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“Qualified, hardworking Americans are denied job opportunities, fired or otherwise discriminated against just because they are lesbian, gay, bisexual or transgender (LGBT)” (Human Right Campaign). Even with the passing and enforcement of employment anti-discrimination laws, statistics show that persons with minority status such as people of color, persons with disabilities and women continue to experience discrimination in the workplace, particularly sexual minorities – LGBT persons (Niles & Harris-Bowlsbey, 2005). LGBT individuals who are also ethnic minorities are at an even greater disadvantage, with African American transgender people faring the worst (Grant, Mottet, Tanis, Harrison, & Keisling, 2001). To date, no federal law exists which consistently protects LGBT individuals from discriminatory practices in the workplace. It is still legal in 29 states to discriminate against employees and job applicants based on their sexual orientation, and legal in 38 states to discriminate based on gender identity (Human Rights Campaign). Within the state of Florida, there are no provisions in place which formally address discrimination based on gender identity; however a Florida court ruled that a person with Gender Identity Disorder (gender dysphoria) is within the disability coverage under the Florida Human Rights Act, as well as sections of the act that proscribe discrimination based on perceived disability. There is no state-wide non-discrimination law that protects individuals based on sexual orientation (Human Rights Campaign).

Vocational psychology researchers, practitioners, and LGBT advocates have made significant attempts to call attention to the vocational concerns and needs of both ethnic and sexual minority groups. Over the past few decades, work discrimination has become a topic of interest in the fast growing literature regarding the vocational issues and challenges of LGBT persons (Chung, 2001; Gedro, 2009; Loo & Rocco, 2009; O’Neil, McWhirter, & Cerezo, 2008).

Work Discrimination

Chung (2001) defined work discrimination as, “unfair and negative treatment of workers or job applicants based on personal attributes that are irrelevant to job performance” (Chung, 2001,p. 34) and proposed a conceptual framework that describes work discrimination along three dimensions: a) formal versus informal, b) perceived versus real, and c) potential versus encountered. Formal discrimination refers to institutional policies or decisions that influence one’s employment status, job assignment, and compensation. Informal discrimination refers to workplace behaviors or environments that are unwelcoming. Perceived discrimination refers to acts perceived to be discriminatory; whereas, real discrimination is based in actuality/reality. Potential discrimination refers to discrimination that could occur if a persons’ LGBT identity is either revealed or assumed. Encountered discrimination refers to discriminatory acts one experiences.

Findings from Research on Work Discrimination against LGBT persons

Following is a brief overview of some of the recent research findings on work discrimination of LGBT individuals. In their report entitled Bias in the Workplace, Badgett, Lau, Sears, and Ho (2007) summarized research findings about employment discrimination of LGBT persons from four different kinds of studies throughout the United States. Surveys of LGBT persons’ experiences with workplace discrimination (self-reports and co-worker perceptions), revealed that 16% to 68% of LGB persons reported experiencing employment discrimination, with 57% of transgender persons reporting the same. A significant number of heterosexual co-workers also reported witnessing sexual orientation discrimination in the work place against their LGBT peers. Of note, 12% to 13% of respondents in specific occupations (e.g., the legal profession) reported witnessing anti-gay discrimination in employment. An analysis of employment discrimination complaints filed with governmental agencies in states where discrimination based on sexual orientation is prohibited, findings revealed that LGB persons filed complaints at rates similar to women and racial minorities (e.g., people of color). An analysis of wage differentials between LGBT and heterosexual workers revealed that gay men earn 10% to 32% less than heterosexual men with similar qualifications and that transgender persons reported higher rates of unemployment (6% to 60% were unemployed) with incredibly small earnings (22% – 64% of the employed earned less than $25,000 per year). Finally, findings from controlled experiments – where researchers compare treatment of LGBT people and treatment of heterosexuals by presenting hypothetical scenarios in which research participants interact with the actual or hypothetical people who are coded as “gay” or “straight – also revealed significant discrimination on the basis of sexual orientation in the workplace.

According to the American Psychological Association (2011), those who self-identify as LGBT are particularly vulnerable to being socioeconomically disadvantaged; this is important as socioeconomic status is inextricably linked to LGBT persons’ rights and overall well-being. Although LGBT persons tend to be more educated in comparison to the general population, research suggests that they make significantly less money than their heterosexual and cisgender counterparts.

In 2009, the National Center for Transgender Equality and the National Gay and Lesbian Task Force published the preliminary findings of their National Transgender Discrimination Survey (NTDS). A staggering 97% of survey participants reported experiencing mistreatment, harassment, or discrimination in some form on their jobs, which included privacy invasion (48% said “supervisors/coworkers shared information about me inappropriately” and 41% said “I was asked questions about my transgender and surgical status”), verbal abuse (48% said “I was referred to be the wrong pronoun, repeatedly and on purpose”), and physical or sexual assault (7% said “I was a victim of sexual assault at work” and 6% said “I was a victim of sexual assault at work”). Survey respondents also reported experiencing unemployment at twice the rate of the population, with 47% having experienced an adverse job outcome – being fired, not hired or denied a promotion at some point in their careers due to their gender identity. Similar findings were reported in the NTDS’ official report, Injustice at Every Turn. Other significant findings were that 57% of participants reported trying to avoid discrimination by keeping their gender or gender transition a secret, and 71% by delaying the transition. Sixteen percent reported that they had to resort to work in the “underground economy” to earn income (e.g., prostitution or selling drugs). Unemployed respondents reported experiencing devastating outcomes, including double the homelessness, 85% more incarceration, and increased negative health outcomes, including twice the rate of HIV infection and nearly twice the rate of current drug use to self-medicate/cope in comparison to their employed LGBT counterparts (Ramos, Badgett, & Sears, 2011).

Frye (2001) argued that transgender persons are regular targets of workplace discrimination even more systematically than their LGB counterparts. In an attempt to ensure professional survival and avoid discrimination, many LGB employees choose not to “come out” at work; however because transgender persons may possess physical and behavioral characteristics that clearly identify them as transgendered at some point in their lives (mainly during gender transition), they are more susceptible to having their sexual minority status revealed against their will (being “outed”). More so than LGB individuals, transgender persons are frequently targets of hate crimes because of their visibility (Frye, 2001).

How/ Why Work Discrimination is related or important to career counseling.

“In the United States, a dominant career-related belief is that the individual controls his or her own career destiny” (Niles & Harris-Bowlsbey, 2005, p. 1); however, individual control is always exercised within a context that varies based on the degree to which it supports one’s career goals. In the case of LGBT persons, factors such as heterosexism, socioeconomic status, and racism may restrict access to certain occupational opportunities. Work discrimination in any form can have a profound effect on one’s career path and development (Neary, 2010). “LGBT people face a complex set of choices that are unique to them because of their sexual minority status” (Gedro, 2009, p. 54). Many of them have to confront “exclusion from certain types of jobs, such as elementary school teachers and child care workers; physical assault, verbal harassment and abuse, destruction of property, ridicule, trans-phobic jokes, unfair work schedules, workplace sabotage, and restriction to their careers” (Kirk & Belovics, 2008, p.32 as cited in Neary, 2010). In the case of transgender individuals, concerns about personal safety while at work preclude the focus on career interests (Neary, 2010). Because of the large amount of energy it requires to integrate a positive gay, lesbian, bisexual or transgender identity, as well as cope with discrimination (within and outside of the workplace), career development for such persons to be postponed, hindered, or misdirected (Alderson, 2003 as cited in Gedro, 2009, p.56; Haley, 2004).

Pepper and Lorah (2008) identified 3 major problems related to the job search process – an integral part of career development – which poses several challenges for transgender persons: 1) potential loss of work history, 2) navigating the job interview process (many struggle with confidence and self-esteem issues), and 3) if an employer asks about work experience under another name. Although slightly different, such challenges may be generalized to LGB job-applicants as well. Helping LGBT clients prepare for these problems is essential in assisting them in their career choice and job search efforts (Neary, 2010).

Work discrimination also has a significant impact on LGBT persons’ mental state, with the most common psychological issues include increased levels of stress and anxiety, depression, lack of self-confidence, drug and alcohol dependency (Neary, 2010), and attempted suicide (Grant et. al., 2011).

Implications & Suggested Interventions for Career Counselors

Like all other clients, the LGBT client may require help with career planning, self-assessment, career exploration, career or job transitions, job search strategies etcetera (Neary, 2010; O’Neil et. al., 2008). Career counselors working with sexual minorities need to create a LGBT-positive/affirming counseling environment, in which clients are free to explore their personal needs, interests and values in a safe place. Such an environment includes tangible and process-related forms of support and affirmation (e.g., displaying quarterly newsletters from the America Psychological Association’s Division 44 and other reading materials or paying careful attention to unique aspects of assessment interpretation) for LGBT clients. Intake forms should encourage them to note their gender presentation, and gender-neutral washrooms should be made available (O’Neil et. al., 2008).

Counselors and other helping professionals involved in the career development process of LGBT individuals should ensure that they develop relevant multicultural knowledge, skills and awareness for conducting culturally appropriate career discussions, realizing that more traditional approaches will likely be ineffective with this particular population. (Niles & Harris-Bowlsbey, 2001). When a LGBT client presents for career counseling, counselors should assess whether they are competent to provide the services requested (O’Neil, et. al., 2008). It is also imperative that career counselors assess their personal biases, stereotypes, and assumptions about the LGBT client presenting for counseling. A client-centered approach is recommended given that the issue of trust building is critical with the LGBT population. From a narrative perspective, adopting a stance of “informed not knowing” will allow the LGBT client the best chance to share their story about their career and life in their own words. Following, the counselor and client collaborate to deconstruct the cultural narratives of gender and heterosexism that promote negative messages and replace them with a more accurate and affirming narrative (Neary, 2010). In the case of personal dislike to LGBT individuals, O’Neil et. al., (2008) advised that counselors refer the client to another professional, receive continuing education and supervision, and engage in personal exploration of the topic as a means to prepare for future clients with similar concerns. The career counselor’s ability to provide effective services to their LGBT clients will be improved by staying current with the relevant literature (O’Neil et. al., 2008).

Career counselors are encouraged to help improve cultural sensitivity where their clients are concerned; this can be achieved by using appropriate names, pronouns and other terminology preferred by their LGBT clients to help validate their identity. Career counselors should also make it a point to educate themselves about the different legal issues experienced by their clients and investigate any written workplace policies that may hold relevance to LGBT individuals, such as the Employment Non-Discrimination Act (O’Neil et. al., 2008; Human Rights Campaign). Further, career counselors should identify and attend to all of the salient aspects of the client’s identity, as clients may identify themselves with an array of sociocultural backgrounds. This is especially important for transgender clients who not only suffer discrimination in the workplace, but in almost every aspect of their lives: education, housing, public accommodations, receiving update identification documents, and health care (Ramos, Badgett, & Sears, 2011).

Pope (1995) as cited in Gedro (2009) outlined four useful interventions for career counselors working in their work with sexual minorities. Pope suggests a discussion about discrimination interventions (exploring the nature and extent of discrimination and any resources available to the client should he or she chose to change their job or career), dual-career couples (e.g., Do you openly reveal the relationship at work?), overcoming internalized transphobia or homophobia with the client (many sexual minority clients possess an intense self-hatred and – loathing), as well as supporting LGBT role models (particularly those who do not work in “safe” occupation).

Finally, career counselors are also strongly encouraged to serve as advocates for their LGBT clients. One author noted that a weakness in the field is “the reluctance or inability to see career counselors as change agents who can help not only individuals to change but systems to change as well” (Hanson, 2003 as cited in O’Neil, 2008, p. 299). Neary (2010) cited Muniz and Thomas’ (2006) five strategies in organization settings that career counselors can use to help cultivate an affirmative LGBT work environment. They include: 1) setting up the context – advocating in the workplace for anti-discrimination and harassment policies, 2) preparing for resistance – taking steps to make the concerns and needs of the LGBT population more visible, 3) leadership commitment – gaining commitment and support from the leadership/management of organization, 4) becoming familiar with or launching affinity and/or resource groups for LGBT persons, and 5) continued learning – additional diversity training (Neary, 2010). The Human Rights Campaign Foundation provides a 5-step checklist for advocating for the rights of transgender persons, and the NCTE’s list of 52 Things You Can Do for Transgender Equity, is also a useful guide for initiating social advocacy (O’Neil, et. al., 2008).

This essay will firstly define what discrimination is and what it means to discriminate. Examples will be used to demonstrate what discrimination may look like. A definition of empowerment will also be used. The essay will then critically explore theory and ideas around power and how power manifests between groups. This part of the essay will touch on the idea of ‘othering’. The essay will move on to focus on mental health, ‘race’ and racism. The essay will use the idea that ‘mental illness’ is a social construct and look at how ‘mental illness’ can be open to influences of racism from society (Bailey 2004). The essay will make links to institutional racism in mental health and psychiatry.

In a basic sense to discriminate means to: “differentiate” or to “recognise a distinction” (Oxford Dictionaries 2012). In this basic sense it is a part of daily life to discriminate. For example, a baby will often discriminate between a stranger and their caregiver. Discrimination becomes a problem when the ‘difference’ or ‘recognised distinction’ is used for the basis of unfair treatment or exclusion (Thompson 2012). Anti-discriminatory practice in social work concerns itself with discrimination that has negative outcomes; whether this is ‘negative discrimination’ or ‘positive discrimination’. Both are equally as damaging.

Thompson (1998) defines discrimination as a process where individuals are divided into particular social groups with an uneven distribution of power, resources, opportunities and even rights. Discrimination is not always intentional (Thompson 2009) and there are various types of discrimination (EHRC 2012). Discrimination can be direct, indirect, based on perception or on association (EHRC 2012). The Equality Act 2010 is legislation that protects individuals and groups against discrimination. The Equality Act 2010 brought together several pieces of legislation to protect several ‘protected characteristics’: age, disability, gender reassignment, marriage and civil partnership, race, religion or belief, sex and sexual orientation. Discrimination does not just occur on a personal level, according to Thompson (2012), discrimination occurs on three levels; personal, cultural and structure. This will be explored more later on.

‘Empowerment’ is a term that often comes in to play when examining discrimination; therefore it is important to have an understanding of both. Empowerment is the capacity of individuals or groups to take control of their circumstance and use their power to “help themselves and others to maximise the quality of their lives” (Adams 2008: xvi). Empowerment is then not an absence of discrimination and power but an individual’s capacity to own or share that power and take control. Therefore empowerment is an anti-oppressive practice not an anti-discriminatory one. They are linked but not the same.

Social workers act as ‘mediators’ between service users and the state. Social workers are in a role that can potentially empower or oppress (Thompson 1997). For this reason Thompson (1997: 11) argues that “good practice must be anti-discriminatory practice”, no matter how high the standards of practice are in other respects (Thompson 2012). Thompson (1997) reminds the reader many times throughout his book that “If you’re not part of the solution you are part of the problem”. I choose to include this because it reinforces that social workers need to challenge discrimination and take action against it. Discrimination is political, sociological and psychological (Thompson 2012). To ‘accept’ and tolerate it and to not to challenge it does indeed make social workers part of the problem. Discrimination has links with power which the essay will move on to explain next.

As defined by the Oxford Dictionary (2012) power is “the ability or capacity to do something; the capacity or ability to act in a particular way to direct or influence the behaviour of others or the course of events; or physical strength or force exerted by someone”. From this definition power could be seen as a coercive force or authoritarian. However, some theorists would argue that there is more to power than just coercion and authority. Parsons (1969 cited Rogers 2008) took a different view on power. He saw power as a way of maintaining social order instead of a force for individual gain (Rogers 2008).

