Formal and Informal Social Inistitutions
Contents
Any
person or
group of people
become institutionalised to a greater or lesser degree
by the community, organisation, culture or ethnic group of
which they are a part of.
The
role of
institutions in the community
(Top)
Institutions define the way we interact
with each other within society. They are determined by the formal and
informal cultures and
values of that society, and provide order and stability within a
community.
Pasquale De Muro and Pasquale Tridico argue that
institutions are necessary in any human endeavor towards social and
economic prosperity. That only by a system of social cooperation,
participation and order can any progress towards fulfilling our needs
can be achieved.
"... Human
development is
defined as a process enlarging people's
choices, achieved by expanding human capabilities and functionings
(UNDP, 1990). Human development is strongly linked with institutions,
first of all because in order to expand human capabilities institutions
are needed. Moreover, institutions need to be rightly oriented,
providing opportunities to poor and to people in general. Values and
social norms such as equality, solidarity and co-operation shape formal
institutions and choices. In turn, capabilities are enlarged by
institutions (Sen, 1985)." (The
role of institutions for human development 2008.P5)
Each
community has its particular institutions that bond the members of
the community. They serve as a foundation for the formal/informal
cultures, values, expectations, objectives, hierarchies,
goals, policies,
constitutions, unwritten laws or codes of behaviour etc. ("social
construction").
Whether the
community is a family, a school, sporting or social group, a cultural
or religious group, a community home, hostel or nursing home they all
need a structure that defines the group.
An
institution could be describes as:
(
Top)
... any club, facility,
organisation
or
activity that:
... has more than one member that
actively participates in the club,
facility, organisation or activity
... is organised within a set of formal/informal
hierarchies, beliefs,
values, expectations and behaviours
... may be highly structured within these formal/informal
hierarchies, beliefs,
values, expectations and behaviours
... shares a set of objectives
(
What
Are Institutions)
An institution therefore
refers to:
... the setting of the
activity: the
design, location
and anything that is removed from or added to, that may influence, aid
or protect the members,
... the structure of the activity: the various restrictions that are
added to, or removed from the activity, or the way the activity is
organised,
... the formal/informal behaviours and attitudes of the members: the
various policies, rules, roles,
hierarchies of the members.
With regard to people with intellectual disabilities, the aged etc.,
the
terms institution and institutionalisation has been used to describe:
The problem is not the institution, but the way in which it is used.
Think of any good examples
of
institutionalised care: living,
education,
health, recreation etc.
Think of any bad examples of institutionalised care: living,
education,
health,
recreation etc.
(
Wikipedia:
Deinstitutionalisation)
It can then be seen that the institution (the building) and the
institution (the
"social
construction")
are three
different things.
The building : large, lots
of people,
separate areas etc.
The "social
construction"
: the roles, values, behaviours and
expectations of its members
The outcomes : of 1) the building, and, 2) it's "social
construction"
At a bank, for example, we open an account and get an account number.
We become a part of that system (institutionalised). The account number
is our identity, and we are treated as a number rather than a person.
The bank is only interested in our financial affairs and other parts of
our lives become less important. The bank has a certain amount of
control in our financial affairs, and we become dependent on the bank
in other areas of our lives.
Banks also have valued roles in society.
They provide the mechanisms that facilitate commercial investment and
economic development. While some groups may see banks as evil,
predatory and self serving, they have a responsibility to their members
(shareholders, employees and customers) as well as the wider business
community.
The bank ...
... provides a service to
the wider
community
... provides for it's own needs
... provides for the needs of it's members
... has to operate within government policy and practice in fulfilling
its role in society.
This happens in all parts of society. We
have an employment number, a tax number, a drivers license number, a
social security number, a passport number etc. that all designed to
group people into classifications and categories that allow a business
or service to function. The terms "Institutionalisation" and
"deinstitutionalisation" are used to describe
the situation that people with high support needs live in, and the
process of enabling these people to live more normal lives in the
community.
Institutionalisation could be described as a loss of identity within
the system.
This can happen anywhere,
where a
person becomes a part of an
organisation, group or "the system" that treats the members as a single
unit rather than individuals. This can happen to a greater or lesser
extent according to the institutions of the organisation, group or "the
system".
Deinstitutionalisation could be described as a gaining of identity
within
the system.
The institutions of the
organisation,
group or "the
system" change to accommodate differences and individual needs of the
members of the organisation, group or "the system". By changing the
setting, roles,
values, behaviours,
expectations of the members where
they have the opportunity to participate in normal activities that
others take for granted.
Characteristics of
institutions:
(
Top)
While the
characteristics of
different
institutions may be similar, the value that
is placed on the institution is mostly determined by the society or
community in which it is used. The Institutions of one community may be
acceptable in providing a valued outcome, but be unacceptable in
another community because the outcomes may be seen to disadvantage the
members (devalued outcome).
These 6 broad characteristics can be further broken down to describe a
particular insitution.
Culture :
Values:
Institutional values (or
social values)
are different to our personal values in that they allow the members to
function within the institution.
Hierarchy :
Institutions are all about
a means of
coordination and cooperation. The hierarchy defines the agenda and
purpose, and the way things get done.
Roles :
Leadership is probally the
most
important role, and provides the identity and purpose within the
institution. Other roles are determined by the hierarchy and the
members in fulfilling the agenda and purpose of the institution.
Expectations :
The members are expected
to fulfill
their assigned role within the institution.
Behaviours :
The way the members treat
each other or
interact with each other is determined by the culture, values,
hierarchy, roles and expectations of the members within the institution.
Institutions and
institutional care:
(
Top)
Any business, service or organisation that provides a service to a
group of people is organised around a set of values, cultures,
behaviours and expectations. Whether the service is a day care for
toddlers, a video hire, a school or hospital, nursing home or prison,
they all have the same
characteristics.
Charmaine Spencer (
Chapter
4 The Institutional Environment (Characteristics of Institutions))
describes 11 characteristics of institutional care as:
"...
