Author: Andre Coleman

Identify and reflect on potential strategies for addressing oppression and unfair discrimination encountered in community care for adults. Examine the implications of this process for a social worker value base.

The Audit Commission report of 1986 and the Griffiths report 1988 emphasised the need for care to become consumer-led; traditionally state run services were quickly contracted out to private and voluntary sector providers. Value-for-money became key, and community care became the favoured option over and above residential care (Blakemore, 2003). Some argued that social work values became secondary to resource-led decision-making (Banks, 1995).

Negative discrimination can be defined as the attribution of negative traits or features with regard to an individual, or a group of people (Thompson 2003). Generally negative discrimination relates to social and biological constructs and can be based upon a multitude of characteristics, such as gender, race, sexual orientation, disability, class, age and so on. Negative discrimination creates situations that can lead to oppressive practices, which is defined by Thompson (2001) as:

“Inhuman or degrading treatment of individuals or groups; hardship and injustice brought about by one group or another; the negative and demeaning exercise of power” (pg 34)

The core principle of the NHS & Community Care Act 1990 was to give people the choice, where possible, being cared for in their own home (Blackmore, 2003), and the social care field was opened to market forces; services users became consumers. However, the purchasing power of service users is disparate, dependant upon social, economic and individual variables. Adults partaking in community care are particularly vulnerable to oppression where there is an imbalance in the distribution of financial or other material resources; economic status can create real disparities in the standard of care received. Service users will often find their financial resources are controlled by their carers, placing the carer in a powerful position and disempowering the service user. This can be countered by being very open with the service user and avoiding “closed” decision-making and mystery (Topps, 2001). The service user should be involved at all levels of decision-making regarding resources. The Community Care (Direct Payments) Act 1996 is encouraging as it allows local authorities to make direct payments to service users, enabling them to arrange and pay for their own care package. This is a positive step forward in empowering community care service users.

It is also important for practitioners and carers to consider their use of language and its potential effects. Dehumanizing and medicalised language can result in a loss of esteem and a sense of disempowerment for the any service user, particularly those with intellectual impairments who maybe less able to understand medical terms. This can be prevented by avoiding jargon and providing lots of opportunities for questions and open discussion. Carers and social services staff should continually check themselves for use of infantilising language and ensure they engage in mature, adult discourse with service users. An example of dehumanizing language that is still used regularly in care setting is the term “manual handling”. Many physically impaired service users have reported this term as degrading (Elder-Woodward, 2001), as the implication is that the person is an object to be handled. The term “moving and assisting” is more widely accepted now.

We should also consider the power that is implied through the assumption that “professionals” have superior medical knowledge, skills and expertise in relation to the community care service user. Often, care plans are based upon the medical model; the impairment is seen as the problem and the service users dependence is emphasized (Adams et al, 2002). Thompson (2001) says social work should take a “demedicalised” stance and look past the pathology, utilizing the social model of disability as described by Adams et al (2002). The social model suggests the service users needs should be considered in a much wider context, ensuring their social and mental health are given equal consideration to their medical needs. Viewing societal constraints as the problem, and not the individual, creates the frame of mind to consider how to remove barriers to mainstream social, political and economic life. Social workers should liase with service users and look towards a solution-focused (not impairment-focused) care plan whereby barriers are identified and solutions sought collaboratively, utilizing strengths.

Social workers are trained to critically reflect on their practice to ensure they continually monitoring their reactions to, and engagement with, service users. Critically reflective practice is crucial in anti-oppressive and anti-discriminatory work. Until recently, community carers were not trained in such practice and therefore were more likely to repeat oppressive practices over and over as they maybe not be aware of the implicit discriminatory messages of some behaviours. The issue is tackled by new regulations, which require all paid carers to hold an NVQ qualification. The NVQ requires carers to consider issues of discrimination and oppression, and look at significant elements of their own identity. It is important this training is followed up by regular supervision and support (Thompson 2003). Care can be stressful, and it is crucial that steps are taken to minimise pressure, where possible, and for managers/social workers to take the opportunity to debrief with carers as necessary.

The ability to identify and promote non-discriminatory and anti-oppressive practice and procedure is a focal point of the social work value base (Training Organisation for Personal Social Services, 1989). Social workers must maintain awareness of the value base by using a variety of strategies to ensure service users are not discriminated against. The aforementioned strategies mean the social work value base is referred to, and reflected upon on a regular basis; it makes it a working, “live” document. All of the aforementioned strategies are referred to within the value base as issued raised by service users.

Anti-discriminatory and anti-oppressive practices are once again key focus areas for social workers and carers alike. It is encouraging that all workers are required to consider such issues within their training and as part of their value base, and steps are being taken to empower service users by facilitating the co-ordination and funding of their own care package. It remains the case that many care-receivers live with friends/family, who ultimately are in a position of considerable power over the service user, which can lead to oppression and discrimination.

References

Adams, Robert et al (eds) 2002 Critical Practice in Social Work. Basingstoke, Palgrave.

Banks, S (1995) Ethics and Values in Social Work. Macmillan Press LTD, London

Blackmore, k (2003) Social Policy: An Introduction. 2^nd Ed. Buckingham, Open University Press

Elder-Woodward, J (2001) Making Sense of Community Care – Recent Initiatives: A service user’s perspective; or, Farewell to Welfare – The perspective of an ungrateful bastard. Retrieved 16^th August 2005 from: http://www.leeds.ac.uk/disability-studies/archiveuk/elderwood/CCPS paper3 (Times12).pdf

Thompson, Neil (2001) Anti-discriminatory Practice 3^rd Ed. Basingstoke, Palgrave.

Thompson, Neil (2003) Promoting Equality: Challenging Discrimination and Oppression 2^nd Ed. New York, Palgrave

Training Organisation for Personal Social Services (2001) National Occupational Standards for Social Work. Topps, Leeds

Schizophrenia is a mental illness with symptoms like delusions, hallucinations, disorganized speech and behaviour, and inappropriate emotions (Barlow & Durand, 2009). These symptoms would distort an individual’s living to a certain extent. For example, the irrational thoughts may result in communication problems. In fact, not only do the symptoms of schizophrenia affect an individual, stigmatization of people with schizophrenia also has profound effects on those people with schizophrenia.

Stigma is the general negative attitudes towards a certain group of people (Schneider, 2004). Many scholars suggested that people with schizophrenia are highly stigmatized (Chang & Johnson, 2008; Gingerich & Mueser, 2006; Prior, 2004). They are generally described as depressed, unpredictable, violent, dangerous and aggressive (Chang & Johnson, 2008; Schneider, 2004). Although these may be true for some cases, it is believed that there is overgeneralization of the situation. The situation would also be worsened by the media (Chang & Johnson, 2006), which sometimes connect schizophrenia to violent acts. For example, a person with schizophrenia would be more likely to be a murder. These negative views would trigger discrimination on people with schizophrenia.

Schneider (2004) suggested the labeling theory to explain why people with mental illness behave in the way that the general public describes as dangerous and violent. He explained that they act as dangerous and violent just because they are stigmatized and play out their assigned roles. Therefore, it can be seen that they may actually be socialized to behave in those ways instead of behaving naturally.

It should be noted that people are not only stigmatized while they are suffering from schizophrenia. A research was done by Cheung and Wong (2004) with 193 people in Hong Kong on the perception of stigmatization on people with mental illness. The result shows that the majority agrees with the fact that “most people believe that someone with a previous mental illness is untrustworthy and dangerous”. Schizophrenia, being one of the mental illnesses, is of no exception. The implication of this research is that stigmatization on people with schizophrenia is a life-long issue, from the onset of the disorder until the end of one’s life.

Gingerich and Mueser (2006) suggested that stigma on people with schizophrenia may make others feel fear of and avoid interacting with those people. This fear and avoidance would in turn reduce the interaction between people with schizophrenia and the public and there would be less opportunity to change the stigmatizing beliefs (Gingerich and Mueser, 2006).

Holmes and River (1998) introduced the concept of social stigma and self-stigma. The aforementioned are social stigma as the general public stigmatizes those with schizophrenia. Chang and Johnson (2008) suggested that there are social messages delivered in the stigma which may lead to self-stigmatization of an individual. This further stigmatization would cause even more negative effects on oneself.

Effect of stigmatization on people with schizophrenia

As suggested by Tsang, Tam, Chan and Cheung (2009), stigmatization prohibits mentally ill people from recovery. Regarding situations in Hong Kong, Tsang et al. (2009) found from a survey that 80% of respondents thought social stigma has negative consequences towards mentally ill people. Compared with the high percentage, much less respondents considered social stigmatization unacceptable. Which means quite a number of people tolerate or accept stigmatization even though they know the impact brought. Other figures found by Tsang et al. (2009) also revealed the severeness of stigmatization in Hong Kong. For example, one fourth of respondents are hesitate to accept people with mental illness and about 30% of respondents oppose mentally ill elderly into elderly home. These thoughts and stigmatizations contribute to the effects brought by schizophrenia and make it more serious in Hong Kong.

There is no doubt that stigmatization poses negative consequences on people with schizophrenia throughout their life. Chan, Mak and Law (2009) confirmed the point above after reviewing a lot of literatures. Firstly, it imposes constraints in daily living on those with schizophrenia. Moreover, it may lead to lower self-esteem, reduced life satisfaction and social adaptation. It also hinders help-seeking behavior. Apart from the above impacts, Corrigan (1998) also suggested that stigmatization would lead to discrimination, followed by loss of social opportunities as members of society withhold the chances related to work or income. Thus lead to poor quality of life.

It should be noted that the psychological, social and biological aspects cause the negative consequences and they are interrelated. Socially, negative attitudes towards people with schizophrenia inhibit the employment opportunities (Corrigan, 1998). The claim is also supported by the finding by the Equal Opportunities Commission (1997) in Hong Kong. It stated that the mentally ill people’s employment rate is low (around 30%). The unemployment problems may trigger a lot of other problems. It is obvious that unemployment causes financial problems. It also places burden on clients’ relatives. Moreover, as stated by Mowbray, Bybee, Harris and McCrohan (1995), “employment offers opportunities for social interaction, builds self-esteem and identity, and is the best predictor of recovery and social integration”. However, without a job, there may be disappointment and self-blame of being a burden to the family or being incapable to earn a living. The psychological aspect of the people is thus affected and may reduce life satisfaction.

Tsang et al. (2003) also suggested that stigmatization not only affect the individual but also his family or social network. An example illustrated is that a large number of people would change seats in public transport when sitting next to people who appear to have mental illness. When going out with the mentally ill people, their relatives or families would feel embarrassed. Thus their emotions are also affected. And because of the stigmatization of experiences that irritate the mentally ill people, they may isolate themselves. The family is also likely to conceal their illness because they feel ashamed of the schizophrenic people. This is particularly true in Hong Kong as Chinese stresses the importance of collective representation of families (Tsang et al., 2003). This further prohibits the individual from interacting with other people. Because of the isolation, the individual is not quite possible to seek help from other. Without social support and social resources, the schizophrenic people are hard to adapt to the environment. This forms a vicious circle and the situation may become worse.

Biological aspects may also increase the seriousness of stigmatization. Age of onset of mental illness may be an important factor. If a person is mentally ill since he/she was young, his/ her social network would narrow down as there may be discrimination and isolation. Thus the support is limited. Moreover, if the person suffers from schizophrenia during college or secondary school, his/her education is not competitive enough in Hong Kong as there are more and more students receiving tertiary education (Census Department, 2005). With the mental illness and lower than average academic achievement, they face a lot more difficulties in employment.

