Labels and Service Delivery for People with Learning Disabilities
| Published date | 01 June 2000 |
| Pages | 3-4 |
| DOI | https://doi.org/10.1108/13619322200000012 |
| Date | 01 June 2000 |
| Author | Bill Robbins |
| Subject Matter | Health & social care |
Labels and Service Delivery
for People with Learning Disabilities
Bill Robbins
Director of Social Services
South Gloucestershire
A personal perspective
Labels and definitions
In the learning disabilities field, the term ‘dual
diagnosis’ is now used primarily to refer to people with
learning disabilities and mental health problems. In
the wider health and social care world, however, it is
used in several other ways. Over the last two years, my
exposure to the phrase has been firstly as a result of
chairing my local drug action team, where the term
means ‘severe and enduring mental illness or disorder,
and problematic drug/alcohol use’. This definition of
dual diagnosis includes:
■those for whom mental illness or disorder precedes
problematic drug/alcohol use and may in some way
precipitate it
■those for whom psychiatric symptoms are
consequent to problematic drug/alcohol use
■those for whom psychiatric symptoms are
independent of their substance misuse.
Understanding how labels influence service response
becomes still more complex when we consider
personality disorder – an area beleaguered by many
problems. As a result, the use of such diagnoses is
often open to question with many psychiatrists
classifying it as untreatable. The World Health
Organisation defines personality disorder as: ‘Deeply
ingrained and enduring behaviour patterns, manifesting
themselves as inflexible responses to a broad range
of personal and social situations.’ An alternative
definition is: ‘Ways of thinking, perceiving, and
responding emotionally that differ substantially from
those generally accepted within a patient’s culture …
patients tend to exhibit a severely limited response of
stereotyped responses … These patterns are usually
evident during late childhood or adolescence, but the
requirement to establish their stability and persistence
restricts the use of the term “disorder” to adults’
(Marlowe & Sugarman, 1997).
The dual diagnosis phrase crops up again in what
appears to be demarcation disputes between providers
of services for older people and those for people with
mental health problems. The mental health services
locally, both NHS and social care, argue strongly that
older people with dementia or severe depression are
their responsibility. The latest guidance on joint
investment plans instructs NHS and social services
managers that plans for older people are expected to
include mental health services.
Changing nature of learning disability services
Turning to people with learning disabilities, I can
recall my early career with the provision of social care
services still in county health or welfare departments.
The subnormality hospitals still reigned almost alone
as the focus of services available to disabled people
and their carers. At that time these institutions still
bore all the vestiges of the vertically integrated, colony
model and were ruled by the psychiatrist closely
supported by a head nurse or superintendent. Society
had chosen the segregated model over the previous
century and had ensured the safety of the community
by the provision of these semi-secure facilities and a
belief in the capability of psychiatry to provide all the
answers and treatments required.
It has taken over 30 years for these hospitals to be
closed and the recognition that learning disability is
an impairment, not an illness, and can benefit from
informed educational, psychological, therapeutic and
social care support. A part of this, the behaviours
which challenge all services, have become entwined
with the clamours for hospital closure and the need to
The Mental Health Review Volume 5 Issue 2 June 2000 ©Pavilion Publishing (Brighton) 2000 3
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