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Institutional Abuse

February 18, 2012

Yet again there are allegations of abuse in a facility run for disabled people, this time by Cornwall Council – John Daniels Centre. In Cornwall we all remember the Budock Hospital abuse scandal, and last year there was the Winterbourne View case near Bristol.

What more is there to add to the various debates that have taken place about all these situations, and how can we help remove/reduce the likelihood they will happen again?

I’ll start by talking about the idea of social capital in its commonest forms, then apply these understandings to the causes of institutional abuse.

Capital

The notion of capital takes various forms, the most commonplace of which is economic capital. We all know how this works – you go into a shop, hand over some money in exchange for a newspaper/chocolate bar/toilet roll/etc.

Money is, itself, of no use to humans. Imagine washing up on a desert island with a crate of bank notes. Apart from burning it for heat, or to cook food, it is, in and of itself, no use at all.

How money works in a capitalised, monetary system, is that it is recognised as having worth (“I promise to pay the bearer, on demand, the sum of…” onUKbank notes). We can therefore trade it in for something more useful to us, by using shops. Without money we are reduced to barter.

There are other forms of capital as well as economic capital. Of particular political interest in the UKat the moment is the idea of ‘Social Capital’ . This is the idea that our social relationships have value, and can bring new resources into our lives that are useful to us.  For example we can hear about new opportunities through our friends and relations (the phrase ‘It’s not what you know but who you know that counts’ is relevant here).

There are at least 2 forms of social capital recognised in the literature. Here I will describe the ideas of Bonding and Bridging Social Capitals.

The Bonding type of social capital refers to the links we have with the people we are close to – e.g. our families, our close friends. Some organisations rely on strong, bonding social capital for their existence, and not all of these are positive organisations. The Ku Klux Clan has very strong bonding capital – the norms within the organisation are perpetuated internally because the relationships within the group are so tight. The adjectives used to characterise this organisation can include ‘secretive’ and ‘closed’.

Bridging Social Capital refers to the links we have with our broader community. These links have been shown to be very useful in bringing new resources into our lives (e.g. Mark Granovetter’s work in the 1970s demonstrating how weak, bridging social capital can introduce new work opportunities into peoples’ lives)..

Social Capital and Abuse

These ideas of the different forms of social capital can be helpful to understand how cases of institutional abuse can take place, and become ‘common practice’ in some places.

The institutions with the worst cases of abuse can be seen to have large resources of strong, bonding social capital within the staff group. The phrases they might use in the presence of new staff could include things like “This is how we do things around here”.

Bad practice might happen, and then, over time, escalate into abuse. Individual staff practice will be influenced by an overwhelming organisational ‘norm’ of bad practice. It is possible to see how bad practice can feed off bad practice, to create a spiral into horrific organisational behaviour.

When this strong bonding social capital is coupled with weak bridging ties to the broader community – with few, if any, visitors calling in unannounced, a culture of closed and locked doors, and few opportunities for inter-organisational staff interaction – then the situation can quickly spiral out of control.

And this is what we see when the doors are thrown open and abuse is disclosed. For Winterbourne View it was only through the hidden cameras of a TV programme that revealed what was happening. We are still waiting to hear more about the John Daniel’s Centre – the police are involved but little/nothing has come to light as yet.

A solution?

Of course the clearest way to reduce this kind of abuse is to close these places down, and provide quality, well-resourced services in the community. There is little political momentum for this at the moment, despite the rhetoric of the Personalisation agenda.

If these places do stay open – and there’s a lot of vested interests, including jobs, in maintaining the status quo – then one way of battling against the possibility of institutional abuse is to open the doors to outsiders. The Care Quality Commission operates on the basis of visits to these places, though how unannounced they are is open to question.

The greater use of disabled people’s organisations in the design/management/monitoring of these institutions could go some way to reducing institutional abuse. Unannounced visits, peer support, peer review, a role in the management of the service, and other mechanisms could be used to open these places up to a critical eye, from the perspective of a service user.

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One Comment
  1. Thanks for the great review, Theo. It reminds me of the problems of strong bonding within medical professions—particularly with physicians and NHS managers—and how this has enabled the same dynamics to occur that were seen in the Bristol Inquiry and the Stafford Inquiry. In those instances, it was not so much a closed building, but a closed system, which is equally resistant to change. Opening up the system/institution can be done best by public participation in audit and governance (see the Tuke Institute paper on methods for this: http://bit.ly/xkPlZJ)
    It’s a great pity that we are still stuck in dealing with the same issues again and again, due to little political will to create toothy regulation in the UK.

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