86 . British Journal of Learning Disabilities Vol. 26 (1998)

Editorial

Dorothy Atkinson and Jan Walmsley

This edition takes as its running, and linking, theme the importance of communication. Anna van der Gaag, in her keynote review, highlights specifically the impor- tance of the ’communication environment’ in supporting development of the communication skills of people with learning disabilities. We would like to see the journal as a ’communication environment’, and continue the same process of developing communication skills across the journal’s community: from editors to authors; from edi- tors to readers (via our editorials); and from authors to readers. It is a continuous and cyclical process, and it involves all of us.

Part of what we have set out to do as editors is to ’open up’ the journal as much as possible. This opening up process means, amongst other things, improving how we communicate with each other. In the ’communication environment’ everyone has their say, and is listened to; in the journal we want to reflect this by encouraging more people to write for it (and thereby getting more people to read it). As we said in our first editorial, we would like to open up the journal’s pages to new writers as well as the more established journal contributors; and to see practitioners, parents and people with learning difficulties writing for the journal.

This is no easy task, and it will take a lot of time and effort on everyone’s part. In our first editorial, we invited practitioners to contribute to the journal; to des- cribe examples of good practice or to develop accounts of the ’day in the life’ of a case manager, a service com- missioner, an advocate or any other of the many new roles in the current learning disability services. We have had several enquiries on how to pursue these ideas but no contributions yet. The invitation remains open. Who will be the first to accept it?

We also want to open up the journal to people with learning difficulties as sole, or joint, authors with what- ever support is necessary to make this possible. This edition includes a letter from Anya Souza, in which she joins the debate on ’Should we prevent Down’s syn- drome?’ It’s good to have the voice of a young woman with Down’s syndrome in the pages of the journal, to balance the views of parents (see Vol. 26, No. 1, 1998) and to address the concerns expressed by Paul Williams, the author of the original article on the subject of preven- tion (see Vol. 23, No. 2, 1995). Anya‘s voice is direct; people with Down’s syndrome are ’human beings and deserve respect’. They also deserve to be heard. We hope that Anya‘s letter to the journal is the first of many - not only by other people with Down’s syndrome in response to the debate on prevention, but also by people with learning disabilities on a whole range of topics of interest.

New writers, with and without learning disabilities, need support and encouragement in getting started and, having started, in seeing the process through. Part of our role as editors is to offer that support and encourage- ment to people who have things to say but who are not experienced in writing for a journal. To that end we have produced ’Writing for the Bvitisli Journal of Learning Disabilities’, a friendly, OU-style, step-by-step guide to taking up - and seeing through - writing for the journal. You can get a copy of the guidelines from Berni Moorcroft at BILD Publications.

The guidelines take you through all the stages of writ- ing, including what happens when you finally send your paper to the journal. This is where it goes for ’peer review’, to be read and reviewed by two people from our panel of referees. They are a crucial part of the journal’s ’com- municative environment’. They give feedback to authors, and advice to the editors. Decisions on whether or not to publish your paper will be based on the referees’ comments, although we always write back to authors personally to explain and to clarify what has to happen next and, sometimes, to soften the blow if the news is disappointing.

We ask a lot of referees. There is no money involved; it’s a voluntary system based on interest and enthusiasm. Good feedback from referees is vital in improving com- munication skills within the journal’s community of authors and readers. We are always on the look-out for new referees. Do get in touch if you are interested; and ask for our handout, ’Frequently asked questions by referees for the BJLD’, as it provides helpful hints and guidance on what is required in this journal in a question-and- answer format.

The papers in this edition of the journal pick up and develop the theme of communication in many and diverse ways. Anna van der Gaag‘s keynote review highlights the importance of effective communication to the quality of life of people with learning disabilities. Communica- tion skills can be learnt, and developed, but they need to be facilitated and supported within a wider social context, including the family, the day service/workplace, and the community. Communication is about opportunities to ’speak’ (or sign), and to be heard, as well as developing skills. ’Supported communication’ may come to be as important as ’supported housing’, according to van der Gaag, but will require a paradigm shift from the indivi- dualised, medical model of disability to the ’integrated environment approach’ of the social model of disability.

Although the papers in this edition vary in content and approach (representing both the medical and social models of disability), they all refer to, or reflect, the importance

British Journal of Learning Disabilities Vol. 26 (1998) . 87

of communication. Communication is obviously crucial in any attempt to evaluate what people think of the ser- vices on offer; in the study reported by George Murray ef al. , this involved seeking the views of people with learning disabilities on their local learning disability team. Consideration had to be given to enabling people to take part in the study, and this meant taking on board the environment in which the interviews were held as well as the intrinsic abilities of people to communicate their views.

Families are part of the ’communication environment’. Family life, though, with a child with learning disabilities may be atypical. In Julia Shearn’s study of mothers of children with disabilities she found that, in spite of their aspirations to work, they were much less likely than other mothers to be in paid and full-time employment. Their aspirations to work were based not just on finan- cial considerations but on their wish to be part of the wider community, to have a variety of experiences, and to engage in adult conversation.

What happens when coinmunication breaks down? Or when people are communicating in ways which are thought to be inappropriate or even dangerous? The re- maining papers look at interventions which have proved effective in quite different circumstances. Christopher Stirling describes how ’natural therapeutic holding’, an approach which builds on the strengths of gentle teaching, can help staff manage aggressive or violent behaviour in both children and adults with learning disabilities. In their paper on sexual fetishism, Selim El-Badri and Barbara Robertshaw describe the personal and social consequences of inappropriate and unacceptable sexual behaviour, and how - for two men with learning disabilities - these consequences were ameliorated by medical (and social) intervention.

Communication is a key issue in the study reported by Peter Cutajar ef nl., of a young woman with a learning disability who developed severe depression following the birth of her baby. Communication ceased because of the depression. Consent to treatment could not be sought, according to the authors, because of the depression and because of the young woman’s learning disability. The Mental Health Act was used instead to ensure that a course of ECT could be given and, as a consequence, communication was restored, and the young woman reunited with her child.

Finally, the point is made that interventions to manage crises, and restore stability, are not enough in themselves. The time comes when the person concerned is ready to resume their place and life in the community. But often this is not possible, according to Stuart Cumella ef nl., because of the shortage of places for people who chal- lenge services. Better communication would help here too - but this time between health authorities, NHS trusts and social services departments on working together to provide supported accommodation in the community.