Interventions

It can be seen that stigmatization causes many negative effects on people with schizophrenia. Therefore, it is necessary to reduce the stigma on them. However, there should be some consideration when intervening in the situation. Chiu, Chui, Kelinman, Lee and Tsang (2006) pointed out that those interventions which focus on changing public’ attitude towards schizophrenia are actually isolating those stigmatized to be a group that deserves special treatments. This in turn reinforces the stigmatization. Chiu et al. (2006) also stressed that there may be the possibility of making those stigmatized more aware of the fact that they are being stigmatized. They may become hopeless about changing the current situation and just conform to the stigmatization.

Hong Kong has actually taken some actions to intervene in the stigmatization on people with schizophrenia. However, it seems that the actions taken are not quite effective in reducing the stigma. For example, “psychiatrists changed the Chinese term for schizophrenia from “splitting of the mind to “perceptual disorder”” (Chiu et al., 2006, p. 1694). However, Chiu et al. argued that the new term was re-stigmatized quickly after a short period of time.

Besides changing the name, there have been anti-stigma programmes which promote a sense that “schizophrenia is an illness like any other” (Davies, Haslam, Read & Sayce, 2006). Davies et al. (2006) pointed out that these programmes failed to reduce the stigma as they deliver the message that individuals cannot control themselves when they are suffering from schizophrenia. This makes the public feel that those with schizophrenia become even more unpredictable and thus increasing the stigma.

As it has been mentioned, stigma on people with schizophrenia can be divided as social stigma and self-stigma. Therefore, interventions at both community and individual level are needed to reduce the stigma on people with schizophrenia.

For the community level, Gingerich and Mueser (2006) suggested letting people understand more about the situation instead of changing how they think about the situation directly. One common but effective way is education (Gingerich & Mueser, 2006). Education allows people to develop a better understanding on schizophrenia, for example, the cause, effects and treatments. They may be able to view psychiatric symptoms as understandable psychological or emotional reactions to life events, thus reducing the fear on people with schizophrenia (Davies et al., 2006). A research done by Chan et al. (2009) discovered that it is more effective in reducing stigma on schizophrenia if there is a lecture about schizophrenia followed by a video show which includes real cases of schizophrenia. They explained the effectiveness of the education-video model as allowing participants to get enough information and background before having deeper processing of the video.

It is suggested that there was little or no organized advocacy by psychiatric patients to strive for their own interest (Chiu et al., 2006), like legislation and resource allocation on people with schizophrenia. Besides, it is suggested that poor treatment of schizophrenia may intensify the stigmatization of schizophrenia (Prior, 2004) because people may over-generalize those small group who are poorly treated and have adverse symptoms as the majority of people with schizophrenia. Advocating for the improvement of services for people with schizophrenia can thus help to reduce stigma by allowing better recovery. Besides, services like employment assistance can help integrate them in society and allow them to develop a social network (Prior, 2004).

For individual level, treatments like medication, psychosocial education (Chang & Johnson, 2008). In addition, family cares and supports are important to reduce stigma on an individual with schizophrenia (Chang & Johnson, 2008; Gingerich & Mueser, 2006) as it is the first system that the individual would situate. If the family is a supportive one, it is more likely that the individual would be less self-stigmatized.

In conclusion, stigmatization poses great impacts on individuals with schizophrenia and their families. These impacts included reduced life satisfaction and social adaptation. Unemployment is also an important factor that affects social and psychological functioning of people with schizophrenia. On the other hand, interventions should not focus on changing public’s attitude towards people with schizophrenia. Instead, it should focus on letting people understand more about schizophrenia and providing supports to people with schizophrenia. In the community level, there can be education and advocacy. In the individual level, there can be medication, psychosocial education and family support.

The Stigma of Mental Illness in Developing Countries

Seeking treatment for mental illness can be a daunting task. Even in the United States, where medical care is relatively easy to obtain, there is a stigma surrounding mental illness. In my own experience of living in a small, close-knit community, I found it nearly terrifying to talk to my primary care physician about the anxiety and depression I was experiencing. In my town, parking my car at the counseling center was like admitting that I couldn’t take care of myself. The common perception in the community was that people need to ‘suck it up’ and not rely on doctors or therapists to get through life. With this clear and prevalent stigma against mental illness and treatment, it took me years to finally get the help that I needed. This issue of stigma was still on my mind when I started looking for a topic for this research project. I was curious about how non-Western and developing countries viewed the issue and what was being done to help lessen the stigma of mental illness worldwide.

What is Stigma?

In order to take a close look at mental health stigma in cultures around the world, we first need to understand exactly what is meant by ‘stigma.’ The dictionary definition of stigma is ‘a mark of disgrace or infamy; a stain or reproach, as on one’s reputation’ (Dictionary.com). This is a good place to start, but it does not accurately define the measurable aspects of stigma, which is necessary for researchers to be able to study it. Link et al. (2004) discuss several theoretical perspectives for stigmatization in general and the stigma of mental illness in particular. Most useful for the purposes of this paper is the framework laid out by Link and Phelen (2001) and discussed and elaborated upon by Link et al. (2004) that suggests several interrelated categories: labeling, stereotyping, separating, emotional reactions, status loss, and stigma’s dependence on power structure. Labeling is a natural way that humans categorize differences, and many labels (shoe size, favorite foods) are not socially salient. Other labels, such as sexual preference or nationality, are much more relevant. ‘Both the selection of salient characteristics and the creation of labels for them are social achievements that need to be understood as essential components of stigma’ (Link et al. 2004). In the stereotyping component, the researchers suggest that the labeled differences are linked to negative assumptions about the labeled person or others with similar characteristics. The next aspect of the ‘stigma process’ is separating, which is the ‘us versus them’ mindset. Link et al. (2004) suggest that one place the initial conceptual framework about stigma is lacking is in the underrepresentation of emotional reactions: ‘We believe that this underrepresentation needs to be corrected, because emotional responses are critical to understanding the behavior of both stigmatizers and people who are recipients of stigmatizing reactions.’ Status loss and discrimination can be overt, like refusing employment to someone with a mental illness, but it can also be much more insidious and pervasive. Link et al. (2004) gives the example that considerably less funding exists for schizophrenia research and facilities for schizophrenia treatment are often located in less desirable locations. The final aspect of the stigma framework is its dependence on power structures ‘ Link et al. (2004) state that this aspect is very important because without social, cultural, economic and political power the concept of stigma would be much less useful.

Now that we understand at least one way in which stigma can be defined, we must next go about looking at the ways stigma is measured. Link et al.(2004) state that there is a considerable lack of study of mental illness stigma in the developing world ‘ they reviewed a large number of studied conducted worldwide, and found only a few in Asia and Africa, though the researchers did clarify that this might have been because their review was restricted to English language journals. This paper will focus on a few key studies, but it is certain that more study in this area is needed to get an in-depth look at differences between cultures and the relative stigma of mental illness.

Some studies focus on the stigma of the general population towards those with mental illness, while others focus on the opinions of people who suffer from mental illness. One survey I found to be particularly interesting and useful is the World Mental Health Survey, in which subjects with mental health issues were asked about their perceived stigma (Alonso et al. 2008). For this survey, stigma was considered to be present if respondents reported both embarrassment and perceived discrimination related to illness. Among people with significant activity limitations (i.e., at least moderate difficulty with cognition, mobility, self-care, or social), the perceived stigma rate was highest in the Ukraine, with 32.1% of respondents reporting stigma. The lowest rate was 3.2% in Germany. The average rate of perceived stigma in developing countries was 22.1%, compared to 11.7% in developed countries (Alonso et al. 2008, Table 1). The researchers’ finding was that perceived stigma associated with mental disorders is universal, but considerably more frequent in developing countries; however, the implications of this finding were not discussed, though they suggest ‘it may be of interest to investigate social, cultural and health service characteristics that differentiate countries in which patients feel less excluded from countries in which patients are more likely to report perceived stigma (Alonso et al. 2008:312). The researchers also found that ‘perceived stigma is strongly associated with common mental disorders, particularly with comorbid mood and anxiety’ (Alonso et al. 2008:306). The implications of this survey are twofold: first, developing and developed countries have different ways of associating stigma with mental illness, although the reasons for this are not clear. Second, people with mental illness are much more likely to perceive stigma relating to illness than, for example, people with chronic physical ailments. Most interesting to me is the fact that the statistics from Alonso et al.’s (2004) study shows that developing countries have nearly double the rate of perceived stigma as developed countries.

Studies of Stigma in Developing Countries

Lauber and Rossler (2006) conducted a review of literature that summarizes results of research on the stigma of mental illness in developing Asian countries. They state that this research is very important because ‘The stigma of mental illness and discrimination against mental patients are believed to be a significant obstacle to development of mental health care and to ensuring quality of life of those suffering from mental illness’ (Lauber and Rossler 2006: 158). They provide a clear discussion of how they defined developing and developed countries:

‘A developing country is a country with a low-income average, a relatively undeveloped infrastructure and a poor human development index when compared to the global norm’Development entails developing a modern infrastructure (both physical and institutional), and a move away from low value added sectors such as agriculture and natural resource extraction. Developed countries usually have economic systems based on continuous, self-sustaining economic growth’ (Lauber and Rossler 2006:160).

This definition helps clarify some of the general differences between developing and developed countries.

Lauber and Rossler’s (2006) review of literature found that people in developing countries in Asia are generally afraid of those with mental illness. They also found that many studies reported respondents who felt that mental illness symptoms were a normal reaction to stress; this finding suggests that awareness of mental illness and the need for medical intervention is lacking in these cultures. However, the results of these studies are similar to the results in Western countries (Lauber and Rossler 2006). Another finding of this study was in regards to help-seeking behaviors: it is much more likely for those seeking help for mental illness to rely on family members instead of professional mental health services (Lauber and Rossler 2006). I found it interesting that the researchers suggest the differences in mental health care in developing Asian countries is due not only to ‘a different cultural understanding of health and health care,’ but also the stigmatizing attitude of health care professionals as well (Lauber and Rossler 2006).

Gureje and Lasebikan (2005) studied the use of treatment services for mental illness in the Yoruba-speaking part of Nigeria through face-to-face interviews with nearly 5,000 adults. They found that fewer than 1 in 10 people with mental health disorders over the past 12 months had received any treatment whatsoever, compared with 25% in the United States (Gureje and Lasebikan 2005). They also found that respondents who did receive treatment were much more likely to be treated in the general medical sector rather than by a mental health specialist; these results are similar to those found in other developing countries as well as developed nations. Another significant finding was that people with mental illness were considerably less likely to use ‘complimentary health providers’ than those with other non-mental disorders: ‘This observation flies in the face of the common belief that traditional healers provide service for a high proportion of persons with mental disorders in developing African countries’ (Gureje and Lasebikan 2005:48). The authors suggest that many of the problems with mental health utilization in Nigeria result from its inadequate health service personnel and facilities, financial constraint, as well as ‘poor knowledge of and negative attitude to mental illness (both of which are rampant in Nigeria)’ (Gureje and Lasebikan 2005:48). This suggests that in addition to the need for better health systems in developing countries, we also need to address the issue of stigma towards mental health treatment.

Another study in 2005 attempted to look at the existing attitudes towards mental illness in the same Yoruba-speaking part of Nigeria. Gureje et al. (2005) studied over 2000 respondents and found widespread stigmatization of mental illness. The researchers found that respondents were often misinformed about the cause of mental illness with 80.8% stating that mental illness could be caused by drug or alcohol abuse, 30.2% claiming possession by evil spirits as a cause, followed by about equal responses of trauma, stress, and genetic inheritance (Gureje et al. 2005; Table 2). The researchers add that only about one-tenth of respondents ‘believed that biological factors or brain disease could be the cause of mental illness,’ and 9% felt that ‘Punishment from God’ was a possible cause (Gureje et al. 2005).

