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Mental health problems in people with learning disabilities

About

What is covered

People of all ages with all levels of learning disabilities can be affected by mental health problems. The mental health problems can, however, be difficult to identify when the person is not able to describe or express their distress, and when they have coexisting physical health problems. Mental health problems are often unrecognised, causing unnecessary suffering.
Some cause of learning disabilities are associated with particularly high levels of specific mental health problems (for example, affective psychosis in Prader–Willi syndrome and dementia in Down's syndrome).
This interactive flowchart covers the identification, assessment and treatment of mental health problems in children, young people and adults with mild, moderate, severe or profound learning disabilities. In addition, there are recommendations on support for family members, carers and care workers.
The recommendations covers all settings (including health, social care, educational, forensic and criminal justice settings).

Updates

Updates to this interactive flowchart

9 January 2017 Learning disabilities: identifying and managing mental health problems (NICE quality standard 142) added.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Mental health problems in people with learning disabilities

What is covered

People of all ages with all levels of learning disabilities can be affected by mental health problems. The mental health problems can, however, be difficult to identify when the person is not able to describe or express their distress, and when they have coexisting physical health problems. Mental health problems are often unrecognised, causing unnecessary suffering.
Some cause of learning disabilities are associated with particularly high levels of specific mental health problems (for example, affective psychosis in Prader–Willi syndrome and dementia in Down's syndrome).
This interactive flowchart covers the identification, assessment and treatment of mental health problems in children, young people and adults with mild, moderate, severe or profound learning disabilities. In addition, there are recommendations on support for family members, carers and care workers.
The recommendations covers all settings (including health, social care, educational, forensic and criminal justice settings).

Updates

Updates to this interactive flowchart

9 January 2017 Learning disabilities: identifying and managing mental health problems (NICE quality standard 142) added.

Sources

NICE guidance and other sources used to create this interactive flowchart.

Quality standards

Learning disabilities: identifying and managing mental health problems

These quality statements are taken from the learning disabilities: identifying and managing mental health problems quality standard. The quality standard defines clinical best practice for identifying and managing mental health problems in people with learning difficulties and should be read in full.

Quality statements

Annual health check

This quality statement is taken from the learning disabilities: identifying and managing mental health problems quality standard. The quality standard defines clinical best practice for identifying and managing mental health problems in people with learning difficulties and should be read in full.

Quality statement

Young people and adults with learning disabilities have an annual health check that includes a review of mental health problems.

Rationale

Annual health checks for young people and adults with learning disabilities can be used to identify and monitor mental health problems. Young people and adults with learning disabilities and mental health needs may have difficulty explaining their health problems, so checking for issues and regularly monitoring needs is important to ensure that these are not missed.

Quality measures

Structure
Evidence of local arrangements to ensure that young people and adults with learning disabilities have an annual health check that includes a review of mental health problems.
Data source: Local data collection.
Process
a) Proportion of young people with learning disabilities who have an annual health check that includes a review of mental health problems.
Numerator – the number in the denominator who have had an annual health check that includes a review of mental health problems.
Denominator – the number of young people with learning disabilities.
Data source: Local data collection.
b) Proportion of adults with learning disabilities who have an annual health check that includes a review of mental health problems.
Numerator – the number in the denominator who have had an annual health check that includes a review of mental health problems.
Denominator – the number of adults with learning disabilities.
Data source: Local data collection.
Outcome
a) Identification of mental health needs in young people and adults with learning disabilities.
Data source: Local data collection.
b) Identification of physical health needs in young people and adults with learning disabilities.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (enhanced GP services) ensure that young people and adults with learning disabilities have an annual health check that includes a review of mental health problems, and that a family member, carer or care worker is involved (as appropriate).
Healthcare professionals (such as GPs) conduct annual health checks that include reviews of mental health problems for young people and adults with learning disabilities, and involve a family member, carer or care worker (as appropriate).
Commissioners (clinical commissioning groups) ensure that general practices are signed up to provide annual health checks that prioritise a review of physical and mental health, for young people and adults with learning disabilities.
Young people and adults with learning disabilities have an annual health check that includes a review of their mental and physical health. This includes:
  • identifying potential new problems
  • looking at all the treatments they are having, to see if they are having any difficulties (for example with going to therapy sessions)
  • reviewing the medications they are taking to see if they have had side effects, any difficulties taking medication or any other problems
  • agreeing a care plan with the healthcare professional for managing any physical health and mental health problems.
If they want, the person may take a family member or carer with them.

