Tuesday, October 17, 2006

Overcoming Disabilities With Discrimination

This is Part II of We Must Discriminate, dealing specifically with how we do a tremendous disservice to our fellow citizens with disabilities when we blindly refuse to discriminate, or rather, to design services with appropriate discrimination for those who have disabilities .

There has been something of a scandal in Wisconsin lately concerning extremely unsanitary and unwholesome housing conditions for people with cognitive disabilities. The title "Mental Health" is still somewhat used with regard to social services for this group of people, although the term "mental retardation" is out of fashion. This sort of scandal pops up now and then, here and there, throughout the country. After some horrified and horrifying headlines, everything goes back to normal (horrible) until the next round of publicity. That is what we get for turning over this vulnerable population to the tender mercies of the social work profession. (Social work has been an abomination ever since it became "gummint work.")

The root of the immediate expose in Wisconsin lies in a lawsuit filed many years ago, which established the legal and civil right of people with mental disabilities NOT to live in institutions. Its practical effect was to empty out the "asylums" which existed at the time. The lawsuit was filed by, and on behalf of, residents of large, centralized institutions who had most of their mental faculties, plenty of individual initiative, and were tired of living a tightly supervised existence that some social worker thought would be good for them. Of course other residents of those some institutions were totally unprepared for any kind of real world responsibility. They very badly needed an "asylum" in the best sense of the word. The lawsuit failed to discriminate between different types and degrees of cognitive disability, as did the the institutions which inspired the lawsuit. So do the collection of group homes and other "facilities" in which the supposed beneficiaries of the lawsuit now reside.

The truth is, some people have cognitive disabilities so severe that they don't have the initiative to take one step out of the door of their residence unless someone gives a gentle shove between the shoulders, and then would stand just outside the door until they starved or froze to death if someone didn't take them by the hand and lead them somewhere else. They are now scattered in relatively unsupervised little private facilities, where poorly paid individuals may or may not be taking good care of them.

Other people have such mild cognitive disabilities that they could cook and clean for themselves, decorate their own home, keep a garden, mow the lawn, but shouldn't be allowed to sign legal or financial contracts because some unscrupulous wheeler-dealer would take them for all they own. There are many shades in between. (Unfortunately, "concerned" relatives, social workers, and professional conservators are prone to take such vulnerable individuals for all they own anyway. If nothing else, the conservators' fees eat up most of the estate.)

The social work profession is awfully keen on the "rights" of people with no discernible brain function to "live normal lives." On the other hand, these eager busy-bodies are just as enthusiastic about bursting into the private homes of elderly people who are doing very well, living the way they want, making their own choices. Social workers are all too ready to make arrogant, peremptory judgments that such elderly couples, or individuals, need "protection" and must have a "conservator" who will sell off their homes and stuff them in an assisted living unit somewhere. (For their own good, of course.)

The truth is, we need to approach the whole subject of cognitive disability with a great deal of discrimination.

Our laws need to be tweaked a little more strongly toward leaving people alone, who have lived independently all their lives. If a legal adult remains capable of saying "this is my home, I'm doing just fine, get lost," that wish should be honored. There should be a very high burden of proof on anyone (blood relative or not, possessing an advanced social science degree or not, police officer or not) who wants to step in and "help." Help is something to be offered when it is ASKED for. Likewise, IF a court action is initiated at all, the presumption should be that anyone who can get up in court and say "I'm doing just fine on my own, get these nosy busybodies off my back" is capable of exercising independent judgment, until proven otherwise.

At the other end of the spectrum, individuals who cannot select food for themselves, cannot go to the bathroom by themselves, cannot read or write, and demonstrate a marked preference for sitting on the floor all day doing nothing, need to be in a stable environment where someone is being paid for an 8-hour shift to take care of them. They do not need to be living "in the community, just like the rest of us" because they are NOT just like the rest of us. They do not need to be in poorly supervised "group homes" where they can most easily be taken advantage of. They do not need to be stuffed onto buses every day to ride to day programs so they can share the joys of the daily commute experienced by suburban business executives. They need to be in bright, cheerful institutions where they don't have to deal with a lot of confusing changes in their routine, and where there can be frequent, efficient supervision of their care.

What about those in between? That is where we REALLY need to DISCRIMINATE. What one individual needs is very different from what another individual needs. Putting two individuals in the same program is doing a slight disservice to each. There may well be at least ten different categorical levels of disability needed to even come close to giving each person their due. But if we really care about people, as opposed to being enamoured of pet theories, we need all those different varieties and levels of programs, offering the many different options that are each appropriate for some of the individuals who have cognitive disabilities. There is no such thing as one size fits all. Therefore we must discriminate.