After posting my previous post, I thought some clarification of definitions is in order, before anyone jumps upon me saying that I advocate large-scale abuse of autistic individuals. I don’t. When I said some autistics may want to live in residential facilities, I meant that some autistics might prefer the living arrangement of a residential facility, rather than the power dynamic – which, in my opinion, is not inherent to residential care and not specific to residential settings.
In the Netherlands, a residential facility is any facility that is funded as one. Supported housing accommodations, by this definition, are residential regardless of their location or size. My former training home, which was located in the community and housed only seven residents, was residential by this definition. Every country has different definitions in this regard. For this reason, I shall use a narrower definition, that a residential facility is a large, segregated facility for people with disabilities or the elderly.
Now both the segregated nature and the size of residential care facilities are sometimes thought of as problematic, especially when people are forcibly put into these settings. However, it is quite possible that some people would prefer to live with a large number of people with the same condition, away from the community. If something like this is set up by people with disabilities, it is called an intentional community, and no-one says that people are not allowed to plan such a thing. So, if someone wants to live in a large, segregated setting, that is not necessarily bad in itself. The problem with residential care is that people are forced into it through cost effectiveness and other nonsensical reasoning.
Beside this is the institutional power dynamic, common but not universal in residential care but also common in any other care setting. Institutional power dynamics are only in part related to the type of facility – for example, it is more likely to be secluded in a psychiatric hospital than in a supported living facility for the mentally ill, because more psychiatirc hospitals have seclusion facilities. In other ways, carers can exercise and abuse power over patients in home care, supported living, or any other form of less restrictive care, and this control can go beyond that exercised at some residential facilities.
Here are a few reasons my own institution – a large, segregated, psychiatric hospital -, is not always considered a “real” institution:
- The doors, at least on my ward, are not locked during the day.
- I can go on leave for up to three days when I want, and am even allowed to leave the country during this time. One woman on my ward was even exceptionally permitted to go on vacation to a different country for two weeks. Note that I am privileged because I am an informal patient; involuntarily committed patients need permission to leave and can’t leave for more than 60 hours.
- I have access to my own money and paperwork. Note that not all patients do.
- I have access to a computer.
There are probably a hell of a lot more things I could think of. Most of these things are considered privileges, when in ordinary society they would be rights – the computer would be the exception, cause that’s a privilege everywhere -, but the fact that I can exercise these privileges, to some people proves this is not an institution. Here, “institution” is equated with institutional power dynamics, and I am told that I don’t have it as bad as some people in residential care. As if I even said that.
Now my former ward, which was a lot more restrictive, and which was riddled with institution power dynamics, was more community-based in location than my current ward. In some ways, my former training home can even be said to have been more restrictive than my current ward, while as I said it was community-based and small, and everyone even had their own apartment. That is not an institution, right?
Now when I say I don’t have a probem with residential care facilities, I am referring to the settings, and only if people with disabilities prefer to live there over the community. I am not referring to institutional mindsets and power dynamics. These often pervade every aspect of care, and they shouldn’t. Abuse, control and lack of civil rights can be found in every type of care, and they are not acceptable.