title: A framework for commissioning services for people with learning disabilities.
abstract: The needs of people who have global developmental learning disabilities (mental handicap) are complex and lifelong. Unless social and health service commissioners agree a framework for conceptualizing their need, there is a danger that services could become fragmented. This paper uses the World Health Organization's model of disabilities to put in context these needs. Using this model it is logical for health services to focus on (1) ensuring access to the full range of primary and secondary health services, (2) reducing the occurrence and severity of intellectual and associated impairments and (3) ensuring the provision of assessment and treatment of behaviour disorders and associated mental health problems. Some of these inputs are required before birth and in early childhood, but a number of people will require health services throughout life because of the presence of other disabilities or continuing behaviour and/or mental health problems. At school age, the education authority should provide the lead in ensuring the best physical and social learning environment. All children with learning disabilities will be socially disadvantaged in adulthood unless they are provided with opportunities for social integration, continuing education, skills training, employment and normal living facilities which meet their needs. Although there appears a logical shift in agencies' responsibilities as children with intellectual impairment progress through life, there is considerable diversity within this group and care can only be effectively provided on the basis of a sophisticated assessment of individual need and provision of integrated care.
authors.affiliation: Cambridge Health Authority, District Headquarters, Fulbourn Hospital.
authors.forename: S
authors.initials: S
authors.lastname: Goh
authors.forename: A J
authors.initials: AJ
authors.lastname: Holland
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000465:Algorithms; D002648:Child; D004519:Education, Special; D004739:England; D006301:Health Services Needs and Demand; D006801:Humans; D008607:Intellectual Disability / Q000628:therapy*; D007859:Learning Disabilities / Q000628:therapy*; D008605:Mental Health Services / Q000600:supply & distribution; D012949:Social Work, Psychiatric; D014829:Vocational Education