• Embed Doc
  • Copy Link
  • Readcast
  • Collections
  • CommentGo Back
Download
 
 
S
UPPORTING
F
AMILY AND
C
OMMUNITY
C
ARE
 
 Malcolm Payne
  Professor of Applied Community Studies, The Manchester Metropolitan University,799 Wilmslow Road, Didsbury, MANCHESTER M20 2RR.
Telephone: UK+(0)161-247 2097, FAX: UK+(0)1204 853499, E-Mail: M.Payne@MMU.AC.UK 
Introduction
Recently, I visited a colleague in another University in Bristol in the south-west of England. She works in a campus on the edge of the city, surrounded by grassland inimposing buildings more than a hundred years old. The University moved into these oldbuildings a few years ago. I used to live in Bristol myself 20 year ago, and visited thesebuilding regularly as part of my work. At that time, they were a psychiatric hospital formentally ill people. Some patients with acute illnesses were admitted for a few weeks,then discharged home again. But many of the patients had lived there for many years,some for most of their adult life, but now they have been moved out to live outsidehospital, and the buildings have been turned into a University. This is in response to agovernment policy of ‘community care’, which has been strengthened and developed inthe 1990s.This is not simply a British phenomenon, but a worldwide trend (Brown, 1985; Ramonand Giannichedda, 1988). It affects not only mentally ill people, but many groups of people in need of long-term care. Neither is it solely a government or political policy.Professional developments have also contributed to the movement towards this policy. Italso responds to the personal preferences of many individuals and to the wishes of communities in many different countries.The basic assumption which lies behind such policies is that people who need long-termcare prefer to remain in their own homes and receive help from family and friends in thecommunity around them. It is also thought that this brings benefit to the family andcommunity in promoting mutual support and strengthening society generally. It oftenseems more cost-effective too, but this is now seen as a false argument. This paperfocuses on the movements towards care policies of this kind and the form of social work practice needed to implement them. The fundamental social work issue is whether peoplecan be cared for in the community, whether the community wishes to care for them and iscapable of doing so. If there are public services, can they be interweaved with informaland community care?The following discussion , which draws from my book 
Social Work and CommunityCare,
(Payne, 1995) is divided into three parts. First, I examine British community carepolicy and its development as an example of the worldwide trend towards this kind of community policy. Then, I look at some of the problems that have arisen with the policyand its implementation. In the third section, I want to explore the professionalimplications of introducing such policies: what are the implications for our practice as
 
PAYNE: Supporting Family and Community Care - 2
 
social workers? In doing so, I want to examine widespread practice policies such as casemanagement, multiprofessional work and networking. These three numbered sections arethen followed by a brief conclusion, making suggestions for applying these issues todifferent contexts.
1 British community care policy
The reason why we remark on community care is that as societies have become morecomplex, their response to dealing with social problems has been to create institutions forpeople who seem to need help. Community care policies represent a shift away frominstitutional care as the main policy for dealing with social need. However, because thereasons for preferring institutional care were not always concerned in the first place withproviding good care, the reactions to this shift have been complex and need carefulanalysis to understand them.There are four issues to be considered. The first is whether we should considerinstitutional care to be ‘good’ care, and why we think community care might be better.Arising from this, the second point, there is the question of the idealisation of ‘community’ and ‘family’ and why this takes place. The third point is the question of cost.Fourth, there is the question of the relationship between formal and sometimes official orgovernment action and informal and non-official and non-government action.The view is widespread around the world that institutional care is undesirable as a way of providing for social needs, but this has obviously not always been so, because there aremany institutions in social provision around the world. We therefore need to ask whyinstitutions have been used and why they have fallen out of favour.In small communities, particularly rural communities, few social problems exist and theyare managed by members of the community as they arise through collective action. Ascommunities become larger and more complex, not all problems can be handled in thisway because people are more distant in their social relations, they may travel away fromtheir families, so that support is lost, large-scale industry, motor transport and the liketend to create problems of ill-health and disability as a result of accidents and since morepeople are together, social problems are accumulated, too. So there seems to be a largerproblem as the result of urbanisation and industrialisation. It is out of these general socialprocesses that the need for a wider range of helping professions, including social work,has been appreciated.At the beginning of this process, putting people in institutions seemed a useful approach.First, it appears cost-effective, because a greater number of people may be cared for by arelatively smaller number of staff than if carers had to visit them in their own homes andcommunities. Specialist staff can be available more easily. Also, for people withdisabilities a special building can be provided and adaptations do not need to be made tomany different homes, which are then unnecessary for the next people who live there.Second, people in institutions are out of the way. They do not offend or upset others bytheir behaviour or disabilities, which many people find distressing when they see them.They can be protected from being exploited by others, for example people with learning
 
PAYNE: Supporting Family and Community Care - 3
 
disabilities need not be sexually exploited or have their money taken away from them, anddisabled elderly people cannot be exploited by offenders. If their behaviour is dangerous,other people can be protected from them. This does not mean only violence or disturbedbehaviour, although this can be a problem. Elderly people or people with learningdisabilities who cannot manage being a pedestrian in modern fast traffic, for example,may be a hazard to other road users.However, in the history of many countries there is another reason why people aresegregated into institutions. That is, institutions are used as a threat to exert social controlover working class populations. If your behaviour is strange, you may be put in a mentalhospital, if you are elderly and do not look after yourself, you may be put in a home, if you do not care for your children properly, they may be taken away from you and put in ahome, if you misbehave, you will be sent to prison, In the 19th century, many Europeancountries had workhouses for poor people. If you were unable to provide for yourself through employment, you could not receive financial allowances, but had to enter theseinstitutions, which were specifically designed to be unpleasant, as an incentive to avoidusing them.The use of institutions as a threat to achieve social control, and their association withpeople who are segregated from society for public safety or their own, means thatinstitutions came to be associated with the mad, the bad or the inadequate. They were notknown as people, but as special groups. So the public does not know these people andtheir problems, perceives them as a problem and is not concerned if they are poorlytreated in the institution. Because people dislike leaving their own family and communityto live in such places, they become separated from normal life and the standard of care isvery poor. Because they are separated from normal life, the people in them learn to rely onthe institution, and do not practise the skills needed for ordinary life. They lose the abilityto deal with modern life. We call this becoming institutionalised. Thus, in institutions forlong-stay care, people lose their motivation for personal development and improvement,and they become a burden on society rather than a contributor to it.While all this is true, it does not mean that institutions are completely irrelevant oruseless. Certain needs can only be met by the specialist services or protection offered byan institution. It is also possible to organise institutions so that they provide training andtreatment which helps people move forward (Kennard, 1983). You can also reduce the ill-effects of institutionalisation by institutional policies such as normalisation (Brown andSmith, 1992) which plan life in institutions in informal, supportive and caring ways tomimic ordinary social relationships outside the institution.The second issue is that, related to all this, we have tended to idealise the ideas of ‘family’and ‘community’. We associate warmth and happiness with close interlockingrelationships with kin and with people who share our interests or our lives. This issometimes the reality. However, we also know that most murders and much conflict andanger takes place within families, and that neighbourhood disputes can be very seriousand hard to resolve. The importance of family and community relationships to most of usmeans that people who have no family or community or are separated in some way from itare even more excluded than if family and community were not so important. So whereas
of 00

Leave a Comment

You must be to leave a comment.
Submit
Characters: ...
You must be to leave a comment.
Submit
Characters: ...