Group
Living
(the setting)
... Standardization of Services
... Treating Residents as a Homogeneous Population
... Formalized Standards of Care Quality
... Accountability
... Hierarchical Structure
... Power Structure
... Professional or Work Relationship
... Medical/Custodial Model
... Dual Nature of Facilities as Personal Residence and Care Facility
... Separateness from Community"
Other characteristics:
... A bureaucratic form of
management
... Has a set of formal/informal beliefs,
values, roles, cultures, expectations
and behaviours
... Formal/informal induction,
initiation
or rite of passage
... Have ownership of their members
... Walls, barriers etc. that separate the members from the wider
community (physical and/or psychological)
... Symbols of authority, keys and locks,
badges, uniforms, restricted areas
... Division of the setting/facility into different areas
... Division of the members into different groups
... Members have particular functions or roles
... These roles describe the
formal/informal behaviours and
expectations of the members
... The routine of the members is organised
... The institution is organised around a particular agenda
... The setting and the activities are designed around the particular
role/agenda of the
institution
etc.
Think of the
internet
(WWW).
Think of the various
communities that
make up the internet
How do the above characteristics fit
into these communities?
Institutions can be
thought of within
two main groups:
(
Top)
1) Institutional care
(formal) :
provides the
mechanisms for providing support for a group in society.
... Short term care
... Long term care
2) Social institutions (informal) : provides the mechanisms for social
interaction
and participation.
(
Top)
Are defined by the agenda, mission statement, objectives,
values and behaviours of the business, service or organisation. These
are generally set out
by a code of ethics and behaviours that can be used to measure the
outcomes of the institution. These can be voluntary, where the servise,
organisation or busness sets its own standards, or mandatory, where
they are built into government regulations that allows the institution
to function.
Short
term care:
(
Top)
Any service that happens in an acceptable period of time, and does
not
have
much impact on our lives. I may get a plumber to fix the tap or go to
the
doctor for a checkup. I can get on with my normal lives without to
much irritation. If for some reason the plumber has to replace all the
pipes in the house, or I have to go the hospital for a few days,
my normal routine is disrupted for an appreciable amount of time, and
may create some stress for me and the others around me. I may enroll
in a course at school or uni and have to change my whole lifestyle to
accomodiate the different patterns and routines. I have books to buy,
lectures to attend, exams to pass, and various other social functions
associated with the school or uni. There are behavoiurs and
expectations required of me and this can be a very stressful period.
However I know that I am working toward a goal, and am prepared to
adjust my normal way of living for the period required. Even changing
a job or moving house can involve a stressful period until I adjust to
the new situation. What ever happens, I know that I still have some
control over my life and still have the choice to opt out of the
system if I choose to.
Goffman
also makes the distinction between long term and short term stay. When
the stay is short time and the outcomes are positively
valued, the person may be able to adjust to their normal living
patterns quickly. Short term stay can also result in negative valued
outcomes that last a persons lifetime.
Long
term care:
(
Top)
It could be argued that the process of institutionalisation starts
within our family, in
the day care centre or kindergarten or with friends
and peer groups. We learn the values and cultures from significant
others in our lives.
Whatever happens, there is a sense of control over our life. We can
plan
and work toward a future, and those institutions are a part of the
backround, just as a canvas is the background that a picture is painted
on. Its only when these institutions become more promonent in our life,
that problems occur.
The longer the time in istitutional care, the more disruption occures
in a person's life.
There is a period of adjustment, and maybe rebellion, to the new
situation.
There is a learning curve involved in finding out how things work
(learning the ropes).
The amount of loss of independence depends on
the reason for the long
term care
the amount of skill and resources the person has
the amount of skills and resources the service has
the amount of control the person has over his/her own life
A person may have to give up a significant amount of his/her previous
life
belongings
friends
lifestyle
may be realocated to
another setting
that is more able to provide for his/her needs.
Shows
the
relationship between
the length of care and the amount of institutionalised care provided.
A person may spend a few years in a hospital or in a university. The
amount of restrictions in the person's life depends on the
institution,
as well as the skills and resources of the service. The longer the
person spends in institutional care, the more institutionalised the
person becomes. For some, this can be a gradual process, and others,
this process can be sudden and abrupt. For others, it is the only way
of life that they have known. Goffman
acknowledges that the concept of a "Total institution" is a
concept only, that institutions can never be total, but can be
positioned on a continuum from open to closed (
Total
Institutions: K. Joans & A.J. Fowles - In Understanding health
and
social care By Margaret Allott, Martin Robb, 1998, Open University P.70).
Goffman uses the term "institution" to describe the building and the
institution of the building (the social construction). An interesting
observation about the
concept of a "Total institution" is that there is an assumption is that
the
staff of the institution are just as institutionalised as the
residents, This may be the case where the staff treat others outside
the institution the same as the residents of the institution, however,
the term "institutionalised"
refers to the residents of the institution and not the staff, visitors
or any outside contact that staff may have with the outside world,
Therefore, any institution, where the residents have no
contact with
others, (staff, family, friends etc.) or the outside world, can be
considered
as a total
institution in the truest sense of the word. Institutionalisation has
been used to describe the negative experiences and outcomes associated
with long term care.
It
is also
interesting
that a person is
not considered institutionalised, where, the experiences and outcomes
are positevely valued.
(
Top)
Informal institutions allow the members or groups to function within
the servise,
organisation or busness. These institutions may vary according to what
the members do within the business, service or organisation. Different
members or groups have different functions or roles that allow these
groups to coordinate their activities within the organisation. These
institutions are informal because they are more about the way these
members and groups interact with each other, rather any formal
policies, rules or
regulations of the servise, organisation or busness. There can be any
number of layers in the business,
service or organisation, The bigger the business,
service or organisation, the more layers there may be.
These institutions...
... provides the role of
the group
within business, service or organisation - what is its role?
... define the way the members or
groups functions within business,
service or organisation - how does it do it?
... set the scope and boundaries of the members or groups within
business, service or organisation - when does it do it?
... define the roles of the members of the members or groups within
business, service or organisation - who does what?
The
relationship between the
formal and informal institutions
within the business, service.
organisation or community
While the community (business, service or organisation) or has a role
in society, each
group has another role within the community, and each member has a
different role within the group, within the community. The
institutions of each layer also determines the way the community
functions within society. Disability services (for example) have
different areas that
support people. Homes
have different cultures. One home may be supported along a medical
model and another may be supported along a social model. While each
home supports the formal institutions of the organisation, the informal
institutions of each home are different.
