Memorandum by Mencap
1. Mencap is the leading UK charity working
with children and adults with a learning disability and their
families and carers. We welcome the opportunity to contribute
to this consultation. We have chosen not to answer directly the
three questions in the consultation paper, but to comment on the
issues we think are most important to the people we work with.
TERMINOLOGY
2. Learning disability is not the same as
mental ill health. A learning disability is lifelong and untreatable,
and affects the way people learn, understand, communicate and
interact with others. The Green Paper rightly defines mental ill
health to include "mental health problems and strain, impaired
functioning associated with distress, symptoms, and diagnosable
mental disorders, such as schizophrenia and depression" (para
2). People with a learning disability face different challenges
from people with a mental illness, and have different needs.
3. In general, the Green Paper limits its
discussion to issues related to mental ill health. However, it
also refers frequently to "mentally ill or disabled people"
and "people with mental ill health or disability" (eg
at para 6.2). This is an ambiguous phrase in English, but a look
at versions of the Green Paper in other languages suggests strongly
that it is intended to refer both to people with mental ill health
and people with a mental disability, including learning disability.
It is not clear why a Green Paper on mental health strategy mentions
learning disability in passing on so many occasions without making
any reference whatever to the factors which distinguish it from
mental ill health.
4. Given the distinction between mental
ill health and learning disability, the Green Paper should do
one of two things. It should either limit itself to a discussion
of mental ill health and its effects, dropping the occasional
confusing references to unrelated disabilities, or it should be
explicit about the fact that its scope is wider than just mental
ill health. If the latter, it needs to discuss learning disability
in much greater detail than it does. This would involve rewriting
the document substantially.
5. The authors of the Green Paper are not
alone in blurring the distinction between mental ill health and
learning disability. The distinction is widely misunderstood,
perhaps because of the fact that both mental ill health and learning
disability are non-physical and invisible, because both involve
the brain, and also because of confusions in terminology. Learning
disability is still sometimes referred to as "mental handicap",
and the word "mental" is sometimes used as a term of
abuse against both people with mental ill health and people with
a learning disability. Given this common confusion, it is vitally
important that the distinction is kept clear when making public
policy.
STIGMA AND
DISCRIMINATION
6. Para 6.2, on social inclusion, appears
to refer both to people with mental ill health and people with
a learning disability. Stigma, discrimination and misunderstanding
are indeed problems for both groups. One element of this misunderstanding
is the confusion between mental ill health and learning disability,
as discussed above. While both groups do experience stigma and
discrimination, the stigma and discrimination they experience
often takes different forms. Putting the groups together, as this
document does, and then discussing solutions almost exclusively
in terms of mental ill health might in itself be seen as a form
of discrimination.
7. Mencap agrees that there is a need for
a shift in public attitudes, for an improvement in public awareness
about mental ill health and treatment options, and for encouraging
the integration of people with mental health problems and learning
disabilities across society. This must include a recognition of
the distinctions between mental ill health and learning disability,
and the distinct needs of these separate groups.
8. Para 6.2 also discusses the replacement
of large hospitals or asylums with community-based services. People
with a learning disability, as well as people with mental health
problems, have historically been placed in long-stay institutions.
Mencap strongly supports the closure of such long-stay institutions,
both in the UK and in Member States in general, and their replacement
with community-based supported living services which enable people
to exercise as much control as possible over where they live and
who they live with.
EMPLOYMENT
9. Para 6.1.1 rightly notes that vulnerability
to mental ill health increases with low social and economic status,
and with job loss and unemployment. People with a learning disability
are more likely to be unemployed than the general population,
and indeed than other disabled groups. In the UK, only around
11 per cent of people of working age with a learning disability
are employed, even though around 65 per cent want to work; we
would not be surprised to see similarly low employment rates among
people with a learning disability across Member States. People
with a learning disability need properly tailored employment support
which recognises their distinct needs.
| 
