Inclusion in the mainstream: Challenges in the care of people with intellectual impairment

Abstract

The effect of care in the community and integration into mainstream health services for people with intellectual impairment (including learning disabilities and other neurological disorders such as acquired brain injury that result in diminished cognition) has proved variable. The Department of Health's policy Valuing People: A New Strategy for Learning Disability for the 21st Century (2001) advocates continued ‘inclusion’ into mainstream services for this client group. While the development of specialist services under the Learning Disability Development Fund is planned for clients who present with complex issues such as severe behavioural problems, there are concerns that such provision is inadequate. The aim of this paper is to highlight some of the challenges associated with the drive to inclusion for many people with intellectual impairment, and the factors that limit their integration with the non-intellectually impaired community. A consideration of the conceptual foundations of the policy of inclusion will help shed light on these challenges and on ways to address them. It is important that nurses working in all fields of neuroscience are aware of some of the pitfalls and problems associated with the policy of inclusion so that they can support their patients and advise colleagues working in mainstream services on caring for this group. It is argued that the benefits of inclusion and the initiatives that have resulted from its development have not been proved and cannot be assumed.