Care to share magazine issue 7

Just a reminder. Care to share magazine issue 7 is out today as a series of blog posts or downloadable PDF.

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Safeguarding 10: Institutional abuse

Guantanamo's rules institutionalised abuse

Guantanamo’s rules institutionalised abuse

Institutional abuse, also known as environmental abuse can be a little tricky to understand. This is because the definition of an institution can be confusing.

Most people think of large hospitals, asylums or even prisons as ‘institutions’. Still others might bring to mind children’s homes or universities. What all of these examples have in common is buildings and so most people think of institutions as being enclosed by walls – by bricks and mortar but that’s not really what the word institution means. Actually an institution is anything governed by rules and conventions. That’s why we also talk about the institution of marriage or religion or of monarchy. It is the presence of rules that defines the institution – not the presence or absence of buildings.

Institutional abuse then is the abuse that comes from the rules that govern the situation, the institution, the environment.

Routines and conventions can be just as abusive as individuals even though they are not meant to be and nobody would want them to be. Let’s consider a hypothetical example….

It is 6am in the care home and the night shift are approaching the end of their shift. Their last task of the night is to help some of the more dependent residents to rise, bathe and dress. They have around half a dozen named individuals to ‘get up’ before the day staff arrive at 7:15am.

Once they’re up they are taken to the lounge where the television is playing 24 hour news. This is appropriate because ‘everyone likes to watch the news’.

At 7:15 the handover begins and lasts until 7:30 when the night staff go home. The day staff have a cup of tea and the work of the morning is allocated. This lasts until around 8am when the residents in the lounge are also given a cup of tea. At 8.30 am they are helped on and off the toilet. By this time the other, less dependent residents have been helped out of bed and are also sitting in the lounge. Medication is given out along with breakfast at the morning ‘drugs round’. At 11am everyone gets another cup of tea (everyone likes tea) and then toileted. By noon the staff are ready for another drink themselves. All the residents are enjoying themselves watching daytime TV in the lounge.

This routine of tea, toilet, TV drugs and food continues day in, day out with set times for everything and no consideration for individual choices. Such a routine dehumanises the residents even though nobody actually wants that and it was never the intention. The abuse is the unintended consequence of the routine.

Of course institutions need rules in order to survive and nobody is suggesting otherwise. Care homes and hospitals can’t function without reasonable routines. Neither can domiciliary care services or outpatients departments. The trick is to ensure that the rules and routines do not discriminate, do not deny individuality and do not ignore the genuine and reasonable needs of the service-users.

Consider for example a menu routine involving pork on Tuesdays. Without an alternative this would discriminate against the dietary needs of people from several religious groups and, of course, vegetarians and vegans.

Systems controlling the need for security from outsiders might inadvertently have the effect of preventing those inside from leaving the building.

Routines involving televised Sunday services played in a communal lounge may be very inappropriate for non-Christian residents unless there is sufficient flexibility to provide them with an alternative way to spend that time.

The problem in identifying institutional abuses is that they are usually unconscious. People don’t plan to be abusive when they set up their systems and routines and so this type of abuse often goes unnoticed.

One way to identify your own institutional abuses is to take note of your justifications. If, when questioned about a particular practice or routine, your automatic justification is something like “That’s how we’ve always done it” then it’s worth asking why. This doesn’t necessarily mean that there’s a problem. Very often the things we’ve always done work extremely well – that’s why we continue doing them. They are effective and not abusive in the slightest. But there’s no harm in asking yourself the question.

Additionally ask yourself if there’s any flexibility in the system. Is there a reasonable alternative for people who need it? Whose best interests does this routine serve, the service-user, the staff or the relative?

Above all remember that tradition is just another way to say ‘someone else’s rules’ and ‘best interests’ isn’t usually the same as ‘what we’ve always done’ or ‘what the relative demands’.