Parsons (1969 cited Rogers 2008) believed that to be able to enforce coercive action and justify it, there needs to be a collective interest from the social system as a whole (Rogers 2008). Lukes (1974) would disagree with Parsons definition on power. Lukes argues that power is less abstract (Rogers 2008) and that exercising power is the decision to exert control. Lukes (1974:74) illustrates this point as: “A exercises power over B when A effects B in a manner contrary to B’s interests”. Dominelli (2008) focuses more on the idea of competing power; which group has more power than the ‘other’. This splits people to either be in the dominant group or the minority. A dominant group tends to be deemed superior, and with superiority comes privilege (Dominelli 2008). As a result the other group is deemed inferior, the minority and disadvantaged. It is this compound of dominance and oppression that discrimination derives from (Rogers 2008). It is a groups perceived superiorly over another group (Thompson 2012) that ‘justifies’ coercive action, control and discrimination.

When people form oppressive relationships the tendency is to make a strategic decision that excludes a particular group or individuals from accessing power and resources (Dominelli 2002). ‘Othering’ can be experienced as multiple; multiple oppression. People can be ‘othered’ simultaneously due to a number of social divisions (Domenelli 2002), for example, being a black woman who experiences mental health issues.

Social workers need to recognise power and its links to discrimination. Not to could further oppress (Thompson 2012). It can feel uncomfortable to be in the privileged position; whether this is as a white person or a man and so on. The ‘privileged group’ need to engage in the fight for equality (Corneau and Stergiopoulos 2012). White people need to engage with the fight against racism and accept responsibility for racism as it is a problem of white society and therefore involves white people (Strawbridge cited Corneau and Stergiopoulos 2012). This explanation can be applied to any other groups that are considered to be the ‘other’.

Rogers and Pilgrim (2006: 15) suggest that superiority is a social construction: a “product of human activity”. Dominelli (2002) goes further to say that oppression itself is a social construct as oppressive relations are not pre-determined but they are reproduced between social interactions and routines. Language is often used as a key part of social interaction and is also a very powerful tool. This relates heavily to social work as social workers are responsible for writing reports/care plans/assessments. Depending on how social workers word written pieces of work can indeed paint a very different picture of the service user they are working with. I was once told that ‘words are the bullets of prejudice’, this illustrates that labels and language can be powerful, damaging, potentially discriminatory and oppressive.

Although labels can be damaging they are a part of social interaction. Labels help us to construct our social world and we use them to find similarities and differences to process the world around us (Moncrieffe and Eyben 2007). Although the process of labelling is “fundamental to human behaviour and interaction” (Moncrieffe and Eyben 2007:19) social workers need to be aware of when these labels have the potential to be damaging, oppressive and rein forcers of discrimination. Social workers need to reflect and consider what labels they give people and what impacts this may have. Labels can be used to change or sustain power relations which can have an impact on prejudice and on achieving equality (Moncrieffe and Eyben 2007).

This essay will use the themes discussed so far to focus in on mental health as an area of practice and critically explore institutionalised racism within mental health practice and psychiatry. To begin I will briefly return to Thompson’s (2012) PCS analysis in relation to mental health and ‘race’. The ‘P’ level is our own individual attitudes and feelings (Thompson 2012). Although it is important to examine our own beliefs we do not live in a “moral and political vacuum” (Coppock and Dunn 2010: 8). For this reason Thompson (2012) also refers to the cultural (C) and structural (S). ‘P’ is embedded in ‘C’ and ‘C’ and ‘P’ in ‘S’ which builds up interlocking layers of discrimination; personal, cultural and structural.

The ‘C’ level is where we learn our norms and values. Individuals learn these values and norms through the process of socialisation which occurs through social institutions such as the family, religion and the media (Haralambos and Holborn 2008). These institutions can produce ideas about what is considered ‘normal’ or ‘right’ (Coppock and Dunn 2010). From this it is not surprising that there is an attitude in society that people who experience mental health issues are violent and a danger to society; even though there is no relationship between mental health and violence (Rogers and Pilgrim 2006). However, the general media uses terms like ‘psycho’ (Ward 2012) or ‘crazed gunman’ (Perrie 2011) in relation to acts of violence creates prejudice. This prejudice can then be used to discriminate. For example, a community may not want a ‘mental home’ to open near them as ‘the mental people’ will cause a threat to their community.

The ‘S’ level is the level of institutional oppression and discrimination. Ideas that Thompson (2012: 34) refers to as being “‘sewn in’ to the fabric of society”. Western psychiatry is laden with cultural values and assumptions that are based on western culture (Coppock and Dunn 2010). This suggests that western and white is ‘normality’ and anything that deviates from this is ‘abnormal’ (Corneau and Stergiopoulos 2012), or as previously discussed; ‘other’. It is the ‘C’ and ‘S’ level which the essay will focus on more.

Institutional racism explains how institutional structures, systems and the process embedded in society and structures that promote racial inequality (Jones 1997). It is considered to be the “collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin” (MacPherson 1999). Jones (cited Marlow and Loveday 2000: 30) goes further than this definition to also include “laws, customs, and practices which systematically reflect and produce racial inequalities”. Institutional racism is believed to be a more subtle and covert type of racism (Bhui 2002) and often said to be unintentional (Griffith et al 2007).

BME groups are differently represented in psychiatry (Sashidharan 2001). People of African-Caribbean heritage are over represented yet people of Asian heritage underrepresented in mental health settings (Sashidharan 2001). As BME groups deviate from the ‘white norms’ they appear to receive either too much attention or too little (Sashidharan 2001). This would suggest that the systems which operate within psychiatry are institutionally racist.

Both ‘race’ and ‘mental illness’ are social constructs (Thompson 1997; Bailey 2004). Thompson (1997) argues that despite the lack in biological evidence for the explanation of racial categories it is still a widely common way of thinking. Bailey (2004) argues that ‘mental illness’ has always been a social construct therefore open to racism and other forms of discrimination. The declassification of homosexuality in the Diagnostic and Statistical Manual of Mental Disorders (DSM) illustrates Bailey’s (2004) point.

‘Race’ immediately brings up issues around power and the relationship between what is seen as ‘natural’ and ‘social’ (Westwood 2002). Historically ‘it was viewed that inequalities around ‘race’ had a ‘natural’ explanation (Westwood 2002). ‘Race’ could be traced back to anthological tradition (Rogers 2006; Craig et al 2012) and colonial discourse with the belief that white identity is superior (Westwood 2002) and that black people are “lacking civilisation”, “savages” and a “subhuman species” (Bailey 2004: 408-409). According to Bailey (2004: 408) “the effects of racism on psychiatry can be directly linked to the early stereotypes about black people arising from pseudoscientific racism”. It is this pseudoscience racism (science which lacks scientific method or evidence) that underpins racism in mental health services today (Bailey 2004).

Racism has many different sides and is a multidimensional form of oppression and discrimination (Corneau and Stergiopoulos 2012; Thompson 2012). Racism is widely known to be the cause of disparities in health and mental health (McKenzie in Bhui 2002; Griffith et al 2007; Craig et al 2012). BME individuals find themselves navigating their way through a system that works from the dominant discourse of the ‘medical model’ (Corneau and Stergiopoulos 2012). This allows a small amount of room for different and alternative frameworks to challenge racism which is already ingrained in the system.

To illustrate this point I will use an example from my practice. I work with a black woman who experiences mental health issues. She has spiritual beliefs and usually openly takes about her beliefs at home. She fears one resident as he is very religious and she feels that he has ‘special powers’. I supported her to an appointment with her psychiatrist as she had begun to feel mentally unwell. He did not enquire about any social, cultural or structural factors that may impact on her mental health. I tried to advocate the experiences she had shared with me and reiterated what she was saying. However, he advised her that the ‘tugging’ she experienced in her stomach was physical and to see a doctor and increased her anti-psychotic medication. Her spiritual experiences were not validated, he individualised the ’cause’ of her ‘illness’ and used a medical intervention.

Western psychiatry tends to separate the mind from the body and spirit (Bailey 2004). According to Bailey (2004) many BME service users find this approach “unhelpful and irrelevant to their experiences of mental distress”. This is because for many BME the mind, body and spirit work in union and the feelings and behaviours behind this is woven into people’s wider existence (Bailey 2004). Kortmann (2010) believes that these types of clinical intervention are often ineffective due to service users non-western origin and tend to quit treatments earlier. For example, some African cultures can believe that seizures are cause by evil spirits (Kortmann 2010) and therefore do not take medication prescribed as they do not believe it to be an illness.

Westwood (2002) writes that the negative impact of racism can have a significant impact on an individual’s mental health. However in a recent piece of research Ayalon and Gum (2011) concluded that black older adults experienced the highest amount of discriminatory events but there was a weaker association with this and experiences of mental health issues. To account for this it was concluded that BME groups experienced more events of discrimination over their life course and as a result have become more resilient to it (Ayalon and Gum 2011).

Some writers argue that to construct institutional racism as the explanation to the disparities in mental health can add to the debate and effectively alienate BME groups even further (Singh and Burns 2006). Singh and Burn (2006) state that, the accusation of racism within psychiatry will give service users the expectation that they will receive a poorer service and this will encourage service users to disengage with services or offer voluntary admission. What Singh and Burn (2006) are speculating is presented by Livingstone (2012) as self-stigma; the stigma that is present on an individual level rather than on a cultural or social. It is the stigma that is internalised that can prevent people from access services (Livingstone 2012) and thus, actively discriminating against one’s self. Therefore, Singh and Burns (2006) argue that individuals to stay away from needed services until it is too late and there are few alternatives but to detain them and enforce treatment.

Although Singh and Burn (2006) make a logical point they fail to recognise BME service user experiences of Mental Health Services. Bowl (2007) conducted a qualitative research to gain the views and experiences of South Asian service users as most literature is through the lens of academics and professionals. The experiences of this South Asian group would certainly suggest the presence of institutional racism within Mental health Services. The main areas identified were their dissatisfaction in not being understood in the assessment process due to language barriers and cultural incompetence (Bowl 2007). This misunderstanding led to misdiagnosis and refusal of services (Bowl 2007).

Racism is often not the only form of oppression that people face. Disadvantage can occur from several areas (Marlow and Loveday 2000). BME groups experiencing mental health issues are already subjected to multiple oppression. There is not enough words in this essay to explore this further but wanted to acknowledge that forms of oppression are not experienced in isolation of each other. For example, links have been made between individual’s lower socio-economic status and experience of mental health issues and how black people can face the added stress of earning less and experiencing higher levels of unemployment (Chakraborty and McKenzie 2002). This begins to illustrate the complexity and how oppression is inextricably intertwined.

Institutional racism has been highlight in a number of Inquiries in practice. It was firstly highlighted in the Stephen Lawrence Report in 1999; a black young person who was murdered in a racist attack and yet again in the David Bennett Inquiry in 2003; a black man who died in 1998 after being restrained faced down by several nurses for nearly half an hour. Lord Laming (2003) also identified issues around racism in his Inquiry into the death of Victoria Climbie. There is not enough words to go into any of these inquiries in any detail but they have been included to demonstrate institutional racism in practice in the police, mental health service and social work.

It may seem that whilst mental health services operate within the medical model that is catered towards the white majority things will not change. Institutions and systems are indeed difficult to change, however social workers can work with service users to empower, advocate, challenge and expose discrimination in services and bring about social change.

Empowerment is complex in general but becomes more complex in relation to ‘race’ and ethnicity (Thompson 2007). Social workers need to firstly be aware of institutional racism before they are able to challenge it (Thompson 2007). For social workers to challenge institutional racism they need to challenge policies that do not address the needs of BME groups. To do this, social workers need to be aware of the complex power relations and deeply ingrained racist patterns in society (Thompson 2007).

In my practice in a mental health setting I have contact with medical professionals and often support services users to appointments. I find that I must hold onto my social work values and not get drawn into the medical model way of working but to remain holistic in my approach.

To conclude, this essay has demonstrated that discrimination is far more complex than treating someone differently. It has focused on a more subtle, covert and indirect form of discrimination: institutional racism. The essay has examined the links between discrimination, racism and power and introduced the idea that ‘mental illness’ and ‘race’ are both social constructs. It is this subtle and covert form of discrimination that can be damaging. It can be hard to recognise as it is woven into the very fabric of society (Thompson 2012). However, the message in this essay is that social workers need to recognise power relations, how they operate, on what level they operate at and to challenge discrimination (anti-discriminatory practice) and work with service user to empower them to overcome these obstacles (anti-oppressive practice). Social workers must ‘swim against the tide’ and not collude with these attitudes no matter how deeply ingrained and embedded they are in society. For the social workers that fail to do so will ultimately become part of the problem.

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This essay will firstly define what discrimination is and what it means to discriminate against something. It will then explain what it means to discriminate against someone or a group in social work practice. This will be a very broad definition that encompasses a variety of different service user groups. Examples will be used to demonstrate what discrimination may look like in social work practice and everyday life. To gain a better understand the essay will critically explore theory and ideas around power and how power manifests between groups. This part of the essay will touch on the idea of ‘othering’. The essay will use social constructionism theory to analyse this concept of power.

The essay will then focus in on mental health. This part of the essay will firstly look at what a mental health problem is and explore the stigma of being labelled with a mental health problem. The essay will then go deeper to focus on how the western medical model can discriminate against Black and Ethnic Minority groups (BME), even if indirectly. The essay will then critically explore why BME adults, particularly men, are overrepresented in the mental health service. Links will be made to institutional racism and the fact that BME children are underrepresented in child and adolescent mental health services (CAMHS).

In in broadest definition, to discriminate means to “differentiate” or to “recognise a distinction” (Oxford Dictionaries 2012). In this broad sense it is a part of daily life to discriminate. For example, an adult may discriminate between lanes on a motorway and a baby will often discriminate between a stranger and their caregiver. Discrimination becomes a problem when the ‘difference’ or ‘recognised distinction’ is used for the basis of unfair treatment. This is the discrimination that social workers need to be vigilant for.

Discrimination is not always intentional (Thompson 2009) and there are various types of discrimination (EHRC 2012). Discrimination can be direct, indirect, based on the perception that someone has a protected characteristic or discriminate against someone who is associated with a person who has a protected characteristic (EHRC 2012). The Equality Act (2010) also aims to protect people with a ‘protective characteristic(s)’ from victimisation, harassment and failure to make reasonable adjustments (Home Office 2012). Thompson’s (1997) PCS model demonstrates that discrimination is not always on a personal level and it is not just solely down to the individual. I will return to the PCS model later on in the essay.

Social workers act as ‘mediators’ between service users and the state. Social workers are in a role that can potentially empower or oppress (Thompson 1997). For this reason Thompson (1997: 11) argues that “good practice must be anti-discriminatory practice”. All other areas of practice could be brilliant and the social worker could have very good intentions but if the social worker cannot recognise the marginalised position of some of the people they are working with their interventions could potentially further oppress (Thompson 1997). Thompson (1997) reminds the reader many times throughout the book that “If you’re not part of the solution you are part of the problem”. I choose to include this because it reinforces that social workers need to challenge discrimination and take action against it. To accept it and to not ‘swim against the tide’ does indeed make us part of the problem.

Where does discrimination come from and why do people, institutions and systems discriminate against people? This part of the essay will critically explore the concept of power and social constructionism in relation to discrimination and social work. Power is defined by Haralambos and Holborn 2000: 540) very loosely as “the ability to get your own way even when others are opposed to your wishes”. This is of course a very simple definition of a complex concept. There are many models and theories around power. Thompson (1998: 42) identified a common theme of “the ability to influence or control people, events, processes or resources”. These common themes of power all have the potential to be used destructively in social work. Social workers have the ability and power to influence and control, whether this is on an individual personal level or as a gate keeper of services or agent of control. Social workers need to be aware of power as they work with people who are marginalised and powerless in comparison; people who social workers could potentially oppress and even worse, abuse.

Giddens (1993) makes close links between power and inequality.