While the home may promote the cultures, values and institutions of the
organisation, the cultures, values and institutions of the home are
dependent on ...
the staff
the residents
The skills and resources of the staff and the residents
Two homes that are supported by an organisation may share the cultures,
values and institutions of the organisation, however the cultures,
values and institutions of the organisation of each home become more
important. Each home has its own identity. The needs of the residents
are different, the staff are different and are organised along
different routines that suit the needs within the home. Even within
each home the informal institutions change according to the
staff that are on duty. One shift may be highly organised and
structured along a medical model. Another shift bay be relaxed and
casual along a social model. The shift may have strong leadership and
is run along along organisational policies and proceedures
Institutional care, then,
is an ordered
and
specalised intervention
that requires an appropriate setting, skills and resources that are not
available within the wider community. The way the care is provided and
the outomes of this care are directly related to the service that
provides the support. A prision, for example, has the same institutions
as a hospital, however it is immediately obvious that the outcomes of
the prision and the hospital are different. Even within different
prisions and hospitals we see different outcomes.
From the above, it can be
seen that the
institutions of the buildings and communities that disadvantaged people
were placed in,
are the same as the institutions of the different buildings and
communities that we
all participate in,
but have different outcomes. At he bank, we have to suffer all sorts of
indignities to get a loan or see a teller. There is no compensation
when something happens to our money because it is not their fault. Even
when it is there fault, there is no one that takes responsibility.
Within the banking institution ...
... There is a sense of
loss of self
within the systen.
... A small staff/client ratio
... Are treated as objects (numbers, interns, defectives ect)
... Settings and activities are structured around staff -->
clients
... Strict separation of staff and clients
While there are these negative outcomes, the value of the institution
is positively valued bysociety. The institution may also be negatively
valued by different communities within society.
Negative outcomes
(devalued):
(
Top)
Collins 1993
(
from
Mental health care for elderly people By Ian J. Norman, Sally J. Redfern,
P 501) describes institutional characteristics that are
negatively
valued as:
"...
denial of humanity and individuality
... no personal space
... no privacy
... little choice
... little comfort
... little personal
safety
... few possessions
... no dignity
... pauperized
... dependent
... no control,
participation or
decision making
... cannot function as
ordinary human
beings"
Other negative outcomes:
... A small staff/client
ratio
... Low value (Sick Person, Subhuman,
Organism, Menace, Object of Pity, Burden of Charity, Holy Innocent,
Deviant etc.
The
Origin and Nature of Our Institutional Models)
... Low expectations
... Are treated as objects (numbers, interns, defectives ect)
... Settings and activities are structured around staff -->
residents
... Strict separation of staff and residents
... Separation of residents into groups
... All residents are all treated and dressed the same
... All residents follow the same daily patterns of communal living
... There is no variety in the routine
... Activities are confined to the facility and separated from the
community
etc.
The above
outcomes can be
changed from negative to positive,
within the institution that provides the care.
Positive outcomes (valued):
(
Top)
Ramon, 1991 (
from
Mental health care for elderly people By Ian J. Norman, Sally J. Redfern,
P 503) describes institutional characteristics that are
positively
valued as:
"...
people first
... respect for the person's
... right to self-determination
... right to be independent
... empowerment"
Other positive outcomes:
... A large staff/client
ratio
... High value
... High expectations
... Settings and activities are structured around residents -->
staff
... Residents are treated as individuals
... Less structured daily patterns of communal living
... Variety of activities and different patterns in the routine to
suite
the residents
... Mixed activities where residents are included in the normal
activities of the community (living, recreational, education and
employment)
etc.
Goffman describes four main
characteristics of institutional care as:
Batch living
Binary management
The inmate role
The institutional
perspective
Rather than describing a characteristic
of institutional (the building
and the
"social
construction")
life, Goffman
is actually describing a set of outcomes that are characterised by the
"social
construction"of
the
institution. These outcomes are described as negatively valued
outcomes. When used in the context of the corrective services or
similar institutions, or in another culture, these outcomes may be seen
as positive outcomes.
Batch living, for example, describes the conditions of living, the
activities and the attitudes of the management and staff towards the
residents.
Batch living is used to describe negatively valued outcomes:
The members are separated
into groups -
authoritarian -
subservient
The members of the subservient groups are all treated the same - as a
group (group living, group activities etc.), rather than as individuals
(no personal choice, no variety etc.) by the authoritarian group.
"It is characterised by a
bureaucratic form of management .... 24 hours a day without variety or
respite." (
Goffman,
1961 : 5-6, in, K. Joans & A.J. Fowles : P.71)
Within the wider community, we see these same outcomes, and although
they
may be less extreme, they are still there in all forms. Sometimes these
outcomes, described as batch living, are a necessary part of the
activity and the setting and are positively valued in providing
positive outcomes for its members. A package tour, for example, the
members are all living together and participating in the same
activities. They are restricted in what they can and can't do, they
have a set timetable that has to be followed, the service provider is
responsible for their welfare etc. The value that is placed on the
packaged tour is determined by the experiences of the members of the
tour. I'm sure you have read or heard about a tour where the members
were poorly treated, were placed in lousy accommodation, left on a ship
or in a hotel for the whole time (these things have happened) etc.
Boarding schools, the
army, a prison are other examples of batch living.
We also see these outcomes (in varying degrees) in living, recreation,
employment and education services that support disadvantaged people in
the community. Does this mean that we need to remove all organisations,
community
groups or services that support disadvantaged people?
NO! There will always be a need for institutions and institutionalised
care in the community.
Goffman
states that no
institution is all open or all closed. That they all share similar
characteristics.
An institution is either positively
or
negatively valued, according to the values
of the community or society that the institution is a part of.
It
is the
total value of the outcomes of the institution that determine whether
the
institution is
positively or negatively valued, rather than the characteristics of
the
institution.
The value of these outcomes are determined by the values of the
community and it's members.
