This essay will show how Goffman's theory of total institutions is supported and why this may cause difficulties for service users. It will also show why it is important for carers 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 Margret Scally, a resident of Lennox Castle, an interview with Colin Sporul and Allen Williamson, two nurses from Lennox Castle, and finally Lesley Learmonth. The trial will also show how carers can facilitate the process to ensure service users are able to speak up confidently when they need to in the future. The members of the society believed him; people with learning disabilities should not be part of the wider community or have the same rights. This view was reinforced when the government began building large institutions to house all those labeled as "mentally defective": "idiots", "imbeciles", "feeble-minded people" and "moral imbeciles". (The Open University (2011) DVD Unit 7, Lennox Castle timeline). Communication is an essential part of everyone's daily life, but for people with learning difficulties or impairments like those at Lennox Castle, it is particularly important. This is why it is imperative that all workers in the health and social care sector “help people to speak up and be heard” (K101, Unit 4 p 183), it is one of the five principles of care implemented in the healthcare sector. Carers should encourage service users to express themselves, which will enable them to create their own individuality or identity, which will give them a better quality of life; this is very different from how people with learning difficulties are independent. Although Lesley, by living in the apartment, benefits from living support and regular visits from a social worker, Lesley tells us: “I love being independent…. I'm settled” (The Open University (2011) DVD Audio 7.3). Amendments to the National Health Service and Community Care Act 1990 emphasized that people with learning disabilities should be helped and supported to "integrate into the community" rather than being institutionalized. This objective was partially achieved thanks to the care evaluations. This gives the service user the opportunity to speak up in confidence about 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 was discussed and the support they will receive. (http://pb.rcpsych.org/content/24/10/368.full).