EHRC Equality and human rights commission., 2012. [Viewed 2012.11.10] What is discrimination? [online]. Available from http://www.equalityhumanrights.com/advice-and-guidance/education-providers-schools-guidance/key-concepts/what-is-discrimination/

Giddens, A., 1993. Sociology (2nd ed). Cambridge: Polity

Haralambos, M, Holborn, M., 2000. Sociology themes and perspectives. London: HarperCollins Publishers Ltd

Home Office., 2012. [viewed 2012.11.11] Equality Act 2010 [online]. Available from http://www.homeoffice.gov.uk/equalities/equality-act/

Oxford Dictionaries., 2012. [Viewed 2012.10.19] Discriminate [Online]. Available from http://oxforddictionaries.com/definition/english/discriminate?q=discriminate

Thompson, N., 1997. Anti-Discriminatory practice (2nd ed). Basingstoke: Macmillan Press

Thompson,N., 1998. Promoting Equality challenging discrimination and oppression in human services. Basingstoke: Macmillan Press Ltd

Thompson, N., 2009. Practising social work. Basingstoke: Palgrave Macmillan

Traditionally people with learning difficulties/disabilities have suffered from social exclusion, discrimination and marginalisation. By exploring how successful the Human Rights Act 1998 has been in promoting the rights of people with a learning disability through legislation, policy, advocacy, the care commission and SSSC and personalisation of service provision, will show if services have enabled people with learning disabilities to enjoy these rights and lead a fulfilling live as an equal citizen.

Historically Human Rights have been intricately tied to the laws, customs and religions throughout the ages. The great religions of the world contribute profound ideas on the dignity of the human being, and are concerned with the duties and obligations of man to his fellow human beings. (Brownlie,1992) The earliest rules about standards of behaviour among people were seen as fundamental to the well-being of society, under the influence of philosophers such as Grotius, Hobbes and Locke. Then, these rights were called ‘natural’ rights, or ‘the rights of man’. (Habermass, 1990)

At an international level, human rights are rules that protect people from severe political, legal, and social abuses. They include all fundamental freedoms and are based on mankind’s demand for a life in which the inherent dignity and worth of each human being will receive respect and protection. These rights exist as morals, values and ethics in human society, requiring the government comply and enforce the rights as law at both national and international levels (Anaya 2004)

The Human Rights Act 1998 is a piece of legislation that adopts the European Convention of Human Rights 1950 which has been made British law containing 30 articles which detail rights and freedom, for example Article-8 states that everyone has the right to respect for private and family life. Another European initiative is the Charter of Fundamental Rights of the European Community, signed in December 2000. It is not law, but everyone is expected to respect the charter declaring the rights of all European citizens to ‘dignity, freedom, equality, solidarity, citizen rights and justice.’ (Owen, 2008)

There have been marked improvements in the lives of people with learning disabilities in the last 30 years since the Community Care Act 1990. The current based philosophy of care has changed the instititionalised care that excluded people from the community at the beginning of the 1900’s, to community care that has enabled people with learning disabilities to live in the community as an equal citizen. However people with learning disabilities are still socially excluded, have no control or choice over their own lives and “were “more likely than others to have bad things happening in their lives” questioning to what extent are the rights of people with learning disabilities being met, on their right to ‘dignity, equality, respect and autonomy.’ (DoH 2008)

People with learning disabilities have greater health needs than the rest of the population. As it has been documented that people with learning disabilities are more likely to suffer chronic health problems. Thus requiring more frequent treatments and health care checks. (DoH, 2001). Research has also shown that these general health needs are not being met through lack of promotion and under-identification of ill health of people with learning disabilities. As people with learning disabilities still face institutional discrimination within the NHS. (Mencap,2007)

The launch of Mencaps ‘Treat me right!’ campaign, has brought to light many cases of appalling treatment that people with learning disabilities have had to endure in hospitals around the U.K. Thus bringing to light serious concerns about the way that people with learning disabilities are treated within our healthcare system. Families came forward to tell Mencap charity for learning disabilities about their experiences and the unexplained death of their loved ones that resulted from discrimination and lack of understanding in treatment from health professionals. In the hope of changing, how people with learning disabilities are treated in the health care system for the future. (Mencap,2007)

As Allan, the father of Mark, who died in August 2003 of bronchopneumonia states:

“We believe that Mark died unnecessarily. Throughout his life, we encountered medical professionals who had no idea how to deal with people with a learning disability or what it is like to be a parent of someone with a learning disability – to know their suffering, to see their distress. If only they would listen…” (As cited in ‘Death by Indifference’. Mencap.org: 2007)

Marks father explains that Mark had a severe learning disability and had very little speech, though he had his own way of communicating his needs, which his family understood. Mark was just 30 years when he died. Two months before his death, Mark had been admitted to hospital with a broken femur. While operating he suffered severe blood loss, Mark was discharged and re-admitted twice in two months, finally dying in intensive care eight and a half weeks after the operation. Mark was left suffering in great pain and distress in the days before his death due to lack of knowledge about learning disabilities. As Marks family believe that it was failure by medical professionals to understand his medical needs or the seriousness of his condition that led to his death. Stating that Marks life could have been saved if medical staff had listened to the family in the first place about Marks condition. (Mencap, 2007)

This lack of understanding from healthcare professional goes against the basic rights of people with learning disabilities by breaching their right to life and access to healthcare (Article 2) Hospital staff awareness and knowledge of learning disabilities is very poor. As staff are often ignorant of issues around consent and capacity to the extent that the person with learning disability is often denied treatment, as staff can be unaware of people’s rights. Staff can be patronizing and speak to people with learning disabilities as if they are children, being completely unaware that people with learning disabilities cannot communicate problems to them or use fancy jargon that people do not understand.

Therefore the healthcare system needs to put in procedures that safeguard the human rights of people with learning disabilities. Current Medical staff should be made more aware of the needs of people with disabilities and it should be statutory that all future medical staff should be taught about learning disabilities when they are students. Mencap put forward recommendations to the Government after their enquiry ‘Treat me right!’ and ‘Death by Indifference’ the outcome is ‘Valuing People Now: The Delivery Plan 2010aˆ‘2011 ‘Making it happen for everyone’ indicates the changes the government plans to implement in improving healthcare services for people with learning disabilities. (Mencap,2007)

People with learning disabilities are at greater risk of having crimes committed against them and face greater hurdles to achieving justice compared to other people in society. People with learning disabilities are often targeted specifically because of their disability, making them more vulnerable to abuse. For many people with a disability, this violation of their human right is seen as a normal part of their everyday life. Therefore people with learning disabilities are less likely to report crimes and seek the help they need to stop these crimes happening. Some people with learning disabilities do not know what is being done is a crime or are unable to communicate and tell someone about the crime committed against them. (Crime and Abuse, 2007)

The report Behind Closed Doors states that people with learning disabilities find it difficult if the complaint is about the person providing care as a person with learning disabilities may fear the loss of care, accommodation or other support if they make a complaint or report to the police. Once a complaint has been made, the Crown Prosecution Service state that the complainant with learning disabilities is not capable of giving evidence, or it will be too stressful for them to do so and this may reduce the likelihood of a successful prosecution. (Crime and Abuse, 2007)

Everyone person with a learning disability has the right to protection of property and person;(Article 3). Theft from adults with learning disabilities is not uncommon. As many people with a learning disability have to rely on personal assistants or carers assist to them in the management of their financial affairs and this trust can be violated. As the following report states, residents with learning disabilities at Dove House in Kirby Muxloe, Leicestershire became victims of crime, when the care homeowner was convicted for stealing money from residents that lived there. Leicester Crown Court reported that Caroline Rice kept half the money she withdrew on behalf of residents from their bank accounts and used false accounting to hide her crime. Rice was convicted of three counts of theft totalling ?500, and eight offences of false accounting to conceal thefts, totalling ?745. (Community Care, 2007)

People with learning disabilities can suffer abuse in a care setting by losing there right to freedom of movement. (Article 2) As a care inspection carried out in supported living found that staff were unaware that it was unlawful to detain people against their will. The staff, rather than the residents held the keys, which meant residents could not lock their bedroom doors. Staff locked internal and external doors to restrict movement, preventing people from freely entering and leaving and restricting access to communal areas, which they had the right to enter into. (Healthcare Commission, 2006)

However, The Regulation of Care (Scotland) Act 2001 has ensured a system of care regulation in Scotland. The purpose of the Act is to provide greater protection for people requiring care services. The National Care Commission is required by the Act to regulate these care services. By registering and inspecting services against a set of National Care Standards. The standards outline the quality of service that care users have the right to expect. They have been developed with the purpose that the quality of care provided and received throughout Scotland will be consistent. The standards also ensure that all care services will be measured against the general principles of Privacy; Choice; Safety; Realising Potential; Equality and Diversity. (NCSC, 2003) ) This ensures that all people are “safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory, abuse or self-harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance.”(NCSC, 2003) If these standards are not being met, then people have the right to complain with no fear of victimisation or repercussion.

As Marcia Ramsay, Director of Adult Services states ” We are tough on poor practice and use enforcement action when necessary, including closing some services. (As cited on Care Commission.com).

However there are limitations within the Care Commission. In that the care standards are not laws, they are just guidelines that the care commission uses in inspections. Poor practice is not always picked up in care settings when the care commission carries out inspections. What about people who cannot communicate to complain or who might not understand what represents poor practice?

People with learning disabilities face a higher risk of sexual assault, rape and domestic violence than the general population. These crimes are regularly committed in care settings by the very people who are meant to be caring for them. Breaching the persons human right to liberty and security and the right to freedom from exploitation, violence and abuse; (Article 5) (Crime and Abuse, 2007)

The Healthcare Commission reported a case of rape and allegations of sexual assault. The judge described the betrayal of trust when he sentenced Peter Clark to six years in prison. Clark was employed to care for a woman in her 40’s who had severe learning disabilities and a mental age of two years. The sexual abuse carried out by Clark was even more unforgivable as Clark had known that she had already been the victim of sexual abuse by a previous carer. (Healthcare Commission, 2007)

All staff in the care sector are now required to be registered with the Scottish Services Care Council and are unable to work if they are not registered. The Scottish Social Services Council (SSSC) is responsible for registering people who work in the social services and regulating their education and training. Its role is to increase the protection of people who use social services, to raise standards of practice and to increase public confidence in the sector. When a social service worker applies to register with the SSSC, they must agree to abide by the Code of Practice for Social Service Workers, which sets out the conduct expected of social service workers and informs people who use social services and the public about the standards they can expect. The Code supports the human rights of people who use care services. (SSSC,2009)

The SSSC can investigate the conduct of registered social service workers. When an allegation of misconduct comes to the attention of the SSSC, it will consider whether there is an issue about a social service worker’s suitability to remain on the register. If serious misconduct has been found the SSSC publishes information to prevent people deemed unfit to look after vulnerable people from ever gaining employment in another area of the U.K. As The Scottish Social Services Council state in their code of practise “Checking criminal records, relevant registers and indexes and assessing whether people are capable of carrying out the duties of the job they have been selected for before confirming appointments”(SSSC,2009)

However the limitation of the SSSC is that some cases of misconduct might not come to their attention, as people with learning disabilities are dependent on paid or unpaid carers and might not report abuse or misconduct through fear of not receiving care. Also some members of staff might not report misconduct through fear of victimisation or repercussion. It does not prevent abuse, as misconduct can still occur in situations where carers are not registered.

An important step in protecting human rights for people with disabilities is to inform them about the nature of their rights. As people who do not know their rights or understand they have rights are more vulnerable to having them abused and cannot speak up for them selves to complain. (Flowers 1998).

One way of promoting human rights for people with learning disabilities is through advocacy. Which is ‘the representation of service users’ interests in order to improve their situation’ (Thomas and Pierson 1996:11). Advocacy can help can people with learning disabilities be heard by giving a voice to people who would not be able to stand up for themselves. As people with learning disabilities can be ignored if they have difficulty in communicating their views or opinions, leading to them becoming marginalized and socially excluded. If people are powerless at making decisions over what happens in their lives, they can suffer learned helplessness that will impact how they live their lives. Therefore advocacy is a tool than can ensure that people with learning disabilities have a means of gaining the same life opportunities as others in society. The advocate can help the person with learning disabilities achieve equality in society by promoting and helping the person speak up for their human rights.(Thomas, 2003)

However advocacy can have limitations for promoting human rights. Many older people remember being punished if they spoke up for themselves from the past when they were institutionalised and could still scared of speaking up now. Many people also fear services being withdrawn if they try to complain, so might not want to impose. Some people with autistic spectrum disorder do not like interaction and might not talk to an advocate, just to avoid them.

Another way of promoting human rights for people with learning disabilities is to let people take control of their lives by allowing them to make their own choices about how they want to live their lives. As Barber (1996) states that people need to experience feeling in control if they want to achieve a successful outcome in their life. (Thomas, 2003)

A method that allows people with disabilities to achieve equality and lead a fulfilling live is through Personalisation of service provision. ‘Valuing people 2001’ is the Governments strategy for implementing Rights, Independence, Choice and Inclusion through personalisation. By delivering public services in a way that gives people using that service more choice, responsibility and control in relation to the service they receive. Personalisation means thinking about public services and social care in an entirely different way. (SCIE ,2008)

The traditional methods of service provision operated around the individual receiving the service, with health and social care professionals making all the decisions on the type of support the individual received. The traditional model was disempowering to people with learning disabilities as it focused on the persons medical problems, ignoring the qualities of the person as human being. (JFK, 2006)

Personalisation starts with the person rather than the service, reinforcing the idea that the person with learning disabilities knows best. They can be responsible for themselves and make their own decisions about what they require and should be given the information and support to enable them to do so, through direct payments, individual budgets and self directed support. (Stalker and Campbell, 1998)

One of the goals of personalisation is independent living, which means “having choice and control over the assistance and/or equipment needed to go about your daily life having equal access to housing, transport and mobility, health, employment and education and training opportunities” (ODI, 2008)

However there are limitations to personalisation. The philosophy behind personalisation sounds good in theory. However people with learning disabilities have different needs in comparison to other service users such as the elderly or mental health patients. The Government has just used personalisation as a broad term that will fit everyone.

The other problem with personalisation is the time period it takes to implement, in allow everybody to improve his or her life chances through personalisation. As the Government states in the ‘Improving the Life Chances of Disabled People 2005’ that they hoped to achieve pesonalisation for all people in Britain by 2025. (ODI, 2008)

In conclusion people with learning disabilities have historically suffered from social inclusion, discrimination and being marginalised resulting from legislation and policies from the past. However the Human Rights Act 1998 has given people with learning disabilities the right to live as an equal citizen through legislation that entitles them to the right to freedom (Article 8) the right for private and family life (article12) right to protection of property and person (Article 3) and the right to life through healthcare (article 2) Services have come far in enabling people with disabilities to live fulfilling lives. Personalisation has allowed people to make choices and decide which services they would to need to live the life they want. This has given people greater freedom and enabled them to be empowered.

However although everyone is entitled to healthcare in the U.K and it is their right to receive treatment. People with learning disabilities are still being excluded, discriminated and marginalized in this area, with health professional’s breaching human rights of people through lack of knowledge and understanding of learning disabilities and lack of knowledge about legislation.

People with learning disabilities are still being victimized and abused because of their disability leading to vulnerability. The Care Commission has ensured that all cares services are regulated to prevent abuse and ensure human rights are not breached. The Scottish Social Services Council code of conduct allows for human rights, through registering of staff, training and making sure severe case of abuse and misconduct from care staff never happen to people with learning disabilities by gathering formation about offenders to make sure they never work with vulnerable people ever again.

Human rights have come far in enabling people with learning to lead lives as equal citizens giving them dignity, freedom, equality, solidarity, citizen rights and justice. Nevertheless although human rights are the law and must be abided, people with learning disabilities are still having their human rights breached through lack of respect, ignorance and prejudice. Suggesting there is still along way to go before everyone with a learning disability enjoys the life they are entitled to.

This chapter first identifies groups or clusters who would be particularly vulnerable educationally in an emergency. This does not catalogue all vulnerabilities in these groups, but tries to restrict it to existing disadvantage which may be exacerbated by emergency or new vulnerabilities created by disaster. It then looks at ‘educational sites’ which are also vulnerable in themselves, or which might contribute to vulnerability. It draws attention to the intersection of multiple vulnerabilities, but also signals the notion of emergency as an opportunity. The chapter also draws attention to hidden or forgotten emergencies.

