Wolfenburger highly medical terminology highlights the traditional thought that a disabled person’s medical condition was the root cause of their exclusion from society, an approach now referred to as the medical or individual model of disability. Encouraging social exclusion by introducing inadequate policies, legislation, promoting inappropriate attitudes, a poor stereotyped media image, inaccessible buildings and information.
We can see then how the social construction of people with learning disability has advocated the attitude of intolerance coupled with a lack of understanding!
Oliver (1990) suggested the medical model, which focuses on how the body works and neglects to consider the non-medical causes of disabilities, reinforces the attitude that if a person does not fit into the same category as the majority than a person has an ‘abnormality’(discussed in Thomas & Wood 2003).
This ideology was challenged in the mid-seventies by the disabled people’s civil rights movement called the social model of disability or barriers approach (Union of Physically Impaired Against Segregation, 1976; Oliver, 1983) who stated:
The Union challenged the norms and values that society held; looking at the impact that society had on restricting people that were not like the majority, such as accessibility of buildings and public transport. They argued that
A quote from Critical Sociology 1996 confirms this stating:
Acknowledgement that the classification of learning disability included a combination of factors both social and medical brought together an approach that was used to identify if a person was classified as having a learning disability. This included the ‘IQ testing’ coupled with the World Health Organisation and the American Association on Mental Retardation definitions which state:
Encouraging, consideration of the whole person and the need for pro- active legislation. In 1946 Judy Fryd, a mother of a child with a learning disability, formed the National Association of Parents of Backward Children (which later became Mencap). She wrote to ’Nursery World’, magazine inviting other parents to contact her. Parents wrote to Judy expressing their anger and sorrow at the lack of services. (Mencap, 2005).
The ‘Report of the Care of Children Committee’(1946) supported the growing public concerns - it complained about the "motley collection" of people it found in workhouses. Roberts (1981) made this statement in his article Mental Health Timeline:
The National Health Service introduction provided for those with Learning Disabilities. Asylums were redesignated as hospitals and the local authorities became responsible under Section 28 of the National Health Service Act 1946. It is interesting to note that Mental Health and Learning Disabilities were still coupled together at this stage.
Policy and Legislation was being forced to reflect the growing public concerns and the 1959 Mental Health Act did away with terms such as ’imbecile’, ’mental defective’, ’feeble minded’ and ’idiot’ to describe people with a learning disability, but did not require local authorities to provide services.
Only 35,000 special school places were available for the 84,000 children thought to need places in Britain. Therefore terminology had been challenged and changed - but it could be argued that attitudes remained static (Mencap 2005).
We could argue that debates concerning the social construction of adults with learning disabilities, coupled with historical background, shows legislation did little to acknowledge the identity and individual worth of adults with learning disabilities, or offer them any social inclusion or citizenship status in society!
What was the impact of salient legislation and policies, which were beginning to be introduced, on adults with learning disability? Did they address the attitudes and imbalance of public intolerance and lack of understanding?
Public concern due to increased media attention surrounding poor conditions in ‘mental handicap’ hospitals, namely the public inquiries into stories of abuse at Ely hospital in Cardiff (1961) and Normanfield (1971), led to a 1971 government White Paper, ‘Better services for the Mentally Handicapped’. Laying foundations for ‘Care in the Community’. Research into hospitals and other newer forms of residential care published in 1978 identified many failings; under-staffing, inadequate resources, poor standards of hygiene, lack of specialist services and extreme social isolation (Mencap, 2002).
Porter and Lacey (2005) verifies this:
Barbara Castle, Secretary of State, challenged the entrenched medical model of disabilities suggesting three initiatives, these would have a major impact on changing ideology, Race (2002) informs us what these were:
What was this trying to achieve? The National Development Groups was designed to ‘balance’ the views of the medical and other professionals –advising on policies in relation to learning disabilities; aimed at promoting best practice and developing alternatives to institutional care. Perhaps a beginning of a change of attitude towards institutionalised care, but did it address the imbalance of public intolerance? (Race 2004 pg40)
The notion of ‘normalisation’ played a part in persuading policy makers and relevant professionals to reject long stay hospital based services. Introduced by Wolf Wolfensberger, and later known as ‘social role valorisation’.
Emphasis was placed on services needing to deliver a high quality of life for people with learning disabilities, by reproducing the lifestyle that was experienced by people who were non-disabled. Thomas and Wood (2003) inform us that this would be realized if:
Two factors played a part in this. Firstly the difficulties arising from releasing monies from the hospitals and the secondly, interestingly – changing the views, rights and roles of people with learning disabilities within society. Thomas and Wood (2003) pg 69
How would this be achieved in the aftermath of historical legacy?
