Reflections on the use of a specialist acute assessment and treatment unit for adults with intellectual disability

The purpose of this paper is to evaluate the impact of a changing commissioning landscape on the provision of specialist acute inpatient care from the perspective of a small category 2 unit in London.

The authors conducted a retrospective survey of all referrals to the unit in 2012 and 2013.

There has been an increase in the referrals and admissions to the unit with referrals covering a wider catchment area. This has resulted in a doubling of the average distance between the unit and the respective catchment areas that patients and their relatives have to travel. The majority of admissions were transfers from mainstream mental health services. There has been a reduction in the mean length of stay.

This survey looks at trends in one category 2 unit in an outer London Borough and therefore, limits generalisability. The data collection was retrospective and there was no information on patients requiring admission but not being referred to the unit.

There continues to be a need for category 2 admission units to serve the needs of a small group of patients with intellectual disability presenting with mental health needs and behavioural problems. Consideration needs to be given to the entire mental health and challenging behaviour care pathway, including the small but crucial element of specialist inpatient management if services are to remain local and responsive to the needs of this group of patients and their carers.

An ill-planned reduction in the number of specialist inpatient units without viable community services, risks perpetuating a situation where patients and their relatives have to travel long distances to obtain appropriate specialist help. Longer geographical distances could also potentially hamper closer liaison between the unit and the community services, thereby reducing the degree of oversight and prolonging the transition and discharge process.

This survey highlights the impact of recent commissioning and service changes on delivery of specialist in patient services for adults with intellectual disability in the immediate aftermath of the Winterbourne Review.