Critical Health and Learning Disabilities: An Exploration of Erasure and Social Murder. By SaraRyan, Routledge, 2026. 117 pp. £31.99 (PBK). (161 including back matter). ISBN: 978‐1‐03‐260500‐5 (PBK).

PurposeThis paper aims to examine the extent to which police services are set up to deal with hate crime against people with learning disabilities; looking at infrastructure, policies, procedures and levels of awareness and understanding.Design/methodology/approachSemi‐structured interviews were conducted with representatives from 14 police services in England. Key documents submitted by the police services were reviewed, and a focus group with eight people with learning disabilities was conducted.FindingsMany police services are committed to tackling hate crime against people with learning disabilities. A wide variety of individuals have responsibility for dealing with hate crime and accountability structures are often unclear. Many services do not have hate crime policies that deal specifically with people with learning disabilities, or even disabled people in general. More training is required to ensure relevant staff are equipped to deal with the issues. Hate crime statistics are regarded as unreliable due to significant under‐reporting, although a few services have implemented innovative interventions to encourage reporting through awareness‐raising and multi‐agency working.Originality/valueThe Coalition Government has called for greater efforts at combating disability hate crime. It is widely acknowledged that the police are still failing disabled victims and witnesses. This paper identifies specific areas for improvement as well as innovative and effective practice that should be shared more widely.

What is known on the subject? Difficulties with the recruitment and retention of qualified nursing staff have resulted in nursing shortages worldwide with a consequential impact on the quality of care. It is increasingly recommended that evidence-based staffing levels are central to the development of workforce plans. Due to a paucity of empirical research in mental health and learning disability services the staffing needs and requirements for these settings are undefined and the availability of tools to aid staffing decisions is limited. What this paper adds to existing knowledge? This paper provides a valuable insight into the practical uses of these tools as perceived by staff members with day-to-day experience of the requirements of mental health and learning disability wards. It reveals that while workload measurement tools are considered a valuable aid for the development of workforce plans, they are limited in their ability to capture all aspects of care provision in these settings. It further emphasizes the inapplicability of a one-shoe-fits-all approach for determining nurse staffing levels and the need for individual and customized workforce plans. What are the implications for practice? This study demonstrates that the development of tools for use in mental health and learning disability services is in its infancy, yet no tool that has been validated as such. It highlights the potential for workload measurement tools to aid staffing decisions; however, a more holistic approach that considers additional factors is needed to ensure robust workforce planning models are developed for these services. The critical challenge of determining the correct level and skill mix of nursing staff required to deliver safe and effective health care has become an international concern. It is recommended that evidence-based staffing decisions are central to the development of future workforce plans. Workforce planning in mental health and learning disability nursing is largely under-researched with few tools available to aid the development of evidence-based staffing levels in these environments. It was the aim of this study to explore the experience of staff using the Safer Nursing Care Tool and the Mental Health and Learning Disability Workload Tool in mental health and learning disability environments. Following a 4-week trial period of both tools, a survey was distributed via Qualtrics online survey software to staff members who used the tools during this time. The results of the survey revealed that the tools were considered a useful resource to aid staffing decisions; however, specific criticisms were highlighted regarding their suitability to psychiatric intensive care units and learning disability wards. This study highlights that further development of workload measurement tools is required to support the implementation of effective workforce planning strategies within mental health and learning disability services. With increasing fiscal pressures, the need to provide cost-effective care is paramount within the services of the National Health Service. Evidence-based workforce planning is therefore necessary to ensure that appropriate levels of staff are determined. This is of particular importance within mental health and learning disability services due to the reduction in the number of available beds and an increasing focus on purposeful admission and discharge.

Purpose– The purpose of this paper is to provide a commentary on “‘I felt I deserved it’ – Experiences and implications of disability hate crime”.Design/methodology/approach– Comparing the findings reported by Richardson and her colleagues with the wider evidence base, it is clear that there is considerable consistency. While scholarship in this area is still nascent, there is sufficient clarity around key issues that should support action to tackle hate crime against people with learning disability and/or autism.Findings– Interventions should not make uncritical assumptions around the vulnerability of people with learning disability and/or autism. Poor service commissioning, design and delivery can play a part in heightening risks. Hate crime is not simply a criminal justice issue, and effective intervention will rely on multi-agency working.Originality/value– The commentary recommends a social model approach towards understanding hate crime and how it may be tackled. It identifies the challenges confronting multi-agency working by situating the analysis against the wider context of public spending cuts and the impact of these on wider societal attitudes towards disabled people.

