Professional and ethical issues when working with learning disabled clients

Abstract

A number of changes in legislation have made an impact on the way services engage with people who have a learning disability. These include the Mental Capacity Act amended in 2007 and the Forced Marriage Civil Protection Act 2007. The impact of these two acts has helped psychological services in particular support people with learning disabilities to make informed decisions about their lives. They have also highlighted issues relating to an individual’s right to make choices, which may not ultimately be in their best interests when they have a learning disability. Prevalence rates Overall, prevalence rates for a mild learning disability range between three and six people per thousand of the general population (DH, 2001). In the UK, it is estimated that up to 350,000 people have a severe learning disability and as many as 1,750,000 people may have a mild learning disability (The Foundation for people with Learning Disabilities 2003). Although recent initiatives such as Valuing People: A New Strategy for Learning Disability for the 21st Century (DH 2001) as well as the Six Lives report ( 2010) and Winterbourne Enquiry (2012) have ensured the lives of learning disabled people have become an issue of public and political importance, historically, the treatment of this population has been poor (Sperlinger 1999). Throughout the nineteenth and first half of the twentieth century, alongside efforts to provide institutional care and training, people with learning disabilities were subject to humiliation, exhibited as freaks, threatened with eradication or put at risk for the ‘good of others.’ The latter was evidenced by the early testing of the measles vaccine (O’Hara, 2003). We would argue that historical perceptions of people with learning disabilities as less valued by society, their needs ignored and their emotional lives largely misunderstood, are still represented in some present day ethical and moral value systems. As a consequence of the above we believe that as well as policy initiatives, the value system of the therapist is paramount and is likely to be reflected in their way of working and being with the client. For example therapeutic integrity might be undermined if a therapist fundamentally believes people with a learning disability lack capacity and should be denied the opportunity, for example, to have fulfilling sex lives or if a client has a genetic disorder/syndrome and the therapist believes this means that they should not procreate.