The term Institution has a few varied meanings. It can reasonably be defined as an Organisation with a formal purpose, having an established structure and administration, geared towards recognised and accepted objectives, using some established rules. It usually has a formal social role and sometimes involves specific types of buildings that helps identify it as an Institution. To say something is 'an Institution' is to suggest that it is well established and acknowledge as having some status &/or expertise within the community, or culture. It is accredited in some way. It can even have 'culture' of its own and help 'set' the culture and attitudes for the community it services. Institutions normally have a positive, solid, reliable 'personality'. They are predictable, reliable and slow to change, checking each step. This 'character' of institutions is largely positive, most of the time, in that people become comfortable with them, can rely upon them and are clear of their purpose. It is the consistent, reliable predictability that normally provides people with some confidence in them. Provided that they continue to provide the service, or security, that they are intended for, there are few complaints. The negative feature of them, can be their inflexibility to change, when change becomes required. They are not naturally geared to sudden change, being established to maintain an established standard. They do slowly change though and this can be due to the repeated change of administrators of the institution, each interpreting the rules and objectives slightly differently. These can be changes due to internal influences Other external forces can also affect this slow change, like the availability of money, the politics of a particular period, new knowledge, criticism, identified failures. They are mostly designed to be cautiously resistive to these influences but there are invariably some gradual, progressive changes. This can lead to a deeper entrenchment' of the objectives and inflexibility; Alternatively it can allow the institution to gradually 'adapt' to new understandings, new conventions and knowledge. When criticised, a combination of these influences can cause the administrators of the Institution to start to operate for the institutions purpose rather than the community, or society they are organised to serve. This 'entrenchment' is often the result of external influences that identify the institutions failings. The criticism progressively cause administrators and other staff, to be defensive and protectionist. Like in the case of individuals, this is not wholly conscious and deliberate. It is a natural phenomenon. This process can progress to the degree where the service they provide becomes less appropriate to the people, or community they are supposed to serve, especially if knowledge and expectations have changed since the institutions initial foundation. There can be an increasingly irrational 'holding on' to largely redundant practices. The review of new ideas and knowledge stops. What once made it reliable now makes it unreasoning and intolerant towards change, rather than responsive & analytical. This process is called 'institutionalisation'. In an attempt to 'hang on' to the original values, it inadvertently become inflexible in its practices. It stops 'growing'. This is first reflected in behaviour and arguments of administrators and then of the staff generally, some of whom become 'institutionalised' themselves. They become dependent upon the institution and protect it, in order to protect their position. Gradually this affects the character and quality of the service they provide to the community. Eventually those that receive the services are forced to accept the now distorted rational and requirements of the institution, in order to obtain the services they need. They too become 'institutionalised'. As the process continues, they further loose some autonomy, in being required to meet the institutions objectives and from being constrained by the now largely redundant rules and practices. They often then become increasingly 'dependent' upon the institution as a result (if not already dependent in some practical way). So, How does this affect Health and Social Services and other Community Institutions?Returning to the Institutions that we are dealing with; Health & Social Care Institutions. The original purpose was one of largely 'Charitable' giving, by those wiser and more skilled, to those less skilled and largely confounded and dependent. These evolved into the 'State' Institutions. As society has developed and the general knowledge of Service Users & Family Carers has improved, the original Institution was forced to adapt from time to time. Some of the 'mystique' surrounding the service the institutions provided had gone. Progressive democratisation has raised expectations of many Service Users. There is a realisation that it is the Service Users who collectively provide the funds and resources. There has been an increasing awareness that people need to be more responsible for their own lives. The frequently unnecessary dependency on the institutions can be quite unhealthy, although increasing reliance on them need not be unhealthy. The institution, which once had gradually established significant status and power, was progressively required to give some of this up. This made the now paid/employed staff and administrators increasingly insecure. The institution becomes defensive and resistive under these pressures. Eventually changes had to be forced through, largely against its internal will and often without the normal 'moderating' of change that the institution would have usually mediated (often successfully). This is the most dangerous phase of any radical change, as the required changes will not happen immediately and the normal 'healthy' mechanism for 'moderating' change has now become 'entrenched' (become resistive), or has collapsed completely. The required changes will be open to interpretation and distortion, and will incorporated many of the old, etsanblished practices; Not necessarily the ones that protect, or mediate the process of change. The problem with the internal collapse of an institutions in this way is that many of the mechanisms that 'tested out' changes have ceased to operate properly. This means that changes introduced are often chaotic, in that the knowledge, processes and existing structure, designed for an earlier purpose, are now adapted for the new purpose. No amount of re-training is going to bring about a smooth, self adjusting transition, or transformation. It is the resistance to 'any' change that brings this situation about for institutions. This is the situation we are now in. The legitimate requirement for adaptation of institutions is rapid enough, the hastily drawn together 'prescriptive' requirements for introducing these changes are often delayed in preparation and then too hastily introduced. As a result, the aims and purpose for change often gets distorted (or corrupted totally) and the normal mechanisms to test out the effects and benefits of the changes fails. As described in the introduction, much of this 'institutional' thinking and behaviour, behind the 'referral' process into the services, is now largely 'blind'. It is a feature of established practice & expectations, learned through normal 'socialisation' and a measure of subtle professional indoctrination; good & bad. Professionals are as susceptible to subtle prejudices, as the rest of us. The established practices of the past get incorporated into the new initiative and 'corrupt' them. They are resistive to change because they are 'comfortable'. The modern insight and skill, of 'seeing things' from the 'perspective' of the Service User, has been at least partially recognised in the fields of Learning Abilities, Sensory Abilities and Physical Abilities. The old