Any retarded citizen who can be effectively self-supporting, and who can be reasonably expected to discharge effectively the obligations of marriage and parenthood, should be permitted to marry and to raise a family ; in no even, once a retarded person is married, should this marriage be annulled on the basis of the exclusive circumstance of mental retardation, nor should that person's right to bear and rear children be abridged. If a genetically transmitted condition exists, the retarded person should receive appropriate genetic counseling to ensure his understanding of the condition.
If it should become evident that a retarded individual has become incapable of rearing his or her children, as may occur with nonretarded parents, the same legal and professional procedures concerning parenthood that are applicable to families of nonretarded citizens should be applied to those retarded citizens.
The right to freedom of movement, hence not to be interned without just cause and due process of law, including the right no to be permanently deprived of liberty by institutionalization in lieu of imprisonment. If a retarded individual is brought to trial and ruled incompetent to defend himself, legal council must be provided, at public expense if necessary. A retarded person must not be remanded to any public institution interminably. When a retarded citizen has been judged to be incompetent to stand trial, that citizen must be provided an integrated, individualized habilitative program.
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Regular judicial and programmatic review of an individual' program must be maintained. The right to speak openly and fully without fear of undue punishment, to privacy, to the practice of a religion, or the practice of no religion , and to interact with peers. A retarded individual should not be made to fear that interacting either exclusively with his or her retarded peers, or with member of society at large, will subject him or her to recrimination.
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Further, he or she must not be made to fear that complaint about or concern with the character of his or her public care will result in retribution. Every effort should be made for each retarded citizen to have time and space for his or her exclusive use. Specific extensions of, and additions to, these basic rights, which are due mentally handicapped persons because of their special needs, include, but are not limited to:. The right to a publicly supported and administered comprehensive and integrated set of habilitative programs and services designed to minimize handicap of handicaps.
The retarded individual may reasonably expect a program of habilitation geared to his or her individual needs at public expense. This program of habilitation should recognize the individual's handicap s , but should be geared o allowing that individual to function in a way as nearly possible approximating the functioning of nonretarded citizens.
Each individual, however severe his handicaps, should be helped to realize his maximum potential through an individualized habilitative program that takes maximum advantage of all relevant services, including social welfare services, medical services, housing services, vocational services, , transportational services, legal services, and financial assistance services.
The program should be subject to regular reevaluation and open review, and should be adapted to reflect the growth and learning of the retarded individual. The right o a publicly supported and administered program of training and education including, but not restricted to, basic academic and interpersonal skills. The society musty make every effort to enable its retarded citizens, form childhood, to learn and us the skills that are necessary to function in the least restrictive setting possible and to function in the community at large with the least supervision that is appropriate.
Among the skills that retarded persons should be afforded the opportunity to learn are self-help skills, money handling, use of transportation services, adaptive interpersonal behavior, reading, writing, the ability o take advantage of other services and sources of assistance in the community, and rewarding use of leisure time. The right, beyond those implicit in the tight to education described above, to a publicly administered and supported program of training toward the goal of maximum gainful employment, insofar as the individual is capable.
The public should provide a comprehensive set of appropriate programs of vocational training designed for retarded citizens. These may be provided through such situations as residential institutions, day care centers, sheltered workshops, vocational rehabilitation centers, or in apprenticeship programs in the larger community. To the extent possible, government at all levels should attempt to see that positions are available for retarded individuals upon completion of their training, either in publicly sponsored programs or in private employment.
Governments also should encourage the employment of retarded workers, by eliminating legal and other artificial barriers to their obtaining jobs. Retarded individuals should not be exploited, either by those who have been entrusted with their care or b members of the society at large. Such exploitation the past has frequently resulted from the individual retarded person's inability either to perceive the exploitative aspect of a situation or to defend himself or herself against it.
The right, when participating in research, to be safeguarded from violations of human dignity and to be protected from physical and psychological harm. In securing that right, it is essential that research with retarded persons be carried out only with the informed consent of the subjects or, in very special cases, of their legal guardians , that retarded persons be made aware of their rights not to participate, and that such research as may be done with retarded persons adhere to recognized contemporary standards of ethics and scholarship.
Nonparticipation in research must never be followed by aversive consequences or the threat or implied threat of aversive consequences. Given the limited ability of many retarded persons to comprehend the nature and possible risks of a research program, it is necessary that particular care be taken to assure that research subject are truly informed on what is required of them, what risks and possible benefits are involved, and what will be done with the data.
Investigators have a responsibility to confine their research with retarded persons to those studies whose outcomes are likely to bear some ultimate benefit to retarded persons. The right, for a retarded individual who may not be able to act effectively in his or her own behalf, to have a responsible impartial guardian or advocate appointed by the society to protect and effect the exercise and enjoyment of these foregoing rights, insofar as this guardian, in accord with responsible professional opinion, determines that the retarded citizen is able to enjoy and exercise these rights.
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A retarded individual frequently requires the food offices and efforts of nonretarded citizens in order to have his or her welfare safeguarded. In most instances, this fellow citizen will be a member of the retarded individual' family. Occasionally, however, it becomes necessary to have an unrelated citizen or agency act in the retarded person's behalf.
The appointment of such an guardian is generally made by the courts; the guardian may be responsible both for the retarded person's estate and for his person. Such appointments should continue to be made by the courts, but only with competent professional advise. The guardian of a retarded individual should not be a public official responsible for the direct and immediate care and management of that particular person.
The loss experience for such an individual would be one of expectation that the lost object will return e. The patient may ask questions such as: How will the loss affect me? Who will understand me now? Who will take care of me? Who will be my friend? Who will give me things? This patient can understand clear and specific explanations of loss and death but will tend to take things literally. Dual diagnosis individuals are people, and as such they desire the same things from life as individuals in the general population do: B's quality-of-life indicators included housing, finances, and his occupational setting.