In addition to the misunderstood causes of mental illness, the researchers found that many Nigerians have generally negative views towards people with mental illness: fewer than half of respondents believed that the mentally ill could be treated outside of hospitals, and only ‘ thought that mentally ill people could work at a regular job. The researchers found that these negative attitudes were equally spread across the socioeconomic spectrum (Gureje et al. 2005). The stigma associated with mental illness in Nigeria is evident in the responses that show ‘most respondents were unwilling to have social interactions with someone with mental illness,’ including fear of having a conversation with or working with a mentally ill person (Gureje et al. 2005:437). 83% of respondents would be ashamed of people knowing that someone in their family was mentally ill, and only 3.4% responded that they could marry someone with a mental illness (Gureje et al. 2005: Table 4). These results support the findings of the World Mental Health Survey that the stigma of mental illness is considerably higher in developing countries than in developed countries, but the research still does not show any distinct variables that could be identified in order to help reduce the associated stigma.

Griffiths et al. (2006) performed a comparison of stigma in response to mental disorders between Australia and Japan, and found some interesting results. This was the only research I found that used similar methodologies to survey the public in two different cultures. Though both Japan and Australia are developed nations, the cross-cultural comparison is relevant to this study. Griffiths et al. (2006) found a significantly higher proportion of the Japanese respondents held ‘stigmatizing attitudes and social distance’ towards mental illness. The authors give several possible reasons for this difference. First, conformity is more highly valued in Japan, so people who deviate from the norm because of mental illness would be more negatively impacted. Secondly, the treatment options in the two countries differ: in Japan, long-term institutionalization is common, while in Australia, community and rehabilitation services are emphasized. The implication is that even among developed countries, significant differences in the rates of stigma and the way it affects a society occur; therefore, any push to combat stigma needs to take into account these cultural differences. The authors suggest that this study may ‘point to ways in which interventions programs for reducing stigma might be tailored for each country’ (Griffiths et al. 2006).

Attempts to Reduce Stigma Associated With Mental Illness

Many countries and cultures have made attempts to reduce the stigma associated with mental illness. Lauber and Rossler (2006) discuss the attempts in some Asian countries to rename schizophrenia in order to reduce the stigma associated with the disease; however, results show that a less pejorative label has little effect on the stigma associated with schizophrenia. Stein and Gureje (2004) suggest the approach of medicalization of suffering, or training healthcare providers to recognize the depression and anxiety that are often related to violence, chronic illness, and poverty ‘ in order for this to be successful, however, overcoming the stigma related to mental health issues is of primary importance. Lauber and Sartorius (2007) states that work towards reducing the stigma of mental illness is very important as a human rights issue: ‘Societal or structural discrimination finds its expression in jurisdiction that restricts the civil rights of people with mental illness in, for example, voting, parenting or serving jury duty, inequities in medical insurance coverage, discrimination in housing and employment, and the reliance on jails, prisons and homeless shelters as the way of disposing of people with mental illness’ (103). They discuss the importance of the normalization paradigm in which people with mental disorders are seen as ‘similar to and not different from other people’ and medicalization, the idea that mental illness is a treatable medical condition rather than a personal defect, in the anti-stigma endeavors (Lauber and Sartorius 2007).

Form (2000) suggests that one important aspect of reducing mental health stigma is to increase what he calls ‘mental health literacy’ or knowledge about mental health disorders: he outlines several education programs that were widespread in the 80s and 90s in the United States ‘ the Depression Awareness, Recognition and Treatment Program and the National Depression Screening Day. These programs received widespread media attention, but their effects have not been studied. Form suggests that one good way to help improve mental health literacy is to target specific populations, such as high school students. However, Form’s research says little about how these ideas would work in developing countries.

In conclusion, a look at the research on stigma associated with mental illness shows significant differences in developing and developed countries, but the reasons for this are still unclear. I had hoped to conclude this research with a set of key differences between high-stigma and low-stigma cultures, but this information, if it exists, was not found. I believe that research on identifying causes for and reducing incidences of the stigma of mental illness is a very important topic in medical anthropology and one I believe will see continued advancement in research in the future.

References Cited

Alonso, J., A. Buron, R. Bruffaerts, Y. He, J. Posada-Villa, J-P. Lepine, M.C. Angermeyer, D.

Levinson, G. de Girolamo, H. Tachimori, Z.N. Mneimneh, M.E. Medina-Mora, J. Ormel, K.M.

Scott, O. Gureje, J.M. Haro, S. Gluzman, S. Lee, G. Vilagut, R.C. Kessler, M. Von Korff, the

World Mental Health Consortium.

2008 Association of perceived stigma and mood and anxiety disorders: results from the world

Mental Health Surveys. Acta Psychiatrica Scandinavica 118:305-314.

Griffiths, Kathleen M., Y Nakane, H. Christensen, K. Yoshioka, A. F. Jorm, and H. Nakane.

2006 Stigma in response to mental disorders: a comparison of Australia and Japan. BMC

Psychiatry 2006, 6:21.

Gureje, Oye, and V. Lasebikan

2005 Use of mental health services in a developing country: results from the Nigerian survey

of mental health and well-being. Social Psychiatry & Psychiatric Epidemiology 41:44-49.

Gureje, Oye, V. Lasebikan, O. Ephraim-Oluwanuga, B. Olley, and L. Kola

2005 Community study of knowledge of and attitude to mental illness in Nigeria. The British

Journal of Psychiatry 2005 186:436-441.

Jorm, A. F.

2000 Mental Health Literacy: Public Knowledge and Beliefs About Mental Disorders. The

British Journal of Psychiatry 2000 177:396-401

Lauber, Christopher and N. Sartorius

2007 At Issue: Anti-stigma endeavors. International Review of Psychiatry. April 2007;

19(2):103-106.

Lauber, Christopher and W. Rossler

2007 Stigma towards people with mental illness in developing countries in Asia. International

Review of Psychiatry, April 2007; 19(2): 157-178.

Link, Bruce, L. H. Yang, J. C. Phelan, and P.Y. Collins

2004 Measuring Mental Illness Stigma. Schizophrenia Bulletin 30 (3):511-541

Stein, Dan J., O. Gureje.

2004 Depression and anxiety in the developing world: is it time to medicalise the suffering?

The Lancet Vol. 364.

stigma. (n.d.). Dictionary.com Unabridged. Retrieved December 1, 2010, from Dictionary.com

website: http://dictionary.reference.com/browse/stigma

The whole world urbanized day to day because of globalization. Every person can go one state to another simply moreover the reason of work, or study. While a person from one different environment or nation work together with another people from a different surroundings, that time they both takes their own social status, culture, nature, believes with them, which are dissimilarity between each other (Google question) As a result, discrimination arises within a people in their working place because every people have different attitude towards the person which may be positive or may be negative. The purpose of this assignment is to discover the problem arise in male dominating workplace which especially faced by women and also analyse the issues and build recommendation for taking action by company as well as provide better solution. This briefing paper focuses the case study of Ms. Rosina Chamar, employee of Dynamic Power Supply International Pvt. Ltd. The business of this company connected to not only in Nepal also running in European countries too. After overview the situation of case, SWOT and PEST analysis has been discussed to solve the problem. At last of the paper, outcomes plus forecasts has been granted for better suggestion.

In this briefing paper, to make clear the difficulties on workplace, Hofstede Cultural Theory and SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis could support a lot to overcome the problems or to meet the best results. Also external factors PEST (Political, Economic, Social and Technical) helps to analyse the Situation and find suitable result.

Terms of Reference

There are many people around the world, who think they are more powerful and superior than other people. This is not result of today’s condition because this happened from the beginning when there were kings and servant, where the very strong people were respected and worshipped while the weak ones were became servant ( Lisa Gayagay, 2009:1). The aim of the assignment is based on the problems which face by the person especially women who are working in place in a male dominating country like Nepal. At first, we all must have to know that stereotypes absorb generations regarding the typical features of the people. Same as prejudice is a manner of the people which can be positive or negative that they show without knowing of the fact. In the case of the sex stereotyping which occurs when persons are judged according to traditional typecast based on gender. Either developed countries or undeveloped counties people have to deal with these types of problems (Prejudice, chapter: 5).

Who I am:

I am a senior counsellor Kritika Gautam. I am working in BK Legal Advice Consultant Pvt. Ltd since 2005. During my working period I have got many knowledge and experience every day. I have got degree from University of Bedfordshire, England in Law and Human Resource Management. So my degree and my working experience help me to get right decision and solve problems. As an advisor, my duty is to take out her in that situation. It’s very essential that an advisor have to solve the client’s problems. During my experience, I have got chance to learn the different problems faced by people because of cultural dominating, traditional dominating. And badly have to say that women are the main target of those kinds of problems.

Who my client is:

My client is Ms. Rosina Chamar. She is working as a financial officer in Dynamic Power Supply International Company in Nepal. She is coming to a multinational company to work from rural community. Because of her talent and graduation level educational certificate she got an opportunity to work with a multinational company. In our Hindu culture, women were blessed as ‘Shakti / Devi’ or power to achieve everything. People were worshipped her vision, sympathy power and even her justice. I have serious difference of opinion with Rosina Chamar’s issues. After hearing her words once, her words struck me. According to my client, in our society we weather treated women like goddess or servants. There are so many examples which show that women have been demoralized, neglected and exploited since the days of caveman. In her case, the first issue is that she has to struggle to stand in male dominated culture where bad languages and sexist jokes which may be norm of man and she needs to consider those types of things. Next point is that a male ego also makes difficult for him to accept a woman from lower cast as his senior even she has the right educational background and credentials (Pushya S, 2009).

What helps my client wishes?

She has come to me for support because she has faced many problems. My client Ms. Chamar, she wishes to get relieve of these problems. To win a male dominating society, she must have to settle in her company. That’s why after facing many difficulties she still working in that company. Either my client is a well educated woman and has 3 years experience in relevant field but unfortunately she has to face problems in her work. And lastly she has to come to me to get idea and advice to solve the problems.

Overview of the situation

In the present situation of our country Nepal, the culture and behaviour of people of town is totally different from countryside. Town become a more modernized and practical. Working in an office is more stressed and have to practical knowledge to do. Also people of the town are totally different from their behaviour, language, outlook and attitude. They have given more priority in group assignment but she has a problem to work together with men. Because she is from low cast and medium family background, her colleagues have negative thinking toward her culture and believe and main thing she is woman. Even town is a place of educated people but the behaviour and thinking of their still same like an ancient period. So, this is a vital problem she has to face. My client first should have to be awake all these situations before taking decision that she will do continue the job or not.

After understanding her all problems, the main problems she faced everyday in her workplace are like the given below and she has to be prepare to get rid from these trouble.

Attitude: – The problem of attitude of men about her is very negative because she is middle class women and she always like to be reserve. That’s why may be her workmates thought that she is unfriendly and self-righteous.

Wages gap: – In every enterprise, women still earning less than their male co-workers. Not only my client, many women around the world had very few rights and also could be sacked from job simply because of their family and social problem like: women had to play a role of mother, housewife. So they have to problem to be a full professional. That’s why even they work hard and active still they get less salary than other equal men. Ms. Chamar also faced same problem of less salary.

Cultural difficulty: – When a woman comes in different society to do something for her future she has to face many problems and the cultural difficulty is one of them. In village most of the families are not allowing to women to work outside the own society, but while coming in town she has to work with different types of men where they have open thinking, culture and environment.

Male dominate: – For better organizational future, company must have to use many type of technique to work. And male and female both are part of good decision making. So my client has to come to work in male dominated society where the male consider as a superior as compare to the female. So it is very hard for man to work with the talented and active female staff. She has a good work experience and knowledge but the man who has top position in the society so they have comparatively hard to follow behind the female.