3.1.1 Gender-related disadvantage

It would be commonly agreed that girls as a broad category are at greater risk during an emergency, because of traditional gender disadvantage. ‘Normal’ patriarchal cultures are strengthened during emergencies, as people seek comfort in routine relations, roles and hierarchies. If girls are routinely left without access to education, this is unlikely to change. Afghanistan, for example, is traditionally seen as a site of educational difficulties for girls (although in Kabul they currently attend schools and projects freely). The links of gender disadvantage with poverty and economic vulnerability are well documented (Mujahid-Mukhtar, 2008). Cultural barriers often cited are limited roles for girls and women, differential treatment of girls in nutrition and health, men viewed as breadwinners, a male dominated education system, gender-differentiated child-rearing practices, low status of women, lack of knowledge of the social and personal benefits of education, gender stereotyping and threat of sexual violence (UNICEF, 2007).

Specific areas related to emergency in many or all countries which have been highlighted in this study would be:

Early marriage (girls are pushed into marriage because of fragile and insecure situations, increased poverty, death of bread-winning relatives, and therefore they leave school). After war, there are fewer men, so girls are pushed into polygamous marriages (as in Afghanistan), but conversely, therefore, men are forced to accept more than one wife. Older people have not adapted their norms to accept single unattached women, as in other post-conflict locations

Child labour (sons recruited in conflict, the need to work, displacement causing vulnerability to be incorporated into trafficking and sex trade). Domestic labour, normally girls, is often not viewed as ‘child labour’ although this can prevent school attendance.
Boys are more likely to receive kits and educational materials because of ‘normal’ male preference in and out of schools (interview data, Nepal).

Protectionism/lack of independence. In the context of the tsunami, in the Maldives secondary schools do not exist on every island, and parents may be reluctant to send their daughters to neighboring islands for fear of pregnancy and also fear of sexual abuse
Abuse. Sexual abuse, rape, gang rape and physical abuse all get worse in the camps and in situations of emergency with the breakdown of law and order and lack of supervision. Men experiencing loss of status are more likely to engage in domestic violence.

Trafficking for prostitution increases, particularly post-emergency when police or security force protection is withdrawn (interview data, Nepal). During conflict, boys may be recruited or taken for enforced labour. Kidnapping and abduction are a threat as well as trafficking.

Religious taboos and misinformation. Oxfam reported that in some cases in the tsunami the heavy and voluminous clothing worn by Muslim women and the cultural barriers that prevent girls from learning to swim contributed to the death by drowning of many women and girls. The same clothing also restricted some women from running to high places or from climbing trees. Anecdotal evidence suggests that many men survived by doing just this. There are reports from many of the tsunami-affected countries of Muslim women who perished because they were too afraid to leave their home with their head uncovered. Conversely, in some cases the waves were so strong that women were stripped of their clothing and there are reports of naked women refusing to climb into rescue boats manned by males from their villages (Pittaway et al., 2007).
Marginalization of females during humanitarian and reconstruction efforts after the tsunami, with lack of consultation about needs and with response efforts almost exclusively headed by male staff. Refuges and camps often showed little regard for women’s health, safety and privacy.

However, gender-related disadvantage does not always mean girls come off worst: in conflict, boys may be more likely to be recruited as child soldiers, and hence lose schooling; in economic difficulties caused by disaster, they may be taken out of school because they have greater earning power. Conversely, there is evidence from Nepal that females joining insurgent groups (e.g. Maoists) may experience higher status there and participation in decision making, and that in this sense, conflict has increased rather than decreased female status. Much depends on their role, whether combatants, supporters or dependents (Plan, 2008a). While an ex-combatant woman may enjoy a more equal status within a relationship or marriage with another ex-combatant, when an unmarried woman otherwise wants to return to her family or community she is a seen as ‘spoiled’, as she would not have been protected in the same way as non-combatants growing up in traditional or conservative cultures.

3.1.2 Internally Displaced Persons (IDPs) and refugees

While these groups which can be caused by an emergency are clearly vulnerable generally, there is sometimes a difference relative to other groupings in that they are identifiable, and that they receive help. In some countries, those formally identified as IDPs may be the more fortunate ones, as they can claim assistance, including educational support. They are visible in the camps, whereas the ‘lone IDPs’ who are fleeing a personal emergency, or who do not have the political knowledge to claim official IDP status, can suffer problems of discrimination or exclusion in a new community. IDPs may not want to, or be unable to, return to their own communities, and have resettled: at what point do they cease to be IDPs, especially in normally nomadic societies where there is much seasonal migration for work?

Specific issues relating to education and emergency are:

Internal displacement exposes children to forced military recruitment; they may become direct targets in the conflict or be subject to unequal or biased educational service provision (Sri Lanka).

Refugees suddenly become a minority, with loss of status and position; there is lack of choice, including educational choice. Afghan refugees in Pakistan complain that they are given very little choice about where to live – the camps nearer Afghanistan cannot guarantee security, and food or shelter cannot be guaranteed in Peshawar. There are the well-documented issues of language and curriculum of their new schools, as well as problems of ‘return’. Afghan refugees in Pakistan for example are now being sent back, causing a highly uncertain situation for them with all this movement.
There is pressure on remaining schools after an emergency to accept more children, which means larger classes, therefore a decrease in quality and in drop-out for all children. ‘Hosting’ refugees amounts to an education emergency in affected communities, with jealousies and feelings that incomers drain resources or hold ‘our’ children back. Refugees may have services that the surrounding communities lack.
Children and families may move several times before settling in one place where they could stay more than six months. If they go to school, children drop out continuously when they cannot keep up or catch up. Older children may be forced to learn with younger children, to match their perceived learning levels, which cause distress and a lack of self-esteem. Security in the camps is a problem (see above), as is health, for example with cholera in Pakistan.
Relocated communities in the tsunami can suffer: in Sri Lanka, various buffer zones in the coastal areas were established to impose limits on where people could live after the tsunami, but some were far from the sea, and parents tend not to send children to school in these circumstances, as this could show acceptance of the unsatisfactory situation.
Refugee and IDP children may be more subject to abuse and trafficking; children living with ‘host’ families are more likely to be abused.
There can be drug and alcohol problems of parents (and children) in IDP camps.

3.1.3 Minority groups/caste/ethnicity

In all countries there are pre-existing patterns of social stratification based on ethnicity, caste, tribe or clan. These are highly linked to social class and socio-economic status. Emergencies will tend to mean that low status groups are further disadvantaged or discriminated against, as power to attract resources is not evenly distributed. Conflict may be between different ethnic groups, or with a majority group and there is rarely a win–win resolution of the conflict; even if the conflict is not directly related to ethnic or other status, as in natural disasters, the lack of capacity to claim rights and resources post-conflict means more polarization. Areas under conflict may find it more difficult to respond to natural disasters, as has been reported for reconstruction after the tsunami in LTTE-controlled areas of Sri Lanka. Recommendations for action suggest projects focusing on a specific group, e.g. safe play areas for children from a specific ethnic group, or education facilities for a specific religious group (Save the Children, 2008a), although there is a danger of focusing, say, on one caste which may cause attitudes to that group to harden.

3.1.4 Economically disadvantaged

Poverty on its own is not always a predictor of vulnerability, and clearly combines with other axes of disadvantage. Emergencies will highlight these. While homelessness in disasters can affect families in every economic stratum, their social capital becomes crucial, as does the network of relatives and friends who can provide support.

The poor are likely to have poorer quality housing, in poorer or lower lying land (or conversely in steep hills) which does not withstand floods, cyclones or earthquake; therefore they can be displaced or live in the open not near to a school. Animals too are not protected, and subject to loss. Food shortages are made worse by emergency, and may mean migration to urban areas to find work.
Rural children are more likely to be out of school, particularly when poor; natural disasters may mean that distances to the nearest school become even greater.
The rapid recent increase in food prices in Bangladesh and elsewhere has had an impact on school attendance, both because children have become hungry and less attentive and because parents have been less able to meet educational expenses. Parents have also been forced to cut back on the use of kerosene for night lighting thereby reducing the evening study period for students (Raihan, 2008).

3.1.5 The invisible

Children without a formal identity (estimated to be 50 million globally) are never registered and there-fore deprived of access to education. In emergencies, they have no claim to resources or proof of age when relocating. It is more difficult to resist recruitment into insurgent or security forces. Children of different ethnic groups may be deprived of nationality and identity.

Street children may come under the category of invisible, as they are harder to track and monitor, and also may not be in formal school. However, there is a debate as to whether they are particularly vulnerable during emergencies, as they are used to surviving, and have personal and social resources which the newly homeless do not have.
The out-of-school by definition tends to be more invisible. They are more vulnerable during emergencies, since, as in Sri Lanka, most of the educational and emergency provisions utilize schools, and the out-of-school tends to be invisible among service providers. The turning away of children in Afghanistan from orphanages, schools or projects can precipitate them being involved in the sex trade, as dancers or working with truck drivers.

3.1.6 Differently affected

This is a broad category of children who are differentially affected by emergency, or who have pre-existing conditions which may be exacerbated by emergency:

Those with disabilities. Those with physical and mental disabilities are less likely to survive a disaster. Special facilities or education are not always prioritized during emergencies. Schools that refuse to take children with disabilities in ‘normal’ times are even less likely to accept them after an emergency. Children may have been injured by landmines, and all need landmine education.
Traumatized children. Children experiencing conflict and witnessing the violent death of relatives and friends suffer a range of traumatic conditions. Children were scared of going back to schools after the tsunami, and even after four years were reported to be ‘very jumpy’ and emotionally unstable at school.
Orphans, especially where there is lack of social welfare support. Absence of orphanages may be a problem, or conversely orphanages may be a site for abuse or trafficking of children. Agencies such as UNICEF and World Education may be against the institutionalization of children, including orphans, and there can be lack of integration mechanisms and support.
Child-headed households. The child can be of either sex, but additional responsibilities (economic and caring) mean such children are unlikely to go to school.
Child soldiers and ex-combatants. Such children have not just lost schooling, but may be traumatized as well as stigmatized on their return. They may be placed in classes inappropriate to their age.
Drug users (living in badly bombed buildings in Kabul, for example). In the Maldives, there is strong social stigma against drugs and children will be expelled from school if caught with them. There are few rehabilitation centers or organizations to help them.
School failures. Those who were failures before an emergency often use the crisis as an excuse to drop out of school.
War children or ‘lost generation’ need to ‘catch up’ within rigid school systems which make this impossible. They may be jealous of the younger generation whose education was not disrupted, and fear the future.
Children in conflict zones. There may be security checkpoints preventing access to school (also for their teachers) and/or danger of mines.
Children of prisoners (criminal or political). These may suffer low esteem as well as economic hardship.
Children in detention centers and prisons themselves. UNESCO runs a de-institutionalization project in Afghanistan, which also includes children in and from orphanages.
Children of sex workers.
Children of the HIV affected and from homes where there are diseases such as leprosy.

3.2 Educational sites and personnel

Schools were destroyed. Schools (and colleges) can collapse in an earthquake and a hurricane in the worst case with students and teachers are still in them. In most of Nepal, a non- architectural and designing phase the presented seismic safety measures. National Society for Earthquake Technology (NSET) with a modification or restructuring of the school program, but can reach only a few.

But in the actual school vulnerability of particular importance is the contract and the corruption of the materials used to make it easier to make the collapse of natural disasters to the schools. Do not let this corruption in Pakistan and China, is going on the list, and this sustained after a disaster or even. In Bangladesh, which has been identified (interview), “build back on the poor “instead of” build back better.” In China, the authorities have also asked the parents did not cause to complain about the building to ensure the death or injury of their children and financial incentives for them. Poor building standards of experience, but also on their return folded the school itself forms to create an emergency (Harber 2005) anxiety in the child and parents.

Schools as a refuge or a takeover of the internally displaced, disrupting education.

Built schools or on the ground that the social distance is an issue, renovated. If the site is in this sense are people died as a cemetery, still popular. As one respondent said: “The school is a graveyard it.”

Children do not go to school for fear of appearing recruited into armed groups, or to go on the road.

In the Maldives, an island, when the school was destroyed, and it was reported that sometimes reluctant to take on children in other islands of the school, while others welcome.

Child labor and domestic workers in their own home or in someone’s home is difficult to adapt to the standard items or in school. Older children can be destructive, is considered “cute” employees.

Temporary schools (even permanent) can move the missing girls and teachers sanitation special.

To form an important topic in the vulnerability of certain groups, the maintenance management systems and school officials. These are usually male-dominated groups, at least moderately high caste and socio – economic status. You are likely to be, during and after CIES EMERGEN the same group, it may be necessary to change the mindset so that they meet for the child or to seek an appropriate school concept. Now the question is, what incentives could make them to change this mindset. How can teacher’s high caste be persuaded to teach low caste children and interact? How can the person who convinced for the school management committee has been grant equitable distribution? One study examined community-based education system in Nepal, that the use of community based school improvement plan to bring elite processes, the process of creating incentives and equity. Strategy of “education” untouchables girls the opportunity to the majority of the population are less willing to tolerate a direct attack, but would under the heading (Gardner and Subrahmanian, 2005) to agree.

3.3 Multiple vulnerabilities

Although it is possible to a certain group or website, as can be seen above, two important questions are immediately clear: First, within and between the clusters they intersect in various ways, secondly , therefore it is difficult to around the “disadvantaged” or even draw “the most vulnerable” limit. It is commented on how to report in India, even if it is taken out of the equation of sex , the majority of the population is at risk. Caste is said to individual well over 50 % of the population affected , although there are exceptions, generally poor Dalits , disenfranchised , less educated , more abused . The vast majority of the population to be at risk if they are fragile along a parameter, they are more likely to have multiple vulnerabilities . Everyone has a different vulnerability so-called beam ” (Fluke, 2007), from a political, economic, social and ideological complex interactions. Practice of:

The third complex is the time – when they begin and end with emergencies (if they do), for those in danger? Vulnerable orphans temporarily take care of a family, but later at a loss and abandonment and exploitation of resources. Vulnerability often associated with children (Zelizer, 1994), perceived social “value” to work in practice or emergency emotionally as the context “victim”. This can dramatically change the changing social and economic priorities. Schools can a neutral body to maintain and improve the child’s “value” when their environment is sensitive.

Uusitalo 1985 asserted that a commonly discussed point about state welfare is its ability to redistribute wealth. However, there are other commentators who do not agree with this assertion and feel that State Welfare (SW) has failed to redistribute wealth and create equality (Miller, 1994; Clegg, 2010; Osborne 2010; Grice, 2009). SW was instituted to, in a way, give basic human rights such as the right to education, health, social services, housing and social security. It was therefore imperative that all individuals had access to it and were treated equally by the system.

Thane (2010) asserts that although UK is perceived to be an accommodating society, inequity and prejudice has long existed in the country. Legislative Acts such as the Discrimination Act 1995, Equality Act 2010 and the UN Convention on Rights of Persons with Disabilities legally give disabled people civil rights, yet disabled people remain at a disadvantage. Massie (2007) claims that disabled people of working age are still living below the relative poverty level. This is affirmed by disabled activists such as Mike Oliver, Colin Barnes and others (Barnes, 1981; Oliver and Barnes 1991). It is alleged that SW has not only failed to ensure disabled people’s basic human rights but it has also infringed and diminished some of these rights.

This essay will examine the assertion, first by defining what State Welfare (SW) is. Second, it will briefly discuss the theory and history of SW in the United Kingdom and critically examine how SW has enabled disabled people to exercise their rights, especially in recent times, through Independent Living, Direct Payments and Basic Income. Third, it will examine the Human Rights Act 1998 and the UN Convention on Rights of Persons with Disabilities in the light of Human Rights principles. Fourth, it will explore how SW has infringed on the rights of individuals relative to education, housing, employment, health and social security. Last but in no means the least; it will highlight the role of professionals in perpetuating dependency, and discuss the role of the Disabled People’s movement in challenging SW provision and developing alternative policies and services to remove disabling barriers. It will conclude by drawing the arguments together relative to the question.

