society has a lot to gain from the understanding of mental health issues in learning disability, which has the potential for skills and treatments to be generalised to other groups in the population.

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