Learning disability teams and mental health trusts

Sir: As O'Hara discusses (Psychiatric Bulletin, October 2000, 24, 368-369), there are interesting times ahead for community teams for adults with learning disabilities (CTLD). Such teams provide a range of services of which mental health is only one component. CTLDs reside within community, rather than mental health, trusts, with important consequences. O'Hara highlights two of these: perpetuation of a model of separate health services for people with learning disabilities and difficulties implementing key areas of health care policy such as the Care Programme Approach. Partitioning CTLDs between mental health and primary care trusts would help to delineate their specialist mental health component. It would also help to achieve the ideological goal of ‘mainstreaming’ while respecting the need for specialist psychiatry.

However, I am concerned about how CTLDs will be received by mental health trusts. Perhaps the single biggest priority of a general mental health trust is to maintain general psychiatric services and when limited resources are available specialist teams cannot always take their worth for granted. Without mention in the National Service Framework, newly relocated CTLDs may find themselves particularly vulnerable and will need to work especially hard to earn status and support. This may be an uphill task where learning disability specialists have little or no significant general psychiatry experience at higher training level and risk being perceived by some colleagues (themselves with no useful training in learning disability) as professional outsiders.