Social and family connection: – In our Nepalese society women has many social barriers and restricted. She must have to follow social rule and morals. But in city life all have freedom to do anything. And she has problem to accept suddenly this condition in her life because it takes few more time to understand.

Harassment: – The last and serious problem she faced is harassment either sexual or languages. About the cases of sexual harassment (Farler, 1978), it mentions examples of many groups of working women: young/old, professional/labour, and rich/poor. It is endemic but very critical issue to workplace. In the case of my client her co-workers and senior managers wanted to take sexual relation with her and they always try to behave badly and mislead. So she is always afraid from that situation and tried to keep safe self from them.

Geert Hofstede Cultural Dimension:

This prejudice problem is not individual problem because the whole society and world faced these types of problems. Not only had women from Nepalese society, all women around the world directly or indirectly beard this problem. Geert Hofstede recommends a theory to understand the cultural differences between peoples, genders and countries (Prentice Hall-Financial tine, 2002). There are five aspects which help to clear the differences between male and female discrimination in workplace and society.

1. Power Distance Index (PDI)

2. Individualism (IDV)

3. Masculinity (MAS)

4. Uncertainty Avoidance Index (UAI)

5. Long Term Orientation (LTO)

To illustrate above phases of cultural differences the graph of Asian and European countries show these briefly:

Five dimension theories of Professor Geert Hofstede
Power Distance Index:

PDI demonstrate the imbalanced allocation of power between the people. This is a level towards which the less powerful members of organization have to accept and seniors of company distributed this unequally. In this graph, Asian countries have highest PDI with a ranking of 70% compare to European countries average of 40%.The power distance between Asia and Europe indicate the high of inequality of power and wealth between genders within the society and culture and even in organizations.

Individualism:

IDV depends on self ego. In above graph, Asian countries have 55% individualism where as European countries have 80%. These huge difference figures indicate that European people were free minded and self dependent than others. Asian people and European people both have different culture, believes, ethnic and behaviour. Women have social boundaries in Asian countries.

Masculinity:

MAS represents the space between the men`s value and women`s value. In above graph Asian countries have MAS as the lower Hofstede dimension of culture with a ranking of 60% and European average just slightly higher at 70%. It surprisingly shows that not only Asian countries have more men’s value because women of European countries also faced this situation. There is not a huge dissimilarity between Asia and Europe.

Uncertainty avoidance Index:

UAI deals with a people and society towards patience for uncertainty and doubt. It represents that a traditional program its associates to think both comfortable and uncomfortable in open conditions. Where uncertainty is escaping in people of those countries has full of power. In above graph, the uncertainty in Asian countries is 50% and in European countries, it is in 40%.

Long Term Orientation:

A higher LTO could be indicative of a culture that is economical and perseverant on the other hand the short term orientations are deference for believes, rewarding social commitments. The LTO score of Asian countries is 60% and European is 30%. That’s shows the result is Asian are short orientated and European are long term orientated.

Analysis of the situation
SWOT Analysis

After the overview of the situation, it is better to analysis the case through strength, weakness, opportunity and threats condition of my client. Starting from analysis of internal factors:

Strength(S):

– Positive sense on skills and attitude

– Work hard in any situation and strong emphasis on decision

– Power to choose own career path

– Experience on work and optimistic

Weaknesses (W):

– Lack of patient

– Weak communication and fearful mind

-Too trustworthy and always shy

-Soft hearted and never say ‘no’ to others

Other external factors:

Opportunity (O):

-Power of leading staffs and company

-Promotion in very high position

-International working

-Possibility of being example of successful women in society

Threat (T):

-Dissimilarities between genders

-Traditional mind of people and social cultural barriers

-Criticism and prejudice in work

-Issues of cast and fear of self identity

All above mention points clear that she has a good opportunity to take defence on prejudice but her weaknesses stopped her to face challenges. Lack of power and support affect her. That’s why after analysis her internal and external weak points and possibilities, she has more positive points which help to support in her future success and stand for defence of imbalance condition of workplace.

PEST Analysis

It is usually used to build the strategies to search external environment. It helps to evaluate the problems created by external surrounding issues. PEST identifies Political, Economic, Social and Technological factors of macro environment.

Political area has a huge influence upon the regulation of business, society and countries as well. Government has many policies regarding the case like more information and awareness about harassment, gender gap, wages facilities in workplace. Government reinforce and upgrade the systems for monitoring equality in employment (Eurofound, 2009).So, my client has to clear knowledge about government policies and rules.

Economic Factor (E):

In present, women are a large part of the employment. They are involving in every kind of work same as men. Either they both work same kind of work or also women do better than men but women get less benefit and wages than men. But today many human rights- national and international agencies and government policies came aware of that situation. They made rights against discrimination and also granted other minorities protection in the workplace. Therefore, she has to talk with her directors about her problem.

Social Factor (S):

In our Nepalese society, women has treated like second class citizens in work and most those people who are from lower caste. Many people either educated or illiterate have same thinking that the community of ‘Dalit’ (Lower caste) which is not considered part of human society. That’s why these community members generally perform the most menial and degrading jobs. My client Ms. Chamar, she is also from Dalit community. Stereotyping about this cast is they must handle dead animals and also consume their flesh. So this is very critical for her to faced bad thinking of people about her and her caste. Under the Nepalese constitution act (1990), caste discriminations were made a criminal offence and there are many rules about stereotyping and discrimination.

Technological Factor (T):

In worldwide, women tend to have less access to education, training opportunities so prejudice and stereotyping still placed in our society. In the case of Ms. Chamar, she has to develop her communication skills more and try to interact with other social literate persons also developed consumers relation. Because of science and technology covers the entire world so she must has to get more information about universal achievement in science, politics, economy and society.

Solution and Recommendation

After analysis all situation, it could be said that this is not a very big problem to solve. Her internal weaknesses and outside issues, cultural differences in society as well as differences between Asian and European culture, after discussing all these areas I would like to suggest to my client to move towards these recommendation. As an advisor, I came to the solution of her case like these ways:

Improve interpersonal skills and power to face challenges.

It is better to make a union of co-workers for equality rights at workplace.

Planning before taking every action regarding safety and power.

Try to avoid behaviour of tolerance everything.

Interact with diverse professional contacts which help to learning about different culture in company.

Try to know about office policies to determine how to handle harassment.

Ensure that the area which create around you help to keep safe in workplace.

Never tackle the harasser. If they threaten and you fear for safety, go directly to management and directors.

Expand your sensitivity and keep an open mind to diversities.

Make it your goal and exercise commitment and patience to remove stereotyping and type casting in workplace.

Apply effort to challenge to learn from things that hard to understand.

Forecast and Outcomes

Stereotyping and Prejudice is a norm of every people in our culture. It takes still more time to move bad thinking about faiths, castes, cultures, and believes of peoples. It would not be change from effort of one person whole society and nation has to do full exercise to keep safe self from stereotyping and prejudice case.

Here in the case of Ms. Rosina Chamar, she is either well skilled and broad minded but after facing these problems she become more weak, frustrate and helpless. These all happened not by her mistakes because these all came from society, government’s weak policies as well as people’s ancient thinking. There is also fault of Management of Dynamic Power Supply Co. because if they take her problems seriously, she would not be in trouble now. If she will try to be bold and motivate self to avoid her challenges, these problems will be no more. Her threats will decrease automatically. There are so many opportunities she has, so she has to develop her strengths more. And it is better for her if Dynamic gets her problem seriously and take action regarding her problems. If she will get positive support from management no doubt that she will obviously do better work for company.

We live in a culture where families are challenged with problems all the time. Regardless of what the problems may be, families need help developing skills to communicate effectively and strengthen their relationships. While most individual can recognize that their families need help, they frequently are not adequately prepared to help their families make needed changes. Obtaining a Masters of Arts in Family and Consumers Science- Family Studies Concentration will help me to help others prepare for change and ultimately achieve both my short-term and long-term goals.

In the short term, I hope to work my way up to become the Lead Housing Resource Specialist at Community Rebuilders. Currently, I’m a Housing Resource Specialist. This experience has created a passion in me to work in the family studies field and learn more about it. A key component that I have found common among all of my clients is that they all wish they could have been prepared for their problems. That tells me that if my clients had prevention methods in place, their problems may not have been a major problem to begin with. Family Life Education works from the prevention model because it teaches individuals and families how to improve family life and to prevent problems before they occur. Family problems, when they can be addressed through prevention, are less damaging for people and less expensive for society.

My long term goal is to help educate families as an Executive Director of a non-profit agency. While studying for the Masters program, I hope to develop the education and skill-set in order to reach my goals. I want to become an effective and innovative professional who can provide effective education and prevention services for families through services my agency can provide. I want to become an individual of high moral and ethical standards whose agency can function as a change agent in my community.

Studying for the Masters of Arts in Family and Consumer Science- Family Life Education is a wonderful opportunity because I will be able to learn the different parts of the family and learn to see how they function as a whole. The Fundamentals courses should give me the framework, while the advanced courses will provide a more specific training. During study, I will also look to take an internship and/or supplemental classes to help further my experience. It is the ability to understand the many different aspects of the family that will prepare me to accomplish my long-term goal of becoming an Executive Director. Equally important, I hope to learn from my fellow students and share with them some of the lessons I have gained from my experience. The best lesson I have learned while working at Community Rebuilders is to step out of the box and think of new solutions to old problems. These creative moments are what will move a family forward during hard times. I expect that graduate work at Western Michigan University will be demanding, challenging, and exciting, and I look forward to attending. During my time in graduate school, I expect to receive the opportunity to learn, grow, and evolve as a person and a family life educator. I am prepared and look forward to investing myself, my time, and my energy toward earning that degree. I hope I will be allowed to do so at WMU.

TOMARA L. MITCHELL
____________________________________________________________________________________

3841 Yorkland Drive NW Apt. No. 9

Comstock Park, MI 49321

(616)337-1852

[email protected]

Profile

Seeking a position which will enable me to utilize interpersonal and leadership skills to positively impact social issues affecting families. Interact effectively with people of varying cultures, backgrounds and professional levels. Committed to establishing connection and building strong relationships with all people. Skilled at identifying strengths and weaknesses in strategies and in creating compassionate and non-judgmental solutions to problems. Proven to be highly motivated and hard working. Possess excellent time management skills.

Education

Bachelor’s Degree in Sociology/General University Studies- April 2009

Western Michigan University, Kalamazoo, MI

Minor: Social Work

Related Coursework:

Crises and Resilience in Families

Social Work Services and Professional Roles

Social Welfare as a Social Institution

Intro to Culture, Ethnicity, and Institutionalized Inequality in Social Work Practice

Social Work Research Methods

Human Behavior and the Social Environment

Group Community and Organizational Behavior

Child Psychology

Global Ecology of the Family

Employment Experience

Community Rebuilders, Grand Rapids, MI February 2010 -Present

Housing Resource Specialist

Operate assigned rapid re-housing and prevention programs

Assist participants in locating and securing housing of their choice

Assist participants in development of strength-based goal and action plans that promotes permanent housing

Provide counseling and advocacy to participants

Facilitate and coordinate supportive service activities for participants

Serve as an ongoing liaison between property managers and participants

Hope Network, Grand Rapids, MI October 2009 – March 2010

Community Living Support

Provided direct supervision to individuals in residential programs.

Displayed appropriate behavior and teaches life skills to residents.

Provided evaluation and instruction in areas of daily living skills or independent living skills to enhance the residents’ ability to reach his/her highest level of independence.

Muskegon Heights Public Schools, Muskegon Heights, MI, September 2009 – February 2010

On-Call Substitute Teacher

Followed lesson plans, left by the permanent teacher.

Created and maintained a climate of respect and fairness for all students.