John O'Brien had a considerable impact upon the development of community care services in the UK. He suggested five key aspects to evaluate aspects of community care services. Known as the Five Accomplishments:
Sincere sentiments: The right of people marginalized by society to have equal opportunity within society is critical. However, the difficulties with normalisation are whether it is the services that negotiate the parameters - or the peoples themselves. This in itself is a power issue Chappell 1992 remarked on this:
To demonstrate, consider one of O’Brien’s accomplishments ‘choice – the right to chose where and whom to live with’. Deinstitutionalization (1970’s) offered what? Grant, Goward, Richardson & Ramcharan, 2005 inform us that:
Whilst we recognise the accomplishments put forth by O’Brien providing an underpinning and guidance for service development and support. Where would you choose to live? Primarily we all aspire to live independently. But working with diversity does not mean treating everyone the same. The Department of Health made an interesting statement, confirming this claim, when discussing the education of disabled children saying:
Did the Griffin Report, 1988 Community Care: An agenda for action, encourage working with diversity in an understandable and knowledgeable manner? This reflected governmental commitment to increase choice –increasing roles for the private and voluntary sectors in residential and domiciliary services, but Social Service authorities would take the lead role in purchasing and organising care.
The NHS and Community Care Act 1990 encouraged a needs-led approach to assessment. Requiring that the Social Worker or assessor to look at what services may have to be purchased or provided to enable that individual to live more independently. Sapey (1993), made this argument:
The ‘voice’ of the person with a learning disability failing to be heard; the ideology of the Mental Deficiency Act 1913 stated that ‘feeble-minded people were neither idiots nor imbeciles, but if adults, their condition was so pronounced that they require care, supervision, and control for their own protection or the protection of others" . We once again see the entrenched attitudes of we ‘know best’! This is reinforced by Morris, (1993) who argued that:
Did the Disability Discrimination Act 1995 combat this attitude? Brayne and Carr (2003) in their book ‘Law for Social Workers’ relate this statement by Theresia Degener (1995):
The purpose of the Act was to make it unlawful to discriminate on the grounds of disability in employment, in services (shops and restaurants) and in selling/ letting property. How has it fared with respects to Learning Disability? An article from Community Care entitled ‘Lack of progress in finding jobs’ reported that:
It is therefore hard to understand how salient legislation has done anything to overturn the entrenched attitudes dating back to 1800’s, with regards to adults with learning disabilities, other than release them from large ‘hospital like’ institutions into smaller segregation units in the communities.
The Prime Minister, discussing the prejudice and discrimination felt by people with learning disabilities and their families, made this statement introducing the White Paper – Valuing People 2001:
Valuing People introduced the government's plan for making the lives of people with learning disabilities, their families and carers better. The first White Paper in 30 years, for people with learning disabilities. It principles include people with learning disabilities having rights as citizens, inclusion in local communities, choice in daily life and real chances to be independent. Fyson and Ward (2005) suggested that O’Briens five accomplishments echo the principles put forth by ‘Valuing People’ stating:
It could be argued that this is ‘normalisation’ modernized; dressed up to be politically correct. Does the same ‘power’ issue exist to give evidence to this statement? In discussing two major issues employment and housing we can demonstrate there are still entrenched attitudes today! (There are many other issues that daily confront adults with Learning Disability e.g. Health, Privacy, friendships, sexuality and sex, Direct Payments, Black and Ethnic minorities, Day Care Centers etc. But for the purpose of this assignment I have concentrated on housing and employment)
The ‘Valuing People’ (2001), paper said this regarding employment and housing:
The positive terminology used here is certainly in sharp contrast to previously used terminology to ‘enable’ to give ‘choice and control’, commendable sentiments. How did Rob Greig report on the progress made, in the ‘Valuing People – the story so Far (2005)’ in these areas?
Employment - the situation is little improved this is because of conflicts in the ‘equal opportunities’ rules. Day Services are in need of change - to include in their remit assisting and helping those who would like employment. The government are attempting to turn around the entrenched attitudes that promote discrimination and oppression – they have developed a new hand book for employers entitled ‘Employing People with Learning Disabilities: A Handbook for employers’ (Sec1:17)
Housing - there is more choice about where to live, but still needs to be more choice. Housing Corporations are considering Shared ownership of houses, Long stay hospitals have agreed they will close by March 06. (Sec1:16)
Amy Taylor(2005), examined some of the set backs to provide Independent Living when she reported that a charity had lost an appeal to overturn the Commission for Social Care Inspection’s refusal to let it deregister 11 residential homes. What was the CSCI concerned about? We are informed:
Five months later a further article in Community Care by Maria Ahmed (2005)highlights that in the four years since people with Learning Difficulties began to be registered as something more than a ‘faint blip’ on the government’s radar, nothing like enough has been achieved despite the commitment of the Valuing People support Team. This is how the editorial comments put it:
Adults with Learning Disabilities want ‘Rights, Independence, Choice and Inclusion’; they want a voice ‘Nothing for us Without us’. How can this be achieved?