practices have been successfully challenged by powerful reference groups. It is still, however, a relatively unrefined skill that requires us to 'transform' our personal experience of 'receiving' services into an enlightened perspective on how Service User's might reasonably respond to the style of service they are provide with. Basically; Would we accept a service they are provided with, in the style that they are required to accept it. There is still a significant mismatch between the Service User's expectations and the types and styles of service being provide. Services are either seen to be failing the Service Users and Family Carers in some way, or they are assessed as not having levels of need appropriate for the services being provided. This is very frustrating but it is not uncommon. The changes needed are little to do with cost but more to do with attitude. As can be appreciated from what has been described above, this 'mismatch' is not going to be sorted quickly. It requires Service User's, and their representatives, to persist in calmly and purposefully making their needs and wishes known, in their terms, not simply from institutional choices that are on offer. The expectations of Service Users will increase further. It is natural that they will and in is to be expected, given the development of government initiatives and the underpinning Convention on Human Rights. At the earlier stages of a personal problem it is not always know what these individual personal requirements will be, at least for the Service User to be able to put them into words. People are very individual and their needs will vary accordingly to their personality, experience & expectations. Some will gratefully accept the 'institutional' norms, others will increasingly not, especially once the initial impact of a problem is resolved. This initial ignorance of possible needs and requirement they may have (when a problem arises) is due to the communities historical isolation from these personal and social problems. This is due to the past institutional isolation of people with 'uncomfortable' problems, like blindness, deafness, physical disability, learning difficulties and mental illness. Few people may realise that people with physical and mental disabilities used to be 'institutionalised' and isolated in 'specialised' institutions, separated from 'normal' society. When did this tendency end? It didn't completely but the 'community' process started as late as the 1970's. People with special physical and sensory abilities and their advocates and those with learning disabilities, started to make a stand and representation, against this prejudiced, sanctimonious and humiliating treatment from the 1950' onwards. By the 1970 we started to see some results. There are still remnants of old practices and prejudices in the community and within some professional groups. It is mental health that is farthest behind in this transition, especially in Rural Areas, where it is more difficult to organise User Led Services. One size does not fit all, but Institutions often deal in a limited set of sizes. They are largely 'off the peg'. This is partly due to limited funding but is also because of poor use of resources and poor, or inconsistent, support of community ventures and Service User initiatives. The administrative cost of providing the services that institutions elect to provide are disproportionately high and use up most of the funds. This is because they are 'defensive' in character and have to adhere (often too rigorously) to apparently inflexible protocols & edicts. Another reason why these services tend to be 'off the peg' in character, is because the diminished funds available to provide the direct service, requires that they provide for as many people as possible with something just good enough to cover the Institutions obligations. The legal constraints upon Institutional and Commercial service provisions are quite odorous. If interpreted too literally they even appear to contradict their declared intention; of providing People Focused, Least Restrictive, Best Value, practices. Charitable organisations, providing some of these services and receiving funding to this end, can be equally constrained. They are often required to invest much time and resource into funding justifications and protective / defensive actions. The least constrained of these groups is the Service User and Family Carer, who, provided they develop and provide their own direct support, in cooperation with others, are not so constrained by the raft of legislation which has been drafted in to protect them. Thee is a certain irony here. Although there are still genuine attempt to be 'inclusive' and 'person centred' (or focused), this largely fails because of the limited resources that are made available to this end. The 'Person Centred focus is restricted to choices within the limited service, not real choice within the community. Some of these specialist services are 'traditional', some are 'legalistic' and some are geared to deal with 'crisis'. There is little room for novelty and creativity, even if the institution was committed to this. There is precious little attention to early intervention and nothing at all for prevention and community education. The expectations of many Service Users and Family Carers now largely outstrip the ability for many institutions to provide an appropriate 'person centred' service. While this is the case there are plenty more who just give in and accept what they are offered, often accepting the 'victim' , 'subservient', or 'disempowered' roles, becoming dependent as a result. You may have recognised this yourself. If left unsupported long enough, most of us tend to end up doing this. It is not deliberate, but it is the natural consequence of institutions putting off support and intervention until a problem becomes critical & challenging. In a way, they create the bigger problems for tomorrow, by ignoring the smaller problems of today. No amount of pointing this out makes much difference. They are so focussed on their normal way of doing things and their 'historical' expertise, they are often unable to see the radical alternatives, never mind organise them. It is for these reasons that the dissatisfied Service Users and Family Carers need to learn some of the language of institutions and how they tick. If you are up to it (perhaps with some help from friends) the process is very empowering and you will get the support you need, possible quicker than you expect. The further consideration of these issues is dealt with later in this section and else where. You can expect some professional support for this, from some quarters, but you may have to take the initiative and be persistent. MIND and other Mental Health and 'Survivors' organisations can also help you locally. From my experience, the setting up of Service User initiatives and Service User led groups, are more successfully and easily established in City and Urban areas. It is much more difficult in Rural Areas. One of the problems to overcome is that of transportation. This can be expensive and difficult and can inhibit the regular coming together of Service User support groups. It is a major problem you will need to tackle with the institution's support. The Professional Practitioners Role in this: Meanwhile, I want to reassure individual practitioners that this is not a criticism of them directly. There are exceptionally bad practitioner in all fields and most of us know of these cases. Where these are bad enough we have to take some responsibility for challenging, or correcting these poor practices. The main difficulties are with the institutional character of existing organisations that provide the services. As described above, these have been established over centuries to maintain consistency, they are designed to resist change. Normally, when things are going