Purpose– While ageing with an intellectual (learning) disability has been subject to increased research in recent years, there remains little knowledge regarding the daily practice issues that disability workers struggle most to support in this cohort. The purpose of this paper is to gain feedback directly from staff regarding the problems they experience in daily work, and to evaluate whether any changes to legislation or practice could potentially alleviate identified areas of concern.Design/methodology/approach– A Delphi project was conducted over three rounds with participants from rural areas of New South Wales (NSW). The panel was composed of support workers who assist people ageing with a learning disability. Participants were asked their perceptions of the main practice issues facing them while they provide support.Findings– The panel identified 29 issues that were considered problematic in the provision of support to people ageing with a learning disability. A thematic analysis indicated three main themes of access to services; time constraints; and funding.Research limitations/implications– The participants in this study were all disability workers employed by non-government organisations in rural NSW, and as such, many of the issues identified may be specific to this population cohort and geographic setting. Any generalisation of these results to other locations or populations must be considered within these limitations.Originality/value– Identification of the issues facing disability staff may facilitate government, health care providers and disability organisations to proactively plan to address current and future problem areas. The consequent effect of improving practices can assist individuals to receive better support and lead to a corresponding improvement in their quality of life. The current implementation of the National Disability Insurance Scheme in Australia is an ideal opportunity for cross-sectoral collaboration to change practice to facilitate better support for a highly vulnerable group of the community.

The present questionnaire based study examined the beliefs about and confidence in supporting bereaved individuals with a learning disability in health ( n =35) and social care staff ( n = 71). The study found that the knowledge of both health and social care staff about the grieving process in individuals with a learning disability was good, with staff recognizing the emotional and behavioural impact this could have on clients. No significant results were found in relation to knowledge about the grieving process in respect of occupational group, gender, experience of working in learning disability services or experience of supporting a client with a learning disability who had been bereaved. Significant results were found in relation to the confidence of staff in both providing support to people with a learning disability who were bereaved and in teaching people with a learning disability about death. Males, social care staff, those who had had experience of supporting a bereaved client and those who had had more experience of working in learning disability services rated themselves as significantly more confident in supporting bereaved people with a learning disability. In addition the two latter groups also rated themselves as significantly more confident in teaching individuals with a learning disability about death. The implications of the study are discussed.

Introduction The Editors Section 1: The Six Guiding Principles 1. Ensuring Dignity and Respect Su Mcanelly and Dorothy Matthews 2. The Importance of Providing Accessible Information for People with Learning Disabilities Pamela Inglis and Su Mcanelly 3. Providing Equal Access to Services for People with Learning Disabilities Pamela Inglis, Andrew Stafford and Kaydii Inglis 4. Personal and Professional Development through Education and Training Su Mcanelly 5. Adapting Your Skills: Thinking Outside the Box Pamela Inglis and Angela Ridley 6. Delivering Quality to People with Learning Disabilities David Atkinson and Gwen Moulster Section 2: Assessment, Screening and Diagnosis 7. Pre/Peri/Post Natal Assessment, Screening and Diagnosis Helen Atherton and Shaun Derry 8. Developmental Issues in Early Childhood Helen Laverty 9. The Health Needs of Adolescence Jo Lay 10. Determining Health and Social Care in Adulthood Mary Dearing and Debbie Crickmore 11. Defining Old Age in the Learning Disabled Population Jo Lay 12. Assessment at the End of Life Isabel Quinn Section 3: Lifelong Health Needs 13. Supporting People with Severe Epilepsy: A Case Study in Diagnostic Overshadowing Malcolm Richardson 14. A Life with Cerebral Palsy: Neil's Story and Jose's Case Examples Malcolm Richardson, Bronwyn Roberts and Anne Lyons 15. Supporting People with an Autistic Spectrum Disorder Stacey Atkinson and Malcolm Richardson 16. Specific Health Needs and Conditions Lesley Montesci and Malcolm Richardson 17. Emotional Difficulties Malcolm Richardson Section 4: Psychological and Psychotherapeutic Issues 18. Sexuality and People with a Learning Disability Stacey Atkinson 19. The Behavioural Needs of People who Have a Learning Disability Mick Wolverson 20. The Mental Health Needs of People with a Learning Disability Stacey Atkinson, Dan Dearden and Catherine Bateson 21. Addressing the Needs of People with Learning Disabilities who Have Offended Anne Todd 22. Bereavement and Loss Nigel Mcloughlin and Paul Armitage 23. Ethical Issues When Meeting the Psychotherapeutic Needs of People with a Learning Disability Monica Murphy, Stacey Atkinson and Angela Ridley Section 5: Changing Roles 24. Inter-Professional Working Jo Lay and Stacey Atkinson 25. Changing Roles in Meeting the Needs of People with a Learning Disability Sheena Kelly and Lyndsey Charles 26. Health Promotion for People with a Learning Disability Stacey Atkinson and Sheena Miller 27. Public Health and Learning Disability Alex Mcclimens

