Mental health support needs of people with a learning difficulty: a medical or a social model?

People with learning difficulties, like all disabled people, face social oppression. Much recent policy and practice are underpinned by at least some understanding of this oppression, and the social model of disability has been influential in discussions of services and supports for people with learning difficulties. However, in the area of mental health, the picture is somewhat different. This paper argues that the medical model has predominated in discussions of mental health support for people with learning difficulties, and that a social model approach could have much to offer. The paper draws on an ongoing action research study in which service providers, families and young people with learning difficulties are working together to articulate what is needed, in order to find routes to improve the support offered to young people with learning difficulties and mental health support needs.     

Views of People with Learning Difficulties about Current and Future Accommodation: the use of focus groups to promote discussion

There is growing emphasis on inclusion as a central philosophy in services for people with learning difficulties in the UK, Europe and the USA. Coupled with this is recognition of the need to actively involve people with learning difficulties in the research process through the use of more inclusive approaches. This paper reports the use of focus groups as a strategy for data collection from people with learning difficulties in a project that sought to review existing accommodation and support. A number of important key themes emerged relating to the importance of social networks, inclusion, reciprocal relationships, privacy and security. The implications arising from these findings for the provision of accommodation and support are considered. Furthermore, it was concluded that focus groups are potentially a valuable approach in research that seeks to actively involve people with learning difficulties.     

Paradoxes, locations and the need for social coherence: a qualitative study of living with a learning difficulty

Policy rhetoric over recent decades has promoted social inclusion of the more vulnerable sectors of society, such as people with learning difficulties. This study aimed to describe the experiences of people who live with learning difficulties in order to inform local service development. Thirty-five people with a learning difficulty and/or a family member were interviewed. A model of social coherence was developed that moves beyond the self-limiting debates about social inclusion and exclusion. It is underpinned by a sense of location for the person with a disability in relation to services and carers, family and community, dependency and risk, temporality and space, events, control and society. Key recommendations are for services to know the individual and his/her family; to be responsive to individual needs; to enhance the capacity of families and communities to support people with difficulty in learning; and to help these people to feel more valued.     

Self-advocacy for People with Learning Difficulties: Does it have a future?

Within such a short-time self-advocacy has become not only fashionable amongst organisations of people with learning difficulties, but also with service providers and non-disabled individuals who have worked in traditional services. The concerns are that self-advocacy has become a process of consulting with users about what they want from services which are usually designed and delivered by non-disabled people. This had led to people recognising and accepting choices that are on offer by non-disabled people. As a consequence an artificial boundary around self-advocacy has been created which has led to people only speaking up about what society is prepared to make available (usually in form of segregated and supervised services) rather than challenging the (lack of) power that people with learning difficulties have in their lives. For people with learning difficulties to gain real change in their personal lives self-advocacy needs to be developed to ensure they not only have the communication skills, but have an appreciation of the importance of changing rules, policies and laws which institutions, local authorities and Governments make to ensure their rights are protected. If they have an appreciation of laws and policies it will result in real change and self-advocacy won't be a tool for service providers. Also, self-advocacy must include speaking up about alternatives to choices being offered, recognising the importance of supporting one another in common areas of concern and to challenge the political system to legislate to provide relevant changes. I have developed a self-advocacy framework model which includes all the elements needed to advocate and achieve permanent change.     

Life History or 'Case' History: the objectification of people with learning difficulties through the tyranny of professional discourses

Case histories of people with learning difficulties tend to privilege information that is useful to professionals, such as IQ and medical diagnosis. Such information allows professionals to slot people with learning difficulties into categories which inform 'treatment' and aid prognosis. Case records, as they are currently constructed, appear to further silence an already oppressed group of people, and to objectify, pathologise and label them. The subjects of such case records do not appear to be treated as stakeholders in the case recording process: their voices are not represented in such writings. Case records do not appear to contain information about the lived experience of people with learning difficulties. Ignorance of the unique histories of people with learning difficulties is dehumanising and allows professionals to psychologically distance themselves. Once humanity has disappeared, it is possible to treat people as 'objects' that can be controlled through 'respected' professional theories and their discursive practices.     