Source guidance

Definitions of terms used in this quality statement

Young people
Aged 13–17 years.
Annual health check
This should involve the person with learning disabilities and a family member, carer, care worker, GP or social care practitioner (as appropriate) who knows them. It should include:
  • a review of any known or suspected mental health problems and how they may be linked to any physical health problems
  • a physical health review, including assessment for the conditions and impairments that are common in people with learning disabilities
  • a review of all current interventions, including medication and related side effects, adverse events, interactions and adherence for both mental health and physical health conditions
  • an agreed and shared care plan for managing any physical health and mental health problems (including pain).
[Adapted from mental health problems in people with learning disabilities (NICE guideline NG54), recommendation 1.6.3; and challenging behaviour and learning disabilities (NICE guideline NG11), recommendation 1.2.1]

Equality and diversity considerations

Healthcare professionals should take into account the communication needs of people with learning disabilities. They should make reasonable adjustments and provide support if needed for people who have limited or no speech, who have difficulty with English, or who have other communication needs.
Communication with the person and their family members, carers or care workers (as appropriate) needs to be in a clear format and in a language suited to the person’s needs and preferences.

Assessment by a professional with relevant expertise

This quality statement is taken from the learning disabilities: identifying and managing mental health problems quality standard. The quality standard defines clinical best practice for identifying and managing mental health problems in people with learning difficulties and should be read in full.

Quality statement

People with learning disabilities who need a mental health assessment are referred to a professional with expertise in mental health problems in people with learning disabilities.

Rationale

The mental health assessment should be conducted by a professional with expertise in mental health problems in people with learning disabilities. This ensures that the assessment and subsequent care is effective and tailored to the person’s individual needs and circumstances, and makes reasonable adjustments to take account of their learning disabilities.

Quality measures

Structure
Evidence of local arrangements to ensure that people with learning disabilities who need a mental health assessment are referred to a professional with expertise in mental health problems in people with learning disabilities.
Data source: Local data collection.
Process
a) Proportion of people with learning disabilities who need a mental health assessment and are referred to a professional with expertise in mental health problems in people with learning disabilities.
Numerator – the number in the denominator who are referred to a professional with expertise in mental health problems in people with learning disabilities.
Denominator – the number of people with learning disabilities who need a mental health assessment.
Data source: Local data collection.
b) Proportion of people with learning disabilities who are referred for a mental health assessment and are assessed by a professional with expertise in mental health problems in people with learning disabilities.
Numerator – the number in the denominator who are assessed by a professional with expertise in mental health problems in people with learning disabilities.
Denominator – the number of people with learning disabilities who are referred for a mental health assessment.
Data source: Local data collection.
Outcome
Identification of mental health problems in people with learning disabilities.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (secondary care providers, mental health services and specialist learning disabilities services) ensure that people with learning disabilities who need a mental health assessment are referred to a professional with expertise in mental health problems in people with learning disabilities.
Health and social care practitioners with expertise in mental health problems in people with learning disabilities conduct mental health assessments for people with learning disabilities. At the assessment, the professional completes a formal mental health assessment questionnaire.
Commissioners (clinical commissioning groups, NHS England and local authorities) commission services that ensure that people with learning disabilities who need a mental health assessment are referred to a professional with expertise in mental health problems in people with learning disabilities.
People with learning disabilities who need a mental health assessment are referred to a professional who has the skills to do this for people with learning disabilities and mental health problems. If possible, this should be carried out in a place familiar to the person, with any family members, carers, care workers or others that they want to involve. If needed, staff should help the person with learning disabilities to prepare for the assessment.