Introduction Patient and public involvement (PPI) is integral to UK health research guidance; however, implementation is inconsistent. There is little research into the attitudes of NHS health researchers towards PPI. Aim This study explored the attitude of researchers working in mental health and learning disability services in the UK towards PPI in health research. Method Using a qualitative methodology, semi-structured interviews were conducted with a purposive sample of eight researchers. A framework approach was used in the analysis to generate themes and core concepts. Results Participants valued the perspective PPI could bring to research, but frustration with tokenistic approaches to involvement work was also evident. Some cultural and attitudinal barriers to integrating PPI across the whole research process were identified. Discussion Despite clear guidelines and established service user involvement, challenges still exist in the integration of PPI in mental health and learning disability research in the UK. Implications for practice Guidelines on PPI may not be enough to prompt changes in research practice. Leaders and researchers need to support attitudinal and cultural changes where required, to ensure the full potential of PPI in mental health and learning disability services research is realized. Relevance statement Findings suggest that despite clear guidelines and a history of service user involvement, there are still challenges to the integration of PPI in mental health and learning disability research in the UK. For countries where PPI guidelines are being developed, attention needs to be paid to cultural factors in the research community to win "hearts and minds" and support the effective integration of PPI across the whole research process.

Social Policy Tensions: Empowerment and Vulnerability The History and Context of Learning Disability: A Parent's Perspective Enabling People with Learning Disabilities to Be Valued Citizens Living with a Learning Disability Enabling Families: A Model of Helping Building Positive Relationships with People with Learning Disabilities Promoting Effective Communication Health and Well-Being Epilepsy, Pain and End-of-Life Care: Health-Care Issues for People with Learning Disabilities Meeting Some Specific Health Needs of People with Learning Disabilities Meeting the Mental-Health Needs of People with Learning Disabilities People with Learning Disabilities in the Criminal Justice System Professional Practice

Valuing People Now’s key focus is to make this vision a reality. This reflects a concern raised by A Life Like Any Other? Human Rights of Adults with Learning Disabilities (‘A Life Like Any Other?’), the report of the Joint Committee on Human Rights’ inquiry into the human rights of people with learning disabilities. The evidence received by the Joint Committee on Human Rights (JCHR) during this inquiry showed that, despite the good intentions of Valuing People, the progress of change has been slow and there is a significant gap between government policy and the day-to-day experience of people with learning disabilities. In addition to concerns about the patchy implementation of Valuing People, the JCHR received evidence of wide-ranging human rights abuses, such as abusive and degrading treatment in health and social care services, and hate crimes against people with learning disabilities. Its conclusion was stark.

Purpose – The purpose of this paper is to offer an introduction to the recently recognised phenomenon of “mate crime” as it affects people with learning disabilities. It looks at how concerns arose, considers what may make people with learning disabilities particularly susceptible, and proposes a provisional definition of “mate crime”. Design/methodology/approach – The paper draws on the author's own project work, and reviews the extant research literature on “disablist” hate crime to examine the extent to which so-called “mate crime” has been both explicitly and implicitly identified and analysed in the literature. Findings – The literature review indicates that “mate crime” has not been explicitly identified in any scholarly research to date, either under that or any other name. Crimes that we might label as “mate crimes” have, however, appeared in more general literature concerning the experiences of people with disabilities in general, and as victims of crime. Social implications – Despite a lack of firm data there is sufficient in the literature, combined with increasing anecdotal evidence and case studies, to suggest that people with learning disabilities are particularly susceptible to “mate crime”, and are being targeted by perpetrators. Increasing independence and reduced service provision are likely to increase the risks. The author argues that mate crime differs significantly from other manifestations of hate crime and abuse, and needs to be conceptualised, analysed and handled differently. Originality/value – Whilst the issue of “mate crime” is gaining increasing professional and media attention it lacks any academic base and a definition. This paper attempts to establish an agreed definition and conceptualisation of “mate crime”.

