The traditional focus on individual impairment has been broadened by the modern concepts of disability to one that recognizes that the effect of impairment is not only dependent on the underlying condition, but is also dependent on the social and environmental factors (RACGP 2007). Therefore, impairment does not necessarily imply that one is disabled or handicapped by it. There are three main types of disabilities
Physical disability Intellectual disability Developmental disabilityIn this analysis we will focus on intellectual disability with particular emphasis on the impact of medical and social models on people with intellectual disabilities.
INTELLECTUAL DISABILITYAn individual is considered mentally retarded or intellectually disabled based on the following criteria:
Where the individual has an intellectual functioning level (IQ) that is below 70 (Carlson 2010). Where significant limitations exist in at least two of the adaptive skill areas (Carlson 2010). Mental retardation manifests itself before attaining the age of 18 (Carlson 2010). IMPACT OF MEDICAL AND SOCIAL MODELS ON PEOPLE WITH INTELLECTUAL DISABILITIESTraditionally, explanations for disability were based on the medical model which views disability as a particular trait in an individual departing from the norm (Harris 2010). There is no doubt that the medical model has significantly impacted on persons with intellectual disability. As pointed out by many theorists, this model is primarily responsible for numerous beliefs and practices surrounding people with intellectual disability.
The view that intellectual disability is objectively abnormal and undesirable has given rise to a large number of related assumptions including the view that disability is objectively bad, is a personal tragedy and thus something to be pitied, prevented and if possible, cured (Harris 2010). This notion perhaps explains many of the practices associated with it including institutionalization, involuntary sterilization, forced rehabilitation, euthanasia, social marginalization and even “mercy killing”(Harris 2010).
In this regard, euthanasia refers to the medically assisted suicide whereby the individual with intellectual disability is subjected to death with the intention of putting an end to his/her suffering (Anon 2006). Since the medical model often falls short of providing a truly assisted living and instead proposing medically assisted suicide, its associated impacts on those with intellectual disability has been heavily criticized with many of the view that sanctity of life is paramount (Anon 2006). Indeed, the freedom of bodily autonomy and personal choice is fundamental freedom to every individual regardless of the disability.
Aside from the medically assisted suicide, there is the aspect of forced sterilization. The most famous case of this involuntary sterilization was that of a woman in Virginia known by the name Carrie Bell who underwent a compulsory sterilization after having been alleged to be mentally retarded (Russel 2006). Carrie Bell became the first woman to undergo a compulsory sterilization in Virginia after the Supreme Court affirmed the compulsory sterilization law (Russel 2006). People with intellectual disability should however not be treated with such an invasive and irreversible procedure. The right to bodily integrity and reproduction are fundamental to personal identity regardless of disability.
Also, persons with intellectual disabilities tend to be more often isolated and institutionalized either in a nursing home, hospital or care home. Such institutionalization denies them their basic right to freedom, citizenship and participation in the community. Supporting this view, Samuel Gridley Howe, founder of the Perkins Institution in Boston (the first residential institution for people with mental disabilities), rejected the trend towards lifelong institutionalization of persons with intellectual disability and instead proposed that they be stimulated by being absorbed back into the community among sound and typically developing persons, as opposed to their segregation away from the rest of the society (Carlson 2010).
With the onset of the social model, there has been a shift in emphasis away from pathologising the individual to stressing on restrictive environments and societal attitudes (Harris 2010). This model views disability as a consequence of the environmental and societal attitudes that hinders people with impairments from interacting and participating in the society (Harris 2010). The model maintains that persons with disabilities are prevented from participating in the society due to social inequalities, discrimination, barriers to opportunities, insufficient support systems, prejudices and negative stereotypes, and general societal attitudes (Harris 2010).
The possibility that mental health problems may be derived from social injustice such as negative stereotypes, social inequality, discrimination and oppression among others is not widely recognized (Harris 2010). It is a fact, however, that people with intellectual disability are more likely to experience such injustice and oppression as a direct consequence of their impairments (Harris 2010). They can experience a vicious circle of isolation, unemployment, poverty, scarce social and support networks as well as insecure housing among others.
With the above in mind, it is worth examining some of the non-discriminatory and anti-oppressive practices that may be employed by social workers in their contribution to mental health services.
NON-DISCRIMINATORY AND ANTI-OPPRESSIVE PRACTICESInitially, most of the mental health institutions in the UK, did not meet the needs of some people while others were overrepresented in the more coercive areas such as compulsion and detention (Roberts, et. al., 2008). However, with the enactment of the Provisions of 2007 Mental Health Act, concerns about the diminishing contribution of social workers to mental health services have been brought to light. Emphasis is now placed on professional collaboration and integration with the training of social workers, which has become the key to providing critical perspectives (Roberts, et. al., 2008).
PROFESSIONAL COLLABORATION AND INTEGRATIONThe widespread adoption of non-discriminatory and anti-oppressive approaches in social work and education has heightened the professional awareness and understanding of issues such as social exclusion, oppression, stigma and stereotypes (Roberts, et. al., 2008). Moreover, social workers have become more aware of their own potential oppression towards individuals with intellectual disability (Roberts, et. al., 2008). In this respect, the National Institute for Mental Health in England has reviewed the roles of a range of mental health practitioners and identified distinctive contributions from the different professions. Value based practice that involves working with this diversity has been developed and is currently at the heart of the mental health policy and practice (Roberts, et. al., 2008).
