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learning-disabilities2

LEARNING DISABILITIES

(The information which follows has been researched and collected from the Faculty of the Psychiatry of Learning Disability of the Royal College of Psychiatrists faculty report[1]).

Firstly through looking at a study by the Leicestershire Learning Disability Register, their results show us that people with learning disabilitiesfrom minority ethnic communities have similar levels of mental health and behavioural problems, and that carer’s experience significantly more stress and receive less support than their White European counterparts.[2] This is an important factor to consider when dealing with patients who are either carers for people with learning disabilitiesor those who have learning disabilitiesthemselves. Armed with this knowledge it should enable you as a practitioner to understand the background as to why a person, or a carer of a person with learning disabilitiesmay struggle to access mental health support services.

There is very little research exploring mental health issues in new migrants with learning disabilities. Owing to the nature of a person’s disability, it is unlikely that people with learning disabilitieswill be economic migrants travelling on their own. They are more likely to be a dependent member of a migrating family.

Migration, whether voluntary or forced, is a traumatic life event causing disruption of lifelong attachments and external stability.[3] Family disruption continues through separations and reunions; and parents who raise their children in a culture that differs from their own often feel disempowered. Migration is associated with culture shock, difficulties with adapting to the new culture and a risk of increase in physical and mental health morbidity. There is evidence that people from some minority ethnic communities are more likely to be diagnosed with a psychiatric illness, especially psychosis, than the White Caucasian population.[4]

There are many contributing factors to the low use of specialist learning disability and mental health services by people of ethnic minority backgrounds these can include:

Lack of information:

Carers from ethnic minority communities are largely unaware of specialist learning disability services. The transition from child services to adult services are highlighted as a particular point where young adults with learning disabilitiesfrom ethnic communities are likely to lose contact with support services.

Lack of appropriate service provision:

Services provided can be insensitive to the cultural needs of ethnic minority communities, alienating them completely. Carers have repeatedly reported issues of insensitivity regarding dietary requirements, lack of same-gender accommodation, provision of bilingual carers and culturally sensitive material. Addressing these issues could present services as welcoming and accepting. Although carers from minority ethnic communities experience similar or higher levels of stress as their white counterparts, they are reluctant to access specialist services due to distrust or fear of services. Although some of the above issues are not specific to ethnic minority communities, users and carers from this background are more likely to react to this by staying away from services, (as highlighted earlier) leading to a sizeable hidden population with complex needs.[5]

The Department of Health document on ‘Learning Disability and Ethnicity’, summarises the evidence from literature on minority ethnic communities and service use as follows:[6]

  • Poor standards of communication.
  • Delays in diagnosis and treatment.
  • Isolation, lack of support and high levels of carer stress.
  • Low take-up and poor access to services.
  • High levels of unmet need.
  • Lower levels of access to benefits and/or receipt of lower amounts of benefits compared with white claimants with similar needs.
  • Low levels of knowledge of services available for the person with a disability or carers.

Language Barriers:

As discussed previously language barriers often present families and carers from communicating the nature and the extent of their problems experienced to primary care practitioners. This often results in inadequate identification or minimisation of the problems and reduced referrals. If you consider the issue of lack of awareness with communication as a barrier this instantly makes it difficult for families to voice their need for support.

Family Dynamics:

The family’s interaction with its own subculture, the wider community and services is determined by experience and perception of stigma. Attitudes to services may be influenced by events, starting with the news that the child has a learning disability. This may result in negative attitudes that are maintained by culturally insensitive choices offered to these patients and families.[7] Where a family has a member who has a learning disability, they often show higher levels of stress due to caring for these family members. Where this does occur, the carer may fail to seek out the services due to lack of education surrounding what is available to them.

All these considerations should be noted when dealing with patients of learning disabilitiesand an understanding should be made that the whole process of accessing or using mental health services can be more stressful for a patient with learning disabilities. The aim of this section is to highlight some points where there is a greater need for education on mental health services and the provision to ethnic minority communities where people have a learning disability.

The most commonly used alternative formats of communication for a person with learning difficulties include:

  • Easy Read
  • Makaton
  • Subtitling
  • Audio Transcription

[1] RC Psych Publications. (2011), Minority ethnic communities and specialist learning disability services – Report of the Faculty of the Psychiatry of Learning Disability Working Group, pgs. 12-18.