well, or when there is no challenge to the nature of the provision of a service the institution provides, they offer continuity and resistance to 'change for change sake'. Unfortunately, once the fundamental purpose of the institution is challenged (and becomes undermined), there is a tendency for it to change frequently, jumping form one fashion to another, one incomplete understanding of an initiative to its counterpart. The institution can become 'reactive', rather than 'responsive' to the need for change. This incomplete process of change is often used to 'evidence' the failure of an otherwise proven, radical initiative. It is actually the failure to understand the principles and context of the required change, which then leads to the inappropriate implementation of a change initiative. Because the purpose for change is not adequately understood, or it is implemented using existing 'systems' and attitudes, its failure (at least in part) is of no surprise to those observing with knowledge of these things. Professionals are often trained in the light of successful and proven perspectives & initiatives and then return to community settings, hoping to implement their knowledge in full. What they often find is a very diverse interpretation of these ideas and the actual practices often falls well short of the ideals and objectives. It is not unusual, in these circumstances, for newly trained people to become disillusioned and distracted from practicing in Service User focused ways, having to compromise (often too much) for the institution's benefit. Trying to maintain 'person focus' and responding to their requirements, can become almost impossible. Add to this is the fact that earlier forms of professional training may not have encompassed some of the basic ideas and some practices may even have contradicted the Convention on Human Rights. This is, indeed, why many of the changes become necessary. Professional's are therefore required to re-adjust the power relationship between the institution, the professional and Service User. Once the fundamental principle for understanding the need for change are established, any continuation of inappropriate practices becomes 'abusive'. Knowledge of an abuse of power (however inadvertent) makes the Person and the Institution 'culpable for its continuation'. Here we become concerned with the sometimes abusive, neglectful and often hidden; 'disabling' and 'disempowering' practices of individuals' and of organisation's, due to persistent ignorance and natural, institutionalised prejudice. Many professionals are unhappy with current institutional practices. They often seek to see what part they can play in helping Service User's provide the service they desire and which best fits their needs, in ways that least create dependency. This is quite a challenge for many, operating within an institution that does not fully appreciate the nature of the changes required, or how to most effectively achieve them. It can be done, however, but it is useful to identify a small group of Service Users who want to take up this challenge with you. I have done this myself in a number of projects and it is very exciting and productive. The projects don't have to be 'permanent', they just need to have an objective and a focus that will attract a small group of people, who will help support each other, with the backup of a professional. It is actually about using Service Users as Volunteers into their own service. Seeking to establish 'permanent' projects, which will become part of the formal service, is very often a mistake. Let them develop their own way and then allow institution to incorporate the new knowledge and expertise into their own core services. Projects should be developed for an identified purpose. When Service Users naturally learn and outgrow them, the project should allowed adapt to fit, or become 'wound up' and the resources and efforts put to a new, more appropriate project. Where and how far a project goes is determined by the service Users and their circumstances that surround them, including their locality and accessibility. There can be difficulties in rural localities and this is why professional involvement is so critical, to enable the coming together of these support groups on a regular basis. The most successful 'Service User' centred initiatives are in inner Cities and Towns. Rural communities are a real challenge, because of the dispersal of the Service Users and because of differing needs and attitudes. How Service User, Professionals & Institutions Expectations differ? I am going to start this sections by considering social, institutional and individual perspectives on: 'Abuse', 'Trauma', 'Distress', 'Victim', ' Disabled' & 'Mental Health' (all of which, we will show, are more closely linked than is often considered). This will be used as the platform for getting across a more fundamental understanding of 'caring' in our modern society, especially where it has gone wrong; to the individuals and the community's disadvantage, in the past and again now. I would argue that this community 'damage', and its more 'individual' consequence, is happening right now and in significant measure, in respect of the; 'Victim Culture' and the parallel 'Mental Health' culture. Here the problems are seen as quite 'organic', firstly in some gross way, and then (if and when challenged) in a more refined, more insidious way. This has been found to be the case for the personal experience of 'Disability' in the past, particularly but us still evident in our community and services. We will again concern ourselves with the now 'abusive' and often hidden, disabling and 'disempowering' practices of individuals and of organisations (due to the institutional ignorance described earlier). If we reflect upon the situation prior to the last century (say the 1840 Reform Movement onwards), we see a relatively uneducated mass of people supported in various ways, by Philanthropy and Charity. Around that time we also see the specialist 'professionals', geared to providing health and care services to those that could afford it. Philanthropic and Charitable enterprises then duplicated this for those that could not afford it. Even at this level of provision there was a measure of 'Means Testing'. The poor had to qualify in some measure for the services made available to them. As has been described, there were significant 'moral' obligations placed upon the receivers of the service. In some measure the nature of the service depended upon adherence to this moral code. There were exceptions, where the 'code' was used more as a model for healthy practices. Philanthropic initiatives seemed to be the least judgmental. It was usually recognised that there is a mutual benefit in enabling people to live improved quality lives, becoming educated, physically healthy, well housed and more creative. These are the features of many Philanthropic projects that were instigated by leaders in industry & commerce. They were the exceptions but their presence is felt even today, in company names and in the initiatives they started. But they were 'models' only, large parts of the country had no such services. The modern problems, in providing these kinds of services, arise when professional groups and managers take on the responsibility, under the 'Local Authorities' and later the Health Authority. We then quickly move into the culture of the 'expert's. There is a recognised social mechanism, not necessarily universal, that if people see their position and status being ''caught up on' by a general population, they tend to either justify keeping these people where they are, or failing that, seek a higher position and status to compensate and maintain their powerbase. In providing services to the general population, through local communities, supported through central and local taxes, a new and expanded