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Formal and Informal Social Inistitutions


Contents

The role of institutions in the community

An institution could be describes as

Characteristics of institutions

Institutions and institutional care

Institutions can be thought of within two main groups

Formal institutions

Short term care

Long term care

Informal institutions

Negative outcomes (devalued)

Positive outcomes (valued)

The institution, the asylum and the nursing home

Institutionalisation, deinstitutionalisation, what's the difference

Historical perspectives of institutionalisation and deinstitutionalisation

Social perspectives of institutionalisation and deinstitutionalisation

Technological perspectives of institutionalisation and deinstitutionalisation

Professional perspectives of institutionalisation and deinstitutionalisation

The institutionalisation of deinstitutionalisation

The institutionalisation of community care







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.
"Institutions are structures and mechanisms of social order and cooperation governing the behaviour of a set of individuals. Institutions are identified with a social purpose and permanence, transcending individual human lives and intentions, and with the making and enforcing of rules governing cooperative human behaviour. The term, institution, is commonly applied to customs and behaviour patterns important to a society, as well as to particular formal organizations of government and public service. As structures and mechanisms of social order among humans, institutions are one of the principal objects of study in the social sciences, including sociology, political science and economics. Institutions are a central concern for law, the formal regime for political rule-making and enforcement. The creation and evolution of institutions is a primary topic for history." (Wikipedia: Institutions)

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:
... A small staff/client ratio
... the building: separate from the community, large, crowed dormitories etc., originally a Psychiatric hospital or an Asylum
... the model of care: usually medical model that is highly structured etc.,
... the structure of activities: group activities, must conform etc.,
... the policies, values, expectations and behaviours of the administration and staff towards the residents.
(The Origin and Nature of Our Institutional Models) (Goffman's concept of total institutions)

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).



Characteristics of an institution.

These 6 broad characteristics can be further broken down to describe a particular insitution.
Culture :
"The set of shared attitudes, values, goals, and practices that characterizes an institution, organization or group"
The culture of the institution is the way the institution is organised. This is generally determined by its role in society. For example, while the institutions of a hospital, nursing home or prison are simular, the culture of each is quite different.
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.

Formal institutions:  (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.

Informal institutions:  (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 – where people are treated as a homogeneous group without the opportunity for personal choice. Activity is undertaken en masse. Rules and regulations dominate and residents are watched over by staff." (Lennox Castle Hospital: a twentieth century institution)

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.

Institutionalisation is all about "building in" these new participatory decision-making processes so that they become, for all stake holders, the normal "way of doing things". (Tools to Support Participatory Urban Decision Making Process)

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 ...
History of Educational Institutions
Characteristics of a Community of Learning, Ernest L. Boyer

Educational institutions were terreble places.
Where only for some groups

The medical institutions ...
Medical institutions were terreble places.
No drugs or medical equipment

The employment institutions ...
Slavery, poor conditions.
Work houses

The disability institutions ...
Conceptions of idiocy in colonial Massachusetts, Journal of Social History, Summer, 2002 by Parnel Wickham
1856.org: Social History of the State Hospital System in Massachusetts
Poorhouse to Warehouse: Institutional Long-Term Care in the United States
THE FORGOTTEN HISTORY: THE DEINSTITUTIONALIZATION MOVEMENT IN THE MENTAL HEALTH CARE SYSTEM IN THE UNITED SATES
History of disability services in Westen Australia
History of disability services in South Australia
Timeline results for history of disability policy in western australia


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.

Chapter 5, Reinstitutionalising Disability,
In Gerard Goggin, Christopher Newell, Disability in Australia: exposing a social apartheid,
University of New South Wales Press LTD Sydney, First published 2005

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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Social Role Valorisation (SRV)
Deinstitutionalisation
Disability services
Disability and community

The role of institutions in society
Characteristics of an institution
Community care Vs Institutional (social) care
The institutionalisation of community care
Institutionalisation, deinstitutionalisation what's the difference
How does the community care? The reality in supporting people with high support needs





Institutions and institutional care
Formal institutions
Short term care
Long term care
Informal institutions


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.
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.




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