This essay will show how Goffman's theory of total institutions is supported and why this can cause difficulties for service users. It will also show why it is important for health professionals to help service users have a voice and be heard to enable them to express their thoughts, feelings, ambitions and requests. This can be clearly illustrated by the case studies of Lennox Castle resident Margret Scally, an interview with Colin Sporul and Allen Williamson, two nurses at Lennox Castle, and finally by Lesley Learmonth. The essay will also show how healthcare professionals can facilitate the process to ensure service users have confidence to speak up when they need to in the future. people with learning disabilities should not be part of a larger community or have the same rights. This opinion was strengthened when the government began to build large institutions to house all people described as "mentally deficient": "idiots", "imbeciles", "feeble-minded" and "moral imbeciles". (The Open University (2011) DVD Unit 7, Lennox Castle timeline). Communication is an essential part of everyday life for everyone, but for people who have learning difficulties or impairments like those in Lennox Castle it is particularly important. This is why it is imperative that all health and social care workers "support people in having a voice and being heard" (K101, Unit 4 p 183), this is one of the five principles of assistance implanted in the healthcare sector. Health professionals should encourage service users to speak up, which will enable them to create their own individuality or identity which in turn will give them a better quality of life; this is very different from the way people with learning disabilities were… middle of the paper… they were independent. Although Lesley receives support and regular visits from a support worker while living in the flat, Lesley tells us 'I like being independent…. I'm settled" (The Open University (2011) DVD Audio 7.3). Changes in the National Health Service and Community Care Act 1990 emphasized that people with learning disabilities should be helped and supported to be "integrated into the community" rather than be institutionalised. This has been partially achieved with the help of care assessments. This gives the service user the opportunity to speak confidently by stating what they feel is the right type of support for them at the end of this. process the service user will have “their own individual care plan” documenting everything that has been discussed and the support they will receive (http://pb.rcpsych.org/content/24/10/368.full).