The therapeutic living gap within adult provision. By Chris Wager.


I am a former Mulberry Bush Child and a Care Leaver, who spent the best part of 17 years in foster care and children’s home.

I have seen and witnessed many changes in the systems that support vulnerable children and adults in this country and remain unconvinced that all of them are for the best.

In this paper, we are going to cover The Therapeutic Living Gap, within adult provision.

The Situation

It’s a sad fact that at the present time adult services have been stripped back to the bare bones, and now operate within the confines of a system that is unable to offer long-term service to anyone that does not meet one of two criteria 1) Has a Diagnosed Learning Disability – With an associated IQ of less than 69 or 2) Suffers from a severe Mental Health Condition – Affecting your safety and or capacity to make decisions.

There are no long-term services for vulnerable adults, instead the emphasis is to rely on short-term interventions in order to prevent a long-term problem (to me this is little more than a really poor attempt to make unrealistic service cuts sound good). It’s a sad fact people with autistic spectrum conditions or learning disabilities that fall below the threshold set for the community learning disabilities teams, cannot be cured by a short-term invention and will continue to need support, support which no one is willing to provide and no one has to provide. This results in many vulnerable adults and young people falling into the cracks of the system.

All too often not to reappear again until it’s far too late.

Unfortunately I am not able to obtain statistics due to lack of professional persuasion and title, but I feel it would be relatively uncontroversial to say that, a significant proportion of young adults with and Autistic Spectrum Condition and or Mild Learning Disabilities, will be suffering from Depression and Anxiety, both of which are a very serious mental health issue, but if these young adults consult with a doctor, they will be told that depression and anxiety are an integral part of autistic spectrum conditions, and therefore there is nothing they can do. (Mental Health Services Do Not Deal with Autism) and that is true for most NHS Trusts in England.

But is depression and anxiety really an integral part of Autism, I do not believe so. Moreover, I believe that the depression and anxiety present in these most vulnerable adults is actually a side-effect of the inadequate support and severe lack of services available to them.

Left to cope alone in a society that many find difficult to understand to understand. They will without doubt feel isolated, vulnerable, small even. Unable to make friends and socialise with ease like their peers do. They are seen as different with in their community which all too often only serves to isolate further.

A favourite quote of mine comes from one of my friends who simply said “if ordinary adults struggle to understand what is social acceptable these day, how an earth you manage I will never know” while I do not approve of the term ordinary, it conveys a very sobering point.


The Arctic Crevasse

These most vulnerable of young people and adults, are trapped, as if buried deep in An Arctic Crevasse, frozen to the core, in pain, and crying out for help. They can see the light above them but try though they may they can find no way to reach the surface on their own, and as yet there is no helping hand reaching down to them. They feel helpless, and in time will reach the point of giving up on living. If not rescued within a relatively short space of time they will die.

For these young people and adults, it is not a physical death that will occur; their death will be one of the emotions and spirit. They will have become so disconnected from the world around them that their ability to integrate with society and to form and maintain healthy bonds and relationships will never recover. ­­­­­­­­­

The fundamental point here is that these very vulnerable young people and adults may as well be trapped in a deep arctic crevasse crying out for help, where no one can see or hear them. For no matter how hard, they try to get Professionals to listen to their needs and provide them with support, they continue to be met with that bureaucratic preoccupation that is filling in forms that have to meet restrictive tick-box style, criteria that only serve to exclude the majority and provide support to the minority.

Although many of the issues that face adults looking for support can be related to funding or budget limitations, there is also a far more fundamental issue and that is significant lack off services and provisions that are actually available.

There is a very limited number of specialist provisions available to provide specialist support to adults and the vast majority of them have a very specific set of criteria and a very limited remit, predominantly for mental health or learning disabilities.

Why is this the case?


A Call for Change

It is high time that we accept and make recognition of the fact that there is a need, demand and necessity for specialised therapeutic care provisions for adults with complex needs and difficulties that require long-term therapeutic nurturing, and support.

We are dealing with a very vulnerable and unique group of adults, that in many ways are still functioning at a level that is far below there years, there emotional dexterity and understanding, will be limited by their past trauma and their ability to cope with emotions is something that may be a near impossibility.

The expectation upon them to live an ordinary life, and integrated with the society around them without long-term support, is either extremely idealistic or serious neglectful.

In order to better facilitate the needs of this group of young adults, there is a need to develop and construct a community of therapeutic in living environments, that are setup and operated with the specialised skills needed to provide a stable, caring, nurturing and therapeutic environment that is able to provide a long-term place for these young adults to stay. Within this environment they will be able to grow and develop a sense of belonging and meaning.

Failure to acknowledge this need, and failure to support these young adults adequately is a serious failure in the Local Authorities and Governments “Duty of Care”.

The system can change, and these Gaps can be filled. This however requires a fundamental shift in the views of professionals within this field, and a need to push for change at a governmental level. It is the duty of these care professionals to fight for the change that is needed and in the best interests of these young adults.




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