At school, for example, the students may negatively value school; they
have to study, do homework, are not allowed to do what they want, are
expected to be at a certain place at a certain time, are put on report
if they don't do what they are told, can not go out at night during the
week, have to wear a uniform, respect the teachers, have to participate
in activities that they don't like (they may also be bullied and
victimised) etc. etc. etc., while the parents and the wider community
positively values the school in that the students develop knowledge,
learn life skills, social skills etc. towards being productive members
of the community.
In a religious convent, for example, the institutions may be positively
valued and provide positive outcomes in one community, while the same
institutions may be negatively valued and have negative outcomes in
another community. Prisons may have a positive outcome for some, and
have a negative outcome for others. Nursing homes can also have a
positive outcome where the institutions of the nursing home provide
positive outcomes for the residents (SRV).
From the above it can be seen that the values (high order, middle order
or low order) of the community and the person determine whether the
values of the institution are positive or negative. Do we, as a
community, value liberty or security as a high order value? Do
we value order and structure, or
freedom and
individuality,
as a high order value? Do
we value the sanctity of human life as a high order or a low order
value?
Do
we
value
a physical life, or a
spiritual life as a high order value? Do we
value individual wealth, or shared wealth, as a high order value? Do
we believe that all people should be treated equally, but
some more than others?
Institutions and institutionalisation can then be seen to have two
definitions within
society.
1) the community
definition is
concerned with normal community
activities such as education, religion, the legal system, or any body
of knowledge or behaviour that is a part of the community and is
organised within a set of formal and informal
settings, beliefs,
values, roles, expectations and
behaviours. These are
usually positevely valued
outcomes.
2) within the human services (social definition), the terms
institutions and
institutionalisation have been used to describe the social conditions
that
people with an intellectual disability lived in, in
society. These are
usually negatively valued
outcomes.
While the
term
Institutionalisation can be seen to have
two definitions, they are describing the same things.
Community definition: the model of care is positively valued.
Social
definition: the model of care is
negatively valued.
"The
term institutionalisation
is widely used in social theory
to
denote the process of making something (for example a concept, a social
role, particular values and norms, or modes of behaviour) become
embedded within an organization, social system, or society as an
established custom or norm within that system. See the entries on structure and agency and social construction for theoretical
perspectives on the process of institutionalisation and the associated
construction of institutions.
The term
'institutionalisation' may
also be used to refer to the committing by a society of an individual
to a particular institution such as a mental institution. The term
institutionalisation is therefore sometimes used as a term to describe
both the treatment of, and damage caused to, vulnerable human beings by
the oppressive or corrupt application of inflexible systems of social,
medical, or legal controls by publicly owned, private or not-for-profit
organisations or to describe the process of becoming accustomed to life
in an institution so that it is difficult to resume normal life after
leaving." (Wikipedia:
Institutionalisation)
Types of institutions:
... Community
... Cultural
... Religious
... Health
... Sporting
... Educational
... Recreational
... Professional
The local museum (
The
Museum's Community Role) is an example of an institution in
the
community, and how the institution relates to the community.
While museum's are not disability service providers, they share some
characteristics:
... Provide a service to
the community
... Rely on government and
community
support
etc.:
The above shows that the term "institutionalisation" both
describes the 1) process, and 2) the outcomes of the process that are
negatevily
valued by a person. When referring to an
institution, there needs to be a new
perspective in the way we approch service delivery. Institutions are
neither open or closed, they just are. The way we use these
institutions within the service determines the outcomes of the service.
The institution, the
asylum and
the nursing home:
(
Top)
Asylum may refer to: (
http://en.wikipedia.org/wiki/Asylum)
An asylum can also be defined as a place of refuge, support or
protection.
Originally these places provided a safe place where disadvantaged
people were looked after. They often had a better life that they would
have had in the wider community. Over a period ot time these places
became larger and larger, and of course the particular institutions of
the asylum changed to accommodate more and more people.
There are lots of historical examples where disadvantaged people had
been well looked after, and while these people were institutionalised
by the system, they were generally better off in the asylum rather than
in
the wider community. With the development of new technology, etc. as
well as
changing attitudes, these people have the opportunity to become
included in normal community activities (the good things and the bad
things) that we all take for granted today.
Just as there are lots of examples of good nursing homes for the aged,
does it mean that we have to pull down all nursing homes because of the
bad examples? Are the institutions of the nursing homes any different
to the institutions of the asylums? While some conditions are not the
best for the aged
(although there is some progress in improving these conditions) and
facilities are old and out of date, there has been no real overall
concerted
effort to change, as we have seen with regard to the conditions of
people with an
intellectual disability.
Institutionalisation,
deinstitutionalisation, what's the difference :
(
Top)
Deinstitutionalisation has been described as ... "the process of
re-establishing people with intellectual disability in a community
through community based services".
Another way to describe the process is ... "the relocation of people
that are supported by an organisation or service into another setting,
where they have a greater opportunity to experience the same activities
as others within that setting".
In the above descriptions, the person still uses the support
systems that are provided by an organisation or service, or within the
disability arena. Issues of
funding, responsibility, accountability, staffing and personal care,
transport and medical are the responsibility of the organisation or
service. The values, behaviours and expectations (institutions) of the
organisation or service provide the institutions of the support used in
supporting the person. The goal is to facilitate the
development
of
valued relationships and
networks within a community, where a
person is valued as a part of that
community.
When moving to another setting, the particular institutions of the
setting may become more important than the institutions of the
organisation or service that provides the service.
Any setting where
people live, work or play has its own particular institutions. They
can't
be
avoided.
Think of any activity you
are involved
with.
Think of the various institutions that may be involved with the
activity.
What are the various outcomes that may be associated with the
activity?
To deinstitutionalise can then be then
thought of as a process of consciously or unconsciously adapting or
modifying a person or people, their values, behaviours, the social
structure, and the environment in which they participate. What is
actually happening is a process of reinstitutionalisation, where, the
outcomes change from negatively valued to positively valued. While
institutionalisation is often referred to the situation of people with
disability (especially people with a mental condition), it is
certainly not limited to this group.
When moving from one
community to another, we take on the values,
behaviours, responsibilities and expectations (institutions) according
to our particular role within the new
community. A father in one
community may be a teacher, or a student in another.
