Analysis of theoretical Perspectives on Disability in Scotland
Corbett (1991) is of the opinion that the idea of 'normality' that is present in the British culture has a contradiction. He says that it generally creates a fear of being different, while at the same time laying great stress on retaining ones individuality. To achieve this individuality people try to stand out in different areas of life which are valued by other people in the society, which may include sports. As a result they do not ponder over doing something that is very different, something that would not be accepted by the society. So according to Corbett this approach results in doing what has already been done and prevents experimentation on new things. Public responds to this difference through amelioration, punitive treatment or rehabilitation. This basically implies that a society where a sport is looked upon with great admiration, a disabled person with a wheelchair has an obvious drawback. These norms are problematic and cannot be altered easily since it is rarely ever that those who are disabled have enough power to control these norms also. The disabled may respond to these limitations put on them either by quietly agreeing to them and adopting whatever role that is given to them by the society or if they completely refuse to accept them they may have to bear the consequence for their 'pathogenic' behaviour (Kemshall, 2009).
The medical model of disability
Obviously ideas of hegemony are applicable in explaining disablement. In advanced societies of the west disability is understood as described by the field of medicine. According to which individuals may be disabled if they have some kind of physical or mental damage.
The field of medicine answers this by finding ailments that would make the disease go away or help the disabled people in adjusting to their environment. These techniques help the individuals to best function in the environment that is labelled to be normal. Finkelstein (1980), however, is of the opinion that such development causes further interdependence of disabled people on those helping them:
The presence of this bond between the helper and the one helped gives way to some notions that if they had not given up something, they would have not required any help for it either. Because the society acts as a helper, we are the one who lay down the norm for finding a solution to this problem (Kemshall, 2009).
Barton (1986) blames the field of medicine as one of the main reasons for forming this perception amongst the society about disabled individuals. This, he further says, has not only had an impact on the need of the society to control the disabled population in UK but has also played a part in the making of institution for managing these issues. Oliver (1990) and Barnes (1990) give a comprehensive picture of the past and the nature of the medical model in the UK. The significant aspect being that majority of the social welfare institutions make use of the definition set by the field of medicine (see, for example, Drake 1994:465, Kemshall, 2009).
The social model of disability
Currently many disabled sociologists and many different disabled individuals do not agree with this medical definition and have come up with a different way which gives specific details about the social model of disability. It highlights the fact that people are disabled by the setup of their society which has been made by people who are not disabled and it does not take into account the mental and physical damage done to a person. So Brisenden (1986) argues that individuals:
… Are disabled by buildings that are made in such a way to prevent us from entering; this as a result causes further problematic situation for our disablements. Problems may come in the form of acquiring education, probability of entering a worthwhile profession, network of friends etc. The argument, however, is not valid because a mere acceptance of the argument implies the recognition of the degree to which we are at a drawback and also are the victim of the tyrannical behaviour of the social environment (Brisenden 1986:176)
Therefore the main focus of the social model is the tyrannical aspects of the economic, social and political environment in which the disable dwell and does not put emphasis on the betterment of the disabled people.
Analysis of the changes in practice in UK over the last decade
The mentally challenged have long faced hurdles to societal acceptance. The society in Scotland shuns them, ridicules them, ignores them and acts towards them as a nuisance in every sense of the word. During the middle ages the mentally challenged were often managed either through expulsion or incarceration. A method known as the ship of fools was sometimes used (Kemshall, 2009). During the time which is now known as the Enlightenment period a certain business oriented asylum became popular. It was commonly known as the mad house. The Victorian period saw measures and concepts known as containment where the "mad men" were kept separate from society. The boundaries which separated these containment facilities were almost nonexistent in some cases. The people were often at danger more from society and less towards society. These so called "lunatics" could be at just as much risk from society as from other sources. There was a period of "deinstitutionalization" following the time of the Second World War. These happened in response to the belief that large institutions were less humane and were more prone to abusive and sometimes extremely violent behaviour. Studies began to show that the concept of the asylum itself was the cause of the risk. It was believed that most mental health patients didn't pose much of a risk to the society if they were in fact released and if such a risk existed then it was low and tolerable (Kemshall, 2009).
During the late twentieth century we see that the concept of community care developed quite rapidly in the UK for caring for the mentally ill. Carpenter (2000) believes this was at least in part a response to the financial crisis after the 1945 welfare provision. And in part it was due to the advancement in neo-liberal social control techniques. The sub-fields of psychiatry and psychology took over much of the work which was previously conducted at these so called institutions. The state began to lose control to professionals and other officials (Rose 1985, 1986a). Its power waned and it began to realize that cooperative process was needed in place of the traditional and typical repressive process previously used Carpenter (2000: 605). Speaking in terms of fiscal gain and loss community-based care is a cheap alternative to the management of the "labour market casualties" (Scull 1979, 1993 as cited in Kemshall, 2009). Pilgrim and Rogers (1999 as cited in Kemshall, 2009) label and identify several elements in community care provision and its development. The elements include:
The deinstitutionalization resulting from the fiscal crisis after the 1945 welfare provision;
The finding and then rapid and widespread use of drug and physical handling;
Evidence-based treatments and the effects of cost effective alternatives; and,
The creation of civil liberty groups and their increasing power in regulating mental health policy
The 1983 Mental Health Act has been running alongside these other legislations. This in effect reduces the tendency of psychological health services to lean towards the medical side. This in turn increases the focus on individual rights, social needs, and support services (Fennell 1999 as cited in Kemshall, 2009). Ryan (1996 as cited in Kemshall, 2009) shows the history of mental health services in six stages with clearly defined management strategies and sites of management.
An emphasis was placed on the partnership and coordination of services following The Community Care Act 1990. This was increasingly exemplified and indeed highlighted and drawn to attention by 'Care Programmed Approach' (CPA: Department of Health 1990a as cited in Kemshall, 2009), and practice guidance for care management (Department of Health 1991e as cited in Kemshall, 2009). Care management and its forerunner case management were seen and were thought to be absolutely compulsory for meeting client needs and amalgamating different and separate sources in to one single untied and singular care package (Ryan et al. 1999 as cited in Kemshall, 2009). Case management didn't have a long life, however. But that is no measure of its importance or indeed its effect on the programs under its development.
Case management focused on the analyses of assessment methods in community care (Onyett 1992). Care management on the other hand had an innate emphasis on the delivery of care packages and treatment techniques. This surpassed the needs-led approach and turned instead to the service- lead control of provision under a subsidiary of the CPA. In the 1990's the divide between needs, risks and rights with respect to mental health widened. Risk began to play a central role in the decision making process of the registered and approved social workers.…