How the Green Light Toolkit Fits With Other Initiatives
The Green Light Toolkit supports mental health services to provide effective care to three groups of people:
- Autistic people
- People with learning disabilities
- Autistic people with learning disabilities
This page lists other initiatives that have shaped the Toolkit and will continue to be relevant to mental health services. For each item, the distinctive contribution of the Green Light Toolkit is highlighted.
Coproduction and feedback
Services should be designed, commissioned, delivered and evaluated in partnership with people using them. As a part of this broad coproduction process, feedback is vital, utilising programmes such as independent advocacy and complaints mechanisms such as the Ask Listen, Do project run by NHS England.
Law and statutory guidance
The Autism Act (2009) and its accompanying strategy (2021) and Implementation plan (2021-22) shapes what is offered to autistic people, while people with learning disabilities are included in the National Disability Strategy (2021). The Mental Capacity Act (2005), Equality Act (2010), Health and Social Care Act (2021), Care Act (2014) and Accessible Information Standard are all influential too. Green Light asks what we want to do, rather than just what we must do.
A series of reports from Health Education England and partners have analysed the skills that mental health staff need to work with autistic people and people with learning disabilities. Some of these reports take a broad approach and set out the skills that all staff need (such as person-centred practice), while others concentrate on a particular group (such as people in forensic services). Several thousand statements are made in total, grouped into similar but not identical categories across the various reports. Green Light is shorter and more digestible. It asks about staff attitudes and capabilities but goes beyond this to ask about buildings, commissioning, monitoring and a range of other factors.
NICE quality standards
The National Institute for Health and Care Excellence (NICE) has reviewed evidence and published a range of standards that are relevant to aspects of the Green Light agenda. Green Light asks about what local people consider to be excellent practice as well as drawing on externally derived standards.
Professional standards are written for one professional group and often relate to just one group of citizens, like this set of voluntary standards that guide Community Learning Disability Nurses or this statement of capabilities written for social workers who are engaging with autistic adults. Green Light pays attention to the experience of autistic people as well as people with learning disabilities and considers how the whole mental health system is joined up to deliver support.
Standards for a specific service
The Royal College of Psychiatrists have created a set of standards for inpatient mental health services and another set for adult inpatient learning disability services and there are similar initiatives like the Star Wards accreditation. Green Light covers all mental health services rather than just inpatient areas, and does not set a threshold but rather aims for continuous improvement.
Inspection and national monitoring
The Care Quality Commission provide an independent, external evaluation of the services they visit and have set out standards for communication and culture. National monitoring systems such as the Mental Health and Learning Disabilities Statistics, the defunct Self-Assessment Framework and the forthcoming clinically led standards for mental health collect, benchmark and report information about people using services but ask few or no questions about autistic people or people with learning disabilities in particular. Green Light invites stakeholders in the local mental health service to review their own practice and commit to a team-defined action plan that will improve this aspect of care.
Oliver McGowan training
In response to the UK government’s recommendations, mandatory training is being piloted to give participants a better understanding of both autism and learning disability. Staff right across health and social care will attend. Green Light is focused on the response of mental health services in particular.
Learning Disabilities Mortality Review (LeDeR)
Evidence from a number of tragedies has highlighted the poor life expectancy and health outcomes experienced by people with learning disabilities and autistic people. The ongoing LeDeR is working to close this gap for both autistic people and people with learning disabilities. LeDeR reviews deaths to identify learning, opportunities to improve and examples of good practice. This information is then used to improve services. The death or someone with a learning disability or an autistic person can be reported here. Green Light asks about health while taking a broader view of the overall quality of mental health care.
Building the right support
For many years now, a number of autistic people and people with learning disabilities have lived in hospitals a long way from home, segregated from their families and communities. A number of connected initiatives are under way to end this practice, including the Building the right support programme (previously known as Transforming Care), Dynamic Support Registers, Care and Treatment Reviews and the HOPE(S) programme. The Government has brought these actions together and published its 2022 Action Plan. Green Light recognises the importance of this work but considers how mental health services can support all autistic people and all people with learning disabilities who may need them, rather than just the people in or at risk of being admitted to long-stay hospitals.
NHS England and NHS Improvement have published and tracked compliance with Learning Disability Improvement Standards, which pay particular attention to data collection related to the Building the Right Support programme and the Learning Disabilities Mortality Review. Green Light is also concerned with people who are at low risk of entering a long-stay hospital , but who may need access to mental health care. It looks for improvement opportunities at team level as well as addressing externally derived monitoring standards. Some mental health services have used the Green Light Toolkit alongside the Improvement Standards so that the detailed work on reasonable adjustments for autistic people and people with learning disabilities is then enriched by the wider comparisons generated through use of the Improvement Standards.
Stopping over medication of people with a learning disability, autism or both (STOMP) is a campaign supported by the NHS to stop the excessive use of psychotropic medication with people with learning disabilities and autistic people. Green Light includes this important topic in its survey questions, and also looks at a range of other things that affect autistic people and people with learning disabilities when they use mental health services.
Positive and proactive care
In compliance with the Mental Capacity Act (2005), Positive and Proactive Care seeks to minimise restrictive practices and help teams wishing to review their practice. Green Light is also committed to maximising autonomy while keeping everyone safe and so asks mental health services to consider this area, but takes a broader view of quality of mental health care.