Professional Middle Class arose to administer and provide the services. Some of these were already available through the existing 'model' services, but others had to be draw from all sorts of backgrounds. This could be any profession from bank clerk to army general. The name given to these local organisations quite adequately describes the character of the service provided. They were the Authority. Included in these organisations were the Housing Authority and the Education Authority. This is how they were set up and it was also a clear indication of the prevailing attitudes at that time. The 'style' was a deviation from the Philanthropic methods of operating but was in keeping with many other Charitable ways of thinking and operating at that time. There still remained a strong 'moral' element to qualifying for the kinds of services. There is little doubt that those who were seen to be immoral, or deemed to be in some way disabled, by virtue of immoral rectitude, obtained an inferior and largely incarcerating form of care &treatment. It is not fair to judge the ways things were done in the 1840's through to the 1900, on the same basis as the attitudes and practices we have now. Many of these services, however much they maintained people as subservient, were improvements on their previous circumstances. They were not, however, true reflections of the best 'models' of practice, by Philanthropists (who often campaigned for the changes), or even the better Charitable operations. The Authorities basically employed 'local' Civil Servants and were governed by local politics, who were the real 'Authority'. These Authorities (developing institutions) took on many of the characteristics of the various institutions that the professionals were drawn from. The Army, Commerce, Industry and Church were suppliers of many of the 'Administrative' sections and people experienced in Charitable and Religious Organisations were the principle model for the Caring services. Others were drawn from many backgrounds and either trained in the current philosophy and practice of the service they provided (housing, sanitation, social care, health, education), or continued their normal practice in a Local Authority setting; Accountants & Solicitors, Clerks, etc. The situation was then much like in an impoverished, developing nation now. Army expertise in strategic planning and in logistics, were useful for the planning and distribution of services. Missionary experience was also useful for similar reasons and the moral Guidence was an integral part of the provision. Many nursing and Caring skills were also developed within religious orders and the Christian ethic was the driving force in5 People sometimes find it difficulty to 'Disclose' distressing events. This is partly their 'inhibition' but it is also often the professionals well intentioned responses that inhibits them. Professional responses are 'coloured' by prevailing social norms and prejudices, including 'embarrassment', for various reasons. It is also distorted by a modern, 'agnostic' societies inability to see some 'apparent strengths' as weaknesses and some 'apparent weaknesses' as potential social strengths. We often protect the one social benefit but not the other, one 'socially disposed' group but not the other 'socially indisposed' group. This is prejudice, and is equal to that of race, gender, sexual orientation and cultural bigotry; but it is hidden by this distortion i have described and the fact they are not 'identified', or 'manifested' as discrete, unified and cohesive groups (as they will be soon). This 'prejudice has been institutionalised again. People come into the caring professions for many good, and a few very bad, reasons but there are a number of 'motivations' that are very common and most appreciated & understood. The consequences of each of these can be quite different though and I want to try an highlight these here, quickly (and elsewhere in more detail). Firstly: The reasons for coming into the 'caring professions', of any kind; Nursing, GP, Consultant, Social Work, Social Care, Counselling, OT, Psychotherapy, Clinical, social and Alternative therapies of any kind Can be any more, or less pure, through to colourful combination of: Financial Gain, Power & Status; Career progression, Keeping the family from Relative Poverty and Helping People, Communities, Individuals, Groups. Well that is a start. You can add to the list. The institutionalising effect that has such a profound institutionalising effect upon the Service User, fist has its institutionalising effect upon the professionals and administrators within it. None of this would be a problem if the institutions did not tend to favour, or accidentally tend to to produce, a particular, 'averaged' flavour of professional 'type', the type it easily understands, can effectively control, substantially predict and effectively manipulate. The type that institutions manufacture. In commerce this is tolerable: You can do the job for as long a it suites you, keep your head down, make good contacts in the field, collect your wages, wait till you get made redundant, just before, or as the company goes busts, get another job with a more insightful and progressive company, that recognises innovation, creativity and critical thinking. Its a paint to have to do but Customers survive and get a good enough TV somewhere else and get the better one later. Of course, you may be with a company that is progressive and entrepreneurial, but fails to fine its niche within the 'competitive' market at that time, people are not ready for it, it is ahead of its time, etc.. As happens with real entrepreneurial companies; you all pick yourselves up and start again with the good ideas and some business lessons learned. No one is hurt. Some believe this is OK in Education and Health & Social Care. Florence Nightingale, Louis Pasture, Ronald Laing, Lord Wilberforce, Lord Joseph Rowntree , Richard Cadbury and countless other successful Social Innovators, I, other Radicals (and silent others) know it is not. We don't agree with this 'boom and bust' style of approach to important Community Resources like; Education, Training and Social & Health Care. Its not our opinion (who can afford them); It is damaging, destructive, short sighted, ignorant and incompetent. It is damaging to the future development of an advancing society that has always, in the past (often in rather quaint ways), protected & encouraged 'Free thinking' educational, social and health innovation. In recent history, in fact, up until the 'Commercialisation' of these Community entitlements & essential services and the institutionalisation of the community itself. This previous arrangement benefited commerce as much as it did the community and individual, although this was only appreciated (and paid for) by the intelligent and insightful few. Some elements of Commerce in the past had helped fund and support these social initiatives; Roundtree, Cadbury, Salt and others. Some, like Microsoft and Virgin do this now. Get out the game 'managers', you are not set up for it. You are out of your depth, Taking bad advice, from people who are also out their depth. If someone is unable to see this problem, from the simple argument presented here I offer a challenge: Unless Executive Managers and Government Ministers, have a very good & convincing argument of their own, that promotes and supports, this necessary innovation and advance, while protecting people at risk, in every service that affects people; These antiquate arrangements are dead in the water. You need and argument that does not 'require' the 'failing' of the institutions that provide the service, and their failure, in turn, to meet the stated objectives and raised expectations that they generate (and I would be happy to hear the argument), In the absence of these, I accept their resignation to these more