The armed forces are a good example, where the members are conditioned
to behave according to a strict regime. A bikie gang epitomises the
antisocial culture, where the establishment
is seen as the enemy. Drugs, violence and antisocial behaviour
characterise the members. However, they have a code of values, ethics,
conduct, as well as a strict hierarchy. Prisons, for example, are
designed to provide positive outcomes for
their members, but how often do we see these people learn the cultures
and values of the others around them? This process of
institutionalisation also happens within ethnic communities, hospitals,
nursing homes, universities
and other places of learning, religious communities, sporting
communities, organisations etc. This does not mean that we should do
away
with these groups or services, or that they are bad, evil places
(although some may be - a value judgment?), on the
contrary, these groups and services have valued roles and are valued
within the
wider community (debatable).
The Australian
Institute
of Sport is an example of an accepted institution that people aspire to
becoming a part of, yet the institute shares most of the
characteristics that are ascribed to people that were placed in
asylums etc.
The athletes:
... are separated from
others in the
wider
community
... are poked, prodded and their every move is monitored and recorded
... are restricted in what they can eat and drink
... have to get up and go to bed at certain times
... training routine is rigorous
... are told what they can and cant do
... are confined to the facility
... whole life within the institute is structured around training to
be the best
We also see this happening within the football community where the
players lives are institutionalised by the formal/informal cultures,
objectives,
hierarchies,
goals, policies,
constitutions, unwritten laws or codes of behaviour etc. of the
Association.
The players:
... symbols of authority
... are professionals that are bound by the
code of the club
... follow a strict regime of the club
... may have a high profile within the football community
... their every move is recorded, dissected, analysed and discussed
... they aspire to play in the national AFL comp, win player of the
year
etc.
etc.
The characteristics of a university (learning institution):
... authoritarian hierarchy
... symbols of authority
... restricted areas
... strict code of behaviour
... division of members into groups
... set roles, behaviours and expectations
... group activities
etc.
The same thing happens within extreme religious
communities, and to a lesser extent in other communities that are
organised around a particular agenda. Just because devalued people may
spend their whole lives in institutionalised care does not mean that
they are any more or less institutionalised than the
athletes/players/students
in the
examples above. It does mean that the institutions of the
athletes/players/students have positively valued outcomes, and the
institutions
of devalued
people living
in the asylum have negatively valued outcomes.
Quite often we see ex-members of a community are still
institutionalised in the institutions of the
community that they were a part of. Members of the armed forces, for
example, can not adjust to living in a
"civilian community".
This also
happens when people move from one ethnic community to another ethnic
community. They may be so institutionalised in the old culture that
they can not adjust to the institutions of the new culture. Students
that are institutionalised within the education system may also find it
hard to adjust to the
"real
world"
and find security within the education community (perpetual students
etc.). Anyone that moves from one community to another has to find all
the local facilities, build new networks and relationships within the
new community, understand the local language, the customs, values,
behaviours, attitudes and expectations, the culture (institutions) of
the community.
We also see a merging of cultures and institutions within a community
where different groups live together and share resources. Where these
new cultures and institutions are not seen as threatening or divisive
they are often used to the advantage of both groups. When these new
cultures and institutions are seen as threatening or divisive, there
may be some conflict, violence or discrimination between the groups.
The members of one group may be devalued as a group, separated,
marginalised or disenfranchised. There is usually some characteristic
of the group that is used to justify there treatment (assigned
devaluing
labels etc.) that allows the community to treat the members of the
devalued community as different. They may be attacked, discriminated
against, or just ignored. Fundamental differences between cultures and
communities has resulted in riots, civil conflicts and deaths, where
members cannot resolve their differences. These differences may become
so institutionalised into the culture of the society in which these
communities live, that generations pass down these attitudes to new
generations so they become a normal part of life. This can happen to
any person or group, where they are seen as
different, or are a threat to the community as a whole.
Think of a setting/activity, and the members of the community within
the setting/activity. Think of the institutions of the setting/activity
as the paint that covers the setting/activity. We can choose to paint
the setting/activity black (outcomes are negatively valued) or white
(outcomes are positively
valued), or even grey, where the outcomes are a mix of negative and
positive values that are specific to the needs of the setting/activity.
"Social
Role Valorisation is intended to address the social and
psychological wounds that are inflicted on vulnerable people because
they are devalued, that so often come to define their lives and that in
some instances wreak life-long havoc on those who are close to them.
SRV does not in itself propose a 'goal'. However a person who has a
goal of improving the lives of devalued people may choose to use
insights gained from SRV to cause change. They may do so by attempting
to create or support socially valued roles for people in their society,
because if a person holds valued social roles, a person is highly
likely to receive from society those good things in life that are
available or at least the opportunities for obtaining them. In other
words, all sorts of good things that other people are able to convey
are almost automatically apt to be accorded to a person who holds
societally valued roles, at least within the resources and norms of
his/her society". (Wikipedia:
Social role valorisation)
"The
major goal of SRV is to create
or support socially valued roles for people in their society, because
if
a person holds valued social roles, that person is highly likely to
receive
from society those good things in life that are available to that
society,
and that can be conveyed by it, or at least the opportunities for
obtaining
these. In other words, all sorts of good things that other people are
able
to convey are almost automatically apt to be accorded to a person who
holds
societally valued roles, at least within the resources and norms of
his/her
society." (P.1) ... "For
example, while SRV brings out
the high importance of valued social roles, whether one decides to
actually provide positive roles to people, or even believes that a
specific person or group deserves valued social roles, depends on one's
personal value system, which (as noted above) has to come from
somewhere other than SRV." (P.4) (Joe
Osburn: An Overview of Social Role Valorization Theory)
It could then be argued
that by
applying the principles of SRV to the
particular setting that is supporting people with disability, there is
a conscious process of changing our values, behaviours, the social
structure, and the environment in which we participate, and that
all participants
are
being
institutionalised, in behaving within a defined
set of goals, values, roles and
behaviours that
promote valued
roles for disadvantaged people.
From the above, it can be seen that deinstitutionalisation is the
process of changing the outcomes of a setting from a negative value
(black)
to a positive value (white).
