Understanding emotional and psychological harm of people with intellectual disability: an evolving framework Author Robinson, Sally, Chenoweth, Lesley Published 2012 Journal Title Journal of Adult Protection DOI https://doi.org/10.1108/14668201211236313 Copyright Statement © 2012 Emerald. This is the author-manuscript version of this paper. Reproduced in accordance with the copyright policy of the publisher. Please refer to the journal's website for access to the definitive, published version. Downloaded from http://hdl.handle.net/10072/47425 Griffith Research Online https://research-repository.griffith.edu.au 1 2 Understanding emotional and 3 4 psychological harm of people with 5 6 7 intellectual disability: an evolving 8 9 10 framework 11 12 13 Sally Robinson and Lesley Chenoweth 14 15 16 17 18 19 20 Sally Robinson and Lesley Abstract 21 Chenoweth are based in the Purpose – A schema for more clearly understanding the emotional and psychological abuse and 22 School of Human Services neglect of people with intellectual disability was developed to support a narrative study with people with 23 and Social Work, Griffith intellectual disability, families and other supporters about the lived experience of this maltreatment in University, Brisbane, disability accommodation services in Australia. This paper aims to describe the review of emotional and 24 Australia. psychological abuse and neglect and the evolving new framework. 25 Design/methodology/approach – A review of existing understandings of this form of abuse in research 26 and policy was conducted, and a framework developed and tested for ‘‘trustworthiness’’ with 27 participants in the research. 28 Findings – A framework of emotional and psychological abuse and neglect is presented. It centres on 29 the misuse of power and control, and goes into some detail in describing the sorts of behaviours and 30 interactions which can occur when it is inflicted, and is tested against the experiences of people who 31 have experienced this sort of abuse and neglect. 32 Research limitations/implications – This is an evolving framework, applied through one study only. 33 Further application and research is needed to test the robustness of the framework. 34 Originality/value – A more complex construction of emotional and psychological abuse and neglect 35 may inform the development of service policy and support education for people with disability, families, 36 and workers. 37 Keywords Emotional abuse, Psychological abuse, Intellectual disability, Definition, 38 Accommodation services, Abuse framework, Mental health services, Australia, Disabilities 39 Paper type General review 40 41 42 Introduction 43 44 The views of people with intellectual disability about their experiences of emotional and 45 psychological abuse and neglect feature very little in either the disability studies or abuse 46 literatures. This paper draws from a narrative study which aimed to find out about these 47 experiences, working with people with intellectual disability, their families and other 48 supporters to develop a detailed picture of the emotional and psychological abuse and 49 neglect experienced by nine people whilst living in disability accommodation services in 50 Australia. While not reporting on the outcomes of the research, this article centres on the 51 issues of terminology we faced in defining this maltreatment, and our response to these 52 At the time of writing Sally challenges. Robinson was a Research 53 Fellow based at The School of 54 Human Services and Social We briefly canvass existing conceptions of emotional and psychological abuse and neglect Work, Griffith University, in the disability studies and related literatures, and in policy, with a particular focus on the 55 Australia. She is now a 56 postdoctoral fellow at Southern Australian context. Following this is a description of the development of an emotional and Cross University, Australia. psychological abuse and neglect framework which somewhat fleshes out this form 57 PAGE 110 j THE JOURNAL OF ADULT PROTECTION j VOL. 14 NO. 3 2012, pp. 110-122, Q Emerald Group Publishing Limited, ISSN 1466-8203 DOI 10.1108/14668201211236313 of maltreatment. We conclude with a discussion of implications for research, policy and 58 practice arising from the use of the framework in this context. 