Source guidance

Definition of terms used in this quality statement

Mental health assessment
The assessment should include a review of the person’s previous history (both physical and mental health) and personal circumstances. This is essential when assessing the person’s mental health problem and developing a mental health care plan. A formal assessment questionnaire should be completed as part of the assessment.
[Adapted from mental health problems in people with learning disabilities (NICE guideline NG54), recommendations 1.8.1 and 1.8.6]

Equality and diversity considerations

Healthcare professionals should take into account the communication needs of people with learning disabilities when conducting a mental health assessment. They should make reasonable adjustments for people accessing mental health services, and provide support if needed for people who have limited or no speech or who have difficulty with English.
Communication with the person and their family members, carers or care workers (as appropriate) needs to be in a clear format and in a language suited to the person’s needs and preferences.

Key worker

This quality statement is taken from the learning disabilities: identifying and managing mental health problems quality standard. The quality standard defines clinical best practice for identifying and managing mental health problems in people with learning difficulties and should be read in full.

Quality statement

People with learning disabilities and a serious mental illness have a key worker to coordinate their care.

Rationale

Appointing a key worker would improve care coordination and help services to communicate clearly with people with learning disabilities and their family members and carers.

Quality measures

Structure
Evidence of local arrangements and written protocols to ensure that people with learning disabilities and a serious mental illness have a key worker to coordinate their care.
Data source: Local data collection.
Process
Proportion of people with learning disabilities and a serious mental illness who have a key worker to coordinate their care.
Numerator – the number in the denominator who have a key worker to coordinate their care.
Denominator – the number of people with learning disabilities and a serious mental illness.
Data source: Local data collection.
Outcomes
Patient and carer satisfaction with their key worker’s coordination of care.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (primary, secondary and social care services that provide care for people with learning disabilities and mental health problems) ensure that people with learning disabilities and a serious mental illness have a key worker to coordinate all aspects of care.
Key workers coordinate all aspects of care and communication for the person, their family members and carers, and the services that are involved. They should maintain regular contact with the person and their family members and carers and specify this in the care plan.
Commissioners (clinical commissioning groups, NHS England and local authorities) commission services that provide a key worker for each person with learning disabilities and a serious mental illness. The key worker should coordinate all aspects of care and communication.
People with learning disabilities and a serious mental illness have a key worker who acts as the main contact for them and their family members and carers. The key worker makes sure that all staff involved are working together, and that the care plan is being followed and is helping. They ensure that any assessments, care and treatments are explained clearly to the person with learning disabilities.

Source guidance

Definitions of terms used in this quality statement

Serious mental illness
A diagnosis of:
  • severe depression or anxiety that is impacting heavily on the person’s functioning
  • psychosis
  • schizophrenia
  • bipolar disorder
  • an eating disorder
  • personality disorder
  • schizoaffective disorder.
[Mental health problems in people with learning disabilities (NICE guideline NG54) and expert consensus]
Key worker
A key worker (also known as a care or case coordinator, or a Care Programme Approach care coordinator) is the central point of contact for the person with learning disabilities, their family members and carers, and the services involved in their care. They are responsible for helping the person and their family members and carers to access services and for coordinating the involvement of different services. They ensure clear communication between all people and services and have an overall view of the person’s needs and the requirements of their care plan. They ensure that services communicate regularly with the person and their family members and carers, in a suitable format.

Equality and diversity considerations

Healthcare professionals should take into account the communication needs of people with learning disabilities. They should make reasonable adjustments and provide support if needed for people who have limited or no speech, who have difficulty with English, or who have other communication needs.
Communication with the person and their family members, carers or care workers (as appropriate) needs to be in a clear format and in a language suited to the person’s needs and preferences. 

Tailoring psychological interventions

This quality statement is taken from the learning disabilities: identifying and managing mental health problems quality standard. The quality standard defines clinical best practice for identifying and managing mental health problems in people with learning difficulties and should be read in full.

Quality statement

People with learning disabilities and mental health problems who are receiving psychological interventions have them tailored to their preferences, level of understanding, and strengths and needs.

