The Traps and Detours of Deinstitutionalisation

Author: Sam Sly

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

The final DH response to Winterbourne View (2012) states: 

All current placements will be reviewed by 1 June 2013, and everyone inappropriately in hospital will move to community-based support as quickly as possible and no later than 1 June 2014

This was fantastic and just what organisations like Beyond Limits were hoping for as a great start for 2013.

However, from my experience so far on moving people from hospital two of the phrases used in this statement give me concern that these dates will not be hit, people will not be discharged and even if they are people will just move on to live in some other form of mini-institution. 

The phrases are ‘inappropriately in hospital’ and ‘community-based support’. 

I believe that the first phrase may be used to prevent people being discharged due to the key decision-makers who have these powers making decisions based on limiting information about a person due to hospital environments that don’t always look at the whole person. This also provides problems for Providers once discharged because information given does not always give the whole story. The second phrase may lead to people being discharged to yet more mini-institutions instead of real homes of their own because of misinterpretation of community-based support.

Our project has first-hand experience of trying to get people discharged from hospital into homes of their own and we have been heavy curtailed by blocks to this process and the limiting nature of hospitals. Decision-makers still continue to say people are ‘appropriately’ in hospital even after 3-9 years of treatment.

Here are some of the blocks we have encountered preventing discharge and keeping people, we believe inappropriately in hospital:

We were pleased to visit one hospital recently though that was taking into account the positive support factors in our care plan when agreeing that future risks would be lowered through them. It was the first hospital to see it that way.

Finally, the phrase ‘community-based support’ can, and has had, many interpretations positive and negative. In every hospital closure or change of policy that I have been involved with in the past the result has been a flurry of mini-institutional developments to resolve the problem of the need for swift mass accommodation supplied as cheaply as possible. These developments, in the long term, cannot usually provide the tailor-made person-centred service that is required for people with big reputations. I have already seen advertisements for new smaller community-based Homes of multi-occupation. These surely are no different than the larger treatment based Institutions, except for the size and location and more than likely a nice community name like ‘X Villa’ or ‘X Lodge’? 

We have to stop doing this, and sort out people’s problems when they arise in their local communities.

The publisher is The Centre for Welfare Reform.

The Traps and Detours of Deinstitutionalisation © Sam Sly 2013.

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.

Article | 12.04.13

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