DEVELOPING SUPPORTIVE NETWORKS AND REDUCING ISOLATIONSocial workers have a key role to play in developing supportive networks for those with intellectual disability and reducing their marginalization and discrimination in the society. Providing therapeutic emotional support and group work approaches to service provision as well as promoting development of practical skills demonstrates the value of networking and mutual support to those with intellectual disability (Roberts, et. al., 2008). For example, a study based in Northern Ireland assessed some of the benefits of therapeutic group work on children with intellectual disability (Roberts, et. al., 2008). The study identified improvements in children’s self-esteem and confidence, improved social interaction and improvements in their academic achievement as well (Roberts, et. al., 2008).
EQUALITY AND SOCIAL INCLUSIONIt is a fact that disability is often associated with all kinds of discrimination including discrimination in terms of employment and education. In terms of employment, people with mental disabilities are often considered as a hazard and are seen as having potentially greater risk of falling ill (Lago & Smith 2010). In terms of education, the view of disability has significantly contributed to separate education for many disabled children. Emphasis has often been placed on corrective treatment for their impairments at the expense of access to mainstream curriculum and contact with other able bodied peers (Lago & Smith 2010). Hence, in a number of circumstances, these individuals have been alienated from the society.
In demonstrating its commitment to equality and social inclusion of people with mental disabilities, part of the underlying standards of the National Service Framework for Mental Health in the UK is to ensure equality in treatment and access to services for all, regardless of the disabilities, gender, ethnicity, age, religion or sexual orientation (Roberts, et. al., 2008). This aims at promoting social inclusion whilst addressing discrimination issues which are often associated with mental ill-health.
PROMOTING INDEPENDENCE AND SELF-DIRECTED SUPPORTEqually important is the promotion of independence and self-directed support to individuals with mental disabilities. In this context, Independence involves giving those with disabilities absolute control over the services and systems that support them (Adams et al, 2002). Key to this is the need to firmly place the principle of independent living within the support systems and at the centre of mainstream public life (Adams et al, 2002). Support services are essential to ensure the independence of these individuals. These services range from access to equipment, health services, personal assistance, independent information, to support from peers and advocates (Adams et al, 2002).
In order to achieve this goal, a number of organizations have been developed in the UK. The Self-Directed Support Scotland (SDSS) is one such organization which actively promotes independent living for the disabled by working alongside other organizations with the aim of supporting and championing self-directed support to the mentally disabled individuals (Adams et al, 2002). Independence may as well be promoted with the use of a person centred approach to planning, which focuses on individuality and emphasizes on the importance of independence and autonomy.
VALUES UNDERPINNING PERSON-CENTERED APPROACHTraditionally, people with intellectual disability have had little input into the design and delivery of services that they receive (Towell & Sanderson 2004). There is however a growing body of evidence of a change in service provision towards a more person centered approach. Person centered approach refers to an approach that enables people to take a lead in planning all aspects of how social care services that they receive are delivered (Mansell and Beadle-Brown, 2004a).
Professional services provided to people with disabilities have traditionally been based on the person’s impairment (Smull & Lakin 2002). Professional efforts have tended to channel services to these individuals according to the category of their impairments such as sensory impairment, learning difficulty or loss of mobility (Smull & Lakin 2002). This has led to a process of assessment that analyzes and quantifies the impairment and its impact based on the ability to undertake a range of tasks (Smull & Lakin 2002).
The most serious consequence associated with such an assessment is that the participation of such people in ordinary community life is then seen to be dependent on their success in achieving these goals (Dowling, et.al, 2006). Person centred planning challenges this notion of “dependence”. It goes beyond the “needs led” or “holistic” assessment and considers a person’s aspirations as neither limited by entitlement to neither services nor dependent upon professional development (Dowling, et.al, 2006). It is concerned with the whole of someone’s life, not just their need for services. In this regard, person-centred planning is high on the national policy agenda in the UK (DADHC 2009).
The main principles and values underpinning person centred planning include:
Independence; – as pointed above, a person centred planning goes beyond the “needs led” approach and considers a person’s aspirations as neither limited by entitlement to neither services nor dependent upon professional development (DADHC 2009). Equality: – Person centred planning challenges the unequal power structures that have long characterized the relationship between the users and their service providers (DADHC 2009). In this regard, Sanderson al (2002) suggested that organizations need to operate from a position where they have “power with” service users as opposed to that where they have “power over” them. Inclusion: – person’s centred planning seeks to develop a better and shared understanding of the person with the disability and identify the person’s aspirations and assess what support him/her might require (DADHC 2009). Choice: – the person must be consulted throughout the planning process and he/she chooses the setting and timing of meetings as well as who is to be involved in the process (DADHC 2009). In this regard, Sanderson (2000) considers friends and family as a part of the planning process. However, the ultimate decision lies with the service user. IMPORTANCE OF PERSON CENTRED PLANNING IN CARE DELIVERYIts importance in care delivery includes (Sanderson 2000);
Helping people achieve their aspirations Clarifying the supports needed to pursue these aspirations Help shape contributions from a range of service agencies by ensuring that they are directed at meeting the goals of the user. Energizes and motivates people based on their understanding and commitment to supporting people with disabilities. CONCLUSIONThere is no doubt that the medical and social model has significantly impacted on persons with intellectual disability. Clearly, we have identified several practices associated with disabilities including institutionalization, involuntary sterilization, forced rehabilitation, euthanasia, social marginalization and even “mercy killing”. There is need for social workers to ensure non-discriminatory and anti-oppressive practices in their association with those with intellectual disabilities. A person-centred planning is equally essential in the delivery of care services to people with mental disabilities.
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