59 60 61 Background 62 Emotional and psychological abuse and neglect remains a source of debate in both 63 research and policy. It is undoubtedly harder to identify than other forms of mistreatment. No 64 injury can be seen, unless the person has also undergone physical or sexual assault 65 (Penhale, 1999; McKinnon, 2008). The impact of emotional and psychological abuse, while 66 potentially severe, may be cumulative, reliant on a sustained attack on the person’s psyche 67 (Iwaniec et al., 2006). Unlike sexual or physical assault, emotional and psychological abuse 68 may be unintentional on the part of the abuser (as in the case of an undertrained staff 69 member following an unnecessarily restrictive behaviour management plan). It is also 70 difficult to isolate from other forms of abuse because other forms of abuse also include 71 emotional or psychological harm (Sobsey, 1994; Kairys et al., 2002). Some authors argue 72 that it can be more strongly associated with the domain of omission whereas most other 73 forms of abuse and assault reside within the domain of commission, or action – so neglect 74 may have more complex role to play than in other abuse areas (Glaser, 2002; Sobsey, 1994). 75 76 77 Underpinning contextual features: misuse of power and control 78 79 Abuse of people with disability who live in disability accommodation services happens within 80 a particular cultural and environmental context. Research by Marsland et al. (2007) sought to 81 identify aspects of intellectual disability service cultures and environments, which could act 82 as early indicators that people with intellectual disability were at risk of abuse. They found 83 that the behaviours, actions, attitudes and decisions of managers and staff, the behaviours 84 of people with intellectual disability, isolation, service design, placement planning and 85 commissioning, and fundamental care and the quality of the environment were all critical in 86 preventing a climate in which abuse could flourish. They also found that power, choice and 87 the organisational climate were significant issues, noting that: 88 power is a significant construct underlying the issue of abuse. Specific issues relating to power 89 have been associated with cultures of abuse. Where there are imbalances of power at any level 90 within the care hierarchy, there is a risk that power will be used inappropriately, increasing the risk 91 of abuse (Marsland et al., 2007, p. 12). 92 It is argued that there is a serious imbalance of power structured into traditional disability 93 services, which perpetuates a climate that is ripe for abuse. Mandeville and Hanson (2000, 94 p. 15) contend that this power imbalance is pervasive and that it ‘‘permeates program policy, 95 agency culture, professional practice, and the personal dynamics in paid relationships’’. 96 Ticoll (1994) details some of the ways in which people with disability are less powerful than 97 those who abuse them. In some situations, people are reliant on perpetrators for physical, 98 psychological or economic support or other necessities, they do not have control over the 99 actions of others who have the potential to invade or disrupt their lives or well-being, and they 100 lack credibility or ‘‘voice’’ if they have the opportunity to make a complaint about their 101 mistreatment. 102 103 According to the seminal work of Wardhaugh and Wilding (1993) on the corruption of care, 104 a number of organisational factors are in play which can result in the conception of people 105 using services as less than fully human – including the neutralisation of normal moral 106 concerns, isolation, a failure of management and lack of accountability and an enclosure of 107 the organisation from scrutiny. Failure to address the fundamental imbalance of power 108 leaves people with intellectual disability vulnerable to the potential abuse of individuals and 109 systems, as they have little recourse to change their own situations. 110 There is clearly not a symmetry of power and control between people who use services and 111 people who provide them. At times, there is a need for other people to take control – for 112 example, when dealing with significant health issues such as epilepsy. More frequently, 113 there is a difficult middle ground to navigate, for instance around the need of people for 114 VOL. 14 NO. 3 2012 jTHE JOURNAL OF ADULT PROTECTIONj PAGE 111 support and practical strategies to address challenging behaviour. Structured programmes 115 and effective teaching which help people to develop practical and relational skills which are 116 in the long-run protective can involve the ceding, or taking, of power and control. It is very 117 important, in the context of abuse prevention and response, to ensure that safeguards and 118 protections are in place around individual interactions and relationships to ensure that a 119 climate which is preventative of abuse is cultivated, and that when problems do arise, that 120 abuse is recognised and quickly stopped. Mechanisms which dovetail on several levels – 121 person-centred circles of support, positive behaviour support plans, service evaluation and 122 monitoring and training and education, for example – need to be engaged to