He was especially fearful when requesting time off work, despite the fact that he had accumulated many weeks of available leave; this was actually the result of a request by Mr. B for time off during the Thanksgiving holiday being denied by his supervisor. B was encouraged to ask his supervisor for a few new duties and a small raise, and he was given a note endorsing these changes. His job description and wages were upgraded almost immediately. He was encouraged to ask his supervisor why leave had been refused last Thanksgiving. When the reasoning was re-interpreted to him correctly he was told that his services had been very much needed during the holiday period , he experienced a boost to his morale, and he readily asked for and received a brief vacation before assuming his new duties.
B lived independently in a small apartment, which was his preference, and was able to afford his monthly bills rent for subsidized apartment, utilities, groceries, etc. This frustrated him at times and he felt it to be an obstacle to meeting new friends. His small wage increase gave him more spending flexibility and facilitated his ability to engage in more social activities. At the same time, like many mildly retarded persons, he felt inferior to co-workers in his occupational setting. Although there were opportunities for social networking through both mental health and mental retardation systems, Mr.
Without directly challenging Mr. B's assumptions about his condition or his family, the psychiatrist facilitated access to a supported educational program, job coaching, and case management. B was in fact not as disabled as some of the other patients; therefore, Mr. B had some recurring themes in his relationship difficulties. He tended to be submissive and passive, which resulted in frustration and an increase in his symptoms of depression and anxiety. He also had self-esteem problems and poor self confidence, which caused him to make poor decisions in relationships and attempt to continually please others.
This in turn resulted in poor boundaries with both men and women, and these difficulties were compounded by his limited insight and judgment. B expressed a goal of being able to voice his opinions with confidence and be accepted as a person by both platonic friends and potential significant others.
Using supportive psychotherapy, the therapist became active and directive in helping Mr. B improve social functioning and coping skills. In general, the goals of supportive psychotherapy include the following: B has learned how to maintain appropriate boundaries in a relationship but still maintain the relationship.
For example, when the therapist ran late for an appointment, Mr. B learned how to assert his legitimate needs and rights in an appropriate manner and learned that the relationship was not threatened by him doing so. B began to practice limit-setting and appropriate boundaries with his family and learned that this was safe to do within these stable and supportive relationships.
B the option of not answering questions when it did not feel comfortable and by giving him specific responses to use when these situations arose in other circumstances and relationships. B described a chronic problem of giving others too much information, even when he felt the questions were personal or intrusive. The therapy setting was also utilized for addressing sexuality and issues of romantic relationships.
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B, often individuals with MR aren't exposed to sexual education, and it is common for family members and others to ignore this aspect of the MR individual's adult life. B like many other MR persons was interested in having romantic relationships and perhaps having children and wanted guidance about these matters. One night, while out with his friends, Mr.
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He went out with this woman several times. The girlfriend ended the relationship with him after just two weeks of dating. He felt pressured by her to engage in sexual intercourse, and gave in despite his better judgment. When he admitted his remorse to her for engaging in sexual intercourse, an argument ensued wherein she told Mr. B she no longer wanted to see him.
The problems that Mr. B experienced in the romantic relationship also involved boundary issues and inability to be an advocate for self. The therapist confronted these issues directly and encouraged Mr.
Rights of Mentally Retarded Persons (1973)
B to voice his opinion and state his preferences within the safety of the therapy setting and to explore his goals in a romantic relationship. The Clinical Manual of Supportive Psychotherapy's goals of supportive psychotherapy can be implemented in the treatment of persons who are mentally ill and MR. These goals are as follows: Supportive psychotherapy is an eclectic form of psychotherapy that is widely practiced in multiple settings and service delivery systems.
It is an effective mode of therapy for the dual-diagnosis patient who meets inclusion criteria and is motivated for treatment. The most frequent goals of the therapy focus on reducing behavioral dysfunction and subjective mental distress, as well as supporting existing adaptive coping skills while maximizing autonomy and independence. These goals are especially relevant to the dual-diagnosis patient who has struggled with issues of disability and dependence and who may have limited experience with interpersonal relationships and social networks.
The working alliance formed in the supportive psychotherapy will provide the necessary forum in which these issues can be addressed and processed. Paulette Marie Gillig, Dr. National Center for Biotechnology Information , U. Journal List Psychiatry Edgmont v. Paulette Marie Gillig Dr. Find articles by Paulette Marie Gillig. Author information Copyright and License information Disclaimer. Psychiatric History and Diagnosis Mr.
Adjunctive Pharmacotherapy Presently there are no identified best practices specific to the MR population; therefore, as of now, the best practices that exist for the general population should be applied. Life Transitions and the Recurrence of Depression At the time a family receives news that a child has mental retardation or a developmental disability, there begins a process of grieving as the family realizes that developmental stages may not be achieved or may be delayed.
Processing Death and Loss with the MR Person It may be helpful to understand how a MR person experiences loss if one takes into account the stage of development of that person. Quality of Life Indicators Dual diagnosis individuals are people, and as such they desire the same things from life as individuals in the general population do: Contributor Information Julie P. Emotional disturbance and mental retardation: Am J Ment Defic. Clinical Manual of Supportive Psychotherapy.
American Psychiatric Press; Mood disorders and intellectual disabilities. Dosen A, Day K. Clonazepam behavioral side effects with an individual with mental retardation. J Autism Dev Disord. Promoting healthy aging and community inclusion of adults with developmental disabilities. Hollins S, Esterhuyzen A.
Bereavement and grief in adults with learning disabilities.