Inclusion and Care in the Community: parallel agendas with similar outcomes?

Johnson and Walmsley (2010) draw parallels between the closure of the large asylums in the UK in favour of ‘care in the community’ in the final decades of the 20th century, and the policy shift in education at around the same time away from ‘segregation’ and towards ‘inclusion’.

The advent of both inclusive education and care in the community can be said to have been nurtured by the United Nations Universal Declaration of Human Rights (1948). This brought about a number of significant conceptual shifts in both Health Care and Education in the UK. Segregated institutions of all types became subject to criticism, and this marked the beginning of the end for the large asylums (Frogley and Welch, 1993) as well as a ‘dogmatic attempt to discontinue special schools’ (Allan and Brown, 2001, p.200).  These policies in both health and education have been subject to scrutiny and criticism with the mildest of accusations being that they have suffered from what Hodkinson (2012) calls a ‘clash between ideality and practicality’ (p.7).

What is clear however, is that the perceived aims and benefits of care in the community and inclusive education have not been felt by those with the highest level of need.    The London Borough of Newham for instance was  the only education authority in the UK to accept fully the principle of  inclusion for children ‘whatever their special need’ (Newham Council, 1995), yet despite determined efforts to close all the special schools in the borough from 1984 onwards, a school catering for pupils with severe and profound and multiple learning difficulties (sld/pmld)  has survived (Jordan and Goodey, 2002), and mainstream secondary schools in the borough provide for pupils with higher level of need in resourced provision such as separate units or classrooms.

Parallels can perhaps be drawn here with the case of a user of mental health services in a large county council in the South of England. I have known ‘John’ for over 40 years. In the late 1970’s he spent several months in one of the large and very well resourced psychiatric hospitals which were once common in the outskirts of London. He was treated successfully, discharged and with GP support managed his condition for many years, had a career and a family. By the time he suffered a serious relapse about 6 years ago, the hospital which had treated him in the 1970’s – and would still have treated him today – had long gone:  its Victorian buildings bulldozed and replaced with an executive housing estate. With no home of his own John is now cared for ‘in the community’, which in his case means a drab and unregistered shared house in poor repair with no garden about 5 miles from the site of the old psychiatric hospital. The residents are looked after by care staff with no significant nursing qualifications and who provide very little in the way of social or community activities. The outlook for John is bleak and with very little contact outside the house his condition is deteriorating.

I am not suggesting in any way that the educational provision for people with sld/pmld is substandard in the same way that care provision clearly is for John. Most provision for those with sld/pmld is excellent irrespective of the setting and for the majority that setting is a special school.

What I am suggesting is that in both health and education, those with the highest level of need have not been adequately included in the parallel agendas of inclusive education and care in the community. The moral rightness of full inclusion and care in the community is axiomatic (*), and so it should be, but as Runswick Cole (2010) suggests, it can also be naïve, especially when it implies the simple placement of those with sld/pmld in inclusive settings or the simple placement of people with complex mental health conditions in the community. ‘All’ really should mean ‘all’ irrespective of cost or the challenges full inclusion might bring.


(*) Axiomatic = self-evident or obvious



Allan, J and Brown, S (2001) Special Schools and Inclusion, Educational review, 53 (2),     2001: pp.199-207


Frogley, G and Welch J. (1993) A Pictorial History of Netherne Hospital. Redhill: East Surrey        Area Health Authority.


Hodkinson, A. (2012) Illusionary Inclusion. What went wrong with New Labour’s landmark           educational policy? British Journal of Special Education. 39 (1): 4 – 10


Johnson, K and Walmsley, J. (2010) People with intellectual disabilities – towards a good life. Bristol: The Policy Press.


Jordan, L and Goodey, C. (2002) Human Rights and School Closure – the Newham Story. Bristol: CSIE


Newham Council (1995). Review of Inclusive Education Strategy: Consultation Document


Runswick-Cole, K. (2011) Time to end the bias towards inclusion. British Journal of Special          Education. 38 (3): 112-119

United Nations (1948) Universal Declaration of Human Rights. New York: United Nations




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