The Threat of Micro-Institutionalisation
Author: Robin Jackson
In this short essay, Robin Jackson, author of the major report - Who Cares? - argues that we are seeing the reemergence of institutionalisation - but in a new form: micro-institutionalisation.
The latter half of the 20th century witnessed the process of de-institutionalisation whereby hospitals for people with an intellectual disability were closed and residents placed in the open community. Whilst the motivation for this profound change is not contested, what is challenged is the manner in which this policy of community inclusion has been promoted and implemented.
Propagation of this policy within a crusade, as is happening at this time, is both dangerous and counterproductive, for it can foster professional intolerance, division and disaffection; lead to the application of powerful and insidious pressures on professional staff to conform; devalue the worth of those who, for valid professional reasons, find ground for criticism; promote the growth of a propaganda industry which places a low value on objectivity and truth; prompt the use of strategies and techniques which indoctrinate rather than teach; encourage poorly trained professional staff to believe that the application of a simple formula will resolve the complex problem of delivering effective and humane services; and result in the creation of an inflexible service that is unresponsive and insensitive to the needs of people with intellectual disabilities.
Paradoxically what one is witnessing today is a process of micro-institutionalisation whereby the deficiencies identified in the old, isolated and discredited mental deficiency hospitals are to be found in an increasing number of ‘homes in the community’. This has resulted from a number of factors: inadequate staffing ratios leading to individuals with an intellectual disability being confined to their residential settings with limited opportunities to be part of their local community; those living on their own in ‘homes in the community’ having only limited contact with their peripatetic support worker and thus feeling increasingly physically, psychologically and socially isolated; overt hostility and victimisation from neighbours resulting in residents being disinclined to leave ‘their home’; and, the introduction of surveillance systems (CCTV) in residential settings so as to monitor the activities of residents thereby reducing staffing complements and keeping down running costs.
Why these developments are a matter of particular concern is because the social care sector in the UK is dominated by ‘for profit’ companies, which in order to keep staffing costs down tend to employ agency and unqualified staff and staff on zero hours contracts. As at least a quarter of ‘for profit’ companies in the UK social care sector are known to be ‘financially vulnerable’, it is very unlikely that such companies will invest in the employment of sufficient and adequately qualified staff as that would significantly increase running costs.
The proven ineffectiveness of the Care Quality Commission as a regulatory body has been demonstrated not just by the frequency of cases of abuse and maltreatment in the health and social care sectors, but by the repeatedly scathing judgements as to its operational effectiveness by a succession of Parliamentary Select Committees. As a consequence there must be a concern for the quality of life of a significant number of people with an intellectual disability. But according to the Chief Executive of the National Development Team for Inclusion, the government believes that people with an intellectual disability constitute too small a population in the UK to be politically significant.
If it is the case that the political profile of people with an intellectual disability is barely discernible, as has been claimed, then the major charities representing people with an intellectual disability must shoulder some of the blame. There is a compelling case for fundamental changes in the structure and operation of these charities and for them to act more assertively and independently. Also needed is a well-developed network of advocacy services representing the interests of people with an intellectual disability: one which is not administratively or financially tied to any of the statutory services. However just at a time when the voice of people with an intellectual disability most needs to be heard, cutbacks in local authority budgets are leading to the closure of advocacy projects. The situation is further exacerbated by the proven inadequacy of current whistle-blowing procedures which discourage staff from reporting abuse or malpractice for fear of victimisation or dismissal.
If as a result of a further financial crisis in the UK, possibly brought about by continuing uncertainties over the UK’s position in Europe or the future of the Eurozone, the government could decide to introduce even more stringent economic measures which may prompt those investors in the social care sector to withdraw and locate their funds in more profitable fields elsewhere. Should that happen, it is not clear what contingency measures the government can put in place to remedy the situation given that local authorities have largely withdrawn from this sector. There is a certain irony in the fact that many of the sites on which former institutions had been situated have been transformed into expensive and exclusive executive housing estates which make no pretence to community inclusion.
It may be argued that the picture that has been portrayed of the present predicament of people with an intellectual disability is unjustifiably bleak. If so, I would recommend scrutiny of my report on this subject - Who Cares? - which can be downloaded from the The Centre for Welfare Reform's website here.
The publisher is The Centre for Welfare Reform.
The Threat of Micro-Insitutionalisation © Robin Jackson 2015.
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.