09December2019

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Archive of past issues of the Journal for critique of science

Issue No. 250 - Walk-ing out of Institutions (to be) with the people (4/4 2012)

ČKZ številka 250 - Iz-hod iz totalnih ustanov med ljudi


Walk-ing out of Institutions (to be) with the people

(ČKZ No. 250 - 4/4 2012)

 

pp. 13–30 by Vito Flaker

A Short History of Deinstitutionalisation in Slovenia

The definition of deinstitutionalisation needs to be broader than just resettlement of the people from closed institutions into the community; it also presents a fundamental shift in the power relations of users and professionals as well as an epistemological rupture away from aprioristic and esoteric knowledge of control towards wisdom of everyday live. The process in Slovenia began in the sixties with the experiment in Logatec demonstrating that an institution can be transformed, introducing new methods of working with people based on democratic relationships, action research and experiment. An incubation period ensued in the seventies in various action research projects, most legendary being the kids summer camp in Rakitna and Črni mrav (Black Ant scouts) camps, providing holidays and including children and youth with various labels in the community leisure organisations. These projects featured anti-authoritarianism, inclusion of the stigmatised, democratisation of the community by the community and group work. The goals of deinstitutionalisation – closure of the institutions and alternative provision of community services – was clearly articulated in the eighties in youth work camps in the long-stay institution of Hrastovec and in the activities of the Committee for Social Protection of Madness. First, community services – group homes, day centres and clubs, self-help and users and carers associations, but also individual planning and direct funding were introduced in the nineties in the nongovernmental sector. The real deinstitutionalisation process commenced in the first decade of this century by resettlement of the long stay inmates in Hrastovec, followed also by other long stay institutions. When deinstitutionalisation had to become a principle guiding the whole system, the process came to a halt, partly because of the lack of political will and partly because of the segmentation of the sectors and professions. Deinstitutionalisation has to be understood as a process of liberation and emancipation, as a movement that transcends the divisions between professionals and people – as an opportunity to work differently – for the good of the people.

Keywords: deinstitutionalisation, community care, movements, social work history

Vito Flaker is a professor at the Faculty for SocialWork at the University of Ljubljana. His main areas of interest are: social work methods and theories, community mental health, theory of total institution, process of deinstutionalisation, long-term care, empowerment, individual planning, risk analysis, residential community services, action and qualitative research, styles and careers of drug use and harm reduction. He was an important and co-founding member of mental health movements (Committee for Social Protection of Madness, Walkout) and Direct Social Work. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 31–46 by Boštjan Slatnar

Medicamentalisation – Medicamentation in the Societies of Late Capitalism

The aim is to present some basic characteristics of the processes of medicalisation and medicamentalisation. Both processes are very complex with various negative and positive effects on the lives of individuals and on the sustainability of public health care systems. The problem is further complicated by the broadness of definitions of both processes on one hand and by foregrounding the analysis of individual cases of medicalization on the other. The most important feature of medicalisation will be emphasized: application of the bio-medical model for explanations and for the treatment of conditions which belong to the normal range of human physical and emotional states. According to this, medicalization is the process by which medical diagnosis and treatement are attributed to normal physical and psychological problems. Medicamentalisation is closely connected with the process of medicalisation, but it is not a necessary consequence of the medicalisation of an individual psychological or physical state. The actors of both processes are numerous. The most important are: the pharmaceutical industry, mass media and different kind of patients associations. The most important direct causes of the medicalisation and medicamentalisation of modern societies are direct to consumer marketing of prescription and nonprescription medications and disease mongering. One of the most interesting consequences of medicalisation is the emergence of the medical consumer, that still further brings changes to the relation between the physician and the patient. Modifications in the privileged places of medicalized joints of ≫power – knowledge≪ are significant socio-cultural effects of medicalization.

Keywords: medicamentalisation, medicamentation, medical consumer, biomedical model, drug marketing, disease mongering, normalised society

Boštjan Slatnar: sociologist. His main field of research interest is the status of fact in human evolution and the naturalisation of social sciencies. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 47–61 by Andreja Rafaelič, Mateja Nagode

The Implementation of Long-Term Care

Long-term care is a new area of social protection that is based on the users needs and their understanding of the quality of life. In other countries direct payments are an important part of the long-term care systems. Discussed in the article are the development of direct payments in Slovenia and other countries. Different systems of long term care and direct payment schemes are presented. The slovene long term care system is provided through different laws and social secruity pillars and has yet to be established. Experiences of the pilot project in direct funding with the resettlements to the community are presented in the last part of the article.
Direct payments are very effective in terms of resettlement of people from institutions into the community. New solutions for the new long term care law that will promote deinstitutionalisation and the development of community services are suggested.