sound reasoning's. Bring it on, as the young & open to anything, courageous 'young' would say. Remember "25-30 years experience!"; but is it the experience of the same things each day for 25-30 years, or 25-30 years, of radically new experiences (or , perhaps some comfortable balance in the middle? Institutions (like people) have character, these are not always good characters. Stagnation, depression, stress, overwhelm and decay affect Institutions, just like they do to the individuals within them, staff and Service Users alike. Of course, by 'institution' we mean what is understood to be the Executive, Personnel Power Base within them. We are actually talking here of the kinds of institutions that naturally operate for within a Classic Oligarchy, upon which modern institutions were based and to which they regress when 'stressed', by social forces (much like individuals are. If you are a more casual observer, just visiting the site, or someone looking for general information on Abuse, Mental Health, Bullying, Health & Social Care. If you are seeking any sort advice, or ideas on therapeutic techniques, talking treatments, complaints procedures, and survival strategies, etc. Please read on & take from this introduction what you can. Otherwise follow the appropriate links to take you to sections you are interested in, but you may miss something critical. I will not apologies for the next paragraphs, those it offends will be aware of its purpose. If you are a little bewildered by it, I apologies for any confusion. You may otherwise feel that this is the end of the abuse story. I promise you it is not. Not by a long way. In your further reading on this site you may identify, reflect upon and more critically review, situations that may be having grave impacts on vulnerable people of various kinds, in situations in which you encounter (including 'you'). If you are a cynical professional, an indifferent & complacent manager of (or within) an institution, or a perpetrator of any kind of abuse, checking out the latest 'conspiracy theories' and wishing to look for weaknesses in arguments of those standing up to wider, hidden abuses, you may wish to leave the site at this point, for the sake of your peace of mind. Warning: What follows may be injurious to your emotional and psychological health. Or alternatively; you could stay around and watch what is coming to you and, perhaps contribute to our debate. You are welcome. The knowledge of your arguments have, and continue, to help us greatly. One of the fascinating features of Internet Searches is that they bring all sort of people to sites like this, as a consequence of searching: 'abuse', violence', 'sex'. Internet doesn't discriminate against intention. It is rare that any situation improves of their own account. Every civilised advance had to be fought for, by the sword, the gun and, by the words, in combination with actions. Those who have been in these deprived and deprave circumstance, and who have then tuned to institutions to assist, (believing that is why they are there) are frequently disappointed, at least in some measure, sometime greatly so. They are disappointed, not so much by the attitudes & excuses they sometime meet (which professions do not realise are 'poor attitudes' & 'bad excuses'). Mostly it is by the real ignorance of the realities of life & the effects upon people who, for very good reasons, can do little to remedy their own situation alone. It is not a fair & equal society and never will be as long as we continue to declare; ' that it never will be'! My own, and others, declaration is it will increasingly be - and we are being proven right. It is not enough to be 'self reflective'; wonderful that this can be (when we get it right, rather than just play at it; a fundamental sense of intellectual humility is good evidence of getting it right). It is also essential to take a 'critical perspective' on the professional and the service 'Institutions' we operate within. By this I mean, the institutions disclosed and 'extant' role; collective attitudes, prejudices and the consequentially distorted purposes, methods and perspectives, or dishonestly stated, supposedly 'person centred' purpose of those institution, all be it that we appreciate there is a quite 'separate' community, or social purpose. Some would say, of the more obvious 'abusive' situations that; The facts will speak for themselves, they need little further justification. In the main this is true and we will rely on the simple, more 'emotional' presentation in those instances. Some would feel and act as if there is a particular approach that is 'right'. They would be wrong, unfortunately, as most professionals find out, but the institutions are slow to adapt. You may also now be aware, however, that even in the most obvious cases of abuse and injustice, there are those individuals and some institutions, that will justify ignoring, and further more engage in and promote, 'clinical forms' of abuses of various kinds, including those of the character we are describing here. Often as a response to a known, or 'overlooked' social, or institutional 'abuse', or 'neglect' This is not a new phenomenon. It is a variation on the theme of 'moral degenerate' and other 'clinical' diagnoses which 'prejudiced' both clinical and social treatments at that time and for years after. These were used as the basis for incarcerating people in 'Subnormality Hospitals', along with other antique classifications & diagnoses. A situation that lasted well into the 70's & 80's, and politically delayed for some into the 90's and beyond. That is in terms of the errors of judgment and interpretations that have been identified so far. Even if this is just presumed to be the consequence of some 'weakness in character', as professional responses, including the 'sympathetic ones' and, possible, most importantly, the sympathetic ones. These are the most insidious kind, although perhaps the least 'intentional'. How much damage can be done by ignorant (and prejudiced, self protecting) 'kindness'? Of course, the identified 'need' and 'social impacts' are appreciated; it is that the explanations & causation that is now suspect and the basic 'cause and effect' analysis that was (and is) fundamentally misunderstood. It was the ;character' of Institutions that 'collectively indoctrinated and 'carried' this 'prejudice, giving it some 'intellectual' credibility. It is the collective job of the 'radical element' within each professional, and in each profession, along with empowered and insightful Service USERS, to challenge that prejudice and fundamental lack, or misrepresentation of scientific understanding operating within the institutions of our culture & society. The trouble is there are too many amateur scientists, in our institutions hoping for solace in believing they are applying scientific method and practice Diagnoses They make better descriptions of personal 'presenting features' than they do of 'personal types' . They also make good frameworks and definitions of social 'features' & 'social phenomena' than they do individual and personal 'diagnostic features' and characters. classifications. The tendency to fir the person to the classification of a condition is abusive. No arguing; it is abusive, prejudicial, unscientific and unprofessional, by any terms. Most importantly, except for the false organisations, financial and 'peace of mind' benefits it appears to afford institutions and society, it is completely unnecessary and contradictory to the principles of both 'personal' and 'social' responsibility. Self fulfilling prophesy, 'paranoiagenic' circumstances, attitudes, behaviours, statements, descriptions, comments and even diagnoses themselves (labelling 'individual' varieties, rather than professional / clinical understanding of presenting problems).  Sorry - his segment is \under development at present.