Definition of Welfare

Academicians, historians and social commentators have all attempted to define State Welfare (SW). Lowe (1993) however, purports that there is no formal definition of the term State Welfare. Wedderburn (1965) defines SW as a government obligation of some level which alters demand and supply to ensure fair income distribution. Lowe (2005) has also defined SW as not just a case of providing an isolated human service but a community where the state embraces accountability for the well-being of everybody. The Cambridge dictionary (2011) has described it as a form of tax collection that allows the state to provide basic human rights such as health, social security etcetera to those who require it.

Briggs (1961) contextualizes SW by arguing that the state uses its’ sovereignty to manipulate demand and supply for labour in three ways. The first is to make sure people receive a basic income regardless of the price of their labour or amount of their assets. The second is to minimise uncertainty by meeting people’s basic needs to alleviate social deprivation and the third is to give people access to good quality services regardless of their social standing. While Marshall (1950) purports that welfare rights and social citizenship are closely connected, rendering SW worthless without welfare rights. Esping-Anderson (1990) also points out that social citizenship is made up of the essential notion of SW.

Theories of State Welfare

State Welfare (SW) does not exist on its’ own, like any other system it is underpinned by various theories. O’Brien and Penna (1998) explain that theories are not intellectual concepts taken out of this world but ideas which give guidance and explains behaviour. SW in United Kingdom (UK) is underpinned by four main theories and they are as follow:

Liberalism

Liberalism takes the view that individuals should support themselves with the state interfering only when they are not able to do so. Gray (1989), a proponent of pluralist liberalism, maintains that there are different kinds of liberals. Firstly, there are those who take individualism to the extreme and rely on themselves alone, with the state intervening only when it comes to their freedom. Secondly, there are those who although are dedicated to their freedom, do not mind communal plans for socio-political progression. Finally, there are those who also see any state interference as evil. Liberals are said to have created the basics of SW (Clegg, 2011).

Marxism

Karl Marx and Friedrich Engels wrote their work during the 19th Century. Marxism concerns itself with materialism. Marx and Engels argued that the antagonism among social classes lead to social change, which finally culminates into capitalism: the common ‘evil’ predominant in today’s socio-economic structures. They see capitalism as ‘evil’ because they hold the opinion that it promotes oppression where the working class are exploited by the ruling class – bourgeoisie (Avineri, 1968 pg 3). The tradition of Marxism does not promote the view of SW as fundamentally the Marxist does not view welfare as the way forward for changing inequalities. (Esping-Anderson, 1998).

Neo-Liberalism

Neo-liberalism is an ideology that sustains an ethical and rational stand for capitalism. It associates itself with economics, social behaviour and social interactions (Thorsen and Lie, 2009). The Neo-liberalists promote the idea of cutting down state debts, reducing state support, changing tax legislation to widen the tax network, getting rid of pegged exchange rates, globalising markets to trade by limiting economic policies that restrict trading among countries, promoting privatisation, private ownership and supporting deregulation. Plant (2010) asserts that Neo-liberalism has produced an open market where the state has ultimate power.

Conservatism

Conservatism is a belief in organisations and traditions that have developed over the years and have shown to be on-going and stable. The term was devised after the 1833 Reform Act by the Tory Party when they changed their name to Conservative Party. The term has origins in Edmund Burke’s 1790 thinking on the French Revolution (Thompson, 2011). The ideology was based on preserving tradition such as the royal family, the church and social classes. Welfare is not paramount on the Conservative agenda as they believe in work, family and patriotism.

History of Welfare

Whelan (2007) states that welfare for the disadvantaged goes a long way back in British history, with individuals and charities such as churches running schools to educate children and charities meeting the housing needs of the working class. The idea behind these benevolent acts was to relieve the social conditions that industrialisation had created (Head, 2009). Poor Laws were one of the first legislations instituted in 1598 to assist the poor and the disabled in the UK by the Elizabethan government (Slack, 1990). The Victorian government continued to uphold these laws, but in the 1900s life became difficult for the working class such that it compelled the liberal government to introduce various reforms from 1906 to 1914.

Some historians’ claim, that state welfare (SW) developed from the 1601 Poor laws (Thane and Whiteside, 2009). Lowe (1993) asserts that the term SW was created in the 1930s, having first been used derogatorily in Germany to describe the Weimar Republic (Lowe, 1993; Gough, 2005). Weimer was a central city southwest of Germany and the first to be associated with SW (Harsch, 1999). In the UK in 1940, during the leadership of Winston Churchill, the conservative government became concerned about the Second World War returnee soldiers and their reliance on the state to earn meaningful living. In view of this, Sir William Beveridge was tasked with examining the already established National insurance schemes. He produced a report which was to establish SW. The key message in his report was the five ‘giant evils’ which were namely: Want (representing poverty); Disease (health), Ignorance (lack of education); Idleness (unemployment) and Squalor (housing) (Timmins, 2001).

The Beveridge report, 1942, brought changes to education that was laudable, such as promoting education for all (Batterson, 1999). This subsequently led to the enactment of The 1944 Education Act which was based on the Education Act 1870 that offered free education to all children in the country. Through the 1944 Education Act, the government intended to give children an equal chance in education by creating three types of schools: secondary modern, grammar and technical schools. Children were select into various school based on the individual ability (Batterson, 1999).

Beveridge’s report was influential and caused the government to start dealing with poverty and instituted constructive measures that resulted in introduction of universal benefits like The 1945 Family Allowance Act (Pleuger, No Date). This act allowed all families in Britain to receive weekly allowances for their children who were under 16 years, regardless of their financial or social status. Subsequently, other systems were introduced such as the National Insurance system that allowed contributing claimants to claim cash benefits from it. The National Assistance Act was next introduced in 1948 and it provided assistance to anybody who needed help or was not covered by other benefits. That same year the National Health Service (NHS) was also introduced and it provided universal health services. Mandated by the 1946 National Health Service Act, NHS operated on the following values: free care, free for all with clinical needs and not based on the ability to pay (BBC, 1998). However, this situation changed in 1951 when NHS started charging for dental treatment and prescriptions.

Beveridge’s report also touched on housing issues. There was shortage of houses after the World War II causing people to live in squalor, but between 1950 and 1955 the government tackled this problem by financing local authorities to build council houses for low income families (Burnett, 1987) The housing shortages compelled the government to take measures to alleviate severity by nationalising utility companies as part of the programme to control living expenses. Thirty years after Beveridge’s ‘From Cradle to Grave’ report, SW became a permanent part of British society. The economy however took a turn for the worse with high inflation and unemployment. People were ever more reliant on SW and there were calls for a change. (Devine, 2006)

Political power changed hands and Margaret Thatcher became Prime Minister in 1979. Mrs Thatcher was of the persuasion that individuals should take care of themselves instead of paying high taxes to support public services like the NHS. Hills (1998), maintains that the Thatcher government emphasised on four things: denationalizing, targeting, disparity and cutting public expenditure. Thatcherism as it was called introduced some far-reaching ideas that produced means testing, selective welfare and privatisation of public services (Glendinning, 1991 ; Hills, 1998). The ‘Right to Buy’ scheme, for instance, encouraged council tenants to buy their homes. All these policies reinforced belief in self-reliance rather than on state ‘hand outs’.

By 1997 Britain wanted a fresh pair of eyes after 18 years under the conservative government. Labour reinvented itself as New Labour with Tony Blair as Prime Minister. He introduced New Labour, announcing the discovery of the Third Way (Walker, 1998). New Labour believed that the route out of poverty was through work and therefore constructed SW on jobs for the ‘able’ and protection for those who were ‘unable’. Hills (1998, pg23) poses the question: ‘is New Labour any different?’ The answer is yes and no as New Labour was seen to have combined conservative ideas of cutting public spending married with a New Labour priority on education. New Labour presented a slightly modified SW as compared to the previous government, the Conservative. They did not however escape criticism, which led to their defeat in 2010.

A Coalition government has been formed and the conservatives and liberal democrats have put their heads together to lead Britain. Their aim is to reduce the state fiscal deficit by cutting public expenditure yet again. The theme for SW reform is making work pay (Turner, 2011). Disability Alliance (2010) has indicated that their organisation is worried about what the coalition reforms mean to disabled people. This is similar to the 1980s, where disabled people faced cuts in welfare benefits, restricted access to work and access to unemployment benefit taken away completely (Glendinning, 1991; Hills, 1998). The Coalition government refers to this change as a move to a ‘big society’ primarily aim to relinquish some of its responsibilities and to give individuals and communities control of services (Sutton, 2011). Reformist Frank Field supports this goal, maintaining that similar arrangements were in place during the 1800s (Sutton, 2011).

Human Rights

The right to health care, education, housing, income maintenance and social services are all fundamental human rights found in state welfare (SW). The United Nations define human rights as an individual constitutional right that should be enjoyed regardless of whom you are and where you are in this world. Each and every one is allowed to have access to these rights without prejudice (United Nations Human Rights, 2011). Amnesty International (2011) define human rights as rudimentary privileges which should be enjoyed by everybody irrespective of whom they are, where they come from, which skin colour they are, and irrespective of their gender, faith, linguistic background or standing. The British Institute of Human Rights (2006) posits that the fundamental human rights are fairness, equality, dignity and respect.

The term human rights was recently coined, but the concept has roots in medieval times. Ishay (2004) asserts that development of the human rights concept has many accounts. Some accounts have said Kings ruled their subjects in such degrading ways because they felt they had the God-given rights to do so. This led people to develop ‘man’ rights to combat the God given rights. Others indicate that the Quran, the Bible and eastern world teachings have all contributed to the development of human rights (Ishay, 2004). Subrahmanyam (2011) also purports that political struggles such as Liberalism, Marxism, Socialism, etc. have all contributed to creation of human rights.

After the genocide committed by Adolf Hitler and his government during World War II, the United Nations General Assembly created the Universal Declaration of Human Rights (UDHR) to prevent that kind of abuse from ever happening again. The UDHR document has become the backbone of many treaties and human rights laws all over the world (Bailey, 2011). Gleeson (2011) asserts that this document was used by the Council of Europe to implement the European Convention on Human Rights (ECHR) in 1953 to safeguard human rights and basic liberties in Europe.

The European Court of Human Rights was also implemented by this convention and anybody who feels their rights have been abused can take their case to this court. Britain joined the convention 1951 even though it was not until 2nd October 2000 before the convention became part of the laws in UK (Jepson, 2004). Another recent treaty is the UN Convention on the Rights of Persons with Disabilities (UNCRPD) which was signed by UK in 2008.

State Welfare enabling Disabled People to exercise their Rights

There have been many policies and laws for disabled people since the establishment of state welfare (SW) in 1945 which have enabled disabled people to exercise their rights. Bracking (1993) states that disabled people’s lives have been transformed since 1939, when disabled people started to speak for themselves. Thornes et al (2000) maintain that there have been four areas of care for disabled people since the establishment of SW. The provision of residential homes, National Health Service (NHS) care, educational services and income maintenance.

There have also been several laws that have assisted disabled people in exercising their rights. The Chronically Sick and Disabled Person’s Act 1970, for instance, was an important law which came to empower disabled people. Through this legislation councils gained authority to provide care, homes and support to people in the community. It also gave disabled people the same rights to leisure and academic services (BBC News, 2010). The Seebohm Report (1968) recommendations also led to the enactment of the Local Authority Act 1970 which gave local authorities the right to set up community care.

The Education Act 1944 recommended that disabled children should school alongside their non-disabled peers (Barnes, 1991). The Warnock Report influenced the 1981 Education Act by recommending that disabled children be educated with their non-disabled peers. The Special Educational Needs Act 2001 gave disabled children, parents and carers the right to be educated in mainstream schools if reasonable adjustment could be made. The Employment Act 1994 made working easier for disabled people even though the quota system did help employers to discriminate against disabled people (Barnes, 1991).

The 1948 National Assistance Act gave assistance and support to people in need and replaced the Poor Law. It also gave local authorities the duty to provide community care services for the sick, disabled, the aged and other people. The 1946 National Health Service provided advice, treatment and care to the nation free of charge (BBC News, 1998). The NHS and Community Care Act 1990 promoted community care which has benefited many disabled people.

The Community Care (Direct Payments) Act 1996, gave local social services the power to make cash payments, but were not effected until 2003, when it became mandatory to offer it to eligible people after assessment. This allows individuals to buy and manage their own care provision. Disabled people also have available to them the Access to Personal Files Act 1987, which gives them the freedom to access any notes or reports about them held by organisations. Access to Health Records 1986, part of the Data Protection Act, gives individuals the right to health records.

The Disability Discrimination Act 1995, which has been replaced in many respects by the Equality Act 2010, safeguards disabled people from being discriminated against in education, employment, access to goods and services, buying and renting. The Equality Duty 2006 demands that public bodies provide services that promote equality. Social security benefits have also become substantial from the humble Industrial Injuries Disablement Benefits and the War Injuries Disabilities Pension to Disability Living Allowance and Carers Allowance which supports extra cost incurred as a result of a person’s impairment. Long term sickness assistance like Income Related Employment and Support Allowance, Severe Disablement Allowance and Attendance Allowance are in place to support disabled people. Further support can be acquired through Working Tax Credit, Income Support, Pension Credit, Housing and Council Tax Benefit (DirectGov, 2011).

Self-directed care schemes like Direct Payments, Personal Budgets and Independent Living schemes also allow disabled people to access opportunities like their non-disabled peers (Barnes and Mercer 2006). Bracking (1993) affirms that Independent Living gives claimants the freedom to live on their own. Furthermore, it allows disabled people to make and be part of decision making processes. Disabled people are able to select and organise services for themselves and not rely on their local authority or other organisations to provide them. The Mobility and Blue Badge Scheme allows disabled people to buy or lease a car and give help with parking. Barnes (2004) purports that independent living can change the value of disabled people’s life.

State Welfare has diminished Rights

British Institute of Human Rights (2006) states that human rights are not simply concerned with legislation but impacts on services provided by the state like residential care, academic institutions, hospitals and support workers in disabled peoples home. Barnes and Oliver (1991) postulate that SW ‘cradle to grave’ promise of safeguarding its participant’s has not worked or else there would not be a demand for a disability discrimination law. The state has therefore not only been unsuccessful in securing disabled people’s fundamental rights, it has impinged and limited some of them. The Socialist (2010) highlights a recent case in which a disabled woman’s UN convention Rights and human rights have been ignored by being asked to wear incontinence pads instead of using a commode at night because of the cost of employing a carer. If the local authority wins this case it will have big implications for disabled people across the nation.

Federation of Disabled People (2011) purports that the Education Secretary, Michael Grove, was recently informed that not dialoguing over the idea of cutting school building schemes resulted in not considering equality concerns. Centre for Studies on Inclusive Education (CSIE) (No Date) propound that inclusive education is part of the international human rights law. Disabled people have been fighting for inclusive education since SW began and the 1944 Education Act was enacted Although it was stipulated in the Act that disabled children should be educated alongside their peers it never materialised. The Warnock Report in 1978 found that one in five children would need special educational support at one point or another during their school life. The report therefore recommended unit are created on school premises to accommodate such needs (Warnock Report, 1978).These recommendations influenced the 1981 Education Act which also asked for children to be ‘statemented’ before being placed in special schools. It furthermore, gave parents the right to appeal against their children special needs assessments. The 1981 Education Act also failed to establish inclusion, integration and accessibility breeching disabled people’s right to access educational institutions at any given time.

Rieser and Mason (1992) indicated that not much had been changed by the 1990s. Disabled children were still being educated with the medical view instead of a curriculum. This led to many completing their schooling without proper qualification (House of Commons, 1999). This breeched their right to obtain official recognition for a course they have completed. The 1993 Education Act tried to give parents more rights to appeal against decisions by the Local Education Authority (LEA) to send their child to special needs school. The Act also extended LEA’s time frames for assessing children with disability and encouraged inclusive education. Part of the subsequent 1996 Education Act identified and modified certain sections in the law allowing parents to choose if their children were to attend main stream schools.

