3/18/2013 1 What Is Institutional Abuse? Winterbourne Human

3/18/2013

Winterbourne

What is institutional abuse?  I am the warm up act for Margaret Flynn! [email protected]  It is a privilege to be so  She is brave and insightful and thorough  She zero’s in on the things that matter and that inform us about what has gone on and what has been taken notice of  So this introduction is designed to pave the way for her very detailed account of what went wrong at Winterbourne on many levels

4 psychological experiments that tell us Human nature …continued uncomfortable things about human nature… 3. Zimbardo (1971) roles define behaviour, the Stanford prison experiment, participants slipped into roles acting out 1. Asch (1950’s) how long is a piece of stereotypes not using their own string…conformity in groups judgment or morals 2. Walster- Hatfield (1966) blame determined 4. Milgram (1974) authority pushed to by the outcome of carelessness not limits as electric shocks given to people behaviour, corners cut may lead to nothing who can’t answer questions when or to catastrophe authorised to do so by someone in power

So what does this work entail .. And what is institutional abuse?

 Containing “usual’ uncensored responses to another  No Secrets set out these types of abuse person and managing difficult emotional reactions such as irritation, disgust, embarrassment, boredom, and ◦ physical sometimes fear, aggression and loss of “the upper hand” ◦ sexual  Managing power helpfully by controlling situations not ◦ financial people, making clear decisions and assigning staff time ◦ psychological and input fairly ◦ neglect  Putting on hold one’s own needs and managing one’s  And these qualifiers self and one’s physical needs throughout a day ◦ institutional (a site of abuse) and discriminatory (a  Caring for others sometimes when you are not feeling motivation) cared for yourself, which is very difficult  But all abuse has a context so…..

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Constellations (not types) of abuse emerge from Institutional abuse is not just a “type” of literature... abuse or a “setting” or “site” of abusive behaviour,- institutions produce Family violence, neglect circumstances and relational dynamics Institutional or negligence that make abuse endemic and without abuse 1. partner violence hate Breaches of 1. rigid regime professional 2. abuse by adult sons or informed preventative and containing crimes daughters strategies, asking people (often on low 2. staff out of boundaries 3. abuse by parents their depth, by powerful staff 4. financial abuse by more pay) to care for damaged and sometimes predatory unmotivated (arrogant) distant relatives damaging people, without support, crimes or 5. may be exacerbated by overwhelmed by resentful staff poverty, racism or social insight, space for reflection or proper (hard-done-by) 3. cruel exclusion parasitic supervision and governance, is a recipe individuals crimes for disaster…. 4. abuse by risks of living alone, Unethical or unauthorised other service users rogue traders, practices in response to doorstep burglaries challenging needs, mental health needs, illness or dementia crimes in Discriminatory access to public abuses in service resources e.g. health care, the abuse in settings employment, benefits, legal community your own remedies, housing home systemic abuse copyright Hilary Brown March 2013 copyright Hilary Brown March 2013

You can hear abuse brewing in the But why don’t people notice conversations taking place in a home sooner?  Lack of a tangible sense of what is wrong  people are lumped together “they”  Lack of certainty that their concerns are  Dehumanising labels , “they eat like animals”, reasonable or proportionate  Sexualised language “males or females”, “they are at it like rabbits” “she’s gagging for it”  Lack of “evidence” to back up concerns  Blaming explanations eg “he knows what he’s doing,” “manipulative”, “winding me up”,  Fear of immediate reprisals or long term  Punitive responses, “they’ve got it coming”, “she needs to detrimental consequences be taught a lesson”, “if he thinks he can treat me like that “  Fear that concern or complaint will not be  Discounting of their feelings, “he doesn’t notice”, “they handled well so that their intervention will be in don’t care” “they are zombies” vain  “Let’s not bother with that appointment we don’t  Joyce,T. and Oakes,P.(2004) Protecting people with intellectual disabilities from abuse: Why does have enough staff on shift today” it take so long for someone to say something Journal of Intellectual Disability Research 48 p419  Marsland, D. Oakes, P. and White, C (2007) Abuse in Care: Early indicators of the abuse of people with learning  This sets the scene for abuse, it provides the rationale disabilites in residential settings and the excuses