What's in a Name? The Implications of Diagnosis for People with Learning Difficulties and their Family Carers

Diagnosis plays a significant role in the shaping of individual identities and the quality of life for people with learning difficulties and their family carers. Diagnostic labels are constitutive of peoples' lives, in that they bring forth pathology, create problemsaturated stories and construct careers as patients and cases. Disabled identities of people with learning difficulties remain largely 'embodied' and within the definitional control of professionals. Whilst the acquisition of a learning difficulty label can open doors to resources, it can also lead to disrespectful and dehumanising treatment, and the severe restriction of opportunities. This paper argues that a social constructionist perspective can offer a way of thinking about diagnosis that challenges the so called 'facts' and 'truths' that underpin and support it. Working in partnership with people with learning difficulties in relation to diagnosis requires professionals to relinquish power by resisting the 'temptations of certainty' associated with diagnostic practices.     

Support and Access in Sports and Leisure Provision

This paper will look at different ways of enabling people with learning difficulties to engage in leisure opportunities: the Support Model and the Access Model. These models will be put in their social context and then critiqued.

The support model will be be contextualised in the theory of normalisation, access in disability theory. The support worker role will be shown to be useful in motivating people with learning difficlties into new activities, as well as having a protecting element, and unwittingly, disguise the level of discrimination people with learning difficulties are subject to.

The access worker role will be shown to have strengths in understanding discrimi nation. With this analysis, it has the potential to dismantle disabling practices. However, the needs of people with learning difficulties have ramifications for disability theory. In practice, that means that ideas of self-advocacy need to be taken on board.

Through interviews with sports personnel, social workers and people with learning difficulties, the implications of creating fully comprehensive access will be examined. I will conclude that both effective support and comprehensive access must be in place before people with learning difficulties are able to make a meaningful choice as to how they are enabled to participate in sports. It is only at that point of choice that the two models become complementary rather than competing discourses of provision.     

Education and affinity? pedagogies of sexual citizenship in LGBTIQ youth support videos

ABSTRACT

This article provides an analysis of some of the ways in which educational resources for youth frame identity, sexuality and normativity within broader contexts of support and sexual citizenship. It focuses on online video resources for young people produced in Australia by the LGBTIQ support and curriculum advocacy organisation Safe Schools Coalition Australia and by the Minus18 Foundation. Developed as part of the larger All of Us educational package, these videos are explicitly pedagogical, presenting the viewer with ‘real life’ experiences from a range of young Australians. We consider the work the All of Us videos do in engaging with concepts of sexual citizenship, particularly as they seek to help young people navigate multiple forms of belonging and support. Of special interest is a series of tensions between normalising tendencies and the complexification of identities, communities, intimacies and belongings. While the videos may be perceived to operate within largely normative conceptualisations of sexuality, they explore ways of building affinity, peer support, and alternative ways of being that extend well beyond the logics usually offered by these frameworks.     

‘I do like the subtle touch’: interactions between people with learning difficulties and their personal assistants

Disabled people have often been denied choice and control in their lives. Although direct payments promise to deliver autonomy for disabled people, much depends on the way direct payments employers and personal assistants handle their interactions. These matters are particularly important for people with learning difficulties, who have routinely been restricted and controlled by their support staff. This paper presents an analysis, based on video material, of interactions between people with learning difficulties and personal assistants. The paper examines how difficult tasks, such as giving advice, can be accomplished in ways that people with learning difficulties find acceptable. Successful interactions are built on sensitivity to the wishes of the person, on a moment by moment basis. It is important that both parties coordinate their body language, humour and timing to demonstrate a close and friendly relationship, which is both professional and on the terms of the direct payments employer.     

