Organising Services for People with Mental Handicap: The Californian Experience

The organisation of services for California's mentally handicapped population is outlined and critically examined. Its distinctive features are noted: a concern for rights, rather than needs; an underlying free market philosophy; an explicit attempt to combine public and private enterprise; and an elaborate system of checks and balances designed to restrain the welfare bureaucracies and ensure that they remain responsive to the changing nature of individual need. It is argued that, despite certain limitations, the Californian system does seriously address three problems that bedevil all attempts to develop a satisfactory system of care for people with mental handicaps: the inherent powerlessness of the client group; the diversity and fragmentation of services; and bureaucratic inertia.     

Do People with a Mental Handicap Have Rights?

The notion of 'rights' in relation to people with a mental handicap has become increasingly fashionable in policy statements in Britain and elsewhere. However, the concept has rarely been used in a clear way, and the application of it has been weak. This article distinguishes between 'claim rights' and 'moral rights' and relates each to specific discriminatory domains. It is argued that in Britain, people with a mental handicap are routinely denied both types of rights, and that this is a sobering context within which to set policies structured upon 'normalisation' principles. It is suggested that more conceptual analysis is needed, alongside a clearer commitment to enforcement through a code of practice and the application of adult rights.     

Supporting People with a Mental Handicap in the Community: A Social Psychological Perspective

Community care is a key concept in policy-making and service provision for people with a mental handicap. Yet the nature of the 'community' and the source of 'care' referred to is rarely specified. The meaning of 'community' is examined in relation to sociological and social psychological research and the assumption that geographical proximity promotes shared identity and caring relationships is called into question. It is argued that an emphasis on place and nostalgic notions of neighbourliness can obscure the difficult social psychological work of creating relationships within which people with a mental handicap can develop positive social and personal identities. The paper emphasises the importance of such relationships and argues that, for many people with a mental handicap, spontaneous local contact will not provide adequate levels of support and involvement. The creation of artificially maintained supportive networks is recommended and the resource implications of achieving good-quality care in the community are noted.     

The Abuse of Deinstitutionalised Persons with Mental Handicaps

A decade or more ago there were a number of Government reports published of inquiries into the ill-treatment of patients in mental hospitals. Now that fewer people with mental handicaps are going into hospitals and others are leaving them to be integrated into the community will they be any better treated by those around them? The situation is briefly reviewed and a solution proposed to the problems uncovered, but the main purpose of the paper is to generate awareness debate and possibly some action.     

Mental Retardation: Impairment or Handicap?

A social psychological approach to mental retardation is outlined in which (1) mental retardation is seen as a social construct rather than a within-individual pathology and (2) the meaning of the construct is related to social interests and purposes. Hence, between group differences in beliefs about retardates are seen as the expression of different group norms, i.e. a social psychological phenomenon rather than an aggregate of individual differences. Empirical support for the approach is provided by contrasting lay people's and psychologists' beliefs about 'retardates', most strikingly in the form of a differential effect of personal contact, which as predicted, 'improves' lay evaluation, but leaves psychologists' beliefs unchanged.     

The Importance of Sex in the Lives of Women Living with HIV: A Critical Quantitative Analysis

The authors explored the importance of sex for 1,289 women living with HIV in Canada. Approximately half of women viewed sex as “very” (19.6%) or “somewhat” important (32.3%) and the remaining reported “neither important or unimportant” (22.0%), “somewhat unimportant” (5.4%), or “not at all important” (20.1%). Women who had a regular sex partner, identified as African, Caribbean, or Black, were more educated, believed HIV treatment prevents transmission, or had better physical health-related quality-of-life reported greater importance of sex, whereas those who were older, used illicit drugs, or experienced violence in adulthood reported lesser importance. Findings underscore the diversity of women's perspectives within the context of their lives.     

Women with Disabilities: Two Handicaps Plus

In the USA, women with disabilities participate less in social relations, educational institutions, and the labor force than expected on the basis of male/female and male non-disabled/disabled disparities. The resulting isolation appears to be linked with attributional, nurturance and attractiveness norms within the American socio-cultural system as well as to self-image and role selection components of the women's self-concepts. Participation, the socio-cultural system, and the self-concepts are viewed schematically as elements in a triangular relationship of circular causation.     

Partnership Transitions and Mental Distress: Investigating Temporal Order

The study uses 15 waves of the British Household Panel Survey and the General Health Questionnaire to investigate changes in mental distress over several years surrounding transitions both into and out of marital partnerships (marriages and cohabitations) using fixed effects models. Entering marital partnerships is associated with reduced distress in separated or divorced individuals but not with those not previously married. Partnership dissolution is associated with very high levels of distress, but most people experience levels of distress a few years after leaving a partnership similar to that of a few years before leaving. These results vary, however, between married and cohabiting individuals, between fathers and mothers, and between age and gender groups.     

Sustaining People Right Through Their Lives: Interview With Graham Martin

In this interview Graham Martin reflects on his long career in child and adolescent mental health. He shares his formative experiences with some of the pioneers in the field of attachment theory and the many varied ways that this information has influenced his work in the provision of care to children in hospital, health promotion, understanding the distress of suicidal youth, and his ongoing therapeutic work with families.     

Walking Delicately Around Mental Handicap,Sex Education and Abuse in Pakistan

Public discussion of child abuse, sexual abuse and the sexuality of mentally handicapped

1 ‘Mental handicap’ is the English term commonly used in Pakistan and widely understood across Asia. It would be incongruous to use one of the more recent terms with which ‘mental handicap’ is being replaced in Britain, but which are seldom used in South Asia. Other obsolete terms in this paper, e.g. ‘pederast’, ‘idiot’, are used in historical contexts.

people is unwelcome in Pakistan, as in some other Asian and Muslim nations. Formal sex education is not given in schools. Sparse documentation exists in historical sources and the literature of anthropology, law, paediatrics, psychology and psychiatry. Some of this is reviewed, bearing in mind that cultural constructions of abuse vary significantly between Pakistan and western countries. Positive resources exist in the ordinary family life of Pakistan. Some families with mentally handicapped children appreciate teachers' efforts to explain bodily changes, personal hygiene and appropriate social behaviour, under the title ‘modesty education’. The accumulation of reliable and culturally sensitive information from a broad range of sources, and its wider dissemination, are important factors in supporting progress. Issues of knowledge and focus are discussed.     

Continuity of Mental Health Care Across Military Transitions

Multiple deployments, a prominent characteristic of operations Enduring Freedom, Iraqi Freedom, and New Dawn, have been linked to increased risk for various mental health conditions. It is also well known that military transitions, such as a change of duty station or discharge, are an inevitable part of military life. While military transitions can be stressful for any service member or veteran, those with mental health conditions face additional challenges. Transition stress can exacerbate a mental health condition that in turn hinders ability to manage the transition, resulting in a cycle of stress. As a result, those receiving mental health care while transitioning often experience difficulty continuing treatment post-transition. This article describes a unique and innovative transition coaching program designed to address this emerging issue.     

On Accepting Relationships between People with Mental Retardation and Non-disabled People: Towards an Understanding of Acceptance

This article outlines the “sociology of acceptance” as a theoretical framework for understanding relationships between people with mental retardation and typical people. As a point of departure, the authors review sociocultural perspectives on deviance and explore their contribution to the study of mental retardation. Based on qualitative research on community programs for people with severe disabilities, the authors next examine the nature of accepting relationships and describe four sentiments expressed by typical people who form relationships with people with mental retardation: family; religious commitment; humanitarian sentiments; and feelings of friendship. The article concludes with a brief discussion of the implications of a sociology of acceptance for the field of mental retardation.