Services for people with intellectual disabilities and challenging behaviour: the Mansell Report. Jim Mansell. Overview. Analysis Action needed now Conclusion. Forward and backward at the same time. Analysis. Typical problems. Community placements break down - PowerPoint PPT Presentation
Services for people with intellectual disabilities and challenging behaviour: the Mansell Report Jim Mansell O U T O F A REA PLACEM ENTS U SER S, C A R ER S A ND STA FF H URT CA R ER S LEFT TO STR U G G LE A LO N E STA FF D EM ORALISED IN CR EA SED R IS K O F A BUSE B A D CA R E PR ACTICES CR ISES A N D PLACEM ENT BREAKDOW NS R E IN S T IT U T IO N A LIS A T IO N ‘SILTIN G -U P ’O F S P E C IA LISED S E R V IC E S LESS CH O ICE A N D CONTROL O F SER V IC E S LO W ER EFFICIEN CY PU B LIC CR IT IC IS M T h e h id d e n co st o f failin g to d evelo p lo ca l service s
Transcript
Services for people with intellectual disabilities and challenging behaviour: the Mansell Report
Jim Mansell
OUT OF AREA PLACEMENTS
USERS, CARERS AND STAFF HURT
CARERS LEFT TO STRUGGLE ALONE
STAFF DEMORALISED INCREASED RI SK OF ABUSE
BAD CARE PRACTICES
CRISES AND PLACEMENT BREAKDOWNS
REI NSTITUTI ONALISATI ON ‘SI LTING-UP’ OF
SPECIALISED SERVICES
LESS CHOICE AND CONTROL OF SERVICES
LOWER EFFICIENCY PUBLIC CRITICISM
The hidden cost of failing to develop local services
Overview
Analysis Action needed now Conclusion
Forward and backward at the same time
Analysis
Typical problems
Community placements break down Out-of-area placements increasingly used Poor quality institutional solutions persist Costs increase while quality declines
Reasons for these problems
Amount of challenging behaviour depends on service competence
Most placements can only support people without problems
There is not enough planning ahead for individuals
The potential challenge
Vulnerable people Between 10 and 46% of
adults have additional mental health needs
12-15% have significant impairment of sight
8-20% of hearing 27% have autistic
spectrum disorders At least 45% have
significant impairments of communication
Vulnerable situations Low level of staff support
in residential homes (about 9 mins/hour)
Less facilitation (1-4 mins/hour)
Communication often doesn’t match person’s needs
High staff turnover and low levels of training
Treatment for challenging behaviour hard to get
Reasons for these problems
Amount of challenging behaviour depends on service competence
Most placements can only support people without problems
There is not enough planning ahead for individuals
Placement competence
Dominant model of care is unskilled minding
Treatment rhetoric perpetuates this Commissioners purchase mainly low-
competence services
0
20
40
60
80
100
Services
NeedCapability
Reasons for these problems
Amount of challenging behaviour depends on service competence
Most placements can only support people without problems
There is not enough planning ahead for individuals
Not enough planning ahead
Children sent to residential schools out-of-area
Care planning overwhelmed by crises• Not enough care managers
• Cost pressures reduce proper planning
• Placements obtained at last minute, often in crisis
• Increasing burden of care on families
Action needed now
Action needed now
Increase capacity of local services to understand and respond to challenging behaviour
Avoid increasing the burden on family carers by reducing levels of service
Provide specialist services locally which can support good mainstream practice as well as directly serve a small number of people with the most challenging needs
Replace low-value high-cost services with better alternatives
Increasing local capacity
Good advance planning for individuals Personalisation – tailor services to
individual Partnership with good service providers Incentivise good services Don’t just buy what is there – make
something better!
Support family carers
Prevent service withdrawal Provide practical help 24/7 not 9-5 Treat families as experts Plan ahead
Replace low-value high-cost services with better alternatives
4 young men with mild learning disabilities, mental health needs and substance abuse problems
From out-of-county placements in 2007 to individual flats supported by voluntary sector outreach support
Cost in first week £7400; cost 2009 £3970
2 young men with severe learning disabilities and serious challenging behaviour
Secure units in 2001 at c£2900 per week each
Now sharing a house with skilled staff support
Costs now £1175 per week
Specialist support to services
Specialist multi-disciplinary challenging behaviour support teams are essential
Make commissioners, managers and professionals work together to ensure that advice is both practicable and is acted upon
Emergency support available 24 hours a day, seven days a week
Budgets to fund a much wider variety of interventions as an alternative to placement in special units
Provide local specialist services Use specialists to help managers lead
their staff Identify responsibility for extra help to
get failing placements back on track and development of replacement homes
Encourage provider cooperation/ mutual support to enhance resilience
Replace ‘one-stop shop’ of challenging behaviour units with range of tailored options
Clarify responsibility for case co-ordination, decision-making and resource allocation
Conclusion
Challenging behaviour is not just an individual treatment problem, it is a service design problem
The key to better support is to build capacity in the local system, rather than waiting until crises occur
This requires coordinated action across a range of areas – ie planned service development with a view to investing for the future