Keywords: long-term care, direct payments, personalized care, experiment, einstitutionalization

Andreja Rafaelič is an assistant lecture at the Faculty for social work at University of Ljubljana. Her main areas of interest are: community mental health, deinstitutionalisation,
personal planning, long-term care. (andreja.rafaelič@fds.uni-lj.si)
Mateja Nagode, BA in Sociology, is a senior researcher at the Social Protection Institute of the Republic of Slovenia. Her work focuses on social policy, especially on social care and long-term care. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 62–73 by Romana Zidar

Labour is not a Commodity

During the persistent financial crisis and increased economic uncertainty, paid work is becoming a privilege, a commodity with a value, deserved only by the ≫deserving≪. This discourse is largely co-created and maintained by the social care services and the welfare state, which is pushing already marginalized groups further to the edge. We try to identify the development and growth of unpaid users labour in some social care organizations. In the article we question what the background is in such practices and what discourses they are producing. At the end we offer an alternative in form of the ≫social work of recognition≪, opposing existing practices of ≫social work of personalisation ≪, based on discourse of deficit.

Keywords: paid labour, employment policy, unemployable, labour rehabilitation, social inclusion programs, unpaid labour, discourses of deficit, alternatives, social work of personalisation, social work of recognition

Romana Zidar, M.A. is licensed social worker, licensed supervisor and assistant lecturer at Chair of organisation and research, Faculty of Social Work, University of Ljubljana. Her work is focused on community organisation and management practices in non-profit organisations, project management, social work in working environment, social economy and social marketing in social work. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 74–85 by Petra Videmšek

Are Group Homes Still Intermediary – Witnessing a Twist of Deinstitutionalisation

Through the research of group homes of non-governmental organisations the process of deinstitutionalisation in Slovenia is explored. In more than thirty years a shift has been seen in deinstitutionalisation. The analysis of results indicated that the contribution of group homes to the deinstitutionalisation process was minimal; the amount of people leaving institutions for the group homes equalled the amount of people returning to institutions from the group homes. Therefore, a redefinition of the group home is required because they are not fulfilling the role of being a halfway house between institution and independence. A restructuring of the group home system would be beneficial because the institutions are already over populated. Without this change the relatives will continue to be overburdened, and there will be more people looking for adequate housing. The group homes often solve the housing problem of people with mental distress. The role of the group home should be more than a cog in the wheel of deinstitutionalisation.

Keywords: Non-governmental organizations, group homes, mental health, social work.

Petra Videmšek holds a PhD in social work and is an assistant lecturer at the Faculty for social work, University of Ljubljana. Her main research interests are social inclusion in the field of mental health and handicap, involvement of service users into research and education, social inequalities in the field of handicap and advocacy in the field of sexuality and sexual abuses for handicapped people and people with mental health difficulties. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 86–94 by Jana Mali

Introducing the Deinstitutionalisation to the Care for Older People

Care for older people in Slovenia is extremely institutionalised. The lack of community-based care is one of the persistent problems obstructing the development of care for older people. The care for older people is dominated by the rigid system of institutions, which do not meet the needs of the heterogeneous group of older people. A particular problem is access to help; it is often unavailable. This state of affairs definitely calls for a change based on research and assessment of old people’s needs including quantitative indicators (the number of formal types of help needed) as well as qualitative ones (needs that are currently not met, types and location of services needed). To be able to meet the needs of its residents, large institutions should initially be sized down, reorganised and converted into smaller units and new living arrangements should be introduced. The process of deinstitutionalisation in the area of care for older people creates an opportunity for the kind of change that would meet the needs of the current older population as well as future ones that are bound to be larger – given the demographic trends.

Keywords: older people, needs, institutional care, community care, total institutions

Jana Mali is Senior Lecturer at Faculty of Social Work, University of Ljubljana. Her areas of research and teaching are social work with older people, social work with people with dementia, supervision in social work, methods of social work, long – term care. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 95–105 by Gregor Lapajne

