Introduction

One-and-a-half million people with learning disabilities (LDs) live in the UK. For 30 years, Britain has moved away from institutional care to small-scale domestic-size homes based on person-centred support that seeks the views of the person. For many people with LDs, there is a gap between UK policy and reality, made worse by recent cuts in public spending. Nevertheless, progress has been achieved and we have come a long way from the institutions so valued by the Victorians. New approaches are needed to address cuts in services, the increasing complexity of the needs of people and increasing levels of loneliness, bullying and hate crimes.

What is a learning disability?

There is no world consensus on the definition of the term ‘learning disability’, now generally preferred in the UK, replacing terms such as ‘learning difficulty’, ‘mental handicap’ and ‘mental retardation,. Some countries use the term ‘intellectual disability’ (Emerson and Heslop, 2010: 1–4). The Department of Health (2001) describes LD as a significantly reduced ability to understand new or complex information and to learn new skills.

LDs occur when the brain's development is affected, either before birth, during birth or in childhood. Causal factors include:

• • maternal illness during pregnancy;

• • the inheritance of certain genes;

• • genetic changes during pregnancy;

• • difficulties at birth causing oxygen deprivation and brain damage; and

• • illness, such as meningitis, or injury in early childhood.

There are thus many causes but often no identified cause. Some conditions associated with LD include:

• • Down's syndrome;

• • Fragile X syndrome;

• • Prader Willi Syndrome;

• • cerebral palsy;

• • autism;

• • epilepsy; and

• • Foetal Alcohol Syndrome.

How does a learning disability present?

The presence of an LD can be recognised at birth or in early childhood. An LD can be mild, moderate or severe. Some people with an LD can communicate easily and look after themselves but take longer to learn new skills, while others may not be able to communicate in a conventional way. People with LDs can grow up to be quite independent, but others need help with everyday tasks, such as getting dressed, and need support throughout life.