Assessing parents with learning disabilities: The parental skills model

Definitions of what constitutes adequate or inadequate parenting continue to be unclear. Not surprisingly, professionals who are required to formulate opinions regarding parental competency often experience difficulties with this task. These difficulties are further compounded when the assessment involves parents with learning disabilities. They comprise a heterogeneous population many of whom have varying deficits and skills. The Parental Skills Model outlined in this paper is offered as a guide to professionals in their assessment of such parents. The model focuses on three primary areas which have been identified as crucial to parenting, namely, parents' life skills, familial history and access to support/resources. When difficulties are encountered by parents with learning disabilities in any of these three areas it appears to have a direct and indirect effect on the child's care and development. A model of good practice is proposed and illustrated with a case study.     

Quality of Life for People with Learning Difficulties Moving to Community Homes

Research concerning people with learning difficulties who have left institutions has typically investigated how well people 'adapt' to life in the community, and has often ignored users' own perceptions of the changes in their quality of life resulting from the move. In this study, eight people with learning difficulties who moved from a hospital and seven people who moved from parental homes to live in staffed homes in the community were interviewed. Choice, privacy, social life and relationships with their parents and staff emerged as important factors in participants' perception of their quality of life. Their relationships with their parents were found to be close, and in some cases their parents were overprotective. Staff were perceived in some cases as too controlling and in others as providing too little support. The findings indicate that people with learning difficulties moving to community residences have aspirations which encompass far more than a wish to adapt to life in the community, and their relationships with family and staff are a central factor in achieving such aspirations.     

'A Feeling of Being Connected': Friendships between People with and without Learning Difficulties

Recently, programmatic attempts to encourage close ties between people with learning difficulties and typical citizens have increased. It is believed that such relationships will extend the assimilation of people with learning difficulties into society. The researcher presents the perspectives of four pairs of friends about the meaning of their friendships. The informants shared similar ideas and expectations about the characteristics of friendship in general. These included its mutual, exclusive, and voluntary nature; the rights, obligations, and responsibilities of friends to each other; and the positive regard or affection found between friends. Despite efforts on the part of service providers to support the development of friendship between people with and without learning difficulties, the biggest barriers for the individuals in this study were the practices of the human service system, which curtailed opportunities for people which would have promoted the development and maintenance of friendships.     

Failure to Learn: A System View*

Educational psychologists, remedial teachers and others working with children who are considered to have learning difficulties tend to regard the problem as being within the child and disregard the importance of the social/educational context. This paper argues that contextual factors are very important and classifies these factors in terms of the subsystems within the educational system. Typical subsystem structures and interactions are discussed and illustrated with case studies. The roles and interventions of the therapist working within the educational system are described. The numerous difficulties in working with a large system are discussed as well as some strategies for dealing with them.     

Listening to care-givers: The community,work and family interface

Vic Riley talks about families challenging and contesting many assumptions about their role in long-term care-giving. His reflections invite the reader to revisit narrow and restrictive images of people with learning difficulties as dependent upon their parents for the provision of care and reveal a powerful picture of changes in the organisation of family life that have taken place in one small-town community. The role of the community in facilitating such transitions cannot be underestimated in the lives of care-givers and the people with learning difficulties they support. This account provides a compelling picture of changing aspirations amongst families involved in care-giving and the reader is invited not just to read it, but to make sure it amplifies their personal understandings and assumptions.     

Reinterpreting learning difficulty: a professional and personal challenge?

I want to explore in this article the ways in which people with a learning difficulty are constructed in a number of ways as disabled, as limited, as being special, and so on. Constructions can also be utilised for different purposes – to ensure that they have effective levels of support and to elevate the status of people with a learning difficulty. Positive constructs may articulate an ‘accentuation of the positive’ as Goodley and Armstrong prescribed. However, whilst I agree with this sentiment, one echoed in Swain and French’s important formulation of an affirmative model of disability, and one that I have also espoused, professionally I also feel that my experience of working with people with learning difficulties makes me suspicious of generalised statements about people, even those deemed positive. This may be especially true in a period of financial rationalisation, where such constructs may seem inevitable in the fight for effective support for people with a learning difficulty.     

