Because of Sidney SN’s idea of For A Better World and the support he received, I share a few words about an interest I once brought into my life.
Deinstitutionalisation of Social Services
I once became interested in the lives of people with intellectual disabilities and the ways in which they can be supported. I believe that some of these individuals may, in certain situations, be more likely to be misunderstood by those around them or to find themselves in conflict situations. Such situations may arise not only from the attitudes or approaches of those providing care, but also from a lack of understanding of their behaviour, needs and specific manifestations of intellectual disabilities or behavioural disorders.
It was through this interest that I was also introduced to the concept of deinstitutionalisation of social services.
In my view, deinstitutionalisation can be one of the best approaches to supporting people with disabilities.
What Does Deinstitutionalisation of Social Services Mean?
Deinstitutionalisation of social services can be seen as the process of shifting support for people with disabilities from large-scale or residential institutions to ordinary individual settings, where they can live as normal a life as possible.
In other words, deinstitutionalisation is also used to refer to the shift towards providing social services focused on supporting individuals to live in natural environment.
Even in Czechia, this idea has existed since 2007 as part of the Transformation of Social Services initiative by the Ministry of Labour and Social Affairs. However, mainstream social services in the country do not generally put this idea into practice. In many cases, social services providers, their management or employers may not even understand what deinstitutionalisation means.
The Concept of Deinstitutionalisation
“The purpose of social services should not be to create the best-functioning institution possible for the people who use them, but to enable them to live as fulfilling a life as possible beyond its boundaries.”
In my view, deinstitutionalisation is particularly important when it comes to supporting people with disabilities. This means gradually moving away from institutional care and residential facilities towards individualised support services. The aim is not simply to replace one type of facility with another—from large-scale or residential institutions to an ordinary house or flat (1)—but to provide services that enable people to enjoy a good quality of life and take advantage of the opportunities the wider world has to offer.
The goal should not be to concentrate people in one place where all their needs are met under one roof and where their lives are largely organised and controlled by the facility and its rules. This is institutionalisation in the way services are delivered. Deinstitutionalisation, by contrast, seeks to promote the inclusion of people with disabilities in ordinary life, encourage their contact with the wider world and tailor support to each individual. A key principle of deinstitutionalisation is that the person should not have to adapt to the needs or the rules of the service, but the service should adapt to the person.
For example, in the case of an autistic person, this should mean adapting the environment, communication methods, sensory stimuli, daily routine, or the way support is provided, rather than automatically labelling the person as “problematic” because they do not adapt to environment of a services.
Ideally, support workers should have enough time to focus on each person, get to know their needs and help them navigate the world around them. They should also help people maintain their dignity and live as fulfilling a life as possible, making the most of the opportunities available to them.
It is equally important to promote independence wherever possible, enabling people to make decisions about their own lives to the greatest extent they can. This is not just about providing basic care and ensuring safety, but also about enabling freedom, preserving dignity and offering genuine choices.
An institutional service may meet some of a person’s needs, but if their daily life takes place primarily inside the facility or its grounds, they are also separated from the wider world and the opportunities it offers. Their daily routines, options and social contacts then depend largely on the rules and operation of the institution. They may also have fewer opportunities to build relationships with people outside the walls of a facility or to be better understood by society at large.
Many people are familiar with little beyond the institution in which they live. As a result, they may not have enough opportunities to discover different ways of life, build relationships outside the institution, develop their abilities or find out what they can achieve independently. What may appear to staff to be a well-organised care system can therefore represent a severely restricted world for the person receiving support.
In my view, the purpose of social services should not be to create the best-functioning institution possible for the people who use them, but to enable them to live as fulfilling a life as possible beyond its boundaries.
Naturally, this should involve providing each person with the level of support they need and respecting their individual abilities and circumstances.
This is what I see as the essence of deinstitutionalisation: not merely changing the location of care by moving it into an ordinary house or flat, but fundamentally changing the approach itself to supporting people with disabilities. The aim should be to create a model of support that places as few restrictions as possible on their ability to live a dignified and fulfilling life, without stigma.
Notes: (1) Equally important aspects of inclusion include ensuring that people are not labelled in any way that emphasizes their association with institutional care. There is no need to put name tags or other identification labels on clothing or personal belongings solely to help staff identify the people they support. Staff should know the people they support and address their individual needs naturally as part of everyday life, in much the same way as in an ordinary family environment. This helps prevent institutional practices and stigma.
The same principle also applies to the domestic environment itself. A home should feel like a real home, not an institution. This includes limiting unnecessary institutional features, such as noticeboards displaying instructions for staff, operational procedures or other administrative information in the shared living spaces.
This principle also applies to the transportation of service users. Vehicles used to transport them should not unnecessarily draw attention to the fact that their passengers receive social services or reinforce the stigma associated with institutional care.
Deinstitutionalisation also raises the question of institutional features that may persist even in an otherwise ordinarily furnished home environment. One example is the placement of fire extinguishers and other safety equipment, which may be determined by institutional procedures rather than by the character and layout of the home. Of course, these institutional features cannot always be removed, as safety requirements must be met. However, the key is to seek solutions that ensure the necessary level of safety while preserving the character of an ordinary home, rather than reintroducing the appearance and routines of an institution into the living environment.
Another important principle of inclusion is, for example, that when people go out into the community, no more than two people should accompany a single staff member at any one time. This helps prevent the formation of larger groups that could attract unwanted attention, place a burden on the wider community and reinforce the stigma associated with receiving social services. It also reduces the risk of stigmatisation during group transfers or visits to publicly accessible places and services. The aim is to enable service users to access these places naturally, as part of everyday life in society, without being unnecessarily singled out as a group of people receiving social services.
