Disabled Clients Are Fellow Citizens
Developments in the Disabled Peoples Movement have brought disability to the fore as a civil rights issue in Britain. Growing numbers of politically active disabled people have generated an awareness of how their rights as citizens are denied by discrimination and oppression. Out of this has emerged the concept of ‘independent living’. A philosophy encompassing the full range of human and civil rights necessary for disabled people to be equal members of society.
Underpinning this are four key beliefs: that all human life is of value; that anyone, whatever their impairment, is capable of exerting choices; hat people who are disabled by society’s reaction to physical, intellectual and sensory impairment and to emotional distress have the right to exert control over their lives; that disabled people have the right to participate fully in society (Morris, 1993:21) The focus of this essay is the potential conflict between this philosophy and the policies and practices of social work.
In particular, contrasting interpretations of the client/social work relationship will be examined with regard to their capacity to foster these ideals. There is ample evidence that disabled people are poorly housed, less well educated and generally receive less in the way of life-enhancing opportunities when compared to their non-impaired peers (Finklestein (1991). For example, they are four times as likely as non-impaired people to be unemployed, while those who do work receive wages on average 20% lower (RADAR, 1994). Most disabled people, therefore, rely on benefits.
Furthermore, those benefits fail to allow for the extra expenses incurred as a result of disability (Cohen, 1996; Thompson, 1996). Thus it is poverty and poor quality of life resulting from discrimination which creates the need for social work intervention. Becoming a client, Davies (1981) suggests, is seen as a ‘sign of having given up’ and as ‘a mark not only of failure but of shame’ (p. 35). This not only further marginalises disabled people from mainstream society, i. e. separates those who are “clients” from those who are not. It also, according to Barton (1993), maintains a..
Culture of dependency in which their low status and vulnerability are reproduced (p. 245). The stigma associated with being a client reinforces the widespread assumption that impaired people are, in essence, incapable of being full members of society (Morris, 1991). Thus legitimising their inferior status and lack of power. They are impaired-ergo they are dependent and need aid. Whereas a more sophisticated view would be they are impaired-therefore they are discriminated against and need assistance to break out of a discrimination/dependency cycle.
Consequently, social work can empower clients by working in ways that enhance the control they have over their lives. Alternatively, it can simply deal with the effects of discrimination. It will be argued that this largely depends on the way clients are perceived in social work. The most persuasive perspective, in terms of shaping policy and practice, has been the medical model. This identifies the problems faced by an impaired person as stemming from an inability to adjust to his or her condition (Barton, 1993). The primary objective of social work here is defined by Thompson (1993) as.. .. paramedical task geared toward care giving and rehabilitation (p. 124). Consequently, little attention is given to seeking alternative, exoteric explanations for the client’s experiences.
He or she is seen as the source and cause of their own problems. The influence of the medical model can be seen in individual casework. Again, this type of approach has been criticised for seeing clients as needing to ‘adapt to the world’ (Hasler, 1993:282). Although external factors are acknowledged, the emphasis remains on changing the client. As one early text book on casework puts it.. The worker may bring about changes in the environment,.. t everything he does has its focus in releasing the client to use himself and his situation-as it is.. (Smalley, 1970:119).
This focus on individual change, together with the implicit assumption Oliver (1989a) identifies in this approach, i. e. that the expert knows best, highlight its oppressive nature. To view the ‘case’ simply as someone who needs professional direction to cope with a negative situation not only undervalues the client’s abilities and strengths, it can often ignore the structural discrimination behind the situation. As one campaigner argues.. Disability isn’t about medicine, health or social welfare.
It is about politics, economics, development and human rights (Masamene, 1994:1). This quote neatly identifies the crux of the problem with individualist approaches. They tend to explain problems in terms of what is within or relates specifically to the client-(something Horne (1994) argues stems from the social work ethic of respect for the individual). ‘Blaming the victim’ or seeing disability as a ‘personal tragedy’ denies the existence of discrimination. More importantly, it may act as a barrier to the generation of policies which could alleviate that discrimination (Oliver, 1987).
An alternative view of clients is as customers who purchase services according to individual requirements. The NHS and Community Care Act (1990) places service provision on a needs-led basis. This should, in theory, allow for the range of services available to disabled people to develop in response to client perceptions of need (Dalrymple and Burke, 1995). In reality, however, the client’s right to choose and define need as a consumer is reduced by a lack of resources and insufficient funding. For example, 65% of local authorities reported recording unmet need among disabled clients in 1994 (George, 1996).
In addition, rationing of resources serves to increase the power imbalance between client and worker. Social workers act as gate keepers to services in which, Kemshall (1986) argues.. Need serves as an exclusion rather than as an inclusion category (p. 34). This often translates to a rationing of services to those deemed most in need. Allocating resources and assessing needs according to common-sense assumptions and expectations of impaired people does little to break the cycle of dependency. Professional ideas about independence tend to revolve around the ability to manage day-to-day tasks (Patrick and Peach, 1989).
Impaired people, on the other hand, define it as being in control and making their own decisions (Oliver, 1989b). The effect of this is the denial of disabled clients’ right to exert choice and control over their lives. Morris, (1996) argues that the very values underpinning community care: choice, control, respect and dignity, are being destroyed by the lack of resources.. People are forced into residential care because it is cheaper than delivering help to them at home; some who remain at home are living in squalor and isolation; others are forced to rely on relatives in situations which create abuse (p. 5).
From this it is evident that restricted resources can be as big a barrier to empowering disabled people as individualist approaches. However, the aim must be to treat clients as equals rather than as people whose rights are unavoidably limited. The pivotal factor in this is the accurate presentation of their needs and experiences. Not only can this help ensure a client- led service develops, it also serves to make visible the disabling elements in society. The Disabled Persons Act (1986) provides for the assessment and advocacy of disabled people.
Regardless of the context of the assessment, the social worker should aim to: ct as a resource for the client to use; encourage the client’s participation as a partner and as a valuable person in their own right; make explicit the assumptions on which the assessment is based, and be prepared to negotiate these with the client; identify where expressed need is the result of oppression and explore with the client different perspectives of their experience; accept the client’s right to define his or her own needs, and avoid focusing on available or suitable services. Disabled clients can then exert control and choice within social work.
This will avoid the paternalistic and dependency creating practices which result from a lack of awareness of how disability is constructed. Disabled people see themselves as victims of an oppressive society. Therefore, intervention based on the same premise acknowledges the existence of external causes for a client’s experiences and promotes self-worth. Something Payne (1991) points out is an empowering act in itself. A practice that seeks to empower should work with clients rather than for them. This entails ensuring that clients have all the information they need to make decisions. and that practice is explicit and open to question.
Above all, social workers and clients must be equal partners in a relationship based on respect and trust. What is required, then, is the participation of disabled people in decision making both on a personal level and at the level of agency policy. The first would be empowering in its own right, and the second could only lead to an enhancement of disabled peoples’ rights as citizens. However, different models of the client/social work relationship have been shown to vary in their ability to achieve this. “Consumers” is a misnomer as low resources means there is little real choice for the client.
Allocation of scarce resources according to official interpretation of highest need is by definition not a client-led service. Seeing clients as individual “cases” personalises the problems of disability and prevents wider social change. Social work then, is best able to promote the rights of disabled clients by seeing them as the victims of discriminating social and cultural attitudes and advocating on their behalf. In effect, the proposition that “clients are fellow citizens” can only be realised by recognising how far away from the truth that often is in a disabling society.