12 Intellectual disability12.1 Service provision
12.1.1 Normalisation and person centred service development
2 min read
Written by Resident Doctor Committee · Published
Terminology
Learning disability is the UK service term for significant impairment of intellectual and adaptive functioning that begins during development. ICD-11 calls it disorders of intellectual development.
People-first language names the person before the condition and uses the current term, "person with an intellectual or learning disability", not older terms now regarded as stigmatising.
Specific learning difficulties such as dyslexia are different from learning disability and can coexist with it.
Impairment, disability and handicap
The World Health Organization's International Classification of Impairments, Disabilities and Handicaps (ICIDH, 1980) separates three levels.
Term | Definition |
|---|---|
Impairment | Loss or abnormality of body structure or function |
Disability | Restriction of activity compared with what most people can do |
Handicap | Disadvantage in fulfilling a normal social role |
Normalisation and social role valorisation
Aspect | Normalisation | Social role valorisation |
|---|---|---|
Originators | Bank Mikkelsen and Nirje, Denmark and Sweden, 1950s to 1960s | Wolfensberger, as a later reframing of normalisation |
Core claim | People with intellectual disability should have access to the ordinary patterns and conditions of everyday life | Valued social roles and social image shape how others treat people |
What changes | Services and environments are adapted, not the person | Opportunities, skills and social perceptions |
These ideas drove the closure of long-stay hospitals, but misused they can demand conformity or withdraw specialist support.
Social model and needs-led services
The social model places disability in barriers created by inaccessible environments, information and attitudes, whereas the medical model looks at impairment and treatment.
The 1971 white paper Better Services for the Mentally Handicapped moved policy towards provision built around what each person needs.
Inclusion in law and practice
The Special Educational Needs and Disability Act 2001 (SENDA) aimed to include pupils with intellectual disability in mainstream schools through accessibility planning duties and amendment of the Education Act 1996, in line with normalisation.
The Equality Act 2010 requires reasonable adjustments in Great Britain, and Northern Ireland has separate disability law.
Person-centred planning starts from the person's preferences, strengths, communication and goals, and supports them to make each decision themselves where possible.
Co-production brings people with lived experience and their families into service design and delivery from the start, with real influence.
A small community home can still be institutional if routines are rigid and privacy is lost, so judge it by daily experience, not building size.