Accessible summaryWhat we did:We made a picture book about cancer for people with learning disabilities.The book explains about cancer.It also explains about the treatments for cancer.We wanted to find out if the book is useful for people with learning disabilities.We met five people with learning disabilities who wanted to find out about cancer.Most of these people had a mum or dad who died of cancer.We watched them when they read the cancer book.We talked to them after they read the cancer book.We also met their supporter. They were professionals.What we found out:• The doctors didn't tell people with learning disabilities about cancer. The supporters had to do it. Sometimes the supporters decided not to tell the person with learning disabilities about cancer.• The supporters found it difficult to talk about cancer and dying. They didn't know enough about cancer themselves.What we want to say to everyone now:It is important that people with learning disabilities are told about cancer.But the supporters need to be helped too.Learning disability staff and cancer staff need to work together.Learning disability staff need training to be health facilitators.Together they can help people with learning disabilities to find out about cancer.SummaryThis paper reports on one of the findings of a small study that aimed to explore how people with learning disabilities accessed and were supported to use a pictorial cancer information book. Five people with learning disabilities who were affected by cancer and their paid carers participated in the study. Support staff in the study were the people who provided cancer information for people with learning disabilities. They struggled with this task, particularly when the person needed information about cancer that exceeded the staff's own knowledge and experience. Most were also inexperienced in dealing with the emotions around cancer. There was little evidence that the support staff received any support themselves, either from cancer professionals or from within their own organizations. The authors conclude that although the findings of this study are based on a small number of people, collaboration is required between health and learning disability services. Further more, in aid of collaboration, staff in learning disability services require education programmes to enhance their skills in facilitating the health needs of people with learning disabilities.

Hate crimes both impact on the individual targeted as well as wider community life, as they indicate intolerance and a lack of safety for disabled people, further spreading fear and othering. Disablism can be said to refer to discriminatory, oppressive and abusive behaviour targeted at disabled people. Hate speech and hate crimes can thus be seen as forms of disablism regularly encountered. The wider social victimisation of autistic people and those with learning disabilities is well documented in research. L. Richardson, through using a survey method as well as focus groups and interviews, looked into hate incidents toward autistic people and those with learning disabilities, including wider forms of victimisation. 46% of their sample had been victimised and many also talked of historical abuse and bullying. National surveys such as by E. Emerson and C. Hatton found a figure of 32%. In both these samples, those deemed more “able” participants experienced more serious incidents of victimisation.

The prevalence of learning disabilities (LD) among children is a critical public health issue; however, recent LD prevalence estimates among children and adolescents aged 6-17 years, as reported by the National Survey of Children's Health (NSCH), remain largely unexplored. Data for this population-based cross-sectional study were obtained from NSCH to estimate the prevalence of LD diagnosis among U.S. children at both national and state levels, and to inspect the 8-year trends in these estimates from 2016 to 2023. Among 221,244 U.S. children, 20,644 had a history of LD diagnosis, with a weighted prevalence of 8.85% (95% CI = 8.59-9.10). Of these, 19,289 were currently diagnosed with LD, yielding a weighted prevalence of 8.26% (95% CI = 8.01-8.51). From 2016 to 2023, the prevalence of ever-diagnosed LD increased from 7.86% to 9.15%, while that of current-diagnosed LD rose from 7.32% to 8.66%, representing relative increases of 16.4% and 18.3%, respectively. The state with the highest prevalence (New Hampshire) had twice that of the state with the lowest prevalence (Utah). This study highlights a critical escalation in LD prevalence among U.S. children and adolescents between 2016 and 2023. Comprehensive screening and support programs must be implemented to enhance early identification and intervention.

The prevalence of learning disabilities (LD) among children is a critical public health issue; however, recent LD prevalence estimates among children and adolescents aged 6–17 years, as reported by the National Survey of Children’s Health (NSCH), remain largely unexplored. Data for this population-based cross-sectional study were obtained from NSCH to estimate the prevalence of LD diagnosis among U.S. children at both national and state levels, and to inspect the 8-year trends in these estimates from 2016 to 2023. Among 221,244 U.S. children, 20,644 had a history of LD diagnosis, with a weighted prevalence of 8.85% (95% CI = 8.59–9.10). Of these, 19,289 were currently diagnosed with LD, yielding a weighted prevalence of 8.26% (95% CI = 8.01–8.51). From 2016 to 2023, the prevalence of ever-diagnosed LD increased from 7.86% to 9.15%, while that of current-diagnosed LD rose from 7.32% to 8.66%, representing relative increases of 16.4% and 18.3%, respectively. The state with the highest prevalence (New Hampshire) had twice that of the state with the lowest prevalence (Utah). This study highlights a critical escalation in LD prevalence among U.S. children and adolescents between 2016 and 2023. Comprehensive screening and support programs must be implemented to enhance early identification and intervention.

People with learning disabilities are facing an increasing number of ‘hate crimes’, the government’s own learning disability watchdog says in its annual report.