From one response to plenitude of needs to multitude of responses to generic human needs

The attribute of a total institution derives from the fact that institutions take care of all the needs under one roof by one authority and in a uniform manner. In the contemporary, post-industrial, diversified society, this is unusual, dysfunctional and ethically wrong, since it is massively curtailing residents’ rights, providing poor satisfaction of needs and is damaging on social, emotional and health levels. The deinstitutionalisation is aiming to the opposite – acknowledgement that people basically have similar generic needs but a very diverse priorities and ways of satisfying them.

While until recently, and still very dominant, professional and lay public have perceived people with disabilities through the perspective of medical model, based on the notion of deficiency and regarded the people with disability to have ‘special needs’ that can be addressed only by specialist action (in a special institution). The so called social model introduces the concept of quality of life as a criterion of social intervention. The main aim of support is to enable people with long-term distress to live a quality life. This means that we have to observe the ordinary needs and see of which needs people with various labels are deprived off, what are the contingencies of these deprivations and what is needed in typical situation corresponding to these needs.

The type of needs that needs to be observed (Flaker et al., 2008):

1. Housing
2. Work and income
3. Everyday activities (including leisure)
4. Social contacts
5. Interaction and stigma
6. Career and dealing with the system
7. Life events - stress, certainty and purpose
8. Emancipation and affiliation.

At the moment there is little systematic knowledge on patterns of how people with disabilities satisfy these needs, what obstacles they face and what kind of support they would need; nor of the extent of unmet needs of the residents, users or potential users of community services. Below we sketch some of the insights regarding these.

Strategically, to put people’s needs as a point of departure in planning services is thus also an important turning point as to look at people with disabilities as primarily people, and to turn the attention from their (in)capabilities to the quality of life. It is important to base the strategy, the development of services on the needs of the people, to consult them individually (by the means of personal plans) and collectively on local and regional but also national levels about what their needs are and put the ‘needs’ as starting point of common effort and public response to distress.

In some of the next blogs we will try to sketch the issues regarding the needs of the people who experience long-term distress. Thus we will try to indicate basic knots of expressing and satisfying needs based on the insights provided by our investigation and conceptual work and in great part on the existing research and other existing data. There was a substantial work done in term of the research that can inform us[1]; this research is, however, biased in two direction. It is particularly rich on the issue of employment, while on other topics not informative enough; there is very little information on everyday life activities and social networks and similar ‘minor’, hard to detect needs. The research design is usually descriptive and quantities, as such lack an analytic dimension and insight in (stories) how people are actually living and coping with their situation.

Claimer: This blog is intended 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.

Reference:

Flaker, V., Mali, J., Kodele, T., Grebenc, V., Škerjanc, J., & Urek, M. (2008). Dolgotrajna oskrba: Očrt potreb in odgovorov nanje. Ljubljana: Fakulteta za socialno delo.

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[1] Main research reference for the discussion below with be the UNDP survey “Needs and Demand for Vocational Rehabilitation and Personal Assistance Services” in the frame of the EU IPA funded project “Promoting Social Inclusion Services”.