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Being a teenager is trying at the best of times. But young people with learning difficulties can face a tougher time. They may be bullied, face problems at school, and are often isolated from their peers. For some this can lead to a mental health problem.

A new report from the Foundation for People with Learning Disabilities paints a stark picture of what life is like for people aged 13 to 25 with learning difficulties and mental health problems. Count Us In says that young people with learning difficulties are twice as likely to develop a mental health problem as other people their age.¹ In fact, up to 40 per cent of young people with learning difficulties also experience mental health problems.


Perhaps more worryingly, the report - which is the result of a year-long inquiry into the mental health needs of this group - says these problems often go unnoticed and untreated by the very services designed to help this client group. It says: "The inquiry listened to widespread concerns about how the emotional well-being and mental good health of young people with learning disabilities were being overlooked or even ignored."

So why are young people with learning difficulties more at risk from developing mental health problems than their peers? Does having a learning difficulty hinder the diagnosis of a mental health problem? And what sorts of services are available for this client group?

Hazel Morgan is head of the Foundation for People with Learning Disabilities, which is part of the Mental Health Foundation. She says adolescence is a particularly difficult time for young people with learning difficulties because of the potential for isolation and loneliness. "Other young people are looking forward to going to college or starting a career and these things are far more difficult to achieve for young people with learning difficulties."

Alan Higgins is clinical nurse manager for the learning difficulties service at the Camden and Islington Social Care and Mental Health Trust. He says the triggers normally associated with mental health problems are exacerbated for people with learning difficulties. "They have limited understanding of subtle social codes," he says. "Sometimes their learning difficulty isn't that apparent, so their peer group and the public don't know about it. This all adds to the pressure on them."

He adds that overprotective parents and care staff can also limit how some young people with learning difficulties mature. "The consequence of this is that they don't develop adequate coping responses to stress," Higgins says.

But learning difficulties can also act as a barrier to having a mental health problem correctly diagnosed, argues Morgan. "Health professionals see the learning difficulty first and the mental health problem second," she says. "They attribute behaviour that might indicate distress to a person's learning difficulty."

Dinah Morley is deputy director of youth mental health campaigning charity YoungMinds. She says it is common for children and young people with learning difficulties to have a dual diagnosis and for professionals to incorrectly see the mental health problem as a manifestation of the learning difficulty.

Higgins agrees: "A person can appear to present odd or challenging behaviour and professionals may assume it's part of their learning difficulty and not a response to hallucinations or other symptoms of a psychiatric condition."

Individuals with learning difficulties themselves might also have trouble identifying when their mental health deteriorates, he says. "A person with a learning difficulty may have problems expressing what is happening to them and describing the symptoms of a mental health problem." The more severe the learning difficulty, he adds, the harder it is for the person to describe the key symptoms which would aid diagnosis.

Once a young person had been diagnosed with a mental health problem they are usually referred to a child and adolescent mental health service by their GP. Unfortunately, Morley says, in the case of children with learning difficulties the service may not have the necessary expertise. "CAMHS need to have someone who has specialist knowledge of these children and what is going on with them, as well as their mental health problem."

Parents interviewed for the foundation's inquiry said it took a long time for professionals to recognise their child's mental health problem and for an appropriate support service to be found for them. Morgan says this is not unusual: "Only young people with mild learning difficulties get access to mainstream mental health services more immediately. Those with severe learning difficulties get referred back to learning difficulty services."


Michelle Chinery has a learning difficulty and is co-chairperson of the national learning disability task force, created by the government after the publication of its Valuing People white paper last year.²

She says she experienced poor mental health when she was younger after becoming depressed when living in a residential home. "I wasn't happy with where I was living and I protested by staying out all the time," she says.

The staff at the home wanted to prescribe her medication but she was unwilling to take any. Fortunately the psychiatrist she saw agreed that drugs weren't the answer to Chinery's problem. She says when she moved into a different home her mental health improved and she now feels happier.

Although Chinery was able to take a stand against medication, she is concerned other young people with learning difficulties who develop mental health problems are not able to. "People get forced to take drugs because residential home staff get the psychiatrists to recommend it," she says. "They don't always need to take them but are given them because they've got a learning difficulty."

Clearly, there is room for improvement in the work that some social care professionals do with young people with learning difficulties who also have mental health problems.

Chinery says more training in mainstream mental health services would help "because they are not knowledgeable about how to work with people with learning difficulties". She also calls for psychiatrists and hospital staff to have better awareness training on the subject.

She supports increasing mental health advocacy so people with learning difficulties can speak up for themselves about their problems. "Information should be made accessible for people with learning difficulties about how they can access mental health services," she says.

Morley also backs increased training for the sector and says anyone working with children should have awareness training on mental health issues. She says: "This group of children are especially vulnerable and they deserve better."

One of the simplest ways to improve the way social care staff work with children and young people with learning difficulties is by respecting the relationships they have developed, Morgan says. "Friendships are often overlooked by professionals and there is a lack of support to help young people with learning disabilities sustain them."

Higgins acknowledges that Camden and Islington Social Care and Mental Health Trust is in the unique position of targeting the mental health needs of people with learning difficulties. He says the service developed in response to local demand and is successful because it works across both health and social services.

He says it is vital for other learning difficulties and mental health services to see a young person with a learning difficulty and a mental health problem as a whole person. He warns: "If they don't the individual won't get a good quality service because it will be fragmented, pulling in different directions and duplicating work."

1 Count Us In, The Foundation for People with Learning Disabilities, 2002, from 020 7802 0312

2 Department of Health, Valuing People: A New Strategy for Learning Disabilities for the 21st Century, DoH, 2001