The therapeutic environment

Support may be provided in general or specific ways as follows.

1. General—the network of care provided for people with a mental retardation and their carers. This will include community teams, special schools, and the specialized residential placements that might be resorted to either for respite or as a long-term home.

2. Specific to a particular disorder—parental support groups exist for autism, epilepsy, and specific forms of mental retardation such as Prader-Willi, fragile X, and Cornelia de Lange syndromes.

A primary aim of supportive services is to integrate people into their community as far as possible. The concept of normalization implies that services should avoid the demarcation that leads to adverse discrimination. Conversely, those with disabilities too severe or too complex for their families or standard teaching or occupational placements may fare better in specialist environments. Examples of these are as follows.

• Some of those with autism who are so distracted by the complexity of everyday life and the unpredictability of people that they need specialist environments which are well structured, predictable, and under their control.

• Those with severe or intractable seizures.

• Those with aggressive or disinhibited behaviour so disruptive as to block the progress of their peers.

The specialist setting encourages mutual support for people and families with similar problems; the staff gain experience and it allows a concentration of expertise. However, segregation encourages stigmatization and there is the risk that, in a group, disturbed people may copy or amplify each other's behaviour.

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