Table Of ContentIssues in Mental Health
Series Editor: Jo Campling
The care and status of persons with mental health problems has
been identified as one of the key issues in health and society in the
1990s.
This series of books has been commissioned to give a multi-
disciplinary perspective: legal, medical, psychiatric and social
work aspects of mental health will be covered. There is also an
international perspective: wherever possible, books will compare
developments in a range of different countries.
PUBLISHED
Suman Fernando
Mental Health, Race and Culture
Shulamit Ramon (editor)
Beyond Community Care: Normalisation and Integration Work
FORTHCOMING
Philip Bean and Patricia Mounser
The Discharge of Psychiatric Patients
Chris Heginbotham
Mental Health and Human Rights
Tessa Jowell and Gerald Wistow
Community Care and Mental Health
Ron Lacey, David Pilgrim and Anne Rogers
People First: How Patients Experience Mental Health Care
The Issues in Mental Health series is published in association with:
MIND (National Association for Mental Health)
22 Harley Street, London WIN 2ED (071-637-D741)
MIND is the leading mental health organisation in England and
Wales. It works for a better life for people diagnosed, labelled or
treated as mentally ill. It does this through campaigning,
influencing government policy, training, education and service
provision. Throughout its work MIND reflects its awareness of
black and ethnic communities, and draws on the expertise of
people with direct experience as providers and users of mental
health services.
The points of view expressed in this publication do not
necessarily reflect MIND policy.
Beyond
Collllllunity Care
Normalisation and Integration Work
Edited by
Shulamit Ramon
Selection, editorial matter, Chapters 1, 7 © Shulamit Ramon 1991
Individual chapters © David Brandon, Mike Lawson, Alexandra Lewis, Julie Segal,
Richard Warner 1991
Softcover reprint of the hardcover 1st edition 1991 978-0-333-51400-9
All rights reserved. No reproduction, copy or transmission
of this publication may be made without written permission.
No paragraph of this publication may be reproduced. copied or
transmitted save with written permission or in accordance with
the provisions of the Copyright, Designs and Patents Act 1988,
or under the terms of any licence permitting limited copying
issued by the Copyright Licensing Agency, 33--4 Alfred Place,
London WCIE 7DP.
Any person who does any unauthorised act in relation to
this publication may be liable to criminal prosecution and
civil claims for damages.
First published 1991
Published by
MACMILLAN EDUCATION LTD
Houndmills, Basingstoke, Hampshire RG21 2XS
and London
Companies and representatives
throughout the world
Edited and typeset by Povey/Edmondson
Okehampton and Rochdale, England
British Library Cataloguing in Publication Data
Beyond community care: normalisation and integration work.
- (Issues in mental health)
1. Great Britain. Mentally ill persons. Rehabilitation
I. Ramon, Shulamit II. Series
362.204250941
ISBN 978-0-333-51401-6 ISBN 978-1-349-21393-1 (eBook)
DI O 10.1007/978-1-349-21393-1
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'But nobody wounded like him could deserve a chance at life. Better
dead said the crones, better dead said history, better jump in at the
deep end decided her strong soul as she heard his crest fallen cry. His
mother it was who treated him as normal, tumbled to his intelligence,
tumbled to his eye-signalled talk, tumbled to the hollyberries, green
yet, but holding promise of burning in red given time, given home.'
Christopher Nolan, Under the Eye of the Clock.
To all of the discovered, and those yet to be discovered, Christopher
Nolans of this world, their mothers, fathers, sisters and brothers.