Protecting Rights of People with Mental Health Distress

The Mental Health Act has been adopted by Slovenia because this field has not been legally regulated in accordance with international standards. It is obvious that the legal regulations concerning involuntary psychiatric hospitalizations before the Act did not even meet the minimum standards of legal protection of rights and personal freedoms of people with mental disorders. Involuntary hospitalization procedures were arbitrary because there were no legal regulations in this field. There were practically no advocacy services available to patients in social welfare and psychiatric institutions in Slovenia. Thus, when the patients were in conflict with the institution they found themselves on their own. In such cases they often need an advocate to be on their side and support them in enforcing their rights. In practice the institutions are unwilling to voluntarily let advocates work inside the institutions, while lay advocates who worked for non-governmental institutions before the new Act did not have any means to work against the institutions on equal terms. Advocates need authorization and a mandate from the government to successfully advocate patients in institutions. Only thus can independent advocacy services that will be able to efficiently support patients in institutions be established. The Act must grant jurisdictions, work duties and an area to work to the independent advocates, and above all grant financial resources to implement their services.

Keywords: mental health advocate, independent advocacy, Mental Health Act, human rights, personal dignity

Gregor Lapajne holds an MA in social work. His MA dissertation topic was Advocacy in mental health and the role of an advocate in mental health. He has been a member of the research group in the project The monitoring of advocates in mental health. Since June 2011 he has been employed as a consultant for perpetrators of violence in the Association for nonaggressive communication. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 106–115 by Petra Videmšek

Role of Users’ Movements in Shifting the Power to the Experts by Experience

Article is based on the literature review where we present development of user’s movement abroad and in Slovenia. User’s movement has key role in professionalization of social work. Methods of social work are basic tool in which the basic element are realised. Social work profession has been legitimised by changing the methods, through traditional methods (classical, landed methods) towards innovative (radical) methods of social work. The latter moved from elitism (professionals know the best, what is good for individual) towards co-creation. With this shift, the role of exert by experience has changes from passive receiver of help towards more active participant in solution seeking for their situation.

Keywords: methods of social work, empowerment, mental health, community services

Petra Videmšek holds a PhD in social work and is an assistant lecturer at the Faculty for social work, University of Ljubljana. Her main research interests are social inclusion in the field of mental health and handicap, involvement of service user into research and education, social inequalities in the field of handicap and advocacy in the field of sexuality and sexual abuses for handicapped people and people with mental health difficulties. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 116–127 by Mitja Krajnčan

Deinstitutionalisation in the Youth Care Re-educational Institutions

The article focuses on the concept and process of deinstitutionalisation in the field of re-educational institutions, and presents a variety of directly associated theoretical guidelines. The concept of decentralisation is described, such as the distribution of functions, authorities and living conditions. Following this, regionalisation is discussed, which concerns the  expediency of placing young people in re-educational institutions in their vicinity. Also discussed the concept of normalization in terms of making life in an institution as similar as possible to that outside of institutions. The process of social integration and inclusion are then explored. The specifics of institutional work are examined in detail, with a focus on its characteristics, challenges and requirements. A reflection on the development of Slovenian re-educational institutions concludes the article with regard to the aforementioned concepts, ideas and processes.

Keywords: deinstitutionalization, normalization, decentralization, regionalization, social integration, inclusion

Dr. Mitja Krajnčan is an associate professor at the Faculty of Education at the University of Primorska. His research interests are in the methods of social pedagogy, residential institutions for children, education outside the family and its alternatives and experimental Pedagogy.  (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 128–137 by Jana Mali

Social Work with Older People and New Social Legislation

At the beginning of 2012 the process of the realisation of two laws, the law on social welfare incomes and the law on asserting public funds, began. Both laws have strong impact on good quality of old age. The paper presents results of a short research in which interviews with older people, users of social services and social workers were conducted and investigated. The findings are terrifying. Older people resign a right to pension benefit; new social legislation caused mass loss of the right to the state pension and increasing dependence of older people on family members (especially their children) income. Older people give up numerous goods, important for assuring the minimum level of quality life in old age. On the other hand the effects of new social legislation intervene in professional social work. The endeavour of essential social work with older people mission (i.e. help for resolving  roblems) is obstructed. Older people are losing the confidence in social workers because their help is not effective enough.

Keywords: older people, social work, quality of life, qualitative research, social legislation

Jana Mali is Senior Lecturer at Faculty of Social Work, University of Ljubljana. Her areas of research and teaching are social work with older people, social work with people with dementia, supervision in social work, methods of social work, long – term care. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 138–143 by Petra Kovačec, Nika Merc

Representation of Mental Health on the Screen – an Obstacle for Deinstitutialisation

The article deals with the presentation of mental health in the mass media. Taking into consideration that the image of the world is also created by mass media, among which the television is still prevalent despite the popularity of the internet, we decided to show how the media present people with mental health problems and how it interprets the process called deinstitutionalisation. The focus was on ten films in individual historical periods and set several minor theses. These refer to the connection of mental health with the film genre, to the handling of users according to the gender, to the medical or social way of dealing with such a topic to the terms used and also to the means of expression, connected to mental health. It is a fact that awareness of the influence of mass media on the audience is insufficient. The mass media help shape the world and create differences and also use films to create a wrong impression about mental health, which is too quickly internalised by the viewers.

