How Much Do You Want To Be Just Like Everyone Else? A Professional Rant

I am a health professional with bad attitude. No, really, it's true.

I'm decidedly dubious about much that underpins good proper professional practice in Health and Social Care.

What am I talking about? In Scotland, like many places, there is a move to provide care and support for people with learning disabilities in 'the community'. The idea is that everyone should access mainstream opportunities for work, leisure, living arrangements, and relationships. Notions of equality and diversity are central to this perspective. The consultation and report that underpins this approach in Scotland is called 'Same as You?' And that is what health and social care professionals work so hard to achieve - to give our clients the opportunity to be the same as you and me.  But...

What is good for me, isn't necessarily what is good for you. There are many different ways of doing things.  You just have to look at the sorts of people who follow this blog and others like it to see that the quest for 'something different' is huge.  But only the narrowest and most mainstream range of life choices is recognised in Health and Social Care circles.  This bugs me because:

• There are many people who neither thrive nor benefit from the mainstream ways of living, and the norm can be downright damaging to some.
• The social, cultural or economic influences underpinning what is 'mainstream' and why this is the case are never considered.
• There is an argument that the mainstream way of living is primarily organised that way in order to benefit the economy and the richest within our economy, not the ordinary person trying to live an ordinary life of health and happiness.

Notions like these are never considered in our professional practice, though during our tea-breaks we may well grumble about its impact on our personal lives.

Have an example. Increasingly, we are supporting people with learning disabilities to live in their own flats or houses, usually on their own, because this is considered the norm. No-one questions if this is necessarily the best option for a specific client, because nor is it questionned if it's the best option for anyone else. There are many people - with and without learning disabilities - living on their own who are lonely, isolated, depressed, anxious, or afraid. If someone does question it, it's pointed out that it's 'not normal' in our society to live in group homes, or to live with people who aren't immediate family. That smacks of institutional care, and by god you'll get the sack if you get caught leaning in that direction. But students live in Halls of Residence or flat-shares - some like it, some don't, sometimes it works, and sometimes it doesn't. It's an option, and some would continue with that sort of mode of communal living if they could; if it weren't so difficult to find the opportunity outwith a university context. Living in youth hostels while I travelled suited me just fine, and I met plenty people along the way who also liked and actively chose that kind of communal living. In other countries, the one-flat one-family unit model isn't so strictly normal.

Likewise, huge resources go into kitting up a client's new home with all the furniture, equipment, utensils and other objects that we all want and need. Some clients love this process and benefit from it, some really couldn't give a damn what colour or style their new suite is, or whether or not they even have one. No-one questions what exactly underpins this norm - a consumerist, materialist, isolationist society. And no-one questions whether that is something we should be aspiring to - either for our clients, or for ourselves.

The environmental impact of the 'normal' way of living - where we each have our individual house and all the individual items deemed necessary to furnish and equip a home - is absolutely never considered. Why should it be for a learning disability population, when its not for the general population?

In Health and Social Care, there are certain principals that guide our practice, and anything outside these principals really isn't our domain of concern. The social change we're chasing is that of equality for a certain sector of society that historically has been excluded, undervalued and mistreated. There is nothing wrong with that goal. But, it seems to me that in day-to-day practice we're often waylaid into focusing on the physical and material aspects of equality - 'normal' housing, furniture, clothing, possessions, and wherever possible, behaviours - an outwardly normal lifestyle. We are too busy, and often too stressed, to take the time to focus on the core spiritual and human aspects of equality - things like rights, responsibilities and respect. Strict adherence to an ethos of 'care in the community' often means that we cannot recognise individuals' needs that don't fit within dominant societal norms. We're meant to be 'person-centred' but that only goes so far under policy, time and budget pressures.  You're much more likely to get a 'person-centred' service if what you want is to be just like everyone else. 

We need to recognise and respect individuals' rights to be different from you or me.