Contents
List of Contributors viii
Acknowledgements ix
Preface x
Part I The Background Dimensions of Normalisation
Work 1
Introduction 3
1 Principles and Conceptual Knowledge 6
Shulamit Ramon
2 Implications of Normalisation Work for Professional Skills 35
David Brandon
Part II Experiencing Normalisation and Social Role
V alorisation 5 7
Introduction 59
3 A Recipient's View 62
Mike Lawson
4 The Professional Perspective 85
julia Segal
5 Creative Programming 114
Richard Warner
6 Public Participation in Decision-making 13 7
Alexandra Lewis
Part III The Test Ground: Turning Principles into
Policies 161
Introduction 165
7 Policy Issues 167
Shulamit Ramon
Name Index 195
Subject Index 197
vii
List of Contributors
David Brandon is a social worker by training, fonnerly director of
North-West Mind, editor of Community Living, author of several
books, and Cl.irrently training service providers in the field of learning
difficulties. His most recent book is on brokerage.
Mike Lawson is the director of International Self-Advocacy
Alliance, vice-chairperson of MIND, active in Survivors Speak Out,
who has personally experienced the pyschiatric services as a
recipient. He is involved in training and promoting self-advocacy
and mutual support among users.
Alexandra Lewis is the chair of the British Community Health
Councils organisation, and until recently also a member of the
Mental Health Act Commission. She is a researcher and planner in
the fields of developmental handicap and psychiatric services for
offenders.
Shulamit Ramon is a social worker and clinical psychologist by
training, senior lecturer at the London School of Economics, with a
wide-ranging cross-national research background. She is the author
of Psychiatry in Britain: Meaning and Policy, and the editor of
Psychiatry in Transition: British and Italian Experiences.
Julia Segal is currently psychologist and researcher with ARMS
(Action Research Multiple Sclerosis), author of Fantasy in Everyday
Life, with considerable experience of work and training in different
settings.
Richard Warner is the director of Boulder Mental Health Center, a
large and innovative service. He is also professor of psychiatry at the
University of Colorado and the author of Recovery from Schizophrenia.
viii
Acknowledgements
I would like to thank the contributors to this volume who gave freely
of their creativity to the project, making my task as the editor
rewarding.
As usuaL T eodor helped with insightful and precise comments,
while Aelita reminded me that there is an ordinary life to be lived and
enjoyed; I am grateful to both of them. Lindsey Olliver helped in the
typing with care and efficiency.
SHULAMIT RAMON
ix
Preface
The title of this book suggests that community care, a principle and a
concept which dominated the approach to people with disabilities for
the last thirty years throughout the Western world, has perhaps
outlived its usefulness.
Developing during the Second World War and especially during
the 1950s and 1960s, community care was a professional and political
response to the guilt evoked by the restricted life led by people with
disabilities in total institutions. 1 The ideal of desegregation resembled
the achievement of the great age of reform which took place 200
years earlier, symbolised in freeing the residents of psychiatric
hospitals from their chains by Pinel and Tuke. Furthermore, it was
believed that by locating services outside the segregating institution,
the need to enter it would decrease and integration with the ordinary
community would take place spontaneously.
Thus community care included the recognition that many of the
people with disabilities residing in institutions had the potential to
lead a more ordinary life in the community. However, neither this
recognition nor the ideal seems to have led to a fundamental change
in social and professional approaches to people with disabilities.2
The focus on dehospitalisation - which constituted the bulk of
community care efforts in the field of disability - as a once and for all
solution to the problem was particularly attractive to politicians.
They could easily identify with this simple humanistic message, made
doubly attractive by the possibility of reducing public expenditure
through care in the community.3 With hindsight and the evidence
accumulated since the 1950s, it seems that concentrating on the point
of transfer has become a crucial stumbling block of the policy.4 For it
meant neglecting the process of change in the institution, its
residents and workers prior to the move; paying little attention to the
life led after leaving the institution; and even less attention to
preventing the need for institutional life in the first place.
Community care has been bedevilled by a conceptual muddle, a
policy muddle, and a practice muddle.
Conceptually, a community can be a neighbourhood, a community
of interest with and without geographical boundaries, or the
configuration of a person's connections and ties.5 Care is about
attending to people's needs in different ways, and at different levels,