Keywords: mental health, presentation, media, film, deinstitutionalisation

Nika Merc is social worker. Her area of study and practical work is mental health in the community. Her main interests are domestic violence and media presentations. (This email address is being protected from spambots. You need JavaScript enabled to view it.)
Petra Kovačec is a social worker. Her area of study and practical work is mental health in the community. Her main interest is media presentations.  (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 144–152 by Simona Smolej, Mateja Nagode

Personal Assistance – Opportunities for Independent Community Living

Personal assistance as a key of providing independent living, greater inclusion, autonomy, equal opportunities and non discrimination of persons who are not able to perform ADLs without another person's support, has a significant impact on the promotion of  deinstitutionalization. In Slovenia, systematic regulation of this area is still awaited. The paper presents a brief overview of personal assistance arrangements in some European countries in
which it has been introduced and regulated already over a decade or more ago. Personal assistance in Slovenia is non-systematically regulated. It is implemented by various organizations that are financed from several sources. It has become apparent that the amount of funding for personal assistance in recent years has been increasing; the same goes for the number of organizations providing personal assistance. However, whether the needs of the users with the highest intensity of needs are better met than in the past is debatable, or the case is that the personal assistance to these persons has remained concentrated within a few organizations. Certain partial changes and improvements in funding and the implementation of personal assistance are thus detected, but unfortunately a stable system is not yet in sight.

Keywords: personal assistance, legal regulation, deinstitutionalisation

Mateja Nagode, BA in Sociology, is a senior researcher at the Social Protection Institute of the Republic of Slovenia. Her work focuses on social policy, especially on social care and long-term care. (This email address is being protected from spambots. You need JavaScript enabled to view it.)
Simona Smolej, M. A. is a social worker. She is employed as senior researcher at the Social Protection Institute of the Republic of Sloveniaas. Her work focuses on social policy, especially on social care programmes,community care, poverty and social exclusion. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 153–159 by Martina Flego, Herta Sorta, Karmen Orel

The Process of Deinstitutionalisation and Abolition of Restraint in the Social Care Home Dutovlje

Deinstitutionalization is the process that includes practical changes, and transforming the treatment of persons with mental health problems. This process counteracts the harmful effects of living in an institution. The basic steps start within the institution by strengthening the relationship of power in favour of the residents. This is very closely related to the abolition of restraint methods. The change in power relations between the actors of deinstitutionalization is also connected with the legal system. The Mental Health Act has not brought the expected results, it is largely inconsistent with both the Social Security Act, the Regulations on standards and norms for social services, as well the code of ethical principles in social work as professional principles, methods and work procedures. The Mental Health Act gives the opportunity for using the methods of restraint in a social care home where, in addition to this unethical and inhumane approach to the tenant, puts workers in trouble. The authors mention some historical data of the opening of the institutions in the world and briefly introduce an example of good practice of the process of deinstitutionalization in the Social care home Dutovlje.

Keywords: deinstitutionalization, social care home, methods of restraint, social care, home Dutovlje

Herta Sorta is an occupational therapist, a senior consultant and the director of the Social care home Dutovlje.
Martina Flego holds a PhD, she is a psychologist and the chief of social care staff of the Social care home Dutovlje.
Karmen Orel is a social worker and senior consultant in the Social care home Dutovlje (This email address is being protected from spambots. You need JavaScript enabled to view it.).

 

pp. 160–164 by Edo Belak

Role of the Relatives in Resettlement into the Community

Together with the person with mental health problems their relatives are also under pressure and distress. As community care in Slovenia is not well established and accessible, the care is usually provided by the relatives. Most of the burden is experienced in the period when the relative who is experiencing mental distress is discharged from the institutions. At that time the relative is left alone without any support with the duty to help the relative with mental health problems. Already the experience of hospitalisation is a shock for the family member, but the return home is an even bigger one. Information is needed by the relatives to know what to do and how to help the person with the mental disorder. Self-help groups are an important source of support for the relatives. As family members of a person with mental health problems have seen the negative effects of institutionalisation they can be important promoters of deinstitutionalisation.

