Challenging behaviour: a human rights‐based approach

Publication Date21 Jun 2010
AuthorSandra Bailey,James Ridley,Beth Greenhill
SubjectEducation,Health & social care
20 Advances in Mental Health and Intellectual Disabilities Volume 4 Issue 2 June 2010 © Pier Professional Ltd
Recent concerns about the human rights of people with
intellectual disability (Joint Committee of Human Rights,
2008) and changes in the NHS giving prominence to service
user views (DH, 2008a; 2008b) have increased our focus on
the need for ethical and critical approaches in working with
‘challenging behaviour’. These concerns have also clarified
the need to develop the ethical approaches already outlined
in the literature on challenging behaviour (Royal College of
Psychiatrists et al, 2007; Allen, 2009; DH, 2007).
The human rights-based approach (HRBA) to challenging
behaviour and risk provides a model for advancing ethical
practice. Arguably, a human rights-based approach to
challenging behaviour offers a number of advantages over
other ethical approaches (Greenhill & Whitehead, in press;
Whitehead et al, in press). First, the human rights-based
approach may offer a more elegant, unifying model for linking
together some of the disparate concepts in existing good
practice, as we hope to outline in this article. Second, it is
based in law, offering a more robust framework for processes
and interventions as recommended by writers critiquing
person-centred approaches (Mansell & Beadle-Brown,
2006). This legislative basis also has the advantage that future
changes in law have to be verified for compatibility with the
Development and definition of the term
‘challenging behaviour’
According to Emerson (2001), the term ‘challenging
behaviour’ was originally developed in North America and
promoted as a more favourable term by the Association
for People with Severe Handicaps. Its purpose was to
be a replacement for some of the pejorative terms used
historically, including ‘abnormal’, ‘aberrant’, ‘disturbed’ and
‘dysfunctional’ behaviour. A formalised, and oft-quoted,
definition of the term was provided by Emerson (1995), who
defined challenging behaviour as:
culturally abnormal behaviour of such intensity, frequency or
duration that the physical safety of the person or others is
likely to be placed in serious jeopardy, or behaviour which is
likely to seriously limit use of, or result in the person being
denied access to, ordinary community facilities.
What Emerson’s definition did not do was specifically
identify the individual as the problem. In fact, the term
was developed to emphasise that a person’s problems
could also be related to other environmental or systemic
factors, such as the support that the person was being
offered. Recent documents, for example A Unified Approach
Sandra Bailey
Community Learning Disability Nurse
James Ridley
Community Learning Disability Nurse
Beth Greenhill
Clinical Psychologist
Merseyside NHS, UK
When the behaviour of people with intellectual disabilities challenges carers and services, complex and competing human rights issues may
emerge. This article explores the human rights issues raised by both people’s challenging behaviour and the attempts of others to respond to
those behaviours. It is suggested that a human rights-based approach to challenging behaviour offers a vehicle for balancing the ethical issues
involved. Key concepts and practical tools from within our service to support clinicians in working more ethically with people’s challenges are
introduced. The potential advantages of taking a human rights-based approach relative to other ethical approaches are also explored.
Key words
human rights; challenging behaviour; service implementation; learning disabilities; intellectual disability; ethical approaches
Challenging behaviour: a human rights-based approach

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