Protecting ‘Vulnerable’ Adults with Learning Disabilities
KEY POINTS
• The abuse of vulnerable adults with learning disabilities is a difficult and disturbing area; the carer requires a high degree of sensitivity, skill and knowledge to address the issue effectively.
• Good quality service provision will ensure that people with additional and complex needs are appropriately cared for.
• Those vulnerable adults with learning disabilities often have other associated health problems.
• All adults should be able to live free from fear and harm, as well as having their rights and choices protected, and this includes those adults with learning disabilities.
Since the late 1950s and 1960s, there has been a growing shift and change in the way in which Western society views adults with learning disabilities and those with mental health needs. Goffman’s (1961) seminal work, Asylums, highlighted the bleak, unfulfilling lives of many adults with mental health needs, exposing the inhuman and degrading conditions that were present in many long-stay hospitals that catered for mentally ill people or those with learning disabilities. Goffman (1961) used the term ‘institutionalization’ to convey the ways in which adults became depersonalized by the systems designed to care for them, including the staff who were meant to provide care in their everyday lives. Goffman (1961) identified a set of features that defined aspects of institutionalization, including depersonalization, block treatment, rigid, inflexible systems of care and social detachment between the staff and those he termed as ‘inmates’.
Adults with learning disabilities have a long history of exclusion, segregation and abuse. Often, this abuse was either ignored or denied, and carers were reluctant to acknowledge that it was happening. It is only during the past 40 years that attempts to change the lives of adults with learning disabilities for the better have had an impact. Segregation allowed these abuses to remain a hidden secret within long-stay hospitals – the primary home of vulnerable adults with learning disabilities. These concerns were boldly stated in The Report of the Committee of Inquiry into Ely Hospital (Howe Report 1969). This report highlighted the rundown provision, poor quality of care and degrading treatment that were present in the worst institutions. In 1975, a committee was set up by the government to investigate these conditions, resulting in the Jay Report (Jay Committee 1979). It recommended both local authority care, thus suggesting a move away from health provision, and developing services based on the values of ‘normalization’.
Wolfensberger’s (1972) Principle of Normalization outlined that services should be designed by those people using them. ‘Normalization’ was taken to mean providing services that ‘ordinary’ people had access to, such as schooling and housing. However, it was to be nearly 20 years before it became accepted government policy to close down long-stay institutions that cared for those with learning disabilities and mental health needs in England and Wales. The White Paper Caring for People (Department of Health 1989) outlined the Government’s obligation to close long-stay hospitals and instead develop health and social care services at a local level. The NHS and Community Care Act 1990 helped to provide assistance for people to live in their own homes, if at all possible. This was more commonly referred to as ‘community care’, and led to the permanent closure of many such institutions. Adults with learning disabilities, and also those with mental health needs, were ‘resettled’ into local communities, often at the expense of long-cherished friendships formed over many years. The belief was that living in small group homes, within local communities, would provide a better quality of life and might lead to greater acceptance within society, as they would no longer be segregated. This translated into services being developed locally to support individual choice, as advocated by O’Brien and Tyne (1989), based on the 5 Accomplishments for Service Provision. For many adults with learning dis abilities, these have been positive changes, but we need to be alert to the possibility of ‘mini-institutions’ developing in some services that may hinder individual choice, freedom and inclusion.