Used classroom instructional time appropriately and wisely

Tax Connection Worldwide, Muskegon, MI, January 2009 – March 2009

Seasonal Tax Preparer

Prepared customers federal and state returns

Provided customer service by quickly and effectively processing transactions to ensure return business and customer satisfaction

Answered multi-line phones, greeted customers and performed light clerical work

MOKA Inc., Grand Haven, MI, July 2006 – January 2008

Resident Support Staff

Supporting small groups of developmentally disabled and/or mentally ill individuals in residential setting

Teaching skills with the goal of independent living.

Heritage Community, Kalamazoo, MI, September 2005 – December 2005

Personal Care Assistant

Provided comprehensive, quality patient care in the area’s top retirement community

Used acquired formal knowledge and skills

Represent the concerns of the resident and their family

Collaborate with team members towards the development and achievement of optimal resident goals.

Family and Children Services, Kalamazoo, MI, February 2005 – July 2005

Respite Care Worker

Managed small group home-like setting for children 4 – 17 with severe emotional and/or developmental disabilities

Served as role model, encouraged and supported personal behavioral growth and helped develop professional and life skills

Maintained healthy environment, inventoried and ordered supplies, and complied with local and state regulations

Lowe’s Home Improvement, Portage, MI, July 2003 – December 2004

Customer Service Representative

Provided customer service by quickly and effectively processing transactions to ensure return business and customer satisfaction

Informed customers of new items and promotions that were available to improve the customer shopping experience

Completed paperwork, handled cash, answered phones, and transferred calls when needed.

Muskegon Heights Public, Muskegon Hts., MI, September 2001 – July 2002

Office Assistant/ Summer Program Tutor

Answered multi-line phones, greeted customers and performed light clerical work

Acquired high level of communication skills and learned to quickly assess and expedite customer needs.

Ran tutoring sessions on daily basis for elementary aged kids during summer school program

Graded work weekly and tracked individual progress

The concept of civil society remains elusive, complex and contested. There are different meanings and interpretations and, over time, different schools of thought have influenced theoretical debates and empirical research. Civil society is conceived to be an arena of un-coerced collective action around shared interests, purposes and values. As a public sphere where citizens and voluntary organizations freely engage, it is distinct from the state, family and the market. From the above conceptions of civil society, they can therefore be considered as the wide array of non-governmental and non-profit organizations that have a presence in public life, expressing the interests and values of their members or others, based on ethical, cultural, political, science, religious or philanthropic considerations (World Bank 2006, Kaldor 2003, Carothers 2000).

The concept has its origin from the Greek philosophy though some scholars consent that its origin dates back in the seventeenth and eighteenth centuries (Kaldor 2003, John et al., 1999) Civil society also has been centrally linked to the contemporary status of democracy and change in the world. It has been presented as the beacon of freedom, the fountain for the protection of civil rights and of resistance against state repression, the mobilizing platform of society for the protection and projection of substantive interests, the compelling force for state moderation and the epitome of popular struggles and civil power has been a central force in political and economic reforms. The activities and even proliferation of civil groups have been seen by several scholars as vital to the democratization process and its sustenance.

Donor discourse on international development policy now places much emphasis on civil society than in the past. Therefore it would be worthy to note that in practical sense, the boundaries between state, civil society and even market can hardly be defined or drawn (Kane, 2001, Camarrof, 1999, John et al., 1999, Salamon and Anheier 1996). Hyden (1995) further clarifies on the concept by emphasizing that there are variables that determine civil society, these include: basis of social action, nature of state action, nature of political legacy and nature of inter-cultural relations. But above all these, from myriad studies conducted, it is clear that the middle class has on large extent paved the way for civil society especially in fostering democracy.

1.1 Objective

The purpose of this research is to understand reality of civil society in Uganda in relation to the theoretical concept of civil society and to go deep to understand the bilateral functions of civil society in Uganda. This study may be of great use to the policy makers, civil society actors, legislators and researchers who might be more enlightened about civil society in Uganda. In doing so the study will be contributing to the board of knowledge about civil society in Uganda.

1.2 Disposition

This thesis will be organized as follows; the subsequent chapter (two) will present methodology used in this study. Chapter three will present conceptual framework. This will include definitions and the concept of civil society that I consider to be crucial for this study. Chapter four will be about civil society reality in Uganda. Chapter five will be about data presentation and analysis.

1.3 Problem Statement

The past two decades have witnessed a proliferation of civil society organisations and they have made big strides towards improving the interplay between political and economic systems and thus have ensured democratic, participatory and decision making in society (World Bank 2006). NORAD (2003), UN-RISD (2005) present state, private sector and civil society as three separate arenas of development that operate independently from each other. Civil society has been well acknowledged as an important third sector whose strengths have positively influenced state and market and it is an important agent for promoting transparency, responsibility, accountability and openness. Civil society model recognizes functions that are believed to be universally applied in all societies and according to Edwards 2004, World Bank 2003, SIDA 2005, the core functions of civil society include: to protect the citizens’ lives, property and freedoms; monitoring activities of state, central powers and state apparatus; advocacy through articulation of interests of the citizens; socialization through practicing values and attitudes of democracy; intermediation and facilitation between state and citizens; building communities through voluntary interactions that build a bond between members of the society and service delivery in social service sector.

Despite its increased importance and value, civil society in developing world has lingered behind and somewhat not understood. In Uganda, the basic descriptive information about civil society, its size, area of activity, sources of revenue and the policy framework in which it operates seem not to be available in an organized way. There seems to be domination of state and market while civil society structures are superficial and are shadows of the ideal model of civil society (Salamon, Sokolowski and Associates, 2003). Moreover, civil society tend to play a supportive role rather than confrontational or conscious raising roles. A report by NORAD (2002) indicates that the involvement of civil society in policy processes is cosmetic with limited impacts in Ugandan society.

Therefore the actual situation about civil society in Uganda seems not to be according to ideal model of civil society in western societies. The point of departure in this study is to investigate and compare civil society reality in Uganda to the ideal concept of civil society in developed, modern and democratic societies while also trying to understand why the bilateral function of civil society in Uganda seem not to work properly. The purpose of the study therefore, is to investigate, understand and eliminate this discrepancy and comprehend the bilateral functioning of the civil society in Uganda with subsequent benefits derived from it.

1.4 StudyObjectives

The general aim of the study is to investigate the reality of civil society in Uganda in relation to the general concept of civil society. There are a number of specific objectives, these include:

To identify major areas of operation by civil society in Uganda.
To identify the major actors of civil society in Uganda.
To identify functions of civil society
To find out factors that influence State-CSOs relationship in area of advocacy.
To determine whether the Western models of CSOs are applicable in Uganda.

Research questions

How applicable is the western model of civil society in Uganda’s context?
How is the relationship between state and CSOs in Uganda?
In what areas of operation are CSOs active in Uganda?
Who are the major actors of civil society in Uganda?
What are the factors that influence the relationship between state and civil society in policy advocacy in Uganda?
What are the functions of civil society in Uganda
1.5 Research Frontier

The thesis aims at filling an apparent gap that exists since most studies have primarily focused on other areas of civil society like the relationship with political parties, civil society in conflict resolution and in poverty alleviation but little has been written on the civil society reality in Uganda with reference to the model concept of civil society.

1.6 Significance of the study

The study will contribute to the board of knowledge. It will be used as a literature for the future studies related to civil society and state in Uganda.

The study findings can also be used to harmonize the relationship between state and civil society so that they can work for the benefit of citizens in the country.

1.7 Structure

This thesis will consist of 6 chapters. Chapter 1 will be about Introduction of the study. Chapter 2 will include conceptual framework while Chapter 3 will be about Literature review. Chapter 4 will consist of Methodology and chapter 5 will be on Data analysis and results. The last Chapter 6 will consist of Conclusions and Recommendations.

CHAPTER TWO
2.0 Methodology of the Study

This chapter is about the methods that have been used in this study and explains the approaches that will be used in order to understand civil society reality in Uganda in relation to the model of the concept in the western democratic societies.

2.1 Methods

This is a qualitative study primarily based on desk research of available documentations about civil society as well as few interviews from the civil society actors in Uganda. The method used for this study has some advantages and disadvantages.

Advantages include: it saves time that would otherwise have been spent on collecting data. It provided a broad data base more than what one can collect. Secondary data also provided the basis for comparisons of the information about civil society in Uganda with the model concept of civil society in the western societies. Lastly, the author did not worry about the informed consent and human subject restrictions and the method is relatively cheap.

Much as the benefits of secondary sources are considerable, their disadvantages are also identified. There was likelihood of having outdated data. The author had no control over how the data was collected. There may be biases in the data that was already collected by researchers.

In order to ensure reliability and validity of the study, many comparisons between the data were made. This involved checking other sources such as other references and information from highly regarded sites on the internet for instance from World Bank, donor agencies, universities among others. The information used was in line with what was collected from other sources. The information is also reliable in a way that it was collected from government documents and other sites mentioned above. The information was valid since the findings relate to the issues and aim of the study.

2.2 Type of study-Case study

A case of Uganda will be used. Goerge and Bennet 2005:18 define case study “as well-defined aspect of a historical episode that an investigator selects for analysis, rather than a historical event itself”. Case study is one of the several methods used in conducting studies in the area of social science, psychology, political science and it has the following advantages:

It will be used in this study because of its high possibility or ability to achieve high conceptual validity. In other words, the researcher is able to compare, measure and identify which indicators best correspond to the concept. It has also been chosen because it helps to understand a variety of intervening variables and makes it possible to single out conditions in a case that trigger out causal mechanisms. However, case study method has a weakness of selection bias. In other words, there is a possibility of overstating or understating the relationship between independent and dependent variables (ibid)

2.3 Data collection

The nature of the study requires drawing lessons from multiple sources. Therefore, in undertaking this, it is proposed that a wide range of data collection methods should be used, both primary and secondary sources of data. The methods will capture qualitative data. The method will provide flexibility in data collection through triangulation of different research methods. This approach will also assist in cross checking information.

2.4 Primary Sources of Data

Different stakeholders will be targeted since they are able to provide valuable insights on various issues of the interest of the study. Among the specific methods that will be used to collect primary data will include:

Semi-Structured Interviews

Semi-structured interviews will be used with key informants in Uganda such as Civil Society actors. Interviews in this regards will be very helpful as they will deal with more detailed perceptions and experiences. The researcher intends to have deep and rich interaction with key informants in order to understand various issues pertaining to the various opportunities and challenges that Civil Society Organizations face. In all cases, confidentiality of sources of information will be ensured to allow for discussion of more sensitive issues.

2.5 Secondary Sources of Data

Relevant literature pertaining to issues under investigation will be collected from the various sources including government documents about CSO and official reports from various sources, including published books, journals, and other relevant materials will be consulted. Internet resources shall also be used to access relevant information as well.

Combining various methods of collecting data will enrich the whole study as each method of collecting data will capture a specific angle of the issue in consideration. Furthermore, different methods tend to have weaknesses when used in isolation, so combining various approaches will enhance chances of getting more reliable information upon which inferences will be drawn.

2.6 Sampling procedure

A non probability sampling strategy will be used, that is, Purposive sampling. This type of sampling will be used because it is helpful in targeting and getting views from those people who are perceived to be well vested with issues of civil society and policy advocacy in particular.

2.7 Data Analysis

Qualitative data from semi-structured interviews will be analyzed using qualitative techniques such as thematic analysis. This will be used because it is highly inductive and will help in understanding more about civil society in Uganda. Another advantage is that the researcher does not impose themes but rather themes are generated from the data.

2.8 Secondary and content analysis

Secondary analyses in this case regard to the studies that are taken from historical data as well as informational materials that exist beforehand but analyzed by other researchers which can be used as sources for new research or study under investigation (Goerge and Bennet, 2005). This will be used in this study on civil society in Uganda in relation to the model of concept of civil society in developed world.