Rationale

Children, young people and adults with learning disabilities are at higher risk of mental health problems than the general population. Standard evidence-based psychological interventions are not designed to take account of the cognitive, communication or social impairments associated with learning disabilities. People with learning disabilities can have a broad range of difficulties, so the care setting and interventions need to be adapted and tailored to each person’s preferences, level of understanding, and strengths and needs.

Quality measures

Structure
Evidence of local arrangements to ensure that people with learning disabilities and mental health problems who are receiving psychological interventions have them tailored to their preferences, level of understanding, and strengths and needs.
Process
Proportion of people with learning disabilities and mental health problems who are receiving psychological interventions that are tailored to their preferences, level of understanding, and strengths and needs.
Numerator – the number in the denominator who receive psychological interventions that are tailored to their preferences, level of understanding, and strengths and needs.
Denominator – the number of people with learning disabilities and mental health problems who are receiving psychological interventions.
Data source: Local data collection.
Outcome
Quality of life of people with learning disabilities and mental health problems and their family members and carers.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (secondary care providers, mental health services and specialist learning disabilities services) ensure that people with learning disabilities and mental health problems who are receiving psychological interventions have them tailored to their preferences, level of understanding, and strengths and needs.
Health and social care practitioners tailor psychological interventions for people with learning disabilities and mental health problems, to match their preferences, level of understanding, and strengths and needs.
Commissioners (clinical commissioning groups, NHS England and local authorities) commission services that ensure that psychological interventions for people with learning disabilities and mental health problems are tailored to match their preferences, level of understanding, and strengths and needs.
People with learning disabilities and a mental health problem have access to psychological (‘talking’) therapies that are designed around their needs.

Source guidance

Mental health problems in people with learning disabilities: prevention, assessment and management (2016) NICE guideline NG54, recommendations 1.9.1–1.9.4, 1.9.8 and 1.9.9

Annually documenting the reasons for continuing antipsychotic drugs

This quality statement is taken from the learning disabilities: identifying and managing mental health problems quality standard. The quality standard defines clinical best practice for identifying and managing mental health problems in people with learning difficulties and should be read in full.

Quality statement

People with learning disabilities who are taking antipsychotic drugs that are not reduced or stopped have annual documentation on reasons for continuing this prescription.

Rationale

People with learning disabilities who are taking medication for a mental health problem would benefit from closer monitoring and a clear rationale for their treatment plan, such as an annual record of the reasons for continuing prescriptions. People with learning disabilities are often given long courses of medication. This is not always helpful, and regular review and agreed shared care protocols are necessary to avoid this.
Effective use of medication to prevent and manage mental health problems is likely to improve the quality of life of people with learning disabilities and their family members and carers, and reduce costs and inappropriate prescribing.

Quality measures

Structure
Evidence of local arrangements to ensure that people with learning disabilities who are taking antipsychotic drugs that are not reduced or stopped have annual documentation on reasons for continuing this prescription.
Data source: Local data collection.
Process
Proportion of people with learning disabilities who are taking antipsychotic drugs that are not reduced or stopped and who have annual documentation on reasons for continuing this prescription.
Numerator – the number in the denominator who have annual documentation on reasons for continuing this prescription.
Denominator – the number of people with learning disabilities who are taking antipsychotic drugs that are not reduced or stopped.
Data source: Local data collection.
Outcome
a) Antipsychotic medication prescribing rates for people with learning disabilities.
Data source: Local data collection.
b) Quality of life of people with learning disabilities and their family members and carers.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (secondary care providers) ensure that people with learning disabilities who are taking antipsychotic drugs that are not reduced or stopped have annual documentation on reasons for continuing this prescription.
Healthcare professionals (clinicians) annually document the reasons for continuing prescriptions for people with learning disabilities who are taking antipsychotic drugs that are not reduced or stopped.
Commissioners (NHS England) commission services that ensure that people with learning disabilities who are taking antipsychotic drugs that are not reduced or stopped have annual documentation on reasons for continuing this prescription.
People with learning disabilities who are taking antipsychotic drugs (medication to help with psychosis) that are not reduced or stopped have a review of their prescription and the reasons for continuing it recorded every year.