All this is, as I have said, often done in ignorance, but not always so. Sometimes it is 'inconvenient', for lots of reasons, to change the institutional approach fundamentally, as is pragmatically required. In social analysis terms we would say 'Manifestly' so (Professor Elliott Jaques, et al) This is why I determinedly continue with the additional use of intellectual, logical arguments & science. The changes that are often made to institutional practices are frequently 'corruptions; of the 'Good Practices being promoted, as I am confident I can show Where the situations, and effects we describe are apparent in other nations and cultures, on a grand scale, affecting children in particular, and defenceless women in many instances, there is now (with modern understanding) usually universal condemnation. Few people, but complete 'psychopaths' would argue against them. Emotional argument is significant and substantially adequate to bring about change. But there are Psychopaths and sociopaths - I meet and talk to them too. Where these same problems can be evident on our own turf, or perhaps hidden away, but next door to us, and subtly wrapped up in sympathetic 'justifications', excuses and convincing, sophisticated rationales. We often don't notice the true abusive effect until they go to court, or they are exposed as lies, perhaps in the press; 'You know, I though there was something odd with the people next door'. 'I realise mow that I should have said something'. 'I feel terrible, they seemed such nice people'. On the other hand, it is also true, that some peoples' prejudiced interpretation of otherwise reasonable but eccentric, or alternative, culturally determined, non-abusive behaviour is assumed to be unacceptable and interpreted as abusive. The neighbour who is being cautious about their observations concerning others, is struggling with quite difficult issues and complex ideas and feelings. Making mistakes is easily understood here. This is why we are here. Some times we do have to think things out a bit, get advice and make very difficult decisions. There are also mature, intelligent, otherwise family loving, law abiding individuals and agencies, that put forward sometimes quite convincing intellectual arguments which assure themselves and some others, that apparently abusive practices (in all other circumstances) are acceptable in some situations and contexts. We would contest that, even where there may be some justification in their argument. These justifications have a tendency to 'grow and extend' themselves to other situations and contexts and also give permission to others to retaliate in kind - FACT. Our more convoluted, complex arguments (which will usually follow on from the clear and simple ones) are included to directly counter these and other, less healthy, 'special case' justifications. We at least hope to help (and to help you) put blocks on these practices drifting over into other areas of more legitimate social freedoms, or less serious social misdoings (as they are bound, according to history, to do). Our general area of operation is in Human Rights (As expressed in the spirit and content of the Conventions, before they are/were adjusted for national, commercial and institutional benefits). Basic Human Rights are not too difficult to understand, they come from a sense of social justice. The words get complicated but the spirit, essence, the feel of them is sound and uncomplicated. We have won them. Get used to it 'abusers' and 'jobs worths'. We are on the steps of your town halls and institutions We are building up a range of information and advice services to provide support to anyone who has a psychological, emotional, or social problem of any kind, due to any cause. We are particularly concerned with those experiences which can be shown to have potential, or actual, negative emotional, psychological, or general health effects of any kind, or that it is felt, or shown, to to have a serious negative social impact. We include support, advice & working strategies to Individuals, Families, Support Workers, or any involved Professionals and Agencies. This will include Executives of Pubic Institutions, or Commerce, wishing to identify, counter, or legislate and develop strategies for dealing with and eliminating these potentially abusive situations and any institutional forms of abuse, whatever their character, or degree. This is the culmination of 30 years of wide ranging experience in the statutory and voluntary sectors (The cumulative experience is significantly greater than this). This experience, unlike many boasts, is wide ranging, reflective and responsive to individual We are all in this together and, if we are genuine, want the same things; resolution of problems and more public understanding. To this end, the site is dedicated to a number of interrelated objectives. We want to draw to it those people from the Service User, Family Carer, Voluntary and Professional groups, who are fully committed to the basic concepts of Community Care; Person Centred, Empowering, Informed Choice and Best & Least Restrictive Practices in any personal, or public endeavour. We agree that Professional Ethics and attention to the the person's needs and risks (as acknowledge in any way by them), should override any and all institutional requirements that tend to take us away from this basic objective. The adherence to these principle will be 'real' and minute to minute, not a nominal inclusion from time to time, as decided by any one contributor. The members of all groups mentioned will have the same status, but may have divergent interests, experiences and strengths. The intention of the site is not just to solve personal problems but to advance & develop knowledge, understanding & experience and broaden perspectives. It is our intention to do this in ways that empower users, carers, and professionals to take direct responsibility for their efforts and obligations, independently of the institutions. Institutions are there to facilitate this independent practice, towards meeting particular needs. We will seek not to discriminate, other than to exclude, &/or publicise, those that would do so. Our objective is to help identify any situation, or relationship, which is abusive & disempowering by its nature, or by its observable effect. We recognise that these behaviours and effects are counter to human rights and will seek to define these situations in Plain English & emotional terms and also in precise intellectual terms. We will assist in strategies to counter, challenge, make public and xxxxxx any situation, relationship, or institutional situation which causes unnecessary, or excessive, persistent stress, distress &/or potential negative health effect. We will do this, whatever the nature of the power base, executive authority, differential in age, size, sex, or creed, and irrespective of any supposed good intentions We will do this in terms that will assist people in recognising actual, or potentially abusive situations, or circumstances. We will identify these situations in general terms and in specific detail, at least to a degree the perpetrators will be able to themselves in the descriptions and, where Our services include conventional advice; individual and interpersonal counselling & guidance; peer group support; suggested 'social' therapeutic techniques and our variations on 'traditional' psychodynamic techniques (Social-dynamics). There is also a wide range of informative and also 'challenging' perspectives on conventional practice and existing theories, which work for some but is often frustrating and inadequate for others. A variety of perspectives is hoped for; Choice is central here! This page is in the stage of preparation. | Some Useful Definitions: Service Users:
