Definition of institutions and deinstitutionalisation[1]

 

 

Institutions and institutionalisation

European guidelines define (total) institutions in terms of and in the context of human rights and the dignity of users, their quality of life and health, independence and social inclusion. 

Institutions are characterised by:

• the isolation of residents,
• collective arrangement of residence,
• lack of influence over one’s own life and
• predominance of the interests of the organisation over individual needs. 

Institutions are not only defined by large number of residents and big buildings, but mostly by the institutional culture - even if the structure is small, it can bear the characteristics of institutional life.

Deinstitutionalisation is based on the realisation that institutional care is harmful, ineffective, unethical solution, which violates human rights (CEG: 21). 

 

Deinstitutionalisation

Deinstitutionalisation is defined by the transformation and gradual closure of institutions and the simultaneous development of community services and improved access to public services, as well as the prevention of institutionalisation (European guidelines). 

It is an integrated planning process of transforming institutions, reducing their capacity and/or their elimination, with the simultaneous establishment of services in the community, based on human rights and standards of performance. (UNICEF)

The process of deinstitutionalisation must be understood also:

• as a change of relations between professionals and users,
• acquiring new social roles and users’ involvement and participation,
• a shift of power from the experts and institutions to the users, and
• as a change of epistemology of long-term distress
• as a social movement that promotes equity and human right.

Deinstitutionalisation is therefore a multi-layered, complex process that involves a plenitude of actors and diverse activities; it is not just technical relocation of the residents of institutions. It can be considered as a change of abstract schemes (strategies, paradigms, legislation), which allow escaping from totalising responses to ones, which take into account person’s priorities and disperse response spatially, introduce a multitude, a (rhizomatic) network of situations and actors – including informal helpers, relatives and other community members – in a common effort, which is as well a transfer the power from the virtual institutions to the actual people.

It is a passage, commonly referred as the transition from "medical" to "social" model. In fact, it is about transitions from reductive to transversal interpretations, from “correcting” to enabling approaches and about a (spatial) shift from institutional to the community responses. 

An actual resettlement of a resident thus means the passage from total situation into being connected to diverse sources of power in a liberating way while enabling (re)appropriation of assets for decent and independent living, using the available resources and creating the desired response. It also means a shift from institutional life-world in the everyday life-world.

 

Transinstitutionalisation and reinstitutionalisation

When deinstitutionalisation is not carried out consistently two other processes that obstruct the transition to community services can be observed. Transinstitutionalisation means that residents of one institution are directly transferred to another institution or after a period of living in the community end up living in one (usually due to inability of community services to deal with users’ needs and other contingencies). Such a transinstitutionalisation has to be avoided by careful personal planning and monitoring of the resettlements and moratorium on new admissions across all the institutions.

Reinstitutionalisation is a process that can be detected on personal, organisational or system levels. On the personal level it means that a person who has left the institution returns to live in an institution. On the level of organisation it means that after an initial period of deinstitutionalisation process an institution that has undergone a process of democratization, opening the doors and resettling the residents reverts these processes and becomes more rigid, closed once again. It can mean that the extra institutional responses like group homes, day centres, and even the individualized provision acquire the more and more institutional features. On the system level, reinstitutionalisation means that after a period of diminishing the institutional capacities, there is an increase of the places in the institution on the national counts. Reinstitutionalisation can be avoided by moratoria on readmissions, by separation of care and accommodation providers, empowering users (e.g. by tenancy rights, personal plans, participation in running services) and establishing a good monitoring system (including strong quality standards). 

Sources:

These definitions are drawn mainly from Common European Guidelines on Transition from Institutional to Community-based Care and on our work done for the groundwork of deinstitutionalisation in Slovenia includin the manual on rapid assessment and response to the needs related to deinstitutionalisation and long-term care. 

References:

• European Expert Group on the Transition from Institutional to Community-based Care (2012) Common European Guidelines on the Transition from Institutional to Community-based Care (Guidance on implementing and supporting a sustained transition from institutional care to family-based and community-based alternatives for children, persons with disabilities, persons with mental health problems and older persons in Europe), Brussels. [On line] Available at: deinstitutionalisationguide.eu/wp-content/uploads/2012/12/2012-12-07-Guidelines-11-123-2012-FINAL-WEB-VERSION.pdf
  Flaker, V., Rafaelič, A., Bezjak, S., Ficko, K., Grebenc, V., Mali, J., Ošlaj, A., Ramovš, J., Ratajc, S., Suhadolnik, I., Urek, M., Žitek, N. v sodelovanju z Dimovski, V., Kastelic, A., Pfeiffer, j. (2015), Izhodišča dezinstitucionalizacije v Republiki Sloveniji (Končno poročilo, verzija 3.2). (študija po naročilu Ministrstva za delo, družino, socialne zadeve in enake možnosti, omogočila EU z uporabo Evropskega socialnega sklada), Ljubljana: Fakulteta za socialno delo.
  Flaker, V., Rafaelič, A., Ficko, K. & Meduza (2014) Hitra ocena potreb in storitev za dolgotrajno oskrbo in dezinstitucionalizacijo zavodov za dolgotrajno osrkbo na področju duševnega zdravja in intelektualnih ovir (DEZ-HOPS), interno poročilo, Verzija 1.0. december 2015, Fakulteta za socialno delo
   
  

  [1] This blog is intentended as a part of Situation Analysis and Assessment/ Evaluation Report of Implementation of National Strategy on Deinstitutionalisation 2008-2018 which will be soon presented to the public within the EU framework project Technical assistance support for the deinstitutionalization process in social sector. For this blog Andreja Rafaelič is considered to be co-author.