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The concept of Deinstitutionalisation and Social Role Valorisation
Institutionalisation, Deinstitutionalisation and Reinstitutionalisation


Social roles are how we see ourselves and others in society. They are often about a particular characteristic (age, gender, race, ethnicity, culture, occupation, disability or even ability) rather than the person. A Muslim, for example, is often treated different because of his/her religion and culture. If the Muslim also had a particular disability or disadvantage, that person would have less chance of becoming a valued member in society. The same can be said for an aboriginal, a bikie or drugie, or possibily even a bank manager or used car salesman.

Social Role Valorisation (SRV) uses the concept of roles in the Implicit sense in that roles are used to generalise the values, behaviours and expectations (the institutions) that define the person or people, within a particular group, activity and setting, as a normal part of society. While this generalisation is true in the most part, I think that it is unwise to assume that the institutions of all activities and settings share the same roles.

For example, Wolfensberger describes in his paper "The Origin and Nature of Our Institutional Models" the buildings that devalued people were institutionalised in. They are characterised by the values, behaviours and expectations within the building. Rather than being institutionalised in these buildings, they were placed in these buildings because there was nowhere else. Because of a lack of skills and resources in the community they were assigned a devalued status. Once this transition happened, it became a normal part of community life (normalised in the community) in a sense that "these people are devalued lets lock them up". The outcome was that people who can not look after themselves, and need a structured life, were placed in large buildings that could provide their basic needs i.e.: they were institutionalised.

If I showed you a photo of a building, chances are that you would not know what its role was unless you knew what happened inside the building. In our community, we see all sorts of activities that are carried out in buildings of a similar design that have similar institutions (universities, hospitals, hotels, office buildings, factories etc). We also see examples of people being assigned a devalued status outside these buildings in communities.

Wolfensberger uses imagery (Semiotics- Signs and Symbols, Image Juxtaposition, Image Transference etc) with great effect so that the reader has an idea of what it may have been like to live in one of those facilities as well as society in general, and how he/she can avoid the same thing in the future. Maybe he has done his work to well, in as much as the points that he is trying to make and concepts he is trying to explain have been absorbed into almost every corner of our culture with gay abandon.

Just because a person has a valued role and is living in a home by himself or with others does not mean that his life is any less institutionalised (in the context of SRV) than he would be when living with 20 or even 200 others.

Whether the person with a disability is institutionalised (in the context of SRV) would depend on the:
... the model of care
... the amount of support the person has
... amount of restrictions the person has
... the setting of activities
... the structure of activities
... the person's relationships with others
... the formal/informal cultures, values, policies, practices and, the behaviours and expectations (institutions) of the administration and staff of the service provider.

When moving from one community (living, recreation, employment or education) to another, for example, we take on the policies and practices, cultures, behaviours, rules and regulations - the normal rhythms - of the community. We have to fit into the particular institutions of the community that we are joining.
Sometimes when the goal is the de-institutionalise a person, all we end up doing is re-institutionalising the person.

By changing the cultures, values, policies, practices and, the behaviours and expectations of the community, where people with high support needs have a better quality of life, we change the institutions of the community.

To Re-institutionalise then, is to bring about, or normalise, a behaviour, activity or policy that supports disadvantaged people within a setting, where that behaviour, activity or policy becomes a part of the setting (institutionalised).




"The authors discuss what can be learned from our experience with deinstitutionalization. The deinstitutionalization of mentally ill persons has three components: the release of these individuals from hospitals into the community, their diversion from hospital admission, and the development of alternative community services. The greatest problems have been in creating adequate and accessible community resources. Where community services have been available and comprehensive, most persons with severe mental illness have significantly benefited. On the other hand, there have been unintended consequences of deinstitutionalization—a new generation of uninstitutionalized persons who have severe mental illness, who are homeless, or who have been criminalized and who present significant challenges to service systems. Among the lessons learned from deinstitutionalization are that successful deinstitutionalization involves more than simply changing the locus of care; that service planning must be tailored to the needs of each individual; that hospital care must be available for those who need it; that services must be culturally relevant; that severely mentally ill persons must be involved in their service planning; that service systems must not be restricted by preconceived ideology; and that continuity of care must be achieved."
Some Perspectives on Deinstitutionalization



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.


Peter Anderson
http://www.psawa.com