The last ten years have seen very many changes in Irish society. We are now a more affluent nation. All the economic indicators are favourable, low interest rates, low inflation rates, a shrinking unemployment level, unprecedented economic growth rates and lots of disposable income available.
On the down-side, the traffic situation has worsened, property prices have soared and there are still social-service deficits.
In the area of health, and particularly in learning disability, the situation has also changed. A cursory look at health expenditure shows that there has been an increase in expenditure. For example, in 1987, the Department of Health spent £113.5m on direct services for children and adults with learning disabilities. These include day, residential and occupational services, but exclude DPMA (DA) and DCA payments. In 1996, this figure was £221.1m, a difference of £108 million over a ten-year period. This cash increase belies the real difference in expenditure. If we measure the difference as a percentage of GNP, which more accurately reflects the real money value, we can see that actual expenditure feel from a 1985 figure of 7.5% of GNP to 5.8% of GNP in 1996. So, while the economy has improved, the amount of money spent on services for people with learning disability has decreased.
Undoubtedly, there has been a change in the style of service rpovision. In 1986, over 2000 people with mental handicap lived in psychiatric hospitals; 5000 lived in residential centres; approximately 700 lived in community hostels; and a further 4000 lived with family members. By 1990, 4600 people lived in residential centres and 1200 lived in hostels and group homes. This trend is continuing, as a direct outcome of the policy of developing community-based residences and restricting admissions to residential centres. The number of people inappropriately placed in psychiatric hospitals continues to be a problem which has still not been addressed adequately. We still have too many people living in outdated psychiatric services because of the lack of new expenditure on appropriate learning disability services.
Many of these outdated services have the hallmarks of traditional custodial care. Institutionalised services are still the norm in ireland. Despite some changes, there is still a long way to go before we can be satisfied with the state of learning disability services. In 1999 we still have around 1400 people who are receiving no service, or an inadequate service. This is a sad reflection on those who determine service policy.
What’s in a name?
Some attitudes have changed. The last decade has seen a gradual change from the use of the term ‘mental handicap’ to ‘learning disability’ or ‘learning difficulty’. This trend was underpinned by the recommendations of the Needs and abilities report, reflecting the transition from a medical perspective to a social one.
Employment trends have also changed from an emphasis on sheltered employment to a model of supported employment and enterprise. This trend has improved the possibility of people with learning disability having more structured work and receiving improved income for work done. Unfortunately there are still large numbers of people in sheltered employment who receive very little income.
Political and social indifference
It is my view that society’s attitude toward disability has not really shifted in recent years. The population of people wit disabilities is still, by and large, a marginalised group on low incomes, dependent on social welfare and without a quality of life equal to the rest of society. This is not to take away from the enormous advances made by services, staff and parents in improving people’s lives. But the problem is bigger than any agency or group of people.
I wrote the following in an article in Frontline ten years ago:
‘There is a need for fundamental reconsideration by society in general and government in particular of its priorities with respect to those who are handicapped. The provision of adequate resources is essentially a political decision. The shifting of resources from institutional facilities to community care supports is a political decision. The decision to transform the concept of community integration into a reality is a political one. The allocation of resources is not just about economic limits; it is about making choices. The choices made by government are influenced not only by the resources available, but by the pressure exerted on it by citizens. This includes the professionals, parents and those who have a handicap.’
These sentiments still hold true in 1999, just as they did in 1989.