Negatively
valued
outcomes : low expectations, conform, structured
around
the
needs of the staff etc.
Positively valued outcomes : high
expectations,
individual, structured around the needs of the residents etc.
It could then be argued that disability service providers today provide
the same, or a similar model of care as the institutions of old, and
the only difference is that the outcomes of the service provider
today are positively valued (or at least by the supporters of the
current model of care).
From the above it can be seen that institutions themselves are never
good or bad. While they all contain the same or similar
characteristics, it is the values of the outcomes that determine
whether the institution is good or bad.
For the athletes who live
in
institutional care the goal is to
represent Australia.
The players of the football club have a goal of playing in the
finals.
Members of religious institutions have a goal of becoming closer to God.
Education institutions have a goal of providing skills and knowledge
to its members.
Corrective services have a goal of rehabilitating its members.
The goals of nursing homes and other facilities that support people
with high support needs is to provide the best care that is appropriate
to the person.
The outcomes of these institutions are seen as positively valued.
The goal of nursing homes,
Asylums
(a safe place)
Psychiatric
hospitals
etc. were
originally intended to
provide a
better quality of life for the residents, however over time these
communities became larger and larger. The outcome was that the
residents
of these communities lost a lot of their rights and
normal living conditions. The wider community also contributed to the
conditions that these people lived in by promoting them as deviant etc.
(
Bethlem
Royal Hospital etc.). The outcomes of these institutions are
now
seen as negatively valued. By changing the outcomes of these
institutions within these buildings from a negative value to a positive
value, we change the
conditions within the buildings, where the residents
have a better quality of life.
Alternatively we can place people with high support needs (severe
disability, aged etc.)
in other community based services that are designed to provide a better
quality of life (deinstitutionalise). People with high support needs
may find it difficult
to
develop these new networks and relationships and become isolated. The
aged may lose the support networks that they had (their families have
moved, their friends have passed away etc.). Depending on the person's
needs, the person may be dependent on one or
more services (transport, home help, personal help, financial help,
medical needs, skills development, special equipment etc.) that are not
available in the wider community. The person then has to rely on an
organisation or service provided that has the resources to support the
person, The organisation or service provider has its own
formal/informal cultures, values, expectations, objectives,
hierarchies,
goals, policies,
constitutions, unwritten laws or codes of behaviour etc. (institutions)
that the person has to fit into. Whether the person is advantaged or
disadvantaged by these institutions depends on whether these
institutions have positively or negatively valued outcomes.
Think of any activity you are involved in:
what are the objectives of
the activity?
what is the structure of the activity?
what are your
relationships within the
activity?
what are the formal and informal beliefs,
values, roles, expectations and
behaviours within the activity?
are the institutions of the setting and the activity positively,
negatively valued or a mixture?
Historical perspectives of
institutionalisation and
deinstitutionalisation:
(
Top)
The role of the state in
society.
The role of the church in society.
The evolutions of the state and church in society
The role of technology in society
The educational
institutions ...
The medical institutions
...
Medical institutions were
terreble
places.
No drugs or medical equipment
The employment
institutions ...
Slavery, poor conditions.
Work houses
The disability
institutions ...
Social perspectives of
institutionalisation and deinstitutionalisation:
(
Top)
Ageing population
Limited resources in prviding for disadventaged people (aged, sick,
disability etc).
Increasing strain on existing skills and resources in society.
Institutional care (the building and the institution) has been around
for a long time. There are religious institutions, educational
institutions, medical institutions, business/employment institutions,
benevolent institutions and even sport and recreation institutions.
Historically, these were all horrible places when compared to what we
are accostumed to today. Institutional care was about social order,
rather than social care. The social construction (or model of care) of
the institution reflected social construction of the society in which
the institution was a part of. Each model of care (religious,
educational, medical etc) has had its
own story of debate, struggle and even voilence within that society. We
see the same thing happening today in China, where a new generation of
workers are rebelling against the social institutions that provided the
vechicle of change within that society. Today, China is is giong
through an identity crisis. Two cultures, the political/traditional
culture and
the financial/indrustral culture are moving China in all sorts of
directions. It could be argued that China is going through a cultural
revolution, as well as an industrial revolution similar to England and
Europe a few hundred years ago. China went through a political
revolution a 20 or so years ago, and it has been only in the last few
years that China has really opened itself to other cultures and
practices.
The literature on the origins of what we refer to as the process of
institutionalisation and deinstitutionalisation seem to be both
limited and biased. Throughout history there are references to the
conditions that disadvantaged people (the sick, the poor, people with
intellectual disabilities, criminals etc.) lived in, however, it was
only recently that the development of drugs and other technologies
allowed certain groups of people to live a more normal life. This shift
in the culture of institutional care has happened at different rates
within different institutions, within different societies.
Disadvantaged people were actually
well
looked after and had a better quality of life than they might otherwise
have had, in the wider community.
A brief look at the history of medicine would show that all sorts of
people suffered all sorts of indignities in the name of science. The
Roman Catholic church and other religions did horrible things to people
in the name of God. Does this mean that we should do away with medicine
and religion (although there are plenty of people who would like to get
rid of both)? During World War 2 people with disability were not the
only group that were targeted by Hitler. Jews and other groups faced
the same, or
a worse fate than disadvantaged people.
As the population of disadvantaged people grew, the
society in which
they lived did not have the skills and resources to provide for their
needs. The facilities became bigger and bigger to cope. They became the
social norm. Any negative outcomes from the model of care were
tolerated because
there were no other solutions (just as nursing homes, mental
hospitals, rehabilitation hospitals, prisons etc. are tolerated today).
Political agendas put the conditions of people with disability in the
spotlight.
Technological
perspectives of
institutionalisation and deinstitutionalisation:
(
Top)
They were experimented on as guinea pigs. They were inspected,
dissected, bisected, tested, analysed.
The emergence of the psychology profession used these groups as a way
to gain more credence as a professional body in society.
Medical/psychology profession developed drugs and techniques
to allow disadvantaged people to live more normal lives.