Normalisation and 'Normal' Ageing: the social construction of dependency among older people with learning difficulties

This paper discusses the new phenomenon of the survival into old age of the increasing numbers of people with learning difficulties. This raises both theoretical and practical policy issues. In the UK health and social services for older people and for people with learning difficulties have followed quite different paths. One has been based on a limited, age discriminatory view of 'normal' ageing; the other has focused on a potentially liberating concept of normalisation. This distinction is being challenged by the advent of older people with learning difficulties, which is raising questions such as, what is the meaning of normalisation in older age? We focus on this key question, illustrating the different principles behind service provision for these two groups and argue that the concept of normalisation is flawed when applied to older people. The alternative of social integration is proposed as the basis for organising health and social services for both older people and those with learning difficulties.     

‘Moving In’: Difficulties and Support in the Transition to Higher Education for In-service Social Care Students

This paper reports on the difficulties and supports experienced by social care practitioners within the educational institution during their transition to higher education. A life transition such as entering higher education causes stress for individuals and social support is essential in successfully dealing with this stress (Anderson et al., 2012). Fifteen social care practitioners were interviewed twice during and once at the end of their first academic year in college. Findings indicate that participants were reluctant to approach staff for help despite anxiety about classes and assignments. Discussion and debate in class helped learning and contributed to feelings of being valued. ‘Moving in’ was a slow process with a physical and emotional impact for which they were unprepared. Student peers were a source of emotional and cognitive support but developing relationships took time. By the end of the transition phase participants noted changes and gains in themselves and their work practices. Recommendations are made to aid the transition to higher education for in-service social care practitioners.     

From dependence to interdependence: towards better outcomes for young people leaving state care

Young people leaving out of home care are arguably one of the most vulnerable and disadvantaged groups in society. Compared to most young people, they face particular difficulties in accessing educational, employment, housing and other developmental and transitional opportunities. Care leavers have been found to experience significant health, social and educational deficits including homelessness, involvement in juvenile crime and prostitution, mental and physical health problems, poor educational and employment outcomes, inadequate social support systems and early parenthood. These poor outcomes reflect a number of factors including ongoing emotional trauma resulting from experiences of abuse and neglect prior to care, inadequate support while in care, accelerated transitions to adulthood and lack of guaranteed ongoing financial and other assistance to help facilitate this transition. Young people leaving care do not currently receive the ongoing support that a good parent would be expected to provide for their children. Using relevant literature from the USA, UK and Australia, this paper examines the factors that contribute to these poor outcomes and potential policy and practice reforms that may lead to better outcomes for care leavers. Copyright © 2006 John Wiley & Sons, Ltd.     

The Impact of Self-advocacy on Families

The impact of self-advocacy on families of people with learning difficulties has rarely been instigated. A participatory research project is currently studying this question. This paper argues that adulthood is central. The meanings attached to self-advocacy by people with learning difficulties are examined to support this, and the family context explored to discover the likely experiences and influences which will condition the reception for self-advocacy. The early findings of the research-from discussions with self-advocacy groups-are presented. We should expect self-advocacy to impact on families and for this impact to exhibit itself in a variety of ways, but because of the experiences and conditioning of families, and of people with learning difficulties, the impact will be complicated. It is this real experience of self-advocacy and families which the research is investigating.     

Real Jobs: the perspectives of workers with learning difficulties

In a central New Zealand region, 14 people with learning difficulties who were identified by disability agencies as successfully employed were interviewed. Semistructured interviews with the paid workers covered topics such as getting and learning their work, pay, choices about social opportunities and career paths. Interviews were transcribed and constant discussion, and challenging of qualitative data identified the following themes: the effect of paid work on lifestyles, how other people were important for support and workers' aspirations for the future. The effect of paid work has meant major changes for a few people by becoming independent of the benefit system and buying their own home. For other workers, it meant having to learn to use the public transport system and choosing their own social activities. Workers' perspectives were used to provide better understanding of the supports needed by adults with learning difficulties to enhance their employment rates and careers in the paid workforce.