VOL: 97, ISSUE: 39, PAGE NO: 41
Fiona Macleod, BSc, DipPsych, is assistant clinical psychologist at Tayside Primary Care NHS Trust
Evelyn McLeish, RNMH, is manager of Angus Projects, Gowrie Care;William Lindsay, PhD, BA, DipClinPsychol, is head of clinical psychology services (learning disabilities) Tayside Primary Care NHS TrustCare in the community developed in response to what were viewed as the inherent deficits of long-stay hospitals for individuals with learning disabilities. A number of research projects, such as those by Allen (1989), Atkinson (1988) and others, were undertaken in the 1980s to examine the after-effects of deinstitutionalisation.
Care in the community developed in response to what were viewed as the inherent deficits of long-stay hospitals for individuals with learning disabilities. A number of research projects, such as those by Allen (1989), Atkinson (1988) and others, were undertaken in the 1980s to examine the after-effects of deinstitutionalisation.
However, from the 1990s onwards there has been a tendency in the literature to ignore the fact that individuals with learning disabilities are still being relocated from long-stay hospitals into the community. The relocation policies have an impact on clients' lives and it is important that individuals relocated in recent years should not be ignored.
The two men and two women who took part in this study had been diagnosed as having severe learning disabilities with varying degrees of mobility, auditory and visual impairments. The four participants were assessed before their move and then at six and 18 months after relocation. Various methodologies were used, including staff interviews and direct observations, to assess the effects of relocation on the clients' behaviour, experiences and quality of life.
Subsequent to the move there had been a decrease in the quantity, but an increase in the quality, of the participants' adaptive behaviours. There had been simultaneous increases in their challenging and interactional behaviours. Rather than merely increasing positive behaviours and decreasing negative behaviours, the relocation may have caused the individuals to significantly increase the range of their responses.
Three years after relocation
The project researchers decided that it would be interesting and worthwhile to revisit the four participants three years after they had moved.
All four were significantly more settled than they had been after the second follow-up. There had been major improvements in their abilities to communicate. All had increased their social skills and interacted more with their peers. One client had been provided with a switch machine to help him to communicate; he had repeatedly engaged in body rocking but this had significantly reduced over the three-year period. Improvements were seen in clients' sleeping patterns, concentration, appetite, continence and personal hygiene.
The researchers also found increased levels of interaction with relatives and participation in community activities and events.
Interestingly, it was found that there had been changes in the individuals' tastes and styles. By being introduced to a wider range of foods and experiences, individuals were able to develop their likes and dislikes. They were also able to exercise a greater level of choice in the community home about what they wore and how their rooms were decorated. These choices would not have been possible in the long-stay hospital.
The staff used a multidisciplinary team framework, which had improved communication among all the professionals involved. The manager of the home reported that staff had become more professional and more confident in their own abilities. They had clearly benefited from increased training and in-service programmes. They were encouraged to develop their skills in areas in which they were interested that were also beneficial to the clients, such as art therapy and swimming.
Asked if there was anything that could have been done differently, the manager said more thought could have been given to relocating individuals together in the same home. Group dynamics is perhaps one of the major issues that needs to be addressed to ensure the effectiveness of a home. Appropriate furniture and furnishings should also have been purchased - one client had a tendency to pick the threads out of the sofa fabric.
If individuals are to experience a 'normal' life, it must be within the community and further community integration would support this. The home is a positive example of the setting required by people with learning disabilities. Not only does it enable clients to cope with the move from hospital into the community, it is also able to adapt to their changing needs.
The care of people with learning disabilities has come a long way from the traditional, institution-based approach. However, it would be naive to assume that all deinstitutionalised individuals have benefited.
The long-term implications of the care in the community policy still need to be addressed. We must ensure that people with learning disabilities can make the same choices and have the same types of experiences as the rest of the community.