Professional perspectives
of
institutionalisation and deinstitutionalisation:
(
Top)
Each discipline of human
knowledge
operates within its own arena (or reality) of knowledge. Each has its
own perspective on life as we know it. Just as an artist or
conservationist has a different perspective of a tree to an economist
or a business person. They all see different values within the tree.
While there may be differences of opinions and conflicts about the
value of the tree, they are all valid.
Disability has been based in folklore, myths, legends and religious
doctrine because of a lack of knowledge, skills and resources to
provide for their needs. These days we have a better understanding of
humanity, and while each discipline has a different perspective, thay
are all valid.
... the medical profession
looks at the
human body and all things associaled with the body: the mind, the
skeliton etc
... the psychology profession looks at the mind and all things
associated with the mind: the body, society etc
... the social work profession looks at the person's relationship with
society and all related things
... the disability profession looks at society's relationship with the
person and all related things
... the aged profession looks at the aged and all related things
... the human development profession looks at human development and all
related things
... the community development profession looks at a community and all
related things
... the business profession links at bussinesses and all related things
The institutionalisation
of
deinstitutionalisation:
(
Top)
"Institutionalised
care for people with disability is alive and well in
Western Australia"
We see
institutions
such as Activ, Identity, TCCP, Rocky bay etc take
over the role of the institutions that they replaced in society.
While the outcomes are different to the services that were provided 100
yeqrs ago, they still provide the support, the skills and resources
that are not available in the wider community.
The various policies, practices and institutions of government,
disability services and organisations provide the community behaviours
towards these groups, and expectations of the way these groups are
treated within the community.
The shift from community care to social care
The dependence on social structures in providing the care
Institutional practices ...
Profiling as a social
policy
Actively supporting people with high needs in the community: the
community provides a supportive role
Service industries become dependent on these institutions
New communities are built that have the skills and resources to provide
for the needs of people with high support needs.
Legatimises the roles of institutionalised care in the community.
The institutionalisation
of community
care:
(
Top)
The roles of the carer
Provides personal care for
a person
that can not look after him/her self
Privides for the physical and social needs of the person
Has limited skills and resources in providing for the person
Is often helped by family, friends,
or a community support
network/group,
or
institutional
support that is provided by a government or community service,
that has the skills and resources to help.
Is the best person to provide the support;
Knows the person.
Is often trained by a medical service that has some knowledge about the
condition that the person sufferes from.
May support the person in a setting that most suits the persons needs
The care is provided in a non-
institutional
way,
in a non-
institutional
setting.
The carer may have other roles such as mother, father, son or daughter,
brother or sister, or worker, student etc.
The carer may also recieve financial support: child support, carers
support or pension.
The amount of financial or social support provided by government or
community service is dependent on some criteria that allows access to
that financial or social support.
The roles of the volunteer
Provides a service that is
not
available in the wider community.
Usually not paid for services, but compensated for expenses.
Provides a
non-professional approach to
service delivery within a service or organisation.
Is bound by the policies, proceedures and other mechanisms of the
service or organisation.
Is bound by the
institutions
of the service or organisation.
Acts as an aid or support to the service or organisation in providing
non essential services that supplement or assist service delivery.
The roles of the support worker
Provides a service that is
not
available in the wider community.
Paid for services provided.
Provides a professional approach to service delivery within a
service or organisation.
Is bound by the policies, proceedures and other mechanisms of the
service or organisation.
Is bound by the
institutions
of the service or organisation.
Provides the essential services of the service or organisation
The above shows that while individuals are looking for a local service
to provide the skills and resources, so they can better fulfil their
own needs, these supports are less likely to be found in the community.
There is a growth in the human service industry that is taking over
from the traditional roles of the community in providing these
supports. Local Rotary, Lions, Apex groups are getting smaller. Church
and school groups have less participation as we knew it in the
community.
In many ways I see this as the community opting out in providing these
roles ...
A lack of community skills
and
resources.
Communities are more diverse and
fragmented these days. They are different places to what they were 100
years ago;
New generations have more things to think about these days. They expect
everything to be given to them.
Everything is reduced to a personal cost. My time is more valuable in
doing something else.
Permissions, insurance and liability issues, legal implications, and
council regulations all make it more difficult for community groups to
get together.
The idea of "placing
a person in institutional care"
is so institutionalised and normalised into the culture of the society
through government policy and practice, the medical arena, schools and
universities, as well as the media, that there really is no choice
these days. A person that can not be supported in the community is
placed in institutional care that has the skills and resources that can
provide for his/her needs.
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Institutions
and institutional
care
Any business, service or organisation that provides a service to a
group of people is organised around a set of cultures,
values, roles, hierarchies, behaviours and expectations. Whether the
service is a day care for
toddlers, a video hire, a school or hospital, nursing home or prison,
they all have the same characteristics. Institutional care is about a
specialised service that is provided within a community, where the
community does not have the skills and resources to provide for the
needs of it's members. While the characteristicts of the institutions
(See
Characteristics
of
an
institution)
of the community,
business, service or organisation are the same, the outcomes of the
community, business, service or organisation are different.
Shows the
relationship between
the skills and resources of the community,
and the amount of support that can be provided
within the
community.
(See Community
care Vs Institutional care)
Institutional
care can be
thought of within
two main groups:
1) Institutional care
(formal) :
provides the
mechanisms for providing support for a group in society.
... Short term care
... Long term care
2) Social institutions
(informal) :
provides the mechanisms for social
interaction
and participation.
Formal institutions:
Are defined by the agenda, mission statement, objectives,
values and behaviours of the business, service or organisation. These
are generally set out
by a code of ethics and behaviours that can be used to measure the
outcomes of the institution. These can be voluntary, where the service,
organisation or busness sets its own standards, or mandatory, where
they are built into government regulations that allows the service to
function.
These institutions...
... provides the role of
the business,
service or organisation within society - what is its role?
... defines the way the business, service or organisation functions
within society - how does it do it?
... sets the scope and boundaries of the business, service or
organisation - when does it do it
... defines the roles of the members of the business, service or
organisation - who does what?
