Sir, – As a parent of a person with an intellectual disability, last night's Prime Time programme sent shivers down my spine. As a parent you get accustomed to the two sides of the intellectual disability world. On the one hand you can meet and be moved by professionals who show incredible kindness and care, while on the other you come face to face with those whose only concern is the exertion of power, their own career advancement and control. I am keenly aware that parents have very little say or choice as to what service their sons or daughters can avail of, and to some degree it is a total act of faith. This imbalance of "power" is perhaps at the core of the abusive behaviour we witnessed in this programme.
The staff who featured in this programme have not only degraded the nation but they have cast suspicion on all those good professionals dedicated to caring for and protecting people with an intellectual disability. It is clear that policies and training are not enough to ensure the welfare of those in day and residential care. All staff, from senior managers to the most junior, have a duty of care, and the culture of turning a blind eye must not be tolerated.
In addition, I suggest that senior managers turn off their computers, stop demanding meaningless reports, get out of their plush offices and visit the centres and residential units. – Yours, etc,
TONY MURRAY,
Fairview,
Dublin 3.
Sir, – The scandal of the abuse of the intellectually disabled patients within Áras Attracta is shocking but it also demands answers to questions, such as what standards were followed in the selection, training, and supervision of the staff that were assigned to work with this vulnerable group. There can be no excuses for those workers who abused patients or did not intervene to stop the abuse, and one can only wonder why these workers felt there would be no sanction regarding their behaviour.
What is of deep concern is the failure of our statutory regulators to ensure that care plans on file are actually implemented and the failure of senior managers to recruit the right type of person to show leadership in creating the proper culture of person-centred care that all staff can be proud of. – Yours, etc,
FRANK BROWNE,
Templeogue, Dublin 16.
Sir, – Following on from the Primetime revelations on practices in Áras Attracta, there are a number of things that we can expect, apart from the customary hand-wringing already on display. These will be the promises of change, the now par for the course independent review or inquiry and lesser heads to roll.
What we can also expect is that nothing will really change and it is likely that the situation in residential homes may actually decline even further. This may sound pessimistic but it may be true.
First, we have been here before. There have been exposés and reviews conducted on similar places in the past, prompting the question of how many times can it happen before it’s actually fixed.
Second, the vision of the HSE is in fact to have only one large service provider for each county in Ireland, dispensing with the smaller and often more person-centred local organisations. This might seem like economic sense but there is not a shred of evidence it will result in better services for the most vulnerable in society, which is what people with intellectual disabilities simply are. Big organisations typically become big institutions and all the ills of big institutions follow suit. Rhetoric will not escape that likelihood, and experience seems to have taught us little in this regard.
Third, the widely accepted goal of services is to have people with intellectual disabilities living in normal homes, in normal places, doing normal things. However, the legislation underpinning services states that these homes must de facto reach the standard of nursing homes in many respects. Nursing homes are not ordinary homes, as much as we may wish to think so, and one consequence will likely be the creation of a small number of purpose-built homes. To make these economically viable and to achieve "value for money", they will probably have to cater for a greater number of residents under one roof and will seriously hamper an individual's personal choice over where to live and how to live, owing to the restrictions service providers now have to adhere to. Higher numbers of residents living together means less individualisation of service. There's a wealth of research evidence to support this but it's an inconvenient truth.
Fourth, and perhaps more worryingly, is the fact that funding for service providers has been cut year on year, and as night follows day it is inevitable that it truly becomes a struggle to deliver a genuine personalised service in a reality of reduced staffing, no training budgets, temporary contracts for staff, etc. Real quality is not cheap. It costs.
Fifth, and finally, we can expect a denial of all the above as denial enables the status quo to trundle along bar the odd earthquake like Áras Attracta, until the inevitable next time occurs. – Yours, etc,
IAN GREY,
Adjunct Associate Professor
of Clinical Psychology
and Intellectual Disabilities,
Trinity College Dublin.
Sir, – The Prime Time documentary "Inside Bungalow 3" has once again demonstrated the plight of people with intellectual disabilities in Ireland. It has also shone a light on the inherent inequity of a system that has been historically grounded in the congregation and marginalisation of people who are perceived to be different.
As expert consultant to the documentary, I must say that the revelations of what was happening, whilst terribly upsetting and wholly inexcusable, are of no great surprise, as I and others have been highlighting the presence of oppression in such services for many years. Indeed, it confirms suspicions that, despite apparently positive changes to services (non-institutionalised clothes, group homes, increased choice), there has not been a change in the fundamental societal inequity that led to these people being excluded from the mainstream of Irish life in the first place.
The instances shown in the programme point to a continuation of the marginalisation and exclusion of such people by society. Such exclusion is dehumanising, and exposes them to subhuman conditions based on control and subjugation. They are, however, only the tip of an iceberg as the culture of control is arguably inherent in the current service model and, as Minister of State for Disability Kathleen Lynch noted, such situations cannot be ruled out elsewhere in the service system.
So, where to from here? It is clear that the Health Information and Quality Authority (HIQA) inspection regime could not have exposed what was happening in Áras Attracta. Many such inspections can, by their nature, be anticipated or, if unannounced, will only reveal what happens in front of the inspectors. The idea of formalising the use of “undercover” staff and hidden cameras has been mooted but may be fraught with legal and privacy concerns.
I have been engaged in intellectual disability nursing and social care education for many years and the vast majority of people who come into such programmes are value-based individuals who are driven by a spirit of altruism. This spirit can, however, be dulled during placement, by the experience of controlling service cultures in which the students learn to “keep their heads down and survive”. Once this pattern becomes internalised in the student, it becomes difficult to break free from. It is imperative that higher education institutes providing programmes for service staff address this issue forthwith and ensure that emerging staff are equipped with the resilience and skills to maintain quality standards of service provision. It is also vital that the HSE and other service agencies implement proper governance systems that support such staff to blow the whistle safely.
Finally, there must be truly independent advocates available to each person with intellectual disability whose role is clearly set down in law.
As Irish people, we are required to speak out too. We must recognise that we have allowed the values inherent in our Constitution to become irrelevant to the lives of many people with intellectual disabilities, and we have failed to stand up alongside those people who were perceived to be different to the rest of us. What type of society do we have when we can ignore the fact that people with intellectual disabilities routinely have their human rights removed? What type of people are we when we do not scream “Stop” in the face of the verbal, physical, societal and/or situational abuse of a group of citizens because they are “different” from the rest of us? Something is fundamentally wrong and needs to change now. – Yours, etc,
Dr FINTAN SHEERIN,
Lecturer in Intellectual
Disability Nursing,
Trinity College Dublin.