Source guidance

Equality and diversity considerations

Healthcare professionals should take into account the communication needs of people with learning disabilities. They should make reasonable adjustments and provide support if needed for people who have limited or no speech, who have difficulty with English, or who have other communication needs.
Communication with the person and their family members, carers or care workers (as appropriate) needs to be in a clear format and in a language suited to the person’s needs and preferences.

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Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Learning disabilities are commonly divided into 'mild', 'moderate', 'severe' and 'profound', but these categories are based on IQ and most UK health and social care services do not measure this. Therefore, this guideline uses the terms 'milder learning disabilities' (approximating to mild and moderate learning disabilities) and 'more severe learning disabilities' (approximating to severe and profound learning disabilities).
All people with learning disabilities:
  • need additional support at school
  • need support in some areas of adult life, such as budgeting, planning, time management, and understanding complex information
  • need more time to learn new skills than people who don't have learning disabilities.
People with milder learning disabilities:
  • may be able to live independently and care for themselves, managing everyday tasks and working in paid employment
  • can communicate their needs and wishes
  • may have some language skills
  • may have needs that are not clear to people who do not know them well.
Learning disabilities are commonly divided into 'mild', 'moderate', 'severe' and 'profound', but these categories are based on IQ and most UK health and social care services do not measure this. Therefore, this guideline uses the terms 'milder learning disabilities' (approximating to mild and moderate learning disabilities, that are often defined as an IQ of 35-69 and impairment of adaptive functioning with onset in childhood) and 'more severe learning disabilities' (approximating to severe and profound learning disabilities, that are often defined as an IQ of 34 or below with impairment of adaptive functioning and onset in childhood).
All people with learning disabilities:
  • need additional support at school
  • need support in some areas of adult life, such as budgeting, planning, time management, and understanding complex information
  • need more time to learn new skills than people who don't have learning disabilities.
People with more severe learning disabilities are more likely to:
  • need support with daily activities such as dressing, washing, food preparation, and safety
  • have limited or no verbal communication skills or understanding of others
  • need support with mobility
  • have complex health needs and sensory impairments.
Learning disabilities are commonly divided into 'mild', 'moderate', 'severe' and 'profound', but these categories are based on IQ and most UK health and social care services do not measure this. Therefore, this guideline uses the terms 'milder learning disabilities' (approximating to mild and moderate learning disabilities) and 'more severe learning disabilities' (approximating to severe and profound learning disabilities).
All people with learning disabilities:
  • need additional support at school
  • need support in some areas of adult life, such as budgeting, planning, time management, and understanding complex information
  • need more time to learn new skills than people who don't have learning disabilities.

Glossary

a person who provides unpaid support to someone who is ill, having trouble coping or has disabilities; this does not include care workers (paid carers), who are included in the definition of staff
people who provide unpaid support to someone who is ill, having trouble coping or has disabilities; this does not include care workers (paid carers), who are included in the definition of staff
a care pathway is defined in this guideline as the ways different services interact with each other, and how people access and move between them
a person who provides paid support to someone who is ill, having trouble coping or has disabilities in a variety of settings (including residential homes, supported living settings and day services)
people who provide paid support to someone who is ill, having trouble coping or has disabilities in a variety of settings (including residential homes, supported living settings and day services)
aged 0–12 years
a key worker (also known as a care or case coordinator) is a central point of contact for the person with a mental health problem, family members, carers and the services involved in their care; they are responsible for helping the person and family members or carers to access services and for coordinating the involvement of different services – they ensure clear communication between all people and services and have an overall view of the person's needs and the requirements of their care plan
is defined in this guideline as: severe and incapacitating depression or anxiety, psychosis, schizophrenia, bipolar disorder or schizoaffective disorder
healthcare professionals and social care practitioners, including those working in community teams for adults, children or young people (such as psychologists, psychiatrists, social workers, speech and language therapists, nurses, behavioural analysts, occupational therapists, physiotherapists and pharmacists); and educational staff
aged 13–17 years

Paths in this pathway

Pathway created: September 2016 Last updated: October 2017

© NICE 2017. All rights reserved. Subject to Notice of rights.

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