[2] Devapriam, J., Thorp, C. F., Tyrer, F., et al (2008) A comparative study of stress and unmet needs in carers of South Asian and White adults with learning disabilities. Ethnicity and Inequalities in Health and Social Care, 1, 35–43.

[3] Falicov, C. J. (1995) Training to think culturally: a multi-dimensional comparative framework. Family Process, 34, 373–388.

[4] Chaplin, R. H., Thorp, C., Ismail, I. A., et al (1996) Psychiatric disorder in Asian adults with learning disabilities: patterns of service use. Journal of Intellectual Disability Research, 40, 298–304.

[5] RC Psych Publications, (2011), Minority ethnic communities and specialist learning disability services – Report of the Faculty of the Psychiatry of Learning Disability Working Group, pg. 18.

[6] Mir. G. Nocon. A. and Ahmed. W. (2001) Learning Disability and Ethnicity: A Framework for Action.

Department of Health.

[7] RC Psych Publications, (2011), Minority ethnic communities and specialist learning disability services – Report of the Faculty of the Psychiatry of Learning Disability Working Group, pg. 15-16.

Easy Read is one way of making information more accessible to people with learning disabilities. Information that is easier to understand allows people to make better choices on issues. The way Easy Read is produced, it cuts out all unnecessary information for its reader, for example, it only covers the information that you need to know and is communicated in plain and simple English. It is often supported by pictures and words which make it simpler for a person with learning disabilitiesto understand. When a word is used which may be more difficult for a person with learning disabilitiesto understand; a clear explanation of what that word means will be shown.

Easy read can also be known as:

  • Making information easier
  • Easier to understand information
  • Simple words and pictures
  • Easy Write
  • Easy Info
  • Easy Access

Makaton is mainly used for people with learning disabilities.

 

Makaton is a language program which uses signs and symbols to help people to communicate.  It is designed to support spoken language and the signs and symbols are used with speech, in spoken word order. This method helps to provide extra clues about what someone is saying.  Using signs and symbols can help patients who have limited or no speech or whose speech is unclear and those who cannot, or prefer not to sign.

Today over 100,000 children and adults, use Makaton symbols and signs.  Most people start using Makaton as children then naturally stop using the signs and symbols as they no longer need them.  However, some people will need to use Makaton for their whole lives.

Research has shown that signs and gestures are easier to learn than spoken words. Children and adults can use Makaton to let others know what they want, make choices, share information and understand more.  This helps build and develop important communication and language skills.[1]

If your patient requires the use of Makaton you can inform us via email or call the office and we can arrange this method of communication for you.

[1] The Makaton Charity, About Makaton, [online], [Accessed] 25th March 2014.

If ever you have any promotional videos or particular media items that you need to convey to your patient, Language Empire can provide subtitling to ensure this media is accessible to those who have hearing impairments.  For many Deaf people and people with hearing impairments, subtitles are likely to be an important channel for receiving information. Subtitling is text on screen representing speech and sound effects that may not be audible to people with hearing impairments.  It is synchronised as closely as possible to the sound.

We can provide different audio formats for people with visual impairments for example:

  • Audiotape
  • MP3 Audio File.
  • Audio CD.

(Audio versions of documents are generally provided via a CD or as an MP3 file).

When producing audio material we will take into consideration the below points:

  • The arrangement of information to ensure it is in a logical order.
  • Minimalizing any background noise and music.
  • The use of voices, for example, ensuring the voice used is appropriate to the subject matter and the audience.

This method allows you to communicate effectively with your patient when they have visual impairments. By creating an audio format for your patient, you can convey messages either discussing treatments plans or results of tests, etc. Your patient will then have this information stored and can go back to this whenever they may need clarification. This method of communication is a good aid to use for patients with learning disabilities, an option to use this alongside any text format will allow them to follow the text of a document whilst listening to the audio, for example speaking difficult words slowly and instructing when to turn the page.

Click on the links below to jump to specific parts of the guide

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ALTERNATIVE FORMATS
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VISUAL IMPAIRMENT
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DEAF/HEARING IMPAIRMENT