Service User Groups have contributed to the recent debates around the development of welfare services. Mencap(2002) is campaigning for:
Valuing People advocated Partnership Boards that were to provide necessary structures for day services and employment designed to meet individual needs. Mencap (2003) have developed a briefing paper to help assist Partnership Board when it writes the housing plan.
Enabling them to make sure the ideas in Valuing People happen, assisting them to think of questions they could ask at Board meetings. Namely:
However, it has to be recognized that Partnership Boards are not statutory bodies and do not have legal powers to make decisions about the use of public monies. Fyson and Ward 2005, informs us that:
Carers (the role of which is immense and a subject matter in its own right) felt misled about the nature of the Partnership Boards. It is interesting to note the feelings of one such carer who said:
It is interesting to note that no National Service Framework exists for working with adults with learning disabilities. Fyson and Ward (2005) claimed that this sent a message to Health Services that ‘learning disability services did not have to be among their key priorities’. (pg 21) These are generally used as a benchmark as to good practice Bill Robbins,(2001) ADSS Lead on Learning Disabilities had this to say on the subject:
Grant, Goward, Richardson & Ramcharan, 2005, inform us developments of ‘People First Groups’stating:
The groups are run and controlled by people with learning difficulties,’ People First’ inform us of their aims :
Social Workers have to be aware of the restraints that the system we work in– which has developed inequalities and has marginalized people. I now purposely use the term people with learning difficulties (rather than disabilities). To work in practice would surely encourage us to listen to the above critiques that the service user group puts forth themselves.
How then can we evaluate the evidence base for practice? Thompson (2000) outlines that
How could we demonstrate the principles of anti-oppressive practice and anti-discrimination throughout the social work process of assessment, planning, intervention, review and evaluation whilst working with adults with learning difficulties?
First how can individual need be meet whilst being sensitive and responsive to the existential challenges we all face, systematic, attuned to issues of inequality, discrimination and oppression, and geared towards countering them where possible. Payne (1997) describes three different approaches to social work. These are:
Addressing social welfare needs on an individualized basis – Person Centered Planning:- this should start with the individual (not with services) reflecting the needs and wishes of a person. Working collaboratively and using effective communication skills should not be underestimated.
Bereford and Trevillion (1995) did a survey asking the question ‘What is good communication and key communication skills?’ this was the reply:
This poses a challenge in Social Work and the varied methods of advocacy would need to be used to the full. Atkinson 1999:5 tells us that:
Race (2004) gave Service users view of advocacy, bringing to mind issues of authority/power discussed earlier:
We must listen to the service user’s voice. What do they say?
So we must consider what comes first the plan or the approach? Fyson and Ward (2005) make this statement:
Person Centred planning would mean ‘Valuing a Person’ enabling people with learning difficulties to realise their aspirations for greater self-determination means tackling the fundamental imbalance of power. We have to recognise the constraints of the government. The Oxford School dictionary (2002) defines valuing as:
A Parent is spoken of as considering their child as priceless. What price or estimate does the government put on the head of someone with Learning Difficulties?
Bill Robins (2005), ADSS Lead on Learning Disabilities made this statement:
Is this happening? Maria Ahmed (2005) informs us that
So can it be said that the government really value people with learning difficulties? Hazel Morgan (2005), Foundation of People with Learning Disabilities, responding to the ‘Valuing People’ paper made this statement:
Recognizing this Social Work should use resources optimistically, creatively and purposefully to provide best practice for people with leaning difficulties, recognizing (as did I after a discussion with a person with learning difficulties within the university) that a person may enjoy living within the current system, regardless of what we may perceive about the real value and impact of salient legislation and policy on adults with learning difficulties.
