A FRAMEWORK FOR COMMISSIONING SERVICES FOR PEOPLE WITH LEARNING-DISABILITIES

The needs of people who have global developmental learning disabilitie s (mental handicap) are complex and lifelong. Unless social and health service commissioners agree a framework for conceptualizing their nee d, 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 service s to focus on (1) ensuring access to the full range of primary and sec ondary health services, (2) reducing the occurrence and severity of in tellectual and associated impairments and (3) ensuring the provision o f assessment and treatment of behaviour disorders and associated menta l health problems. Some of these inputs are required before birth and in early childhood, but a number of people will require health service s throughout life because of the presence of othe disabilities or cont inuing behaviour and/or mental health problems. At school age, the edu cation authority should provide the lead in ensuring the best physical and social learning environment. All children with learning disabilit ies will be socially disadvantaged in adulthood unless they are provid ed with opportunities for social integration, continuing education, sk ills training, employment and normal living facilities which meet thei r needs. Although there appears a logical shift in agencies' responsib ilities 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.