Although not a universally acknowledged as an acceptable term, this is the term that is currently used to identify those of us who 'receive' services from professional groups and agencies. It is not ideal but is an attempt to resist 'objectifying' people who receive some kind of health, or social care input into their lives. The Irony is that the term also works against 'user inclusion' in some ways. This is in the sense that you / we are also the potential, or actual provider of the services in various ways. We collectively 'own' these services and have a legal and moral right to influence the development of them. We can also help run them and determine how they are provided. In some instances, we are also the direct providers of a service. At present 'Service User' is the best term we have available, which does not connote being 'done to'. Whether we like it or not, it was the term coined, almost unanimously, by delegate to a number of Conferences, for people with learning difficulties, some 30 years ago. This was soon after the concept & practice of 'Community Care' was beginning to evolve. An initiative that began with the Campaign to improve services to people with learning difficulties. There are problems with all these terms; like patient, client, customer, people, citizen, etc. The concept of 'Social Inclusion' assumes (rightly) that there has been some 'exclusion' of important groups, and that society is magnanimously 'giving back' status, in our relationship with professionals & institutions. Actually it is 'Service Uses', and those professionals who appreciate themselves as 'service users', who have demanded this status of 'citizen user' of our collectively owned, public services. We seek to continue this wobbly trend and are confident the process will continue until professional managers fully understand the principles involved. The term 'Service User' helps us re-frame this relationship, but it is the underlying attitude & ethic that determines the true character of an 'empowered' partnership. Whatever the term used, it needs to connote a potentially active & informed participation, at all stages & levels. This should be from assessment stage, through the provisioning, to review & completion. The term, & the philosophy behind it, does not ( should not), give the impression of mere representation, or token inclusion on paperwork, or in a meeting. Informed service users and their representative, will eventually determine Policy and the acceptable Practices for the services provided to meet their needs. This philosophy will eventually be sustained for all service users, of any public service. It will be enlightened professionals that will ensure the necessary self-advocacy for this to happen. Professionals:
By this term, we mean those trained &/or expertly experienced, ethically guided employees, involved in assessing needs & risk, and in providing appropriate services to meet these. The professional services provide support that is geared toward protecting us, maintain safety & security, ensure justice, promote recovery, or help overcome the various problems we encounter in life (which affect our health, personal & social wellbeing). A classic definition requires that Professionals are understood to be 'paid'. In fact; the essential requirement is that they are (or can be), ethically & legally 'accountable' for their expert actions & advice. This, of course, means that they are usually 'retained' for that purpose, but this does not have to be the case. Volunteer , or independent 'professionals' can have a similar expert status but must be willing to be 'accountable' for their actions in some way, even though they are not paid. They also have the benefit of not being so constrained from expressing criticism of institutions, although funding agencies can now be seen to try & exercise this kind of restriction.This group of Professionals may be considered to include not only Consultants, GP's, Nurses and Social Workers but also Care Workers, Managers, Hospital Cleaners, Benefit Officers, Housing Officers. Police Officers, Court Officials and the like. Such professionals have an obligation, collectively determined by ourselves, to assess us for the appropriate allocation of services, support, advice & sanctions. This assessment is legally required as an assessment of need, not conditional on resources available. Shortages of resources must be declared separately.Professional Agencies / Institutions:
The services provided by these professional agencies are, ideally, determined via an informed dialogue; between interested citizens, people currently receiving services, those who have done so in the past, the professionals themselves, the overseeing agencies & representatives of service users & the professions, and our local and national political representatives.The level of funding and general disposition of these services, evolves over time. It is influences by many things but is rarely adequate for the purpose. There is a balance between established conventions & evolving ideas. Progress is often two steps forward and one step back. Apart from the responsibility for 'assessing' our needs, they & other professionals, have a responsibility to enable and provide direct services & care to ourselves as service users. In doing this, within the constraints imposed, they do not always honestly state the position. They are often constrained by policy in ways which contradict their professional ethics and are counter to the original governmental policy (or, at least, the original intention of it). More importantly, ways that contradict the 'spirit' in which their services are developed and offered. Professional Agencies can become defensive and allocate too much of their time and resources covering their backs and too little time meeting the challenge of providing a good quality, comprehensive and preventative service. Ironically, it is this defensive position that causes most of the legal, ethical and media problems. Too many people remain at risk, in spite of more resources being put in. Like the Media perspectives that they are concerned about, they become concerned with negative impacts and are therefore risk adverse. While attending to the negative possibilities they generate too few positive outcomes. The Media (& therefore the public) focus remains on the failures, delays and waiting lists. People no longer expect a great deal from public sources and with adequate, good quality, empowering support, they can actually do a great deal to help themselves. To do so they (an we) have to take some risks. Risks that the first attempts will not work. Risks that the outcome will not be perfect but will satisfy the person adequately and reduce the consequences for others. That is the best we can expect. What is the Professional Role:
In essence, professionals take on those responsibilities that were once undertaken by the Elders, Grandparents, Aunts, Uncles, the Extended Family, Wet Nurses, Busy Bodies, Nosey Neighbours, Gossips, Wizards, Barbers, Story Tellers, Officials and Sooth Sayers of previous epochs, cultures & tribal systems.Modern Professionals do their best but are still a poor replacement, constantly seeking to improve their role but rarely developing the mystical properties that citizens find attractive. In taking over the roles, professionals do not always improve upon them and sometime, in trying to purify the role, they actually loose some of the essential qualities that make them most effective. These 'mystical' qualities are the catalysts that make the technical magic work. It is the 'bedside manner' of the older GP and the un-analysed 'social care' component of Nursing. It is the quiet, unassuming affection and respect we feel for our charges. It is the appreciation of the stubborn individualism that appears to work against our expertise and yet, keeps the person wholly themselves, in spite of their problems. It is the gentle struggle between those doing and those being done to, which leaves both sides slightly stretched, slightly dissatisfied but both empowered and potent. It is doing those little things, just enough, that break the rules, steps outside the circle of blind policy and make the individual feel special. It is the use of human instinct, well honed intuition (established wisdom of experience), lateral thinking and the creative