Sir: The emotional debate about community care (reports, 27 March and Letters, 29 March) does not sufficiently emphasise that the label "learning difficulties" (mental handicap) covers an enormously large spectrum; from people who have relatively minor problems to those who (in the severe category) are best described as having multiple handicaps. This group may have sensory disorders, neuromuscular disorders, epilepsy, psychiatric and behaviour disorders.
The suggestion that the needs of everyone in this very large continuum can be best served by a single model of care is not borne out by research nor by common experience. There are many people who live in small group homes in large cities such as London who spend a great deal of their time in relatively confined spaces and do not have a wide choice of friends, social events, education and space; village communities may be better able to offer such opportunities in many cases.
Surely the best approach is not to take refuge in polarised ideological positions but to realise that a wide range of services is needed depending on the nature of the needs of the individual.
Unit of Developmental Psychiatry
Charing Cross and Westminster
University of London