About the Safeguarding series

This blog series first appeared on Stuart’s personal blog early in 2010. It has been reposted here as part of a process of ‘rationalisation’ in which work from several blogs has been removed and reposted on only two.

Safeguarding 9: Discrimination

As most people are aware many forms of discrimination are unlawful in British society as they are throughout much of the rest of the world. However the nature of discrimination (what it actually means) isn’t always so clearly understood. The confusion about what is and is not discrimination isn’t helped by the way that certain individuals or groups claim ‘discrimination’ when really they are simply failing to get their own way.

A recent example of this involves the Bristol ‘Healing On The Streets’ (HOTS) team. This faith-based group published materials claiming that any and all ailments from mental disorders to cancer would be cured by the power of prayer. They did not state this as mere opinion but rather they presented it as fact without any reasonable evidence to support the claim. This would be a problem in any organisation, not just a religious ministry.

Hayley Stevens is a paranormal investigator who was ‘leafleted’ by a member of the HOTS team. She was concerned that the published material may offer ‘false hope’ to desperate and vulnerable people. She was also concerned that it might discourage people from seeking medical care and so she contacted the Advertising Standards Authority (ASA) who upheld her complaint and ordered the group to remove such claims from its publications. The HOTS team subsequently issued a statement claiming that Hayley represented a group, generally opposed to Christianity. They have since removed that statement from their website.

Criticising fraudsters for false advertising is fair comment. The reason for criticism of the HOTS team is not their religion, it is their unethical behaviour in making false claims that would be a problem whoever produced the publicity.

We can see then that what does or does not constitute discrimination depends upon relevance. It would be discriminatory to say that all religious people are liars but it is not discriminatory to ask all people, religious or not, for evidence to back up claims of miracle treatments and to expect them to abide by the law and by accepted advertising standards when they cannot.

It is when we make unreasonable distinctions between people that we are guilty of discrimination. For example when we make assumptions about someone based upon characteristics that have nothing to do with the issue at hand. This sort of discrimination, based upon irrelevancies, is what happens when people make judgements based upon skin colour, religious affiliation, nationality, ethnicity, disability, profession or sexual preference. Skin colour for example has nothing to do with trustworthiness and disability does not invalidate a person’s right to be treated with respect. In both cases, colour and disability, the ‘condition’ is irrelevant to the point under consideration.

However the fact that an individual belongs to a group that is regularly discriminated against does not mean that they can do no wrong. A gay man who assaults his neighbour in a dispute about a garden fence will still be prosecuted. But he will be prosecuted because of the assault. His sexuality is irrelevant. He may claim discrimination on the grounds of his sexuality but his claim will not be taken seriously by the courts because his sexuality is not relevant to the case at hand.

On the other hand a gay couple refused accommodation in a hotel or guest house would be supported under anti-discrimination legislation for exactly the same reason. Their sexuality is not relevant to their right to use services.

Similairly if the manager of a residential drug rehabilitation unit were to evict an Asian man because of his use of illicit substances on the premises he could not then claim racial discrimination. The eviction would be because of the rules of the service which are applied equally to all service-users regardless of skin colour or racial type. Colour is simply irrelevant and therefore the decision to evict is not discriminatory – it is simply an appropriate response.

The basic ‘rule of thumb’ then is to ask if the alleged discrimination is relevant. Is your action the result of the individual’s need or behaviour or is it motivated by the fact that they belong to a particular group.

If it’s because of individual circumstances and would be the same whatever subgroup the person belonged to then it’s probably not discrimination. I say probably not because there is the additional aspect of institutional discrimination that we will consider in a later post. If it’s because of the subgroup they belong to (eg religion, LGBT, disabled, Asian etc) then there’s a good chance you really are discriminating.

As ever ‘relevance’ is the key when deciding whether or not you’re being discriminatory.

About the Safeguarding series

This blog series first appeared on Stuart’s personal blog early in 2010. It has been reposted here as part of a process of ‘rationalisation’ in which work from several blogs has been removed and reposted on only two.

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