Word Count 3047(excluding References)
BIBLIOGRAPHY (texts/journals/published papers)
Single Authors (as handbook instructions)
Morris, J., 1997, 1st Edition, Community Care: Working in partnership with service users, London, Venture Press
Oswin, M., 1991, 1st Edition, Am I allowed to cry? - A study of bereavement amongst people who have learning difficulties, London, Souvenir Press
Payne, M. 1997, Social Work Theory, 2nd Edition, London, Macmillan
Race, D. 2004, Learning Disability – A Social Approach, London, Routledge
Thompson, N. (2000) Understanding Social Work, Preparing for Practice, Basingstoke, Palgrave.
Thompson, N., 2001, 3rd Edition, Anti-discriminatory practice, Basingstoke, Palgrave
Joint Items
Beresford, P. & Trevillion, S (1995) Developing Skills for Community Care – A collaborative approach. UK Arena
Brayne,H and Carr, H. (2003) Law for Social Workers, 8th edition, Oxford, University Press
Fyson, R & Ward, L (2005) Making Valuing People Work, Strategies for change in services for people with learning disabilities, Bristol, Policy Press.
Grant G, Goward P, Richardson M & Ramcharan P, 2005, Learning Disability, A Life cycle approach to valuing people, Berkshire, Open Press University
Thomas D & Woods, H ,2003, Working with Peole with Learning Disabilities, Theory and Practice,London, Athenaeum Press.
Means, R, Richards S and Smith R, 2003, 3rd Edition, Community Care, Policy and Practice, Basingstoke, Palgrave
Oliver, M.and Sapey, B., 1999, 2ND Edition, Social Work with Disabled People, London, Macmillan Press Ltd.
Porter, J & Lacey, P, 2005, Researching Learning Difficulties, A guide for Practioners,London, Sage
Joint Items (continue)
Prout, H. T. & Strohmer, D.C. (Eds),1994, 1st Edition, Counselling & psychotherapy with persons with mental retardation & borderline intelligence, New York, Clinical Psychology Publishing
Thomas, D. and Wood, H. 2003, Working with People with Learning Disabilities, Theory and Practice, London, Jessica Kingsley Publishers
INTERNET BIBLIOGRAPHY
Association for Residential Care, ARC explained,
,
accessed: 01/05/02
Clark, L. and Marsh, S, 2002
Studies/archiveuk/Clark,%20Laurence/language.pdf,
accessed 24/10/2005
Community Care Act 1990 – General Practice Notebook
,
accessed 14/11/2005
Community Care, 2005 – A Lack of Progress in Finding Jobs
accessed 14/11/2005
Faster Dictionary,
,
accessed 14/11/2005
Mencap, 2002 Making it work
http://www.mencap.org.uk/html/campaigns/employment_index.htm#2
accessed 2/12/05
Mencap, 2003, Briefing paper for Partnership Board Representativesabout housing plans
http://www.mencap.org.uk/download/ldpb_housing.pdf
accessed 2/12/2005
Mencap, 2005 Changing attitudes to people with a learning disability,
http://www.mencap.org.uk/html/about_mencap/changing_attitudes.htm
accessed: 24/10/05
INTERNET BIBLIOGRAPHY (continued)
Morgan (2005) The Foundation for People with Learning Disabilities
accessed 02/12/05
Mencap
,
accessed: 24/10/05
Northfield, J., British Institute of Learning Disabilities, Learning disability factsheet, , , written: 20/07/01
accessed 24/10/05
Central England People First Aims
http://www.peoplefirst.org.uk/aims.html
accessed 28/11/05
Randall Smith, March 2005, The School for Policy Studies Working Paper Series, Paper Number 9, http://www.bristol.ac.uk/sps/downloads/working_papers/sps09_rs.pdf
accessed 28/11/05
Robbins B 2001, Valuing People: A New Strategy for Learning Disability for the 21st Century
accessed 14/11/05
Robins, B (2005)Association of Directors of Social Service
accessed 2/12/05
Roberts, Andrew 1981-/timeline - Mental Health History Timeline <http://www.mdx.ac.uk/www/study/mhhtim.htm> Middlesex University
Valuing People – The Story So Far, 2005
accessed 14/11/05
1834 Poor Law (2005)Vote For Women
accessed 14/11/05
World Health Organisation, 2001, World Health Report 2001 - Mental health: New understanding, new hope,
,
accessed: 02/05/02
Journals
Taylor, A. (2005) ‘Setback for providers looking to promote independent living, Community Care, 2-8 June 2005, pg10
Ahmed, M. (2005) ‘ First ‘tsar’ post for person with a learning difficulty to start next year, Community Care, 24-30 November 2005, pg5 &8
Ahmed, M (2005), Directors Fear for learning Difficulty services as NHS spending fails to rise. Community Care 20-26 October 2005,pg8