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Assessment and Treatment Units

Author: Sam Sly

A version of this article was first published in Learning Disability Today.

I have been tweeting over the past months as part of the #107days campaign for Connor Sparrowhawk about the things I have learned about Assessment and Treatment Units (ATUs) in the years I have been helping people leave Units to return to a real life and a home of their own in the communities they came from. 

I have learned may things, most of which lead me to conclude that ATUs do not have a place in the rehabilitation, if rehabilitation is even the right word to use, of people who have been labelled by others as having ‘challenging behaviour’. Taking someone out of the environment that has become problematic to ‘treat’ them elsewhere does not, nor ever will, help them in the long term – instead it transfers the person to a new, often more challenging environment where they instead have to learn a new set of expectations, rules and behaviours that will not apply when they go home. 

Throughout my career I have often reflected back to where the fire within me to fight the injustice that people with learning disabilities experience on a day-to-day basis first started and what continues drives me to continue to fight to help people stay in their communities and sort out issues and not have to go to ATUs in the first place.

I conclude that my passion for this work crystallised when I came across Wolf Wolfensberger’s work as a young social worker. His theory of Social Role Valorization (SRV) has as much relevance now as it did when he formulated it in 1983. Wolfensberger’s SRV not only helps us identify what methods we in services and society use to devalue people with learning disabilities, but also can help us in our work, giving us tools to counteract the effects. 

Social devaluation has long term effects on people, and those in ATUs experience the most extreme wounds (the emotional, psychological and physical hurt that is inflicted) and devaluation. Wounds can wreak havoc on not only the person but those closest and committed to them (family and friends) as they also become devalued by association. 

The labels given by the powerful (professionals and services) to people like ‘challenging’, ‘forensic’, ‘criminal’, ‘deviant’, ‘lacking capacity’ and ‘patient’ all serve to differentiate them from the norm in a negative way and keep them separated and controlled; reiterating the destructive roles in life that have been assigned to them over and over again. A very sad business indeed. 

These labels never get forgotten and cannot be erased for as long as people are treated by services as their labels and this is reinforced throughout a person’s life in the professional reports that follow them around. Wounded people are relegated to the status linked to their label and they are continually rejected by their communities, society, and services. 

This can lead to people taking on the roles they are assigned - deviant, child-like, criminal, and outcast and they may become scapegoated. They are likely to be segregated and congregated with other labelled deviant people (for example in ATUs) and lose control of everything including their autonomy and freedom and this then leads to people losing their home and place in the community and then family and relationships. 

Natural freely given relationships are replaced with artificial/bought ones and de-individualisation starts to happen which leads to material poverty, impoverished experiences, and exclusion from the knowledge that gives meaning and direction to life and provides community. Ultimately their life becomes ‘wasted’ and in extreme situations, as happened to Connor Sparrowhawk and countless others in our Specialist Hospitals systems over the years, people become objects of brutalisation. 

What everyone (valued or devalued) needs to flourish is to have what Wolfensberger describes as the ‘good things in life’. This is why planning around people’s gifts and talents, hopes and dreams, and not around people’s deficits is so important and I think this is one of the reasons ATUs don’t work as the ‘treatment’ there is targeted at deficits; a person’s challenging behaviour and not on achieving the good things in life. 

The good things in life are:

  • Family or to belong and be loved
  • A transcendental belief system
  • Not to always be scared of the imminent threat of hardship 
  • To be viewed as a human and treated with respect
  • To be treated justly
  • Friends
  • Meaningful work
  • Opportunities and expectations to discover and develop skills, abilities, gifts and talents
  • To be dealt with honestly
  • To the treated as an individual 
  • Access to the ‘sites of everyday life’
  • Being able to contribute, and having one’s contributions recognised as valuable

It is worth reflecting on which of these ‘good things in life’ you yourselves have in your lives and why they are so important in making life worthwhile and fulfilling. Then consider the ‘good things in life’ again, through the eyes of a person who is stuck in the hospital system and ask yourself how impoverished a life they are probably living?

Follow Sam on twitter: @SamSly2


The publisher is The Centre for Welfare Reform.

Assessment and Treatment Units © Sam Sly 2014.

All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.