The enactment of the Special Educational Needs and Disability Act 2001 brought disabled children close to inclusion. LEA were now under duty to provide mainstream education for children if that was the wish of their parents but this should not be to the detriment of non-disabled students (Vaughan, No Date). Disability and Equality Duty 2006 gave public services the duty to improve equality in all their services delivery. The most recent Equality Act 2010 also demands that all those providing services like education to provide fair and equal services to people.

The conceptualisation of moving towards an all inclusion option for education for people with disability has made in roads with the introduction of the Education Act (Virvan 1992). Policies and Green papers such as ‘Excellence for All Children: Meeting Special Educational Needs, 1997’ and the advancement of technology have not been able to address significantly the challenges that face disabled people in education. Johnson and Cohen (1984) suggest that challenges in the classroom, communication levels and total social inclusion are still not fully addressed leaving disabled people’s right to effective education breached.

The Office for National Statistics Labour Force Survey 2009 indicates that UK presently has 1.3 million disabled people ready and free to work. 50% of people with disability at employable age are actually employed as equated to 80% of people without disabilities. It is also noted that the type of disability also influences the figures significantly. For example, only 20% per cent of people with mental health difficulties are in work. About 23% have not got any educational credentials in comparison to nine per cent of people without disabilities. Non-disabled people get roughly ?12.30 in equation to ?11.08 that disabled people get (Shaw Trust 2011). These figures evidence the disadvantages disabled people face in employment.

Lindbeck (1996) states that Keynesian idea of full employment and Beveridge universal state welfare (SW) system stem from the same roots. In Britain for instance, the government’s committed to providing employment, universal state welfare and well-being to its citizens but disabled people had less chances of being in work than their non-disabled peers in the 1970’s. These figures improved in the 1980’s because a lot of non-disabled people were out of work. By the 1990’s things had become worse with 21% against 7% of non-disabled people were out of work. Fagin and Little (1984) assertion that people have dignity, sense of belonging and responsibility in working hold true. Most disabled people however, are stuck on state benefits because of unemployment and under employment situations. Where is their right to respect for their private and family life, home and correspondence if they cannot be involved in community life?

Barnes (1992) propounds that reasons given about difficulties that disabled people face in employment is out-dated and no longer acceptable. Although the 1944 Employment Act was designed to give disabled people opportunities in paid work the quota system undermined it. The Disability Discrimination Act and Equality Act 2010 were all designed to combat employer attitude and discrimination but there remain barriers like medical screening, age, education, experience, transportation, appearance and environmental factors that need to be addressed to allow the disabled person to participate actively in employment.

Berry (2010) advocates that the idea of state welfare (SW) was to eradicate divisions amongst people, but seems like the impact of the SW has made these divisions even more noticeable. He further asserts that the property division among property holders and renters is emphatic than ever. Equality Human Rights Commission EQHRC (2011) state that there are certain rights a person has in relation to housing and home ownership. One of them are to have and delight in the possession of property, but clearly owning your own home is something that most disabled people do not have the power to acquire. Derbyshire Coalition of Disabled People (DCODP) (1986) state every person has the authority to dwell in a home in any average place but critics have said this is not possible because there is lack of houses in UK more so accessible homes.

Although the 1970 Chronically Sick and Disabled Person Act requires local authorities to provide the housing needs of disabled people, most councils have sold their properties and have little stock left (BCODP, 1987). Some Local authorities have to work with other organisations to meet the housing needs of disabled people. Accommodation and supported housing are usually few and farther away from town centres, thus isolating disabled people and breaching their right to independent living. Disabled people also usually have to go through a medical assessment to get into social housing. This practice has been slammed by disabled commentators advocating that it is discriminatory (BCODP, 1987). The Housing Act 1988 did not include disabled people in purchasing council flats and houses in the 1980s. Peck (2011) submits that a lot of people with disabilities cannot get assistance to enable them avert being homeless. Those who do get housed sometimes face houses with adaptations that are not up to standard (Heywood, 2001).

State welfare (SW) amongst other things was to provide financial assistance that will relieve poverty and create social protection for all citizens. However, disabled people do not seem to have experienced this relief. Carvel (2005) asserts that three in ten disabled people who are employable are poor and this gap is widening regardless of what the state is doing to combat societal handicap. Smith (2008) advocates that the charity Leonard Cheshire Disability’s recent report reveals three million disabled people in UK in 2008 lived in relative poverty.

Palmer (No Date) states that about a third of people with disability falling between ages 25 and 65 onwards live in poor families, half of Non-disabled peoples figure. Disabled people are poor because they often do not work. Statistics indicated that about 60% of disabled people are not employable in contrast to 15% of non-disabled people (Palmer, No Date). A large percentage of disabled people are willing to work but cannot find employment. Disabled people often do not have the credentials required for working. 75% of people who are of employable age and on benefits are either ill or have a disability.

The 1988 disability survey conducted by the Office of National Statistics confirms this deprivation. The survey recognised that most disabled people rely on social security benefits, but the 1988 benefit reforms did not consider these findings and cut social security spending which in turn affected disabled people. DisabledGo (2010) advocate that Equality Human Rights Commission (EHRC) is apprehensive about the governments Work Capability Assessment test and the impact it is having on Employment Support Allowance claimants. Cooper (2010) asserts that the 2011 housing benefit reforms will make a lot of people homeless. The government’s plan to cut public spending and relieve itself of some its responsibilities will undermine schemes and programmes that support disabled people. This will inevitably corrode disabled peoples right.

The National Health Service posits that disabled people have intolerable challenges accessing their services (Department of Health, 1999) The National Health Service’s core value is to provide health care for all in UK but it is apparent this not the case. Wide spread discrimination has been reported by various organisations and the media. Brindle (2008) and Triggle (2007) submits that an official inquiry has found that NHS discriminates against people with learning difficulties. They further alleges that the main shortcoming of the NHS is the lack of knowledge in learning disability issues. Disability News Service (2009) state a recent report by Every Disabled Child Matters indicates that disabled children are being let down by the NHS despite having the resources to support them.

Aspis (2006) alleges that disabled people’s right to life is in today threatened, as medical staffs are allowed to make life and death decisions about disabled people without making clinical references. He further alleges that scientific experimentations like gene manipulation and pre-natal screening could wipe out disabled people in the not too distant future. F

The Services Available to Disabled Children
Introduction

Disability is all too often seen as a social problem i.e. it is seen either in terms of personal tragedy or of blame. Disability has been theorised in a number of different ways, most of which locate the problem in the individual rather than the broader social, political, and economic influences. This has implications not only for the location of the blame for social problems but also for the ways in which services for certain groups are delivered and accessed. All too often access to services is hindered for children with disabilities and the burden of care is left to the family (Moore, 2002). In many cases it would seem that if a child has a disability then this is seen as a matter of private concern for families. The present Government advocates a mixed economy of welfare where welfare is provided in part by the state and partly by private companies operating for profit. The shift from public to private has received much publicity and contributed to social problems and to social exclusion (Giddens, 2001).The mixed economy of care (largely as a result of the 1990 NHS and Community Care Act) has meant that access to care for children with disabilities has become problematic. Thus families who are already stretched both financially and emotionally face further stress as the result of being unable to access appropriate care and services for their child. This tends to support the view that having a child with a disability results in the family as a whole being disabled by the unjust society in which it is situated (Fazil et al, 2002)..

Within the human services great emphasis is placed on the rights of the service user, and this discourse is also evident in Government debates on social support and caring for people with disabilities. All too often however, this remains at the level of discourse and is not followed through when it comes to policy making. This assignment will therefore undertake a critical review of research into the services available to disabled children to assess whether the problem is as broad as some theorists would have us believe, and what might be done to alleviate the problems faced by families who have a child with a disability.

Research Question

What services are available to children with disabilities and what are the difficulties associated with accessing them.

Protocol

The area of interest is children with disabilities. The outcomes are what services are available and what if any difficulties might be associated with accessing those services.

Objectives
To carry out a critical review of literature to discover what services are available to children with disabilities.
To ascertain whether it might be argued that perceptions of disability might affect what services are on offer and how these might be accessed.
To assess whether parents receive accurate information from professionals
To make recommendations
Search Strategy

A broad search was undertaken of the following:

Disability and Society

Community Care

British journal of social work – Child: Care, health and development

www.doh.gov.uk/research

www.socresonline.org.uk

www.jrf.org.uk

www.leeds.ac.uk/disability-studies/archiveuk/archframe

A broad search of Taylor Francis journals and Google Scholar was also undertaken. Key word and key word phrases were, disability, family, service users, disabled children, disabled children and their access to services, access to services for disabled children, effects of disability on family life.

Part of the problem for disabled children and their families has been an over-reliance on the medical model of disability which locates the problem within the person. Inclusion discourses and debates about discrimination tend to suggest that this pathologising of children with disabilities is further extended to their families for example Bowler and Lister Brook (1997) when speaking of children with Downes Syndrome say that:

The identification of a genetic basis for Downes Syndrome led many researchers to explore the possibility that there might be behavioural phenotypes in addition to physical phenotypes that result from specific genetic abnormalities (Lister and Brook, 1997 p.13).

Clearly this is locating the problem within the child and does nothing to improve perceptions of either the disabled child or his/her family thus discriminating against the family as a unit. Most of the studies looked at in the following review, and the ones concentrated on in the analysis, report distorted perceptions of disabled children and their families. They also report that services for disabled children are not consistent nor easily accessible.

The key concepts that were present in the literature were an assumption that people have plenty of extended family support, use of formal and informal care arrangements, any difficulties in securing access to appropriate services, and the effects that having a child with disabilities has on families. Most of the research indicated that across the board service provision for children with disabilities was at best patchy and at worst lamentable and that it was this, along with perceptions of disabled children and their families that affected access to appropriate services.

The review begins with an indepth assessment of three studies in particular and then reviews the concepts generally.

Families and Children with Disabilities

Fazil et al (2002) undertook a triangulated study (i.e. one that uses both qualitative and quantitative research methods) into the circumstances of twenty Pakistani and Bangladeshi families in the West Midlands who had at least one disabled child. The aim of the research was to try and understand whether and in what ways the discrimination that these families might face was compounded due to the fact that they had a child or children with disabilities. The researchers used a combination of structured questionnaires and semi-structured interviews to obtain their results. The research focused on parents’ experiences, their use of formal services, their material circumstances, and the ways in which having a child/children with disabilities affected their lives. A significant finding of this research was that while Government discourses centre on the integration of service provision in Birmingham (where these families live) there was:

The absence of systematic services which came across most strikingly (Fazil et al, 2002,p.251)

This view is supported by research undertaken by the Audit Commission (2003) whose findings suggested that across the country, rather than the integrated and joined up services that are promised, service provision was a lottery. How much service and what kind of services offered to disabled children and their families depended very much on which part of the country they lived in.

Clearly the move to make partnership working the norm does not always succeed. Molyneux (2001)^[1] maintains that this only works when certain guidelines are established at the outset. His research into successful inter-professional working established three areas that contributed to the success of such partnerships. Staff needed to be fully committed to what they were doing and personal qualities of adaptability, flexibility and a willingness to share with others were high on the agenda. Regular and positive communication between professionals was seen as endemic to good working relationships and service delivery. This communication was enhanced (in the study) by the instigation of weekly case conferences which allowed professionals to share knowledge and experiences (2001, p.3).

Dowling and Dolan (2001) undertook secondary analysis of a qualitative study using the social model of disability as an analytical frame. Disability is usually defined too ways, as a medical model where the problem is located in the person and the social model where the problem is located in society i.e. as a social problem. The researchers found that having a disabled child in a family could marginalize the whole family who then suffered from unequal opportunities and outcomes. Through their use of the social model of disability as an analytical framework the researchers found that these families often suffered financial hardship along with stress created by social barriers, prejudice and poor service provision.

Some studies tend to suggest that much of the care that is on offer is discriminatory – that is to say it takes the view that disabled children and their parents have a tendency to be over reliant on services. This article was a summary of the work undertaken in Leicester and it did not therefore, contain the views of parents and their children. Bush (2005) is a senior manager in children’s services and in his summary of what are called ‘inclusive’ services for disabled children he points out that the services are only on offer for a short while so as to discourage over-dependence on the service. This is not to say that some of the tasks undertaken by this partnership group are not beneficial, but there is no guarantee that any of the services would be ongoing.

Fazil et al (2002) focused on the problems faced by members of two specific ethnic groups, the study was included because it was felt that the problems and feelings expressed within the study were quite representative of the feelings and experiences of many parents who have a child or children with disabilities. Although the study was very small, consisting of only twenty people, the use of both qualitative and quantitative data gave the study a breadth that it might not otherwise have had. Certainly the implications of the study were that services are difficult to access and all too often professionals make assumptions about the level of care and support that parents are able to give – these assumptions were also made in relation family support systems that the respondents may have had. The research also found that lack of support and the continuing struggle to access services and make ends meet affected parents’ views of themselves and their abilities to cope.

Bryman (2004) has this to say about the use of both quantitative and qualitative methods

It implies that the results of an investigation employing a method associated with one research strategy are cross-checked against the results of using a method associated with the other research strategy (Bryman, 2004, p.454).

All in all the study was fairly well balanced, and did not for example, appear to exaggerate parent’s fears. The use of data triangulation tends to add weight to the findings of this particular study.

Dowling and Dolan’s (2001) study tends to support the findings of Fazil et al. There appears to be a common feeling that when families have a disabled child or children then they, along with their child, are marginalised. Such marginalisation leads to stress in families and problems in accessing care. In many cases professional assumptions about these families increase the stress involved in obtaining appropriate services and care. This in turn supports the findings of Gregory (1991) that perceptions of disability and the assumption of parental responsibility has a huge impact on family relationships and on respondents’ own views of themselves as parents.

Bush’s (2005) summary of a particular project in Leicester supports the idea that parent’s of disabled children are in some way responsible. The services in Leicester operate to help parents cope with their disabled child in the short term and then the onus is placed back on parents in the long term. The project aims to prevent what it terms as an over dependence on service provision. It seems to be the case that the feelings that the parents of disabled children have expressed in other studies are generated by the kind of services that treat parents as though they are trying to shirk their responsibilities to their children. This was a very short article that briefly described the services on offer, some of which would need to be continued even though they were only provided on a short term basis, for example physiotherapy. As the author of the article states:

Each intervention is administered with the intention of ensuring that the services are short-term and discourage dependency (Bush, 2005, p.128).

This may seem overly critical of the project because until its inception two years ago many of the services that it offers were not available at all in Leicester. The fact that even now they are only available in the short term tends to support the notion that access to services for disabled children is often problematic.

Access and Attitudes in Service Provision

Case (2001) found that parents of children with learning disabilities were often dissatisfied with the professionals with whom they came into contact and when services were provided they tended to be reactive to the problem rather than proactive in solving it. Perceptions of children with disabilities, and particularly learning disabilities are often devalued by society and this devaluation is evident in poor service provision (Chappell, 1997). King et al (1997) maintain that service provision often reflects how children with disabilities are perceived by medical and social work professionals rather than the needs of an individual child. This follows the view among many researchers that the medical model of disability is still at the forefront of most professionals’ minds.

The problem … is that medical people tend to see all difficulties solely from the perspective of proposed treatments for a ‘patient’, without recognising that the individual has to weigh up whether this treatment fits into the overall economy of their life. In the past especially, doctors have been too willing to suggest medical treatment and hospitalisation, even when this would not necessarily improve the quality of life for the person concerned. Indeed, questions about the quality of life have sometimes been portrayed as something of an intrusion upon the purely medical equation. (Brisenden, 1986:176).

The medical model leads to the treatment people with disabilities as passive objects of medical attention. This view is oppressive of people with disabilities and spreads to other social relationships, it sees disability as pathological i.e. rooted in a person’s biology, and thus unchanging. Contained within this model is the perception of people with disabilities as problematic. As an adjunct to this model, disability has been theorized as a personal tragedy, which means that individuals with a disability are seen as victims.

