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Accessible summary • We asked eight members of staff who were working with people who had a learning disability, and also, complex mental health needs to tell us how they felt about their work. • These workers told us that not having enough staff and having a wide range of patients with different needs to look after made their job difficult. We felt they tried to put a ‘brave face’ on but we felt they worried greatly about working with patients who had complex mental health needs. • We did not feel these workers were given enough opportunity to think and talk about their feelings about their work. Staff tried to cope with these difficult thoughts and feelings about their work by trying to forget them or by thinking about other things. • Staff need to be given time to think and talk about their work and their feelings towards their patients. This may help them to feel less stressed and more able to cope with their patients and their work. Summary Experiences of eight staff working with people who have a learning disability and complex mental health needs were explored by interviews and analysed using the free association narrative interview approach (Hollway & Jefferson 2000). Participants reported that organisational factors such as not having enough permanent staff and having to manage a complex patient mix impacted upon their work. Participants’ unconscious communications were interpreted as evidence that they were experiencing projected anxiety from their patients. Participants did not appear to be given opportunities in work to reflect upon their emotions and often coped by repressing painful experiences or displacing these onto the organisation. Staff would benefit from exploring their conscious and unconscious reactions to their patients.

Summary This article argues that the interpretative and negotiating approach of hermeneutic ethics can inform research into the experiences of people with learning disability more usefully than bioethics. Terms and ideas are defined; philosophers and researchers who have employed them are described; arguments for and against the proposition are considered; it concludes by summarizing the position and its implications. Two final reflections pose questions researchers may find it fruitful to consider, or to discuss with users, carers and professionals.

Summary A small group of experienced community workers providing risk management for men with learning disabilities who sexually offend was studied. Attribution statements participants made about their risk appraisals were analysed using the Leeds Attributional Coding System (LACS). Results highlight the effort participants made to obtain sufficient information. They focused on factors external to the service-user for most effective risk management, but their confidence was undermined by other staff minimizing the importance of such risks. Services that fail to develop specialist risk assessment skills and to address the modest ‘economics of effort’ required for effective practice may compromise risk management by community staff.