2.9 Content analysis

This is another approach if used properly enables research problems to be identified both qualitatively and quantitatively. Three basic requirements used in this method include. First, the author should be objective, in other words he/she should not follow their instincts or the way they see materials but should follow an objective approach of representing the materials. In this study this will be followed and done. Second, is the exclusion and inclusion of the content. This implies that the author in some cases has to include or exclude some contents much as it can be useful or useless for the study (Mikkelsen, 2005). This has also been applied in this study in order to ensure coherence.

2.10 Materials used

Materials used in this study were obtained from already published books, articles and journals. Additional materials were obtained through the internet via various data bases that include: ELIN, LIBRIS, Google scholar. Official government websites were also used as well as other reputable sources like official website of the United Nations, World Bank, academic institutions and think tank organisations were also used.

Other relevant information about civil society in Uganda was obtained from the news paper publications of The New Vision, The Daily Monitor and The Weekly Observer and bulletins from civil society organisations in Uganda.

2.10.1 Evaluation of the sources

When dealing with sources which normally present different views from different authors, it is important to remain unbiased while using them as the source of information for the study but students normally find it very difficult to deal with. In order to evaluate the sources this study will base on the set of methodological rules of simultaneity, genuineness, independence and tendency.

2.11 Previous Studies on Civil Society

Several studies have been conducted and many authors have written a lot about civil society. Kaldor Mary (2003) a school professor on Global civil society at London School of Economics in her article “Civil Society and Accountability” highlights the issue of trusting civil society groups in regard to giving the voice to the marginalized. She further sheds more light about moral accountability and procedural accountability referring civil society groups being accountable to the people they serve and accountability as internal management respectively. She finally elaborates on difference between Non-Governmental Organisations and civil society by indicating that the former is a subset of the latter.

John Keane, a re-known scholar and a Professor of Politics at the Center for Study of Democracy, university of Westminister. He has published many books and articles on civil society, democracy and politics. He has collected myriad samples about what writers have produced on the subject of civil society especially writers in Europe. In one of his books “Civil Society and the State, New European perspective”. He clarifies on distinction between state and non-state realm of civil society. He further coins out why the distinction which was important in the first half of nineteen century but later lost trace (Keane, 1988).

Hyden Goran a professor of political science at the University of Florida. He has published a lot on governance, politics and civil society. In one of his books “Assisting the growth of civil society. How might it be improved?” he analyses various literatures on civil society and supports the idea that civil society is an important tool that has been directed at promoting democracy in societies which are under dictatorial regimes. He further points out that in many cases external support is meant to complement the efforts of transition from despotic rule, but rather, the strengths of civil society depend on the domestic social forces of a certain country (Hyden, 1995).

A study conducted by World Bank, (2006) elaborates that increase in conflicts in 1990s contributed to a focus on civil society as key actors in peace building initiatives and hugely contributed to massive increase of civil society sector. The study also points out that the presence of civil society does not simply result to peace building, but rather, proper understanding and analysis of civil society functions, validity, scope and content are paramount to peace building initiatives.

CHAPTER THREE
Conceptual Framework of Civil Society
3.1 Defining Civil Society

Different scholars define civil society differently. Some scholars define it broadly while others define it in specific or narrow terms. For instance Carothers (2000), Kaldor (2003) define it in specific terms as “a domain parallel to but separate from the state realm where citizens associate according to their own interests and wishes” (Carothers, 2000:1) and Kaldor, (2003) defines it as an associational sphere between state and family aggregated by organisations which are detached from the state and they are formed by society members voluntarily to guard and preserve their values and interests. From the above definitions, there is a common thread in which all authors depict civil society as autonomous from state and market. Further, there seems to be a consensus among the definitions on the term civil society signifying that it is an arena or sphere made up of different or a collection of groups amalgamated together with the a common shared purpose, values or interests. Is this amalgamation of different groups harmonious? It seemly unlikely to have a harmonious relationship between these groups because they have different interests, values and their social fabric is totally different. Therefore to belong to one sphere or dome and have same reasoning, tolerance among each other and advance one goal as civil society sector might remain a myth not a reality.

However, some scholars define civil society broadly to mean that it goes beyond being an arena between state and family. For instance Centre for Civil Society goes further to mean that civil society does not only mean a sphere outside state and market but even its boundaries in between them can never be drawn and therefore very ambiguous and Shauder et al., (2003) portray it as an all-inclusive term often used to mean social structures and interests further than household and outside the state institutions, including voluntary associations and non-profit organizations where people mingle for their collective interests. It would be argued that by making civil society all-inclusive like what Shauder et al argues above, renders it more ambiguous because like it was earlier argued, merging different groups of different backgrounds clearly makes civil society mysterious concept.

There is another category of scholars who define civil society in a broad way for instance Cohen and Arato (1992), Michael and Edwards (1996:1) look at civil society as not only a sphere of charitable links and informal networks in which groups and individuals come together to participate in activities of public importance but also is a realm of private voluntary association, from neighbourhood committees to interest groups and philanthropic enterprises of all sorts.

According to the definitions above, civil society is consented as a set of voluntary and not-for-profits associations sharing same interests. This is not far from what has been defined by afore mentioned authors but the difference here is that Shauder et al broaden the definition to imply that civil society goes beyond household and state while Cohen and Arato include an aspect of “charitable links” and “informal networks” to the definition, to some scholars it is a mixture of formal and informal and perhaps that why its boundaries are unclear. These links and networks as commonly known are horizontal linkages/networks and vertical linkages, that is, a connection of groups in a same category and connection of groups in different categories respectively. These different points of view clearly depict the term civil society to be an imperceptible concept which many social scientist have come up to conclude that it has no universal definition and therefore difficult explain due to its vagueness.

It becomes different from what Parnini (2006:4) defines it as the “totality of groups and individuals in a country who show a regular concern for the social and political affairs in that country without fulfilling the function of political parties”. Closely related, in his writing, Hyden, (1995:3) defines civil society as “the political realm, specifically the means and processes through which citizens shape the character of political life in their country”.

All the definitions above portray civil society as a sphere made up of myriad individual groups and associations, but other scholars like Hyden bring in an aspect to show that civil society is a ‘political realm’ which becomes quite different from what other scholars or authors who believe that civil society is rather public or social realm. This sparks further debates; hence the term has become a centre of both political and academic discourses all over the world. It becomes an elusive term because what Parnini explains above signify that civil society cares more about what government should do to suit the interests of citizens but does not play the role of political parties, yet to some scholars, political parties are part of civil society and if anything there are some civil society actors which play the same roles as political parties; a case in point is the role of mobilizing citizenry. This role is played by actors like church, community based organisations or even non-governmental organisations.

The working definition for this study is thatcivil society is an amalgamation of both human and associational activities that operate in a non-restrictive, open to everyone sphere without involvement of the state and market. It is a dome where people express their interests and ambitions but with pull factors based on common goal, values and customs.

3.2 The Evolution of Civil Society concept

The contemporary term ‘civil society’ has its origins in the early modern period in the seventeenth and eighteenth centuries, however, Kaldor (2003), points out that the term has its origin from Greek political philosophy. This is not far from what John and Comaroff (1999) noted that the term became prominent in the late eighteenth and early nineteenth centuries in the period of modern European state formation, when it was used and explained by Ferguson, Kant, Hegel, Marx and Tocqueville. It is further argued that apart from being used by Gramsci, however, it did not thereafter dominate western political theory until recently (ibid). Kaldor (2003) further indicates that it has been narrowed in 20th century into forms of social contacts that are separate from both the state and market.

There is a commonality in which different authors above perceive the genesis of civil society. This implies that the concept itself was in existence though dormant before seventeen and eighteen centuries but civil society activism became prominent at a point in Europe when most societies sought to have a modern state. Thus modern state formation phenomenon in Europe was envisaged to have a civil society which would play an important supportive role in fostering democracy as part of the means of transforming societies from authoritarian rule. What should be known at this point is that civil society was brought in as one of the ingredients for democracy just as Hyden (1995) clarifies that civil society was a vital step towards the direction or realization of modern and democratic society.

The most recent usage the concept of civil society has been distinguished into three versions: the ‘activist’ version which emerged in 1970s and 1980s especially in Latin America and Eastern Europe which referred to the idea of a area outside political parties where individuals and groups aimed to democratize the state, to restructure power, rather than to capture authority in a traditional sense (Kaldor 2003). It is imperative to note that different versions were perceived differently by different scholars. In the first version (activist), the situation in Latin America and Eastern Europe compelled the need for civil society because there were military dictatorial regimes and totalitarian communist rule respectively. It seems the term was dubbed ‘activist’ because it was quiet hard for the common people to change governments in these regions, so what people did was to devise means of removing the government through formation of active groups independent of state which would change the relationship between state and societies (ibid)

The ‘neo-liberal’ version which Salamon and Anheier (1996) argue, is connected with views of ‘third sector’ or ‘non-profit’ sector that was developed in the United States where there are groups or associations that were not controlled by the state or even the market, but were important with potential of facilitating the operation of both. It is argued that this version was taken up by Western donors in the early 1990s because CSOs were needed to mitigate against the shocks associated with Structural Adjustment Programmes, to provide social safety net and foster good governance. It should be remembered that when SAPs were introduced by Bretton Woods institutions, governments were forced to cut on spending on public services, in so doing, civil society was to come in and bridge that gap as well as help in fostering good governance.

In comparison with the first or ‘activist’ version, it is observed that in the neo-liberal version came with the element of minimizing the role of state by checking the abuses and practices of the state just like what Kaldor had earlier alone argued, this version is linked with the ideas of social capital and trust of Robert Putman and Francis Fukuyama respectively. This differs from the first version of ‘activist’ in Latin America which mainly hinges on conscientization of the poor and breaking the culture of silence the ideas of Gramsci and the inspiration of liberation theory. The overall difference between these two versions seems to be that neo-liberal version has an element of endorsing the western way of governance just as Salamon and Anheier had earlier indicated that it was developed in United States; while the activist version aims at emancipation and enhancement of human rights and justice but both have a commonality of being western-driven.

The above versions are in contrast with the third version of civil society ‘the post modern’ which asserts that the ‘activist’ and ‘neo-liberal’ versions are a Western discourse. Post-modern version criticizes activist and neo-liberal versions because there is exclusion of civil society actors like religious groupings and organisations which are based on kinship, they are sidelined and considered as traditional, that is why John and Comarrof (1999) clarify on this by arguing that there should not be ‘good westernized civil society and bad traditional un-civil society. Therefore, here, we should ask ourselves, is there bad and good civil society? The answer is no and yes, but in order to be rational, the definition should include all the categories mentioned in the activist version (social movements), neo-liberal version (third sector) and post-modern version (traditional and religious groups).

The western concept of civil society has largely strayed from its original meaning and role where NGOs are considered as the same as civil society. The terms ‘civil society’, ‘NGOs’ and the ‘non-profit sector’ have been regarded as the same by western donors since the early 1990s (Parnini, 2006:4). However, it can be argued that a full understanding of civil society has more than what NGOs does because civil society is a public sphere where non-state actors are mingled together. It has to include social movements that promote emancipation of poor and excluded, it has to include social organisations that protect and promote the interests of members, and it has to include nationalist and religious groups that foster empowerment of national and religious groups respectively. Therefore, it is rather a combination of all these actors that a coherent and robust collection can act together in order to bring transformation in society.

Nevertheless, Kane (2001) observes, civil society can be fostered through taking part in participatory activities ‘through grassroots organisations, through se

CASE WORK ASSIGNMENT:

CASE STUDY

INTRODUCTION:

“Social casework is a method of helping people individually through a one-to-one relationship. It is used by professionally-trained social workers in social work agencies or organizations to help people with their problems of social functioning. Problems of social functioning refer to situations concerned with social roles and their performance. (Mathew 1991)”.