Treating children with disabilities as victims arguably leads to their becoming almost invisible in service provision. Goble (1999 cited in Case 2001)) maintains that the needs of disabled children and their families are often not addressed because issues that are important to service users, rather than service providers, are not really considered and are under researched. Hornby (1994 cited in Case 2001) has argued that professionals often neglect to provide parents with all the information that they should have when it comes to the needs of their child. If children with disabilities are to get the correct treatment and have access to appropriate services then the parents should be fully informed.

Clearly disabled children’s access to services is hampered by social perceptions and by the perceptions that professionals have. This has resulted not only in problems accessing services, but when services are accessed they are not always appropriate to a particular service user’s needs. Research tends to focus on perceptions of disability and the disadvantage that it brings but as yet there is little evidence of what disabled children and their families actually want from service providers.

Conclusion and Possible Policy Implications

The prevalence of the medical model of health and the ways in which families are kept under-informed regarding the disability of a family member, particularly a child, affects family relationships. It also affects the attitude that professionals may take to disabled children and their families. Gregory (1991) maintains that when a person is diagnosed as ‘disabled’ this affects the ways in which society and the family respond to and deal with that person. Families themselves can tend to see the disabled family member as ‘sick’ and different. Gregory (1991) found that having a disabled family member also affected the way in which mother’s viewed themselves because ideological images of motherhood focus on having an able child. Thus a woman may feel that she is somehow not a mother because of the ways in which society defines motherhood. While doctors may diagnose a physical or learning disability families are often left to cope without either sufficient information or professional help. In a number of cases families have reported that hospitals have refused to admit non-emergency cases unless a parent or carer remains on site to provide additional support (http://www.cafamily.org.uk/rda-uk.html). A shortage of nursing staff and the increasing tendency to perform surgery on a day care basis means that many families are left with extra caring responsibilities once they take the disabled child or adult home. (http://www.cafamily.org.uk/rda-uk.html).

In conclusion it would appear from the literature that service provision is sporadic and often not appropriate to the individual needs of disabled children and their families. It might be recommended that more research is needed into what users actually want from service providers and that perhaps as one study suggested users fare much better if they are assigned a single key worker who will liase with all service providers.

Bibliography

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Bryman, A 2004 Social Research Methods Oxford, Oxford University Press

Bush, C. 2005 “Inclusive services for disabled children” Practice Vol 17 (2) pp 127-130 Routledge

Case, S. 2001 “Learning to partner, disabling conflict:”Disability and Society Vol 16 (6) pp 837-854

Coffey, A and Atkinson, P (1996) Making sense of qualitative data, Sage, London

Dalley, G. 1988 Ideologies of caring: Rethinking Community and Collectivism London, Macmillan

Dowling, M and Dolan L. 2001 “Families with children with disabilities: Inequalities and the social model” Disability and Society Vol 16 (1) Jan 1st 2001 pp. 21-35

Fazil, Q. Bywaters, P. and Ali, Z. 2002 “Disadvantage and discrimination compounded: The experience of Pakistani and Bangladeshi parents with a disabled child in the UK” Disability and Society Vol 17 (3) May 1st 2002 pp. 237-253

Gough, D and Elkbourne, D 2002 “Systematic research synthesis to inform policy, practice and democratic debate” Social Policy and Society 1 (3) pp. 225-36

Gregory, S. 1991 “Challenging Motherhood: Mothers and their deaf children” in Phoenix, A and Lloyd E, eds. 1991 Motherhood: Meaning Practices and Ideology London, Sage

Macdonald, G 2003 Using Systematic Reviews to Improve Social Care London, Social Care Institute for Excellence

Millar, J 2000 Keeping Track of Welfare Reform York, York Publishing Services for the Joseph Rowntree foundation

Molyneux, J 2001 “Interprofessional team working: What makes teams work well?” Journal of Inter-professional Care 15 (1) 2001 p.1-7

Moore, S. 2002 Social Welfare Alive 3^rd ed. Cheltenham, Nelson Thornes

Morris, J 2003 “Including all children: Finding out about the experiences of children with communication and/or cognitive impairments” Children and Society Vol 17 (5)

Oliver, P. 1990 The Politics of Disablement Basingstoke, Macmillan

Oliver, M 1996 Social Work with Disabled People Basingstoke Macmillan.

Such, E. and Walker, R. 2004 “Being responsible and responsible beings: children’s understanding of responsibility” Children and Society 18 (3) Jun 2004, pp.231-242

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1

The Disabled American Veterans is an association sanctioned by the US Congress for military disabled veterans of the US Armed Forces that helps them and their families through different means. It as of now has more than 1.2 million individuals. Charity Navigator does not rate the DAV as it is a 501(c)(4) association. It does rate the Disabled American Veterans Service Charitable Trust.

Debilitated veterans in the US in the result of World War I ended up truly impeded, with minimal legislative backing. A number of these veterans were deaf, blind, or rationally sick when they came back from the front lines. A surprising 204,000 Americans in uniform were injured amid the war. The thought to structure the Disabled American Veterans emerged at a Christmas party in 1920 facilitated by Robert Marx, a U.S. Armed force Captain who had been harmed in November 1918. Despite the fact that it had been utilitarian for a few months at that point, the Disabled American Veterans of the World War was authoritatively made on September 25, 1921, at its first National Caucus, in Ohio. While visiting over the U.S. as a major aspect of the election battle of James M. Cox, Judge Marx promoted the new association, which immediately extended. It held its first national tradition in Detroit, Michigan on June 27, 1921, at which time Marx was selected the first national administrator.

In 1922, an auxiliary women’s organization was established. The DAVWW continued working through the Great Depression to secure the welfare of disabled veterans, despite the fact that their efforts were vexed by fundraising challenges and the desire of the public to put the World War behind them. In the midst of these agitated years, DAVWW was issued by Congress federal charter, on June 17, 1932. The demands of World War II required the pressing expansion of the organization, which officially transformed its name to Disabled American Veterans to recognize the impact of the new war. In 1941, DAV propelled a direct mail campaign, distributing miniature license plates which could be joined to a key ring with instructions that lost keys should be mailed to the DAVWW, who would return them to the owners.

In 1944, the DAV started offering a National Service Training Officer Program at US University in Washington, the first venture of training that finished with a two-year mentorship program. In 1945, the DAV extended the program and accumulated the assembling house, inevitably buying complete responsibility for program in 1950. The program demonstrated dependable and very effective, both in acquiring donations and utilizing veterans in production. By 1952, 350 individuals were utilized in the endeavor, which acquired over $2 million a year in donations. In the mean time, the quantity of disabled veterans had been expanded by the as yet progressing Korean War.

The DAV suffered a decrease in the later 1950s and into the 1960s, with lessening funds and leadership; however it energized around the veterans of the Vietnam War furthermore concentrated intensely on living up to expectations for detainees of war and lost in action. Vietnam veterans soon filled the decreased ranks of the National Officers Service. On Veterans Day, 1966, the DAV moved its central command to Cold Spring, Kentucky. The accompanying year, the IdentoTag program was ceased for giving location marks, with an appeal for gift, when changes in license plate rehearses made proceeding with the IdentoTag program impracticable.

The DAV experienced generous change in 1993, when inner contentions concerning the administration of the association prompted a watershed election that turned over the organization to new hands and the National Program was redesigned. In 1998, DAV National Wilson Arthur joined with Lois Pope and for Secretary for Veterans Affairs Jesse Brown to push for congressional approval of the American Veterans Disabled for Life Memorial. When fundraising was finished in 2010, the DAV and its offshoots had raised more than $10 million for the memorial. Dedication of the memorial is situated for October 5, 2014.

This mission of DAV association is to give free proficient aid to veterans and their families in getting advantages and administration earned through military administration by the Department of Veterans Affairs (VA) and different organizations of government. It likewise gives effort concerning its program administrations to the US individuals by and large, and to disabled veterans and their families particularly. Broadening DAV’s central goal of trust into groups where these veterans and their families survive a system of state-level offices and neighborhood sections; and giving a structure through which disabled veterans can express their empathy for their kindred veterans exhaustive a variety of volunteer projects.

The Disabled American Veterans Organization gives administration for nothing out of pocket through an across the country system of 88 DAV National Service Offices. The Disability Assistance Transition Program administration give free help to administration individuals at Intake Site areas at military establishments by Disabled American Veterans Transition Service Officers with treatment records, recording introductory cases for VA profits and meet with the U.S. Division of Defense, the U.S. Bureaus of Veterans Affairs and U.S. Division of Labor facilitators and different members in the move process from military life to regular citizen life.

Numerous outreach programs like DAV’s Mobile Service Office, Veterans Information Seminars, Homeless Veterans Initiative and Disaster relief grants. The Mobile Service Office Program is designed to bring assistance for disabled veterans and their families living in geographic provincial areas on veterans’ benefits, documenting claims and services closer to home by taking out long trips for veterans to the National Service Offices. This outreach project is design to instruct veterans, their families and survivors who are unconscious of veteran’s legislature benefits and programs, counseling and claims recording assistance service by DAV’s National Service Officers (NSO) at communities all through the nation.

The Disabled American Veterans Homeless Veterans Initiative is supported by the DAV’s Charitable Service Trust and the Columbia Trust, This activity promotes the advancement of supportive housing and necessary services to assist homeless veterans get to be gainful, self-sufficient members of society. DAV Disaster relief grants may be issued with the end goal of giving: nourishment, attire, and transitory shelter or to acquire relief from damage, illness, or personal loss resulting from regular or national disasters that are not secured by insurance or other disaster relief agencies. Since the DAV disaster relief grants program commencement in 1968, $8.7 million has been disbursed to veterans that suffered losses amid characteristic disasters.

References:

STEVE WILSON, Have a financial plan before transitioning, 2015

Wilborn, Thom ,“Architect of Modern DAV Retires”, May 2, 2013.

Orkin, Lisa Emmanuel, “Disabled Veterans Memorial has DC Groundbreaking, 2010.

The aspect of social work practice I feel most difficult to perform is the gerontological social work. This paper would firstly describe the context of social work practice with old people. After that, I would exam the reasons preventing me from effectively conducting helping process by evaluating my attitudes, emotions and experiences as well as by reviewing professional literature on social work practice with old people. In the end, I will shape a personal plan on how to address this weakness in the future.

Keywords: social work practice, aged, difficult aspect

Reflection Paper on Difficult Part of Social Work Practice

There is a universal folk saying that everyone wishes to live a good long life, but no one wishes for old age. Although in virtually every helping process attempt, social workers bring their own emotional or cognitive influences to intervention, I feel especially difficult to perform in the interventions dealing with older adults.

Describing the context of social work practice with old people

With the development of medical and health care and with the baby boomer generation’s entering into their old years, the aging of population in the twenty-first century has become increasingly concerned by more and more people. In responding to the drastic transformation of social institutions such as elderly social service and health-care system, the social work practice with old people turns out into one of the most popular social work aspect today.

Apart from the well-known nursing homes and hospital, there are other settings for gerontological social work as well. Geriatric care management, community social service agencies, adult day health care, legal services??home health-care agencies , macro settings for gerontological social workers and community planning also play their active roles in serving the older adult in a variety of ways.

The gerontologiacal social work, which needs high level of self-awareness, commitment and professional skills, is somehow a complex mission for us to carry. Many social workers admit that social work practice with old people is both challenged and exciting for the reason that, at one hand, it reminds of feelings about death, aging of our family and one’s own attitudes toward helping the disadvantaged and vulnerable old adults; on the other hand, it also presents joys and delightful pictures and makes us think more about ourselves.

Root of difficulty
Review own personal factors

Among all the factors that influence my ability to perform this particular area, the subtle effects of my social and personal massages and the counter-transference feelings of old people would be matters of cardinal significance. Furthermore, I also affected by my characteristics and cognition to certain kind of old people.

Stereotypes. When I was a child I always heard people saying that old people are vulnerable and need help, and older adults are less valuable as human beings because they have to rely on their children. At home, I was asked to behave properly and not offend grandparents; otherwise I would get scolds and punishment. While at school, I was required to help older people for that they have trouble getting around. These stereotypes toward elderly are usually negative for me and imply an attitude or unintentional message that old people are hard to take care of, stubborn, old-fashioned and unpleasant.

Consequently, I always feel that I cannot handle the relationship with older people well and they will not like me. I feel uncomfortable in front of many of my eldership because I do not know how to keep conversations going with my poor eloquence and interpersonal skills. Even though I understand ageism is a destructive social justification when I grow older, I still cannot change the comments I once made on aging and I am a little bit afraid of old people to some extent.

Personal emotion factors. I am by nature a sentimental and emotional person from an early age. My grandma passed away when I was in primary school. She left me even before seeing my admission into university and engagement with my fiance. I always think that if she could see these, she would be very pleased and also, I would be the most delight person in the world. She always lived a difficult life when she was young and did not enjoy much in her late years. Sometimes all my family members would feel guilty for missing the chance to treat her well before she left us.

As a consequence, when facing the dying older people, especially female elderly suffered from chronic disease or cancer, I inevitably feel urgent to ‘save’ them and so scared to face the truth that they will eventually die someday. I doubt myself about what I can do for them and I am so scared that they will leave me before I can do anything right or helpful. In fact, that is one of the most difficult challenges in social work practice for me.

Real understanding of old people. As a social worker, I appreciate that getting old does not inevitably mean the loss of intelligence, memory and cognitive functioning. I also understand that developing a level of understanding is necessary from a social worker standpoint, and it helps me to anticipate client needs and perform an ongoing self-critique in order to improve and grow my helping process. However, many times I feel I am not able to truly understand them and consider things from their perspective of views as I never experienced true aging. Many decisions I made somehow reflect my own perception of the situation such as to decide whether an old adult should stay in own home or hospital, or to conclude that an older person is showing poor judgment about financial decisions. Furthermore, it would be even harder to perform my role as a social worker when a balance between the opinions of the older adult himself, his family and the social worker need to be achieved. This obstacle prevents me from behaving more successfully at building a sustainable relationship with elderly clients and I simply do the work and move on.

When everything needs more time and patience. With the tight time schedule and many objectives to be accomplish, sometimes a social worker needs to be in a hurry to push on the intervention process. And some other times even if I have explained many times, it is still necessary to have extended periods describing complicated appointments to older clients. I always tend to speed it up although in that case, in order to attain my goal I should slow down to give them more time to think about the process. Lack of patience would be another problem preventing me from effectively working with elderly or even almost every aspect of social work practice.

Reviewing the professional literature

Many social workers admit that, even though both meaningful and satisfactory, working with elderly people can need a high level of self-awareness and self-discipline. The truth that everyone must eventually face the developmental stage of aging and death for themselves and their families may contribute to the anxiety and complexity of the helping process, as social work practice in the aspects of domestic violence or drug abuse may not personally affect worker. This can impact workers with older clients on both a conscious and subconscious level.

Ageism and Death Anxiety. In most cultures around the world, particularly the Chinese culture, people feel uncomfortable when deal with death or anything related to death. From an early age, children are asked to avoid to talking death and dying, and to replace the word death with phrases such as “passed on,” or “gone on to another world”. Therefore, the social workers dealt with older people may require more self-control and comfort on the acknowledging the real pain caused by the loss of human life of family and friends.

The anxiety of aging and dying process on one’s own work, combined with generally indisposed experiences about the proximity of death surrounding older adults, bring about some social workers’ avoiding work with the aging. According to the Hong Kong Social Workers Registration Broad’s data gathered from its members about their areas of practice, despite older adults make up about 12.8 percent of Hong Kong population, less than 6 percent of social worker identify gerontological social work as their field of practice, which compared to nearly 30 percent for mental health.

Countertransference. The reactions, real, and unreal, to a certain individual can occur irrespective of origin and can be based on one’s own past or present experiences or characteristics. Counter transference can be described as social worker’s reactions involve feelings, wishes, and unconscious defensive patterns onto the client. In the professional relationship with old people, a social worker may place negative feelings or dislikes of older persons onto the client, which restrict his willingness (no matter consciously or unconsciously) to continue investigating and result in impatience or intolerance of the aging. On the other side, old clients who evoke images from one’s past such as parents, grandparents or other elderly family members can make process even more arduous to advance as a result of ‘destructive’ sympathy and the ‘need to save an older person’.

