Book Review
Mental Health Care for People with Learning Disabilities
Helena Priest and Michael Gibbs
ISBN: 978-0-443073-53-3 2004 224 pages Churchill Livingstone
Jan Walmsley
Assistant Director, Health Foundation, London; Visiting Professor, Open University, Milton Keynes, United Kingdom
This book offers comprehensive and up to date coverage of an important, and somewhat neglected area, the mental health needs of people with learning (or intellectual) disabilities. The book takes the position that a lot can be done for the many people with learning disabilities who experience mental health problems if they are recognised and treated appropriately, but that diagnostic overshadowing combined with poorly trained and unaware staff means it is often assumed that behavioural problems or mood changes represent the disability rather than being seen for what they are - symptoms of a mental health problem. As well as setting the historical and social context for the situation, the authors provide clear information about a range of common, and sometimes less common, mental health conditions, and attempt to show their prevalence and how they might manifest in people with learning disabilities. A very welcome aspect is the coverage of policy issues and service provision - all too often ignored - and although this is very UK centred, its precepts have more general application. How mental health conditions impact upon carers and families is also dealt with in a constructive fashion.
Although the authors are not specific about their intended readership, it is possible to deduce that it is aimed at a very wide audience of potential readers, including policy makers, educators, professionals, unqualified care staff, and family members. This leads to a certain unevenness of style. Some chapters are written in a very accessible style, with case studies and in text questions to stimulate the reader to apply the knowledge presented to real life situations. Others, particularly those which describe mental health conditions, and tools for treatment, are far more technical, and unlikely to be readily assimilated by some of the people who will be key if interventions are to be made - especially unqualified care staff who are in the best position to notice when a client begins to manifest symptoms of mental ill health.
I have a few reservations about some aspects of the book. The 'user' voice is absent, though we hear plenty from the perspective of family members. I believe this leads to the omission of an important dimension of mental health problems in this group of people, the experience of being marginalised, not listened to, deprived of meaningful activity. Hence the emphasis is on medical interventions, rather than taking a more socially based approach to understanding why people with learning disabilities experience mental health problems more frequently than the norm. We are told about, but do not feel directly, being left behind as siblings branch out into adult life, for example. Inclusion of the voices of people with learning disabilities would, I believe, have strengthened this message. The case studies are a little one dimensional. Richer, more multi facetted stories would have been more stimulating. And, perhaps a minor quibble, but one which limits its usefulness as a reference book, the practice of putting references at the end of each chapter rather than a full list at the end is irritating, particularly as the bibliography is one potentially of its best points.
Overall though, a book to be warmly welcomed and one that is especially appropriate for mental health or learning disability nurses who want to extend their range of expertise to include this fairly large, and poorly served, group of people.
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