Keywords: mental health, family members, rights, community care, deinstitutionalisation

Edo Belak is the president of the Slovene Forum of relatives at the NGO Šent, he is a member of the Slovene Commitee of Relatives of People with Mental Health Problems. He is an advocate of people with mental health problems and a member of the group that is preparing the National plan of mental health (This email address is being protected from spambots. You need JavaScript enabled to view it.).

 

pp. 165–176 by Andreja Rafaelič

Seven Hundred Kilometres is Far, but not Far Enough

The Walk-out went on the road with the intention of condemning total institutions. Total institutions have been defined as peace time crimes because they deprive their inhabitants freedom and do not provide for their needs. Deinstitutionalization is an alternative to enclosure. The start of the process of deinstitutionalisation in Slovenia in the field of mental health are described. Special attention is also paid to the Italian experience with the closure of the mental health hospitals and the establishment of community services. Since deinstitutionalization has stopped in Slovenia it has been decided to promote it within a movement. People with the experience of total institutions, social workers and others merged in the movement. On the road twenty six round tables or public debates were organized. They have shown that the goal of deinstitutionalization is declared by everyone, the main obstacles to it are the lack of finances and collaboration between services. Since most of the institutions are in a process of restoration or have just been restored it is believed that  deinstitutionalisation in reality is not promoted by the institutions.

Keywords: total institutions, deinstitutionalisation, movements, communiry care, mental health

Andreja Rafaelič is an assistant lecture at the Faculty for social work at University of Ljubljana. Her main areas of interest are: community mental health, deinstitutionalisation, personal planning, long term care. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 185–196 by Monika Bohinec

Diagnosis and Its Person

Johnny is a person with universal wide thoughts, with a pleasant hippie appearance; he is full of gracious gestures and deep wisdom. These characteristics have been strengthened in the late teen age period and were the reason his parents took him to the psychiatric hospital. He found himself in a vicious circle of total institutions and spent a large part of his life in the enclosed units, where the psychiatric system has not been able to understand his world. Psychiatrists declared him a man who is unable to live independently outside of institutions. He joined the Walk-out movement when in Hrastovec. After the walk he stayed in Ljubljana to live in a group home. He replaced the world of diagnosis, disease, medicine staff and a locked door for the life in the community, friends, fun and philosophical thoughts. He had the support of the movement, especially when he found himself in the arms of the psychiatry again. Now he lives a free life trying to acheive his goals and desires, which is not easy in the system of social protection for people with a long institutional career. Obstacles that a person faces in the community are softer and more sophisticated compared to the walls of institutions and convictions of psychiatric diagnosis. The system of social and health care in the community does not allow progress in a persons life and promotes the stagnation of serivces on a national level.

Keywords: institutional career, hospitalization, diagnosis, stigma, community mental health

Monika Bohinec is a social worker at the Agency IN, a nongovernmental organization in the area of mental health in the community. Her activist pathway was marked by students movements against tuition fees and privatization of higher education, the Walk-out movement and occupy movement 15o especially group Direct Social Work. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

pp. 197–211 by Andreja Rafaelič, Monika Bohinec

Providing Care for the People Who Walked out of the Institutions – Solidarity and Freedoom Therapy

After the Walk-out care had to be organised for the walkers that decided not to return to the institutions. Enabling public pressure and advocacy has been one of the tasks of the movement. Negotiations with the Ministry of labour, family and social affairs, special care homes, nongovernmental organizations and local authorities had started. Agency IN has been the only nongovernmental organization that has been willing to provide care for the walkers. The lives of the walkers have changed dramatically. The resettlement to Ljubljana has been a challenge for the walkers, their social workers and volunteers. The solidarity that has been created during the movement provided them with enough support and help to realise most of their goals. The movement enabled them to make friends and live in the community. While experiencing a lot of successes in their lives, obstacles have been encountered. Inadequate laws and the passivity of the ministry of social affairs has been one of the most oblivious.

Keywords: movement, solidarity, resettlement, support in the community, deinstitutionalisation

Andreja Rafaelič is an assistant lecture at the Faculty for social work at University of Ljubljana. Her main areas of interest are: community mental health, deinstitutionalisation, personal planning, long term care. (andreja. This email address is being protected from spambots. You need JavaScript enabled to view it.)

Monika Bohinec is a social worker at the Agency IN, a nongovernmental organization in the area of mental health in the community. Her activist pathway was marked by students movements against tuition fees and privatization of higher education, the Walk-out movement and occupy movement 15o especially group Direct Social Work. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

 

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