The Independence/ dependence fight. Old people want to maintain their independence to make decisions while the social worker commits to promote self-determination and dignity of the individual. But things are not that simple. When an elderly claims for increasingly supporting service and experiences growing difficulties to maintain independence on his own, it will be confrontational to live up to the elderly expectations.

McInnis-Dittrich (2008) states ‘A worker can appreciate the desperate efforts on the part of an older adult to stay in his or her own home. Yet when an older adult is struggling with stairs or a deteriorating neighborhood, and difficulties in completing the simple activities of daily living challenge the feasibility of that effort, professional and personal dilemmas abound.’ This is a good example to understand that sustaining independence in the gerontological social work is a critical goal which has no simple good answer.

Private functions become public business. Discussing the topic such as an old woman’s bladder and bowel functions or an older man’s maintaining an erection or urinating with clients may cause awkward and uncomfortable resistance when social workers and other helping professional get involved. Therefore, sometimes it is important to be sensitive to the deeply personal nature when social workers try to acquire necessary comprehension of an older adult’s health conditions. A better understanding of interpersonal skills and psychosocial adjustment to aging would be helpful and essential.

Personal plan to address this weakness
Overcome stereotype influence

First of all, I hope that from now on I will pay more attention to those featuring active, healthy, productive, and successful older persons so that I will develop a balanced understanding about aging and elderly. Aging is not painful and debilitating. Many wise, gracious, and humorous elderly have made admirable contribution to the world and have shown remarkable strength to achieve a positive as well as enthusiastic life.

Secondly, another important thing for me is to keep the lines of communication open with older adults. If I can open my heart to communicate, they will share more with me. The stronger relationship between us will help me cope better with the stereotype challenges.

Last but not least, in my future helping process I will often ask myself: ‘does it reinforce stereotypes again?’ I should start from every thing in daily life to alter the attitude that hinders my ability to face the normal changes of aging. Make a change in attitude is not easy, but I will try my best to drive myself on the right direction.

Awareness and Introspection

Awareness of the emotional influence is the first and the essential key to solve my problem. How well do I manage my own anxiety with this client’s situations should be my first concern. I will always remind myself that do not be affected by my experience and differentiate my experience of losing a family member from the intervention my client. That will help me to distinguish between the older people’s need and my own need and, to remain focused on the clients’ need.

Furthermore, I could seek help from colleagues and supervisors as well. By discussing the situations with them, I can expose and explore my own feelings and get advices in order to effectively facilitate help process.

To truly understand elderly

Above all, I will try to get in touch more with old people to truly feel their emotional and cognitive problems, as well as to open my heart and listen to them. Maybe I can join them more in their music, art activities in communities. Aging does not necessarily mean the loss of memory and cognitive capacities, and I will try to explain the information in a variety of ways so that we can build understanding relationship.

Moreover, reading more books about the psychological problems of the elderly would be really useful to analyze their psychological changes and behavior patterns. Equipped with a better look at the findings from professional social workers, I will more effectively comprehend the aging process the distinguishing features of elderly.

Finally, I should learn from experienced social workers to get more suggestions when I feel difficult to continue. For one thing, they can improve my ways of carrying intervention by pointing out my mistakes. For another, they can help me understand and get the most from their strength and weakness by providing convenient and professional advice.

When the National Health Services (NHS) was founded in 1948, one of the principles was to provide complete services to all and free at the time of need in UK (nursing times.net 2009). Access to healthcare services is based on clinical needs of an individual and not the ability to pay the services. This means everyone has the rights of accessing to health and social care, although it is still a major problem for low social group and ethnic minority who are facing personal, socio economic, cultural and problems happening as results of the structure of health and social care processes (POSTNOTE 2007).

In this essay, a case study will be used to demonstrate a patient with learning disability who faces various problems during his access to health and social care services and factors that contributed to these problems. Also it will focus on how nurses could support these individuals to make decisions about their care. The meaning of learning disability will be explained. The assignment will also look at major cultural and social economic influencing the health and health choices of individuals. Also it will analyze the differences between health education and health promotion and with their importance in individual in accessing health and social care. The challenges inherent in meeting the needs of people of varying abilities and social backgrounds will be look at as well as the factors that trigger the accessing of multi-professional health and social service. The essay will also discuss the understanding of the legislation related to the provision of health and social care, as a nurse why are we needed to be aware of the inequalities in provision. A name mentioned in the case study has been changed in order to comply with the code of NMC (2008) and consent was obtained from the patient and the name Anil will be used in stead.

Anil is a boy of eighteen years old who came to UK from South East Asia seven years ago. He lives with his parents in the housing estate of East London where majority are ethnic from South Asia. His father who earns minimum wages works in a food factory in six days a week, speaks English and his mother is a fulltime housewife and does not speak English, only Hindu.

Anil was born with Asperger syndrome, a lifelong disability that affects how a person makes sense of the world, processes information and relates to other people. People with Asperger can find difficult to communicate and interacts with other (NAS 2010). Anil had never been to hospital in India and he was treated by traditional healers. He only started seeks medical assistance when he moved to UK. Anil physical condition has deteriorated recently. He does not eat well; look tired, sometimes suffered headache and finding difficult in sleeping. Since he came to UK, he had been to school for three years only and he never had friends. He does not mix well with other people and his parents do not bother about this. At times he lets himself become a little neglected.

Anil represents a small and vulnerable group in a society who find difficulty in accessing and using health and social care because of the greater health care needs they have than general population. Motor and sensory disabilities, Epilepsy, hypertension and Alzheimer’s disease are some of the conditions that are common in this group (NURSING STANDARD 2010). The MENCAP report (DEATH IN DEFFERENCES 2007) states that people with learning disability are being treated wrongly in all part of healthcare provision and they are not equally valued in the health services. The government also revealed that people with learning disabilities are poorer particularly uptake of invitations on primary care and hospital provisions such as access screening services (ALD 200/01). Because of their greater needs of healthcare, they are more prone to a wide variety of additional physical and mental health problems as it shows to Anil. According to Tudor- Hart (cited in Hart 1985) there is an increasing in evidence of an ‘inverse care law’ where those who needs are greatest get the least.

Learning Disability is a life long condition which has a significantly reduced ability to understand new or complex information and it is vary from one person to another. The World Health Organization (WHO) defines learning disability as impairment of the body function which limits the activity of an individual in performing a task or action (WHO 2010)

According to Thomas and Woods in their book ‘Working with people with learning disabilities 11(2003), a learning disability is a terminology used to label people with lower level of intellectual that is lower than the average to normal people in the society. The term itself was widely accepted in England following a speech in 1996 to MENCAP by Stephen Dorrell, the then secretary for Health. From time to time the title and labels have changed and this has been driven by several influences. The term used to cover children with specific learning problems that may arises from a number of different things like emotional problems, medical problems and language impairment (BILD 2004). In the past, many people with learning disability were lived in institutions and have been labeled differently by their generations. Many different forms of terms have been used before. Terminology such as menace, sub- human organism, unspeakable objects of dread, holy innocent, diseased organism, eternal child and many more (WOLFENSBERGER,1972). There are about 1.5 million people with learning disability in UK who require different levels of support (MENCAP). It has been identified that approximately 26.5% of people who have learning disability as being associated with genetic factors (Craft et al 1985).

Learning Disabilities is caused by problems during brain development before, during and after birth (RCSLT 2009). There are different types of learning disabilities some of which are Asperger syndrome (a specific type of Autism) which affect a person the way interact to the world, reading disabilities, writing disabilities, non verbal learning disabilities (NVLD) and many more (ALD 2000-2010), reading disability (dyslexia), speech and listening disability, and auditory processing disorder. It is often detected in early childhood.

In UK there are laws and policies which describe how the needs of people with learning disabilities should be met. The purpose of these laws and policies is to improve quality of life and based on empowerment, making choices and decision, having the same opportunity and rights as other people and social inclusion. Policy such as` valuing people’ which explain how the government will provide same opportunity and choice for people with learning disabilities and their families to live full and independent lives as part of their local communities and to ensure they gain maximum life chance benefit ( DOH 2010).

The Disability Discrimination Act 1995 which is a piece of legislation promotes the rights of people with learning disabilities to access healthcare and other care services. Healthcare providers must respect, support them and their families and conforms to professional standard (NHS 2006). It is the NHS duty to make sure they provide an equal service that can be easily accessed by anyone according to this Act.

Most of the people with learning disabilities have sensory and physical impairment that make it hard to make their choices and to understand by others. A piece of legislation which protects them in England is Mental Capacity Act 2005 which is empowers and protects vulnerable people who are not able to make their own decision. People with learning disability will still have the right to give their consent for daily living and accessing the services despite of having significantly reduced ability to understand new learning skills (NURSING STANDARD 2010). If the person lack a capacity of giving or refusing consent, it is still possible for care providers to provide care and treatments for the best interest of the person (DOH 2003). A survey showed that nearly 62%of all people with learning disabilities depend on their parents and other caregivers (EMERSON et al 2005).

However, healthcare providers have a duty to understand and recognize the needs of a person with learning disabilities and make sure their needs are met. It is a nursing role to work in partnership with the clients to overcome barriers by identifying what management and decision to represent the person mostly professionally although clients and their cares may make their own decision.

People with learning disabilities in lower social classes are particularly disadvantage relative to the higher social classes in accessing healthcare services because of physical, social, psychological and economic barriers that limit their full participation in society. Acheson (1998) identified the links between inequalities and poor health. He noted that health inequalities were widening with the poorest in society being more affected than those who are well off. The post code lottery which depends on where you might live is a big issue in NHS. The availability of better treatment, drugs and waiting time in a deprived area where people depend on state healthcare provisions will carry on experience poor access to services and treatment than those who have the power of buying services in private services (GUARDIAN 2000).

People from ethnic backgrounds experience healthcare service differently due to their lack of knowledge which can be limited by the ability to communicate in English. They may find challenge to enter healthcare services because it may require, for example making a telephone call, appointment, coping with a queuing system and complex procedures ( NHS 2006). Different in culture’s attitude and stigma between where they came from and UK can impact Anil’s health. It is believed that South Asian parents don’t have positive attitudes towards disabilities because religious and superstitious beliefs (ROYAL COLLEGE OF PSYCHIATRIC 2003). Anil’s parents might not take his problem seriously because of their background and social stigma of having a child with disability (AUTISM-INDIA 2008).

According to the report of Department of Health (2009) a review in development in tackling health inequalities of Acheson, recommended the improvement of living standards of people with lower income than average. Among the people in this group are people living in a deprived area and depend on social housing. Also people with learning disability may fail to get the necessary services because of lack of understanding about health issues articulating their needs based on their poor experiences of education system (Mathews 1996).

Research carried out by Cartwright & O’brien1976 found that General Practitioners spend far less time with their patients from lower classes ( cited in Hart 1985,p59). The situation may be more complex for service users who have little or no verbal communication and those with learning disability. A learning disability person may be unable to identify and describe the signs and symptoms requiring accurate medical attention. The information may not be presented in accessible format and the staffs may ask questions which can not understand (NURSING STANDARD 2010).

Unavailability of an experience interpreter in the healthcare settings can be barrier. It can affect the sensitivity of patient’s values and attitudes. To use a professional interpreter can reassure patients to communicate and feel freer when describing their religious beliefs and unsatisfactory environment conditions but to healthcare professionals may feel disempowerment and may depend on interpreters in order to carry out their roles (ROYAL COLLEGE OF PSYCHTRIC 2003).

Sometimes physical access may be an issue for people with learning disability; they find their appointment times are often too short to understand the system because of their difficulties and transport needs to access healthcare facilities are more distant. Practitioners may be given job in deprived areas with all facility available but they may be in the risks of vandalism, theft and anti social behavior (Thomson J et al 2003 p59).

The aims of the government today in UK is convince individuals to be more involved in their health. But the problems with availability of health promotion services and involvements are some of concern due to the restructuring of health and social care for people with learning disabilities has been accelerated by NHS and community care Act (DOH 1990, Emerson Et al 1996 chap 11). For example, most of the health promotion discussion and activities to accessing suitable primary healthcare is focus on medical involvements such as immunization (Stanley et al 1998 p71). Some of this medical approach can lead to reinforced dependency for people with learning disabilities. Those with severe learning disabilities, their needs are becoming known to service providers through secondary and tertiary care after being referred by primary care. Among health promotion is prevention which is focusing on decrease of risk occurrence of diseases, disabilities and handicap. These activities occur in health care settings. Primary prevention is to prevent from risk factors such as obesity through education, exercise and diet. Primary prevention produces information on various health issues in pictorial and easily understandable format such as cancer. On secondary prevention, it involves identifies early signs of diseases occurring such as cancer screening and tertiary prevention is involves reducing the impact of the disease and promoting quality of life through active rehabilitation (Thomson et al 2003).

Anil’s state of confusion may be caused a number of factors which might need further investigation. It is the duty of his General Practitioner (primary prevention) to refer him to hospital (secondary prevention) for investigation. A consultant may decide whether Anil has physical or mental illness.

To deal with and removing barriers such as difficulty with interpersonal communication, health promotion will need to promote inclusion and reduce inequalities in service provision (Thomson et al 2003 p129). World Health Organization (2010) has made it clear that health promotion is the process of enabling individual to improve and increase control of their health. Many primary healthcare professional do not have skills to overcome this problem as results those people who have learning disabilities are less likely to receive lifestyle advice than those who do not have learning disabilities (Fitzsimmons & Barr 1997). Learning disability nurses have a variety of skills in communication and observations which could be useful to teach other healthcare professionals in health and social care settings (Thomson et al 2003 p131)

Health education as a part of health promotion is defined as a planned communication activities designed to attract well being and ill health in individuals and group through influencing the knowledge, belief, attitudes and behavior of those in power of the community at large (Tannahill 1985p167-8). For people with learning disabilities, health education might promote social inclusion through decreasing negative stereotyping by valuing and respecting their needs. On a more individual level, people who receive health education messages have a choice to decide whether to follow or not the message given (Thomson J et al 2003).

Building partnerships between nurses, careers, other professional and people with learning disabilities is essential in order to promote and educating health by identifying their physical and mental health condition (DOH 1995). A partnership is not only the way to bring up to date statutory services but also is about developing and acknowledging the collective responsibility for the health and wellbeing of the community which they belong (Thomson J et al 2003, p102).

Having the opportunity to make choice about their healthcare is critical to their sense of inclusion in society. It is also a key factor in allowing individual like Anil to feel in control of his life. The NMC (National Midwifery Council) code of 2008sets out number of responsibilities on nurses to promote choice and respect the decisions of those they care. Nurses need to help them making their choice by making some simple adaptations. The first step can be taking a little more time to explain something and giving the person with learning disability more time to understand what is being said (NURSING STANDARDS 2010, P53).

Other approach could be the involvement of relative or paid career not to make choice on behalf of the person with learning disability but to use their knowledge of the person to help the care professional interpret or to explain treatment options. In all this processes, nurses need to ensure that they obtain consent before they begin assessment and treatment. Any decision to be taken by the staff must be in the interests of the person and must regard to his or her human rights.

To conclude, the essay has set out key difficulties experienced by people with learning disabilities in accessing healthcare services and the gap between rich and poor who are accessing healthcare appear to be widening. People who have learning disabilities are generally underestimated and find themselves failure to succeed their expectation. They experience more health problems than any other group in a society but use healthcare services less than the general population (RODGER 1996). Inequalities in health for people with learning disabilities must be dealt with by healthcare providers in health care provision with the aim of closing the division between the general public experiences and this group. By using good quality of health care and respecting people’s rights to access, and making reasonable adjustment, the lives of people with learning disabilities can be changed. Healthcare providers have a duty to ensure that people with learning disabilities are offered regular checking and are included in health screening program.