INTRODUCTION OF AGENCY:

Vinimay trust is situated in Koperkharaine, navi-mumbai (Maharastra State). Established in 1981 and registered in 1989. It is a social work organization [NGO] working for under-privileged children and youth staying in, and emerging out of, child welfare institutions. It is an organisation which run and managed by volunteers. Today it has more than 250 volunteers. It is working for children and youth welfare. It has a 3 storey building in Koperkharaine name Tarun Sadan, where the boys stays It is primarily working for child welfare and youth welfare.in child welfare it arranged the many activity, like birthday celebration, organising games games and picnic and various event in different child welfare homes that comes under the child welfare department in Mumbai, beside this it does youth welfare activity as rehabilitation of the boys through a facility of lodging, saving and various programme, which helps them to fit themselves in the larger society. The boys here come from various child welfare institution with various background they need various support through the government, through the society and Vinimay trust is just an experiment of that. It is fair to say that the flaws in the child welfare institution, leads to the creation of these type of institution. There are not so many after care institution in Mumbai and in these type of scenario, Vinimay trust took a step forward toward a just society. There are capacity for 52 boys in the Vinimay Trust who stay there for three years from the date of admission and this process is going on since its establishment Though these boys have no identity and address proof or other documents which are very critical for living today and in the lack of these basic documents, they have to face several hurdle in the life So the boys who come here must have to open their bank account, Aadhar card, pan card, voter card within six month from the date of admission here. Though Vinimay trust do these work and for that the local government body play a pivotal role in the process.

CASE STUDY:

I have selected the case of Gajanand for the assignment. Though he was new to Tarun Sadan. Usually boys there played cricket, watching TV in group. Prima facia he was also in the group but never talk much to anyone. Within three month he ran away four times four times from the Tarun Sadan. Though his background, that were written in the file of Tarun Sadan and that information itself come from previous institution says that he has experience of running away from home and from some institution. He is employed but he didn’t go to job regularly and he left the job thrice.

GENERAL INFORMATION:

NAME- Gajanand ( name has been changed for the purpose of confidentiality )
SEX- Male
AGE- 18
EDUCATION QUALIFICATION- 6th
RELIGION- Hindu
Name of the child welfare institution– David Sussane Industrial School
Family information- no family information
Date of admission in Tarun Sadan- 5/04/2013
Mother’s name- no information
Father’s name- no information
Skill– 6 month fitter course from Maharastra State Board of Vocational Examination in June with First class.
Harmful habit- Tobacco

Job detail

Current employment- Tayyar Ho. K, Juinagar
Position- housekeeper
Monthly salary-8500
Earlier Employment Detail- Anand Hotel, Koperkharaine

Life history

He was living with his family but he didn’t know about them. He ran from his home with his friend but he missed his friend somewhere in the train. His native place is Islapur, Nanaded. He think his family is living in his native place. He went to Pune once to meet his uncle but he took him at Sarva Seva Sangh 0rg. He also ran away from this organization.

WORKING WITH INDIVIDUAL- STAGE INVOLVED:

There are seven stage are involved while doing casework with individual. These stage are as follows:-

Engagement
Assessment
Planning
Implementation
Evaluation
Termination and
Follow-up

TOOLS AND TECHNIQUES:

Listening
Observation
Interview
Home visits
Relationship

TECHNIQUES:

Acceptance
Assurance
Facilitating Expression of feelings
Encouragement and Reassurance
Being with the client
Emotional support

In my field work there are very large scope of doing the casework study because its work for institutionalised people.

First stage is Engagement in which there is a systematic study of client, his/her situation related to his or her problem. In this process, I collect information like what is the problem with the client and what can be the associated problem can be arise with the problem. Though the first step is the most difficult step for any individual. How to interact, how to build rapport with them, how to make him free to speak up. When I first met with my client, it was confusing moment for me. As I tried to talk to him, when I says hey bhai, idhar aao, he looked at me and ran away from there and all the boys who were playing cricket there, laugh at me. After that whenever I tried to talk with him, he didn’t respond me appropriately as if he was fearing from me. He never looked at me properly but when I went to nearby park with some other boys of Tarun Sadan, I took him also and that trip was the ice-breaking between us. During the process of engagement I used several tools and technique on various occasion. The basic tenant for any social worker is acceptance and listen to them, what they are saying. In this stage I used listening, interview and observation by using almost all the technique. Earlier the client was not talking to me but through these techniques, it create an environment there where he feel comfortable and then my interview take place. Though it was not a onetime interview, it was an ongoing process. There I observe some behaviour in the client and that is

Being introvert
Shy
Not speaking to most of the boys
Not doing the job properly
Some little Memory of his family
Strong determination to go to his family
Individually tried to trace his family
Bad memory of child welfare institution
Not good perception on women
But he was very humble when he became familiar with me
He didn’t complain too much about anybody
No girlfriend and not focused on that
Says he will marry as their parents wish

In second stage, it includes assessment, which aimed at finding answers to three major questions: what is the problem? How it has arisen? What can be done to solve it? The need of social assessment is that of making a conceptual picture of the problem, which will help in deciding the action plan. It is the need to understand the structure of the personality and factors influencing and obstructing personality development. In this stage I figured out various incidents impacted his believe system and a strong attachment to his memory of his family. He ran away from his home, from Pune and from Tarun Sadan. The factor leading to leave his home was just a flow with his friend but after that he realised that what he is missing and that familiar care and support, that attachment to his family. Though the time he left his home he was 8 years of the age and he has little memory of his home. Only he know is his village and some memory of the station where he catches the train from his home. But one thing is clear is that due to his inner urge to go to his family leads to various other situation where he is not loving his job, running away from Tarun Sadan and being shy is a product of that. Though he stays with three room mate who has family in his village and other has sister, so this repeated expression of the attachment to the family of his roommates also forced him to think about his family.

Through during almost every process I used all the techniques that written above and regarding tools except home visit I used all. So the major problem I found in his situation is that

Familiar memory
Psychological support
Lack of confidence
Not believing on others
Fear of unknown
Hesitating to talk with other

Third stage is planning in which worker should make the plan for proceeding the case that how they proceed and how they start. So, my planning was

Counselling support
Tracing his family
Create an environment where he feels comfortable and doesn’t hesitate to talking with others
More engage in jobs and recreation activity
Try to search a better livelihood option for him

Though in my case assessment, planning and implementation overlap many a times. In some cases what I understood about my clients some aspect of his behaviour earlier was changed after some incidence. I am just giving an example of him is that when I first though that it’s his laziness that why he is not wanting to go to job but with rigorous engagement and analysis of the situation it came that it was his obsession for his family that captured his mind so much that he doesn’t think beyond it. So earlier what I planned changed as I came up through new aspects.

Fourth stage is Implementation or intervention in which there are the helping activities for the client known as intervention. This step has to blend with the plan of action following social assessment. There are many ways through client can be helped like assistance in terms of emotional and concrete support, material things like money, articles, medicines etc. non-material resources like information and knowledge, by bringing change in human and physical environment and through counselling to facilitate change in the feeling, thinking, knowing, speaking and doing behaviour of the client. In this stage I implements all the plan that I took, as tracing the family, counselling supports, better livelihood options etc. though in the Tarun Sadan there is facility of Counselling by a NGOs Disha Kendra. But he didn’t go to that session regularly and also he speak not too much there. In nutshell according to him “ye sab chutiappahai”. I took several session with group and individual on self-assessment and motivation. Whenever I interacted with him I tried to give some input of thinking in him and make him aware of many reality.

I tried to trace his family, I discussed with my field work superintendent on this issue, how to trace his home though he has experience of tracing many boy’s family there. Still I didn’t able to trace his family, though several fact which are needed to correlate and understand the real fact is really a hard and time consuming job. Once again I blame the time but I know blame is not outside its inside me. Regarding the livelihood option I went through several processes of finding the jobs and contacting many agencies that provide job. Still I am in the process of implementation.

Fifth stage is Evaluation in which we look at the result that we can achieve our goal or not? Till this stage I couldn’t reach. The implementation part was so long and the time that I spend on the case work was not too much for me to finish this case work. Though I used to evaluate myself on the fact that either I achieved the task that I took. Though in my case I evaluate my own approach and where I am going every day whenever I interacted with my clients. Though final evaluation didn’t taken place.

DILEMMAS:

As a social work student who has to discuss things about my client to supervisor had dilemma regarding the how can I ensure the confidentiality.

RESISTENCE:

There were lots of resistance which was actually improved through communication, rapport-building & home-visits.

Transference and counter transference was not observed.

According to the World Health Organisation, most developed world countries have accepted the age of 65 years as a definition of “elderly” or older person. (WHO: 2012) However, in the UK, the Friendly Societies Act 1972 S7(1)(e) defines old age as, “any age after fifty”, where pension schemes mostly, are used, it is usually, age 60 or 65 years for eligibility. (Scottish Government: 1972) The term ageism, is defined as process of discrimination and stereotyping against people because of their age. Around a quarter of older adults in the UK, report having experienced age discrimination. (Age Scotland: 2012) It affects many institutions in society and has a number of dimensions, such as job discrimination, loss of status, stereotyping and dehumanization. Ageism is also about assuming that all older people are the same despite different life histories, needs and expectation. (Phillipson: 2011)

The policy, All Our Future also (Scottish Government: 2007) indicates that over the age of fifty, is a stage where life circumstances start to change in ways that can be significant for the future. An example of this can be; children leave home, change in working patterns, people have less work and more time for themselves. In addition, from fifty onwards, this can be a time when physical health may deteriorate, causing possible health problems, such as, osteoporosis, osteoarthritis or coronary heart disease. What is more, the state of general health overall, decreases substantially, people face changes in appearance, their physical state deteriorates and they are not as fit as they used to be. Surely, this must be difficult to accept! However, ageing can also cause some psychological effects, such as, changes in memory function, a decline in intellectual abilities, or even memory loss. As a result of a degenerative condition of brain’s nerve cells or brain disorders, many people may develop dementia, Alzheimer or Parkinson disease. Wilson et al. (2008) who draws attention to physical, biological and psychological effects of the ageing, pointing out that ageing is not itself a disease, but some specific diseases may be associated with this process.

Older people are a group that used to be in a marginal concern in the social work profession, but has recently moved to one of central importance. (Phillipson: 2011) This is caused by the remarkable speed of demographical change. The number of older people is increasing, both in absolute numbers, and as a proportion of the total population. The ageing of the population indicates two main factors: the downward trend in the birth rate, and improvements in life expectancy. (Phillipson: 2011) In Scotland, in 2010, there were an estimated 1.047 million older people age over 60, with older people being one fifth of the Scottish population. (Age Scotland: 2012) In the last hundred years, Scotland’s life expectancy has doubled from 40 in 1900, to just over 74 for males, and just over 79 for females in 2004. By 2031 the number of people aged 50+ is projected to rise by 28%, and the number aged 75+ is projected to increase by 75% (Scottish Government: 2007) This issue requires to be deeply analysed in terms of how society will be able to respond effectively to the complex needs of older people.

