In Spain, three parallel processes have taken place during the last 20 years: decentralisation, a health reform and a mental health reform. These processes have produced an extremely complex situation in support and care for people with mental retardation. The decentralisation process was not accompanied by a clear definition of the co‐ordination mechanisms among local authorities, and as a result many different health and social care systems have emerged at different times. This makes the description of the current care organisation difficult. An important characteristic of the Spanish system is the major role of NGOs in care and policy‐making and planning in this area. A shift from institutional to community care has begun for both psychiatric patients and people with mental retardation, but compared with neighbouring countries and published standards, the provision of intermediate services and non‐hospital residential care is very low, and the situation is worst for people with mental retardation and psychiatric problems.
We compare the deinstitutionalization of psychiatric patients and the developmentally disabled in the United States and demonstrate that there were two path-dependent…
We compare the deinstitutionalization of psychiatric patients and the developmentally disabled in the United States and demonstrate that there were two path-dependent processes with significant qualitative and quantitative differences, ultimately leading to better outcomes for developmentally disabled individuals.
Using secondary literature, we construct a sustained comparison of the two processes in terms of outcomes, timing, tempo, extent, funding, demographic composition, and investment in community services. We then reconstruct the strategies of de-stigmatization and framings of moral worth deployed in the two cases, analyzing their effects on deinstitutionalization in terms of conceptions of risk, rights, and care.
Deinstitutionalization began later for developmentally disabled individuals than for psychiatric patients, and was a more gradual, protracted process. It was not driven by fiscal conservatism, discharges, and the trans-institutionalization of the senile aged, as was deinstitutionalization for psychiatric patients, but primarily by the prevention of institutionalization of young children, and increased investment in infrastructure. Consequently, the deinstitutionalization of the developmentally disabled was far more thorough and successful. The process was shaped by the framing of the developmentally disabled as “forever children” by parents’ organizations that demanded a balance between autonomy, protection, and the provision of care. In contrast, the deinstitutionalization of psychiatric patients was shaped by their framing as autonomous citizens temporarily suffering from “mental health problems” that could be prevented, treated, and cured. This frame foregrounded the right to choose (and also refuse) treatment, while undervaluing the provision of care.
Many people with learning disabilities experience mental health problems, and the outcome is likely to be better if they have a good mental health service. Opinions vary…
Many people with learning disabilities experience mental health problems, and the outcome is likely to be better if they have a good mental health service. Opinions vary about what form a good mental health service for people with learning disabilities would take. Great changes have occurred in services, but research about the effect of these changes is sparse. This paper explores the nature of mental health problems which require services and compares two models for providing a specialist mental health service for people with learning disabilities.
While the right to life, ‘personhood’, and the educability of people with profound and multiple learning disabilities are still under‐debated, service providers and…
While the right to life, ‘personhood’, and the educability of people with profound and multiple learning disabilities are still under‐debated, service providers and research workers continue to extend the boundaries of expectation with respect to what such people can achieve. In this paper the messages of recent research are summarised and key references for fuller information suggested. The need to bring together such specialised knowledge in the framework of an ordinary life aimed at enhancing competence and quality of life is urged.
This paper offers readers a review of the literature on alcohol and illicit drug misuse in people with learning disabilities, focusing on six key areas. First, clarity is…
This paper offers readers a review of the literature on alcohol and illicit drug misuse in people with learning disabilities, focusing on six key areas. First, clarity is provided on the definition of ‘misuse’. Second, prevalence rates are examined along with the methodological difficulties involved in such studies, the authors arguing that prevalence rates are higher than current estimates. Third, the authors explore the relationship between the intra‐ and inter‐personal risk factors. Fourth, the nature of the substance misuse is explored, with a focus on offending behaviour. Fifth, a range of treatment modalities are described with a series of recommendations for more robust evidence‐based interventions. Last, the authors explore the gaps in policy that lead to a dearth in service provision as well the barriers which people with learning disabilities face on entering treatment services. The paper cites four innovative projects that address this population's needs in England, and illustrates how Northern Ireland has positioned the needs of this hidden population within the Department of Health, Social Services and Public Safety (Northern Ireland).
Charles Darwin's correspondence with Dr. John Down indicates that both men thought of people with mental retardation as being akin to humanity's evolutionary predecessors. Recent attempts to teach people with mental retardation to use the computer languages taught to apes show that this conceptualization of mental retardation has remained an unspoken and perhaps unformulated element in public and professional attitudes to people with disabilities ever since. Refuting this conceptualization points the way to a more productive approach to the conditions now classified as ‘mental retardation’.
This article explores the nature of the classifications of learning disabilities as promulgated in the diagnostic manuals. By leaving aside all doubts and controversies…
This article explores the nature of the classifications of learning disabilities as promulgated in the diagnostic manuals. By leaving aside all doubts and controversies that surround the concept and measurement of intellectual functioning, weaknesses are exposed from within those manuals' own frames of reference. The difficulties arising from using the international sub‐classifications of learning disabilities when the national classifications should apply are discussed.
It has been suggested that the emotional needs of people with intellectual disabilities have been neglected (Kroese, 1998). More recently there has been evidence of…
It has been suggested that the emotional needs of people with intellectual disabilities have been neglected (Kroese, 1998). More recently there has been evidence of increased clinical and research activity in this area (Beail, 2003; Bouras & Holt, 2007; Foundation for People with Learning Disabilities, 2004). Currently much of the focus in this area is on mental ill‐health. This article will consider briefly the literature on mental ill‐health, with particular emphasis on the development of individual treatment approaches. From this discussion it will be evident that much of the research and theory in this area focuses on deficits and disadvantage. I will go on to suggest that a clinical and research focus that explores strengths and resilience will offer a more positive agenda for developing understanding of emotional well‐being and mental ill‐health in people with intellectual disabilities.
People with learning disabilities are typically over‐represented in Western criminal justice systems. They are vulnerable during police questioning, and may not comprehend…
People with learning disabilities are typically over‐represented in Western criminal justice systems. They are vulnerable during police questioning, and may not comprehend their right to silence; they may confess, or acquiesce to the police version of events. They may have a long history of challenging behaviour which has never been appropriately addressed until the behaviour brings them into contact with the criminal justice system. It is important for service providers to have a working knowledge of the criminal justice system, and a clear idea of their role in relation to the client, especially during police interviews.
This paper introduces service changes impacting on adults with learning disabilities, defines the concepts of learning disability, needs and need assessments, dual…
This paper introduces service changes impacting on adults with learning disabilities, defines the concepts of learning disability, needs and need assessments, dual diagnosis and mental health needs and considers their service implications. Between 25% and 50% of adults with learning disabilities have mental health needs, and the main clinical types are outlined. The findings from a national multi‐professional survey of services for adults with learning disabilities and mental health needs are summarised and the difficulties of meeting the complex needs of these adults are demonstrated. Recent developments in clinical diagnostic assessment, needs assessment, care planning, outcome monitoring, staff training and service evaluation are discussed, including the possible advantages of the care programme approach (CPA). Recommendations are given for services for adults with learning disabilities and mental health needs and points for discussion with service users and carers are suggested.