Short
term care:
Any service that happens in an acceptable period of time, and does
not
have
much impact on our lives. I may get a plumber to fix the tap or go to
the
doctor for a checkup. I can get on with my normal lives without to
much irritation. If for some reason the plumber has to replace all the
pipes in the house, or I have to go the hospital for a few days,
my normal routine is disrupted for an appreciable amount of time, and
may create some stress for me and the others around me. I may enroll
in a course at school or uni and have to change my whole lifestyle to
accomodiate the different patterns and routines. I have books to buy,
lectures to attend, exams to pass, and various other social functions
associated with the school or uni. There are behavoiurs and
expectations required of me and this can be a very stressful period.
However I know that I am working toward a goal, and am prepared to
adjust my normal way of living for the period required. Even changing
a job or moving house can involve a stressful period until I adjust to
the new situation. What ever happens, I know that I still have some
control over my life and still have the choice to opt out of the
system if I choose to.
Goffman
also makes the distinction between long term and short term stay. When
the stay is short time and the outcomes are positively
valued, the person may be able to adjust to their normal living
patterns quickly. Short term stay can also result in negative valued
outcomes that last a persons lifetime.
Long
term care:
It could be argued that the process of institutionalisation starts
within our family, in
the day care centre or kindergarten or with friends
and peer groups. We learn the values and cultures from significant
others in our lives.
Whatever happens, there is a sense of control over our life. We can
plan
and work toward a future, and those institutions are a part of the
backround, just as a canvas is the background that a picture is painted
on. Its only when these institutions become more promonent in our life,
that problems occur.
The longer the time in istitutional care, the more disruption occures
in a person's life.
There is a period of adjustment, and maybe rebellion, to the new
situation.
There is a learning curve involved in finding out how things work
(learning the ropes).
The amount of loss of independence depends on
the reason for the long
term care
the amount of skill and resources the person has
the amount of skills and resources the service has
the amount of control the person has over his/her own life
A person may have to give up a significant amount of his/her previous
life
belongings
friends
lifestyle
may be realocated to
another setting
that is more able to provide for his/her needs.
Shows the
relationship between
the length of care and the amount of institutionalised care provided.
A person may spend a few years in a hospital or in a university. The
amount of restrictions in the person's life depends on the
institution,
as well as the skills and resources of the service. The longer the
person spends in institutional care, the more institutionalised the
person becomes. For some, this can be a gradual process, and others,
this process can be sudden and abrupt. For others, it is the only way
of life that they have known. Goffman
acknowledges that the concept of a "Total institution" is a
concept only, that institutions can never be total, but can be
positioned on a continuum from open to closed (
Total
Institutions: K. Joans & A.J. Fowles - In Understanding health
and
social care By Margaret Allott, Martin Robb, 1998, Open University P.70).
Goffman uses the term "institution" to describe the building and the
institution of the building (the social construction). An interesting
observation about the
concept of a "Total institution" is that there is an assumption is that
the
staff of the institution are just as institutionalised as the
residents, This may be the case where the staff treat others outside
the institution the same as the residents of the institution, however,
the term "institutionalised"
refers to the residents of the institution and not the staff, visitors
or any outside contact that staff may have with the outside world,
Therefore, any institution, where the residents have no
contact with
others, (staff, family, friends etc.) or the outside world, can be
considered
as a total
institution in the truest sense of the word. Institutionalisation has
been used to describe the negative experiences and outcomes associated
with long term care.
It
is also
interesting
that a person is
not considered institutionalised, where, the experiences and outcomes
are positevely valued.
Institutional care, then,
is an ordered
and
specalised intervention
that requires an appropriate setting, skills and resources that are not
available within the wider community. The way the care is provided and
the outomes of this care are directly related to the service that
provides the support. A prision, for example, has the same institutions
as a hospital, however it is immediately obvious that the outcomes of
the prision and the hospital are different. Even within different
prisions and hospitals we see different outcomes.
From the above, it can be
seen that the
institutions of the buildings and communities that disadvantaged people
were placed in,
are the same as the institutions of the different buildings and
communities that we
all participate in,
but have different outcomes. At he bank, we have to suffer all sorts of
indignities to get a loan or see a teller. There is no compensation
when something happens to our money because it is not their fault. Even
when it is there fault, there is no one that takes responsibility.
Informal institutions:
Informal institutions allow the members or groups to function within
the servise,
organisation or busness. These institutions may vary according to what
the members do within the business, service or organisation. Different
members or groups have different functions or roles that allow these
groups to coordinate their activities within the organisation. These
institutions are informal because they are more about the way these
members and groups interact with each other, rather any formal
policies, rules or
regulations of the servise, organisation or busness. There can be any
number of layers in the business,
service or organisation, The bigger the business,
service or organisation, the more layers there may be.
These institutions...
... provides the role of
the group
within business, service or organisation - what is its role?
... defines the way the members or groups functions within business,
service or organisation - how does it do it?
... sets the scope and boundaries of the members or groups within
business, service or organisation - when does it do it?
... defines the roles of the members of the members or groups within
business, service or organisation - who does what?
The
relationship between the
formal and informal institutions
within the business, service.
organisation or community.
These
Informal
insitiutions
could also be described as the social systems
of a business,
service,
organisation or community.
- Peer groups
- Cliques
- Networks
- Departments
- Hierarchies
- Factions
- Divisions
- Politics
Are all ways that the members of a business, service, organisation or
community organise themselves.
When providing the most
appropriate
care for people with high support
needs ...
1) The community is not
where the
person is living, but where the
person participates, shares experiences and has valued relationships
with others.
2) People with high support needs (severe disability, aged etc.)
will always need support structures as a part of their lives.
3) The amount of participation in a community (living, education,
employment or recreation) is directly related to the skills and
resources of the person, and, the skills and resources of the
community that the person wishes to participate in.
4) Institutions are going to be around in one form or another
whether we like it or not, It is the way that they are used that is the
problem.
5) The institutions of a society towards a particular group
determine the way the group participates in society.
6) The institutions of a particular government department,
organisation,
profession or service define the way the person is supported within
that society.
7) Facilities that support people with high support needs do not
need to be the nursing homes or prisons in the
sense
that they are today, but can become warm inviting community places that
offer a range of services to the community, as well as be a part of the
wider community within that society.
8) People with high support needs are a minority group in our
society, and will have the same problems as other minority groups in
being a part of society.