Recent research into early And that ……………….. indicators  Shows “gut instincts” can be articulated  “A significant feature of the early accurately indicators …is that they are not complex  Themes fell into 6 domains or obscure entities. Instead they highlight ◦ Behaviours, actions and attitudes of managers tangible and often readily identifiable ◦ Behaviours and attitudes of staff evidence of decaying and unsafe ◦ Behaviours of people with learning disabilities services. Such indicators are visible to ◦ Isolation external people who spend time in ◦ Service design, placement planning and commissioning services as part of their professional roles ◦ Fundamental care and the quality of the environment or as a consequence of familial  Marsland, Oakes and White 2007 relationships. (Marsland et al 2007 p17)

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Abuse doesn’t stand out against a blurry They also show that service service level issues bleed into the practice of individuals and teams background…the background masks, collude with and hides abuse  “an extensive reliance on the “bad apple” model.”….overlooking contribution of staff cultures, management failings and isolation … yet there appears to be a tendency …to undervalue these factors and to over emphasise the importance of individual failings… (op cit p18)  So formal and informal cultures matter

Causes of institutional abuse, bad The “causes” of institutional abuse lie in the interaction apples or bad barrels? not just a simple bad apples or bad barrels split? Systemic causes Systemic causes

Negotiated changes and Unrealistic Regulatory action improvements to service Regulatory framework expectations or and sanctions quality, action planning Poorly informed or and sanctions targets Funding Changes to commissioning, cost and quality Poor cuts Changes to Overuse Poorly planned services communication commissioning, cost or of agency designed Discrimination between staff in staff team quality agencies services based on Unintended Un or ill- Careless racism or Malevolent intent Unintended Malevolent informed recruitment gender service model Bad team Cruel, sadistic, intent Willingness to dynamics Unaddressed bullying staff or those Staff who lack knowledge learn and bullying in staff with previous or support or who cannot implement team criminal behaviours training manage their responses People who use Harsh upbringing no empathy vulnerable others to Prosecution, disciplinary make themselves feel action, professional ok regulatory action and/or Support, (re-)training, and barring from workforce Individual causes supervision or treatment Individual causes copyright Hilary Brown March 2013 copyright Hilary Brown March 2013

Taking some of these interacting factors These things get played out in seriously we see that … abusive teams……  Policies that don’t match resources have no credibility  Conformity and bullying and this spells danger (Wardaugh and Wilding 19913)  Abuses of authority and power, including racism  Unfairness and staff teams or shifts left to manage and sexual harassment themselves leave fertile ground for bullying, racism or intimidation (Autonomous work groups) they develop  Informal leadership and cliques/favourites their own way of doing things and cutting corners  Negative images of, and narratives about,  Punitive models creep in where challenging behaviours service users that in turn fuel are not well understood, managed and contained  Blaming, punitive, dehumanising interactions  People who have been harshly treated themselves tend to react harshly to others when cornered or faced with  Empathy that should provide a brake is over- loss of control/competence ridden

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And these things are replayed So management and containment relies internally on  When faced with difficult choices or hard  Understanding of service users and the challenges we argue with ourselves about how complexity of their needs to act ◦ I am usually such a good person  Creating positive roles for staff ◦ They are throwing it back in my face  Careful recruitment and retention of staff ◦ I have worked so hard for this person ◦ No-one will notice  Creating positive and helpful stories  I give myself a “moral holiday” (Tomita 1996) about the people we care for, who they  If I want to abuse, I overcome my own scruples, I evade are, why they do what they do, why they consequences and I overcome or discount the victim’s resistance (Finkelhor 1984) may have problems  Modelling compassionate and containing

To summarise, in order to prevent institutional abuse we need

 An accurate understanding of ◦ Early indicators and manifestations ◦ Very good practice and support for difficult areas of the work ◦ Necessary infrastructure and structures that underpin acceptable care ◦ Knowledge of how abusive dynamics arise in teams and how they can be contained and managed ◦ Specialist knowledge and ordinary humanity Doing nothing is not an option it is a passive way of permitting  These need to be shared and embedded in the work abuse of the most vulnerable people, you have to work of the home and the wider professional and together to prevent abuse, to notice and to keep putting positives in place of negatives. commissioning network copyright Hilary Brown March 2013 copyright Hilary Brown March 2013