use of knowledge and resources.Although politically incorrect to some, it is the love we let them borrow, for long enough, until their friends, family and neighbours are able take over once more. It is being the projective object upon which all the frustrations and worries can be loaded, while they struggle to recover and regain their relative independence. We are the Cart Horses of caring, not the thoroughbreds of the academic racetrack. Professionals differentiate and become specialist, or remain generic but in either case they are becoming overly intellectual presently. It is an historical phase we go through now and then, individually and culturally. Our institutions and managers are keen to give over the responsibilities but are unable, or unwilling, to give over the appropriate level of empowerment to administer those responsibilities. Professionals, on the other hand, will have to be more accountable for themselves. In finding their feet, professionals are now expected (rightly so) to give up some of their power to the people they provide a service to. As 'experts', this is difficult for them to do. To do it, they to must also be empowered. They need to become independent practitioners, adequately, trained supported and encouraged to take decisions in the interests of their charges. This is especially the case with the new 'Capacity Act' (UK). It is a trend that is unavoidable and natural development of these professions. These are exciting times but users of services need to find a new balance and take on more of the power, and some of the responsibilities that were once afforded the professionals alone. The objective now is to see a true partnership but not everyone knows, or understands that yet. It is a period of adaptation, every bit as essential as those that have happened in the past and those which are happening, else where, in our societies and cultures now. Professional Partnerships:
To obtain a true partnership there have to be understandings on both sides. Perspectives that will sometimes stretch the professionals understanding of individual experience, perception, beliefs and conceptualisations. Many of us have become adept at this and I will not pretend it is other than a considerable challenge. This is especially the case in some forms of abuse and in the case of Mental Health, Social Pathology & Dementia.It is difficult to establish and maintain a rapport of conceptual understanding with a disturbed, distressed and dysfunctional person. When we are adequately prepared for this, and it is otherwise possible to do so, it is necessary to protect ourselves from the impact it can have. To do, this requires more than academic understanding and counselling skills. It requires us to reflect on the least of our own psychological and emotional aberrations and scale these up to the level of the service user's experiences. We can then only use these as a base from which to operate. We next have to be creative and lateral in our thinking and make a leap of imagination, based upon what we are told by them, checking with the person that we are half way near to their account of their experiences and perceptions This approach is not the classic case of 'humouring' the person. It is necessary, bizarre as it may seem, to accept the person's account as real as any experience that we have had. For the person it real and although unique to them, has features that are common with other peoples' experiences, some of which are socially accepted as legitimate perceptions and perspectives. The difference we experience, in working with those who seek, or are deemed to require our help, is that they are either feeling very unsafe and confused by their experiences, or, they are secure with them but unable to translate them into meaningful communication with others, to the extent that they and others may be put at risk, or the person becomes socially, psychologically, or emotionally isolated. As in most cases, where we are required to solve a 'conflict' problem, we have to start with where things are at, and work through to a point where both sides are at least partially partially satisfied. To do this requires us to 'understand' where the other person is coming from and for us to help them understand where we (and others) are at. Both are accepted as valid, if conflicting positions, but both seek to compromise to the point where real some communication can begin. Once this is done, it is only our general social skills that can eventually enable the person to understand their own perspective in the context of others and thereby achieve a compromise that both sides can live with. Mostly we have to help the person feel safe with their experiences and understand these in the wider context of family, friends, employers and neighbours, etc.. They are not alone in the peculiar character of their perceptions. Their experiences do have a validity and t is our job to find out the how & the whys. In this way we can help them establish a 'bridge' with the more common psycho-social experiences and wider perspectives . and to the greater understanding of themselves, ourselves & the perspectives of others. Doing this is (& has always been) a creative process. This process goes on quite naturally in the 'normal' world. People experience alternative, or distorted perceptions and perspectives at various times of their lives. For some, this is part of their natural creative process, largely safely under their control and directed towards creative, or spiritual expression of various kinds. We may not fully understand the mechanisms involved but we can appreciate the public outcomes of their expression, if it finds rapport in our own 'on-the-edge' understandings and experiences. It is important to remember how strong a contrast we can experience between differing cultural perspectives. Some cultural practices and perceptions are equally as extraordinary to us as any expression of 'mental illness'. This has been particularly noticeable during historical periods of exploration, but modern insights can have the same impact. These alternative perspectives and cultural variations puts the abuse and mental health issues into some kind of tangible perspective. We are not required to agree with and adopt the alternative perspectives on life, other cultures, humanity, sanity and alternative normalities, but we are to be expected to seek an understanding of them so that we can engage with them effectively. This is not that intended to be anything more than a metaphorical comparison:
It would be nonsense to expect a police office to become an actual criminal, in order to understand and deal with criminal behaviour. It is not ridiculous, however, for them to establish a rapport with criminals, such that he is able to understand and in some ways empathise, with their thinking processes, purpose and intent. Adequate professional supervision, job satisfaction, social recognition and sufficient remuneration should ensure they remain on the right side of the professional relationship. Similarly, people who have become experts in breaking and entering and in picking locks could well become expert locksmiths and security advisors. In much the same way, those most competent at producing computer viruses and at hacking computer systems can, in their rehabilitation, become experts at computer security. And so it is with our dealings with those who somehow become alienated, isolated and psychologically, emotionally and socially distressed. We need to gain a rapport that produces a deeper mutual understanding, which then enables us to bring the person into a social context in which the constructive features of their personality, intellect, perceptions & conceptualisations have some social validity., NOTE: This Document is still at some stage of development. You are invited to respond and comment on its content and its logic. If you return to the document at a future date, you will be able to see its continued development, hopefully reflecting your own and others commentary. TRC. eMail: terry.couchman@visitweb.org |
