In 1961, the sociologist Erving Goffman published Asylums, which described the way that people responded to being in an institution, behaving and thinking in ways that would be socially unacceptable in everyday life. He observed the process of institutionalisation, in which people were socialised into behaving in ways that defined their role, meeting whatever psychological needs they could. What’s often forgotten is that Goffman was describing the behaviour and attitudes of the staff, just as much as the inmates.
The Healthcare Commission has published a damning report of the treatment of people with learning difficulties in the care of the Sutton and Merton Primary Care Trust. It’s a catalogue of physical and sexual abuse, similar in many ways to the report on the Cornwall Partnership Trust published last July.
The finger of blame seems to point to the NHS, the implication being that if residential services for people with learning difficulties were controlled by local authorities, this kind of abuse would be less likely to happen.
Perhaps that’s the right answer: social work is based on the discipline of sociology, looking at social interaction and social need. In theory, governance based on social work principles should be more capable of avoiding and detecting institutionalised abuse. But…
I can tell you from personal experience and the stories of my disabled colleagues and the experiences of my personal assistants who have worked in residential units, that abusive, institutionalised behaviour is still everywhere – in the private sector as well as the public sector. I’m sure everyone involved with the protection of vulnerable adults will believe the same thing.
The problem isn’t evil individuals. The problem is human nature: whenever one group of individuals is put in charge of another group, norms will develop. What managers can do, and inspectors can enforce, is to foster cultures which are benign, progressive and intolerant of abuse, where it’s easy for service users and workers to tell someone when they feel that individuals or the system is harmful.