Beyond Community Care: Normalisation and Integration Work PDF
Preview Beyond Community Care: Normalisation and Integration Work
Issues in Mental Health Series Editor: Jo Campling The care and status of persons with mental health problems has been identified as one of the key issues in health and society in the 1990s. This series of books has been commissioned to give a multi- disciplinary perspective: legal, medical, psychiatric and social work aspects of mental health will be covered. There is also an international perspective: wherever possible, books will compare developments in a range of different countries. PUBLISHED Suman Fernando Mental Health, Race and Culture Shulamit Ramon (editor) Beyond Community Care: Normalisation and Integration Work FORTHCOMING Philip Bean and Patricia Mounser The Discharge of Psychiatric Patients Chris Heginbotham Mental Health and Human Rights Tessa Jowell and Gerald Wistow Community Care and Mental Health Ron Lacey, David Pilgrim and Anne Rogers People First: How Patients Experience Mental Health Care The Issues in Mental Health series is published in association with: MIND (National Association for Mental Health) 22 Harley Street, London WIN 2ED (071-637-D741) MIND is the leading mental health organisation in England and Wales. It works for a better life for people diagnosed, labelled or treated as mentally ill. It does this through campaigning, influencing government policy, training, education and service provision. Throughout its work MIND reflects its awareness of black and ethnic communities, and draws on the expertise of people with direct experience as providers and users of mental health services. The points of view expressed in this publication do not necessarily reflect MIND policy. Beyond Collllllunity Care Normalisation and Integration Work Edited by Shulamit Ramon Selection, editorial matter, Chapters 1, 7 © Shulamit Ramon 1991 Individual chapters © David Brandon, Mike Lawson, Alexandra Lewis, Julie Segal, Richard Warner 1991 Softcover reprint of the hardcover 1st edition 1991 978-0-333-51400-9 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced. copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 33--4 Alfred Place, London WCIE 7DP. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. First published 1991 Published by MACMILLAN EDUCATION LTD Houndmills, Basingstoke, Hampshire RG21 2XS and London Companies and representatives throughout the world Edited and typeset by Povey/Edmondson Okehampton and Rochdale, England British Library Cataloguing in Publication Data Beyond community care: normalisation and integration work. - (Issues in mental health) 1. Great Britain. Mentally ill persons. Rehabilitation I. Ramon, Shulamit II. Series 362.204250941 ISBN 978-0-333-51401-6 ISBN 978-1-349-21393-1 (eBook) DI O 10.1007/978-1-349-21393-1 Series Standing Order (Issues in Mental Health) If you would like to receive future titles in this series as they are published, you can make use of our standing order facility. To place a standing order please contact your bookseller or, in case of difficulty, write to us at the address below with your name and address and the name of the series. Please state with which title you wish to begin your standing order. (If you live outside the United Kingdom we may not have the rights for your area, in which case we will forward your order to the publisher concerned.) Standing Order Service, Macmillan Distribution Ltd, Houndmills, Basingstoke, Hampshire, RG21 2XS, England 'But nobody wounded like him could deserve a chance at life. Better dead said the crones, better dead said history, better jump in at the deep end decided her strong soul as she heard his crest fallen cry. His mother it was who treated him as normal, tumbled to his intelligence, tumbled to his eye-signalled talk, tumbled to the hollyberries, green yet, but holding promise of burning in red given time, given home.' Christopher Nolan, Under the Eye of the Clock. To all of the discovered, and those yet to be discovered, Christopher Nolans of this world, their mothers, fathers, sisters and brothers. Contents List of Contributors viii Acknowledgements ix Preface x Part I The Background Dimensions of Normalisation Work 1 Introduction 3 1 Principles and Conceptual Knowledge 6 Shulamit Ramon 2 Implications of Normalisation Work for Professional Skills 35 David Brandon Part II Experiencing Normalisation and Social Role V alorisation 5 7 Introduction 59 3 A Recipient's View 62 Mike Lawson 4 The Professional Perspective 85 julia Segal 5 Creative Programming 114 Richard Warner 6 Public Participation in Decision-making 13 7 Alexandra Lewis Part III The Test Ground: Turning Principles into Policies 161 Introduction 165 7 Policy Issues 167 Shulamit Ramon Name Index 195 Subject Index 197 vii List of Contributors David Brandon is a social worker by training, fonnerly director of North-West Mind, editor of Community Living, author of several books, and Cl.irrently training service providers in the field of learning difficulties. His most recent book is on brokerage. Mike Lawson is the director of International Self-Advocacy Alliance, vice-chairperson of MIND, active in Survivors Speak Out, who has personally experienced the pyschiatric services as a recipient. He is involved in training and promoting self-advocacy and mutual support among users. Alexandra Lewis is the chair of the British Community Health Councils organisation, and until recently also a member of the Mental Health Act Commission. She is a researcher and planner in the fields of developmental handicap and psychiatric services for offenders. Shulamit Ramon is a social worker and clinical psychologist by training, senior lecturer at the London School of Economics, with a wide-ranging cross-national research background. She is the author of Psychiatry in Britain: Meaning and Policy, and the editor of Psychiatry in Transition: British and Italian Experiences. Julia Segal is currently psychologist and researcher with ARMS (Action Research Multiple Sclerosis), author of Fantasy in Everyday Life, with considerable experience of work and training in different settings. Richard Warner is the director of Boulder Mental Health Center, a large and innovative service. He is also professor of psychiatry at the University of Colorado and the author of Recovery from Schizophrenia. viii Acknowledgements I would like to thank the contributors to this volume who gave freely of their creativity to the project, making my task as the editor rewarding. As usuaL T eodor helped with insightful and precise comments, while Aelita reminded me that there is an ordinary life to be lived and enjoyed; I am grateful to both of them. Lindsey Olliver helped in the typing with care and efficiency. SHULAMIT RAMON ix Preface The title of this book suggests that community care, a principle and a concept which dominated the approach to people with disabilities for the last thirty years throughout the Western world, has perhaps outlived its usefulness. Developing during the Second World War and especially during the 1950s and 1960s, community care was a professional and political response to the guilt evoked by the restricted life led by people with disabilities in total institutions. 1 The ideal of desegregation resembled the achievement of the great age of reform which took place 200 years earlier, symbolised in freeing the residents of psychiatric hospitals from their chains by Pinel and Tuke. Furthermore, it was believed that by locating services outside the segregating institution, the need to enter it would decrease and integration with the ordinary community would take place spontaneously. Thus community care included the recognition that many of the people with disabilities residing in institutions had the potential to lead a more ordinary life in the community. However, neither this recognition nor the ideal seems to have led to a fundamental change in social and professional approaches to people with disabilities.2 The focus on dehospitalisation - which constituted the bulk of community care efforts in the field of disability - as a once and for all solution to the problem was particularly attractive to politicians. They could easily identify with this simple humanistic message, made doubly attractive by the possibility of reducing public expenditure through care in the community.3 With hindsight and the evidence accumulated since the 1950s, it seems that concentrating on the point of transfer has become a crucial stumbling block of the policy.4 For it meant neglecting the process of change in the institution, its residents and workers prior to the move; paying little attention to the life led after leaving the institution; and even less attention to preventing the need for institutional life in the first place. Community care has been bedevilled by a conceptual muddle, a policy muddle, and a practice muddle. Conceptually, a community can be a neighbourhood, a community of interest with and without geographical boundaries, or the configuration of a person's connections and ties.5 Care is about attending to people's needs in different ways, and at different levels,
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