This part of the report takes into account the socio-political context of the welfare policy. Social work underwent fundamental changes from the 1960s, following broader ideological, political and economic developments. To understand the current role of social work within society and wider policy framework, particularly with older people, it is important to analyse the past that has reflected on contemporary practice. By the 1960s, more attention was beginning to be paid to the social consequences of capitalism, that started to be seen as the economic order of an unequal and unfair society. The strong critique of that system is known as radical social work, that grew on the ideology of Marxism. (Howe: 2008) The publication of the Kilbrandon Report (1964) consequently led to the introduction of Social Work (Scotland) Act 1968. This embedded social work firmly within the state sector, with the voluntary sector as complementary. (Ferguson & Woodward: 2011) Social work wanted to be seen as a unified profession, that offered generic services, to overcome earlier fragmentation and overspecialisation of services. Social workers were obligated by law, to assess needs and promote social welfare by providing services. However, the government of Margaret Thatcher began to weaken the state welfares responsibilities to help people in need, leading to the major ideological shift in 1980s called neoliberalism. As a result, the Barclay Report (1982) intended to clarify the role and task of social workers employed within statutory or voluntary sector. The later Griffiths Report (1988) was similar to Barclay Report, in terms of promoting greater choice, participation and independence of the service user and carers. However, neoliberalism undermines the role of welfare professionals, allowing the rich to become richer, and marginalise the poorest and most vulnerable individuals. (Ferguson & Woodward: 2011) Woodward and Ferguson (2011) argue that the neoliberal trend has been continued under the new labour government, leading to managerialism and bureaucratisation. Therefore, contemporary practice is drawn by extreme pressure of marketisation and managerialism, leading to a profession dominated by stress, frustration and strongly focused on meeting deadlines. The labour government has also been driven by the developments associated with consumerists ideas, such as, personalisation that places the service user at the centre of service design and delivery, or direct payments that emphasise independence and individual choice, through giving service users their own money, to buy their own services. (Woodward & Ferguson: 2011) For a long time, neoliberal economic and social policies in the UK speculated a very different concept of what social work should be about. The Changing Lives report of the 21st Century Social Work Review (Scottish Government: 2006) has brought a significant shift within social work polices, through an expression of dissatisfaction of social work, that was mainly caused by a lack of opportunity for relationship based working with service user. The policy has reshaped the profession, providing social workers with additional space to develop good social work practice. There have been initiatives to improve recruitment, and increase professionalism and standards within the workforce, as well as improve integration in the planning and provision of social work services. (Scottish Parliament: 2008) Integration has been developed through Modernising Community Care: An Action Plan (1998) and Community Care Joint Future (2000) that introduce Single Shared Assessment (SSA). In Scotland, Joint Future is the driving policy on joint working between local authorities and the NHS. The other key policy themes are personalisation, self-directed support, early intervention and prevention as well as mixed economy of care. (Scottish Parliament: 2008) Another significant report that brought about change in policy, and later, in Scottish legislation, is the Sutherland Report (1999). This provided free personal and nursing care on the basis of assessed needs. (Petch: 2008) The above review of social work policies framework, is a good illustration of the constantly changing role and function of social work. Social work operates within the wider context of a constantly developing policy, ideology and legislation. The reality and ideology has changed people and society to face a new challenges. Social work makes a key contribution to tackle these issues by working with other agencies to deliver coordinated support to increase the wellbeing of older people.

In terms of needs and issues when working with older people, the first thing to consider is the partnership of health and social care, especially within areas such as: assessment, care management, intermediate care and hospital discharge. The main problems are, tight budgets, resources and reconciliation of financial responsibility between bodies. Which always raises dispute who should pay for services? Wilson et al. (2008) stresses the importance of rationing services in social work, due to a low budget, which leads to delays in provision of services, and lack of time to develop more creative forms of practice. This causes unnecessary delays and constraints. One might expect that new Integration of Adult Health and Social Care Bill (Scottish Government: 2012) will resolve these problems by the joint budget and equal responsibilities of Health Boards and Local Authorities.

The next issue is the assessment and intervention process, that are seen as balance between needs and resources, evidence and relationship based practice. It can be an issue to find appropriate resources that will meet the needs of the individual. A major element during assessment is the relationship with service user, and that the appropriate methods of communication are adopted to identify the needs of older people. The practitioner must take the time to get know the older person and resist pressure from other professionals to do a quick assessment. (Mackay: 2008) In social work there is constant need to utilise evidence based practice on the grounds that it is empirical knowledge which guides the decision making process, such as three stages of theory cycle (Collinwood & Davies: 2011) There is no doubt evidence based practice is important, but this view may undermine relationship based practice, which is equally important. Rightly, Wilson et al. (2008) refers to relationship-based as a main feature of social work practice, that shapes the nature and purpose of the intervention. It is a unique interaction between the service user and the practitioner, that helps to obtain more information and define the best way of intervention.

The problem of autonomy and protection is another factor in the relationship when working with older people. This raises the question of capacity, consent and the deprivation of liberty of older people. This group of service users is often a subject of legislation that deprives their human rights, this is because they are likely to be affected by cognitive disorder such as dementia. The term dementia, includes Alzheimer’s disease, vascular and unspecified dementia, as well as dementia in other diseases such as Parkinson’s. It has been estimated that in the UK the number of patients diagnosed is 821,884, representing 1.3% of the UK population. (Alzheimer’s Research Trust: 2010) The assessment of incapacity or mental disorder is not straightforward and proves ethically and morally difficult for both service user and social worker. Social workers have to manage the balance between acting in accordance with the wishes of the individuals, and what is in their best interests. It has been suggested by policy and legislation that the views and wishes of people expressed through self-assessment would remain at the heart of intervention. (Wilson et al.: 2008)

Another issue is abuse of older people, which may have many forms, and can be very severe in extend. Older people are vulnerable to abuse, or indeed, not having their rights fully respected and protected. The problem came to public awareness not as long as few years ago. Despite the fact that legislation came into force through Adult Support and Protection (Scotland) Act 2007, it is estimated that elder abuse affects 22,700 people in the Scotland each year. (Age Scotland: 2012) Older people are a subject of physical, psychological abuse, neglect, sexual or financial harm, that normally takes place at home, in hospital, residential care or day centre. (Ray at al.: 2009)

Age discrimination is next issue one wish to consider, older people are disadvantaged because of their relatively low socio-political and cultural status in a contemporary society. They are repeatedly presented as a drain on resources as they no longer actively contribute to the growth of society. They do not work and do not pay taxes anymore. Older people are systematically disadvantaged by the status they now occupy within society. Wilson et al. (2008: p. 620) rightly suggests that old age is “socially constructed”. A good example of this is retirement, which officially, makes people old and unavailable to work, despite the actual physical and emotional state of the individual.

Other forms of social construction that significantly affect the experience of old age are class, gender, race and ethnicity. (Wilson at al.: 2008) An illustration of this can be the statement that older people have much more in common with younger people from their class, than they do with older people from other classes. (Philipson: 2011) Disadvantages and inequalities, experiences during life can magnified during the process of ageing, through differences in access to health facilities, health status and lifestyle that may influence life expectancy. There is no doubt that experience of ageing is subjective, and depends on many factors, but it seems to be a matter to firstly, consider class, gender and race at the first place. When discussing poverty and inequalities, the points to bear in mind are issues of discrimination of older women, who are less likely to have as great a pension as a male partner, due to the fact many women are paid a lower wage then men. Moreover, women tend to live longer than men, therefore, are potentially more vulnerable to live alone and in poverty. (Age UK: 2012)

There are many forms of disadvantage associated with older people in poverty such as; low income, low wealth and pension, debts or financial difficulties, feelings of being “worse off”, financial exclusion, material deprivation and a cold home. The first three are experiences by around 20% of older people, half of older people experienced at least one of the nine forms of poverty described above, and 25% had two or more. A minority 3% suffered from three or more forms of poverty. (Age UKa: 2012) In terms of ethnicity and race there are significant inequalities in the process of ageing. An illustration of this can be the black community of older people, who are more likely to face a greater level of poverty, live in poorer housing and have received lower wages. In addition, they are more susceptible to physical and mental illness often due to heavy manual work, racism and cultural pressures. (Phillipson: 2011) All these discussed factors must be taken into account when working with the older person.

It can be argued that one of the main needs of older people is the importance of active listening to this group of service users, who are often because of age ignored or disregarded. This is supported by Kydd et al. (2009) who highlights how important it is for older people to feel that they are being listened too. Another important need of this group of service users, is the need to stay at home as long as possible, which is supported by the policy, All Our Future (Scottish Government: 2007) that offers; free personal care, telecare development programme, care and repairs services or travel scheme free bus passes. The policy aims to improve opportunities for older people, foster better understanding towards this group of service users, create better links between generations to work together and exchange experiences. Improve health and quality of life by promoting well being and an active life within the community; enhance care support and protection of older people. Improve housing and transport as well as promote lifelong learning.

The last part of the report identifies policy framework and organisational responses. The discussion about social care for adults began in the UK through Green paper Independence, Well-being and Choice (Department of Health: 2005) and the subsequent White Paper, Our Health, Our Care, Our Say (Department of Health: 2006) these documents set out the agenda for future. This is based on the principle that service users should be able to have greater control over their own lives, with strategies that services delivery will be more personalised than uniform. The contemporary social work is driven by emancipatory issues such as social justice, empowerment, partnership and minimal intervention. (Dalrymple and Burke: 2006) Empowerment theory is the process of helping people gain greater control over their lives. Empowerment is not simply a matter of enabling or facilitating but it involves helping people to become better equipped to deal with challenges and oppression they may face. (Thompson: 2009) On the grounds of empowerment grew the idea of service user participation that came to law in 1990 through NHS and Community Care Act. (Ray et al.: 2012) There is still increasing acceptance that people who receive services should be seen as own experts in defining their own needs. This is in accordance with the exchange model of assessment presented by Smile and Tuson et al. (1993), where the social worker views the individuals as experts of their own problems. The role of the practitioner is to help the service user to organise resources in order to reach goals that are defined by the service user. The Scottish Government’s policies and initiatives addressing to older people, highlights the importance of developing services that focus on maintaining independence, encouraging choice and promoting autonomy, such as; Changing Lives (2006), All Our Future (2007), Independent Living in Scotland (2010), Reshaping Care for Older People (2012a). These policies highlight the importance of service user participation in the process of decision making and intervention. These tendencies of improving choice and autonomy of older people, have resulted in the creation of personalisation and self-directed support programmes.

Personalisation enables the individual to participate and to be actively involved in the delivery of services. Personalisation also means that people become more involved in how services are designed by shaping and selecting services to receive support that is most suited to them (Scottish Government: 2009) The programme directly responds to wants and wishes of the service user regarding service provision. Personalisation consists of a person centre approach, early intervention and prevention, and is based on mentioned above empowering philosophy of choice and control. It shifts power from the professionals, to the people who use services. (Department of Health: 2010) However, it could be argued that approaches which extend to service user control, in realty, can be seen as transferring risk and responsibilities form the local authority to the individual service user (Ferguson: 2007)

Another option, recently promoted by the government, is Self Directed Support (SDS), a Bill that was introduced into the Scottish Parliament last year, and recently has passed stage three. The bill seeks to introduce legislative provision for SDS and the personalisation of services and to extend the provisions relating to direct payments. (Scottish Parliament: 2012a) The SDS approach had been brought into Parliament previously, and was reflected in many reports and policy initiatives such as: Changing Lives, Reshaping Care for Older People. SDS allows people to make informed choices about the way support is provided, they can have greater control over how their needs are met, and by whom. Social workers, working on behalf of local authority, will have a duty to offer SDS if the individual meets the eligibility criteria. The four options to consider are; direct payment to the individual in order that that person will arrange their own support, the person chooses the available support and the local authority will make arrangements for the services on behalf of that person, the social worker will select support and make arrangement for provision, the last option is a mix of the above. (IRISS: 2012) The idea of SDS is a great opportunity for service users to expand their control over which services provided. However, this raises a question of how many people will be ready to utilise option one of SDS. Would an ordinary person, who uses the services, have the skills and knowledge to take responsibility for their own care, for example to employ their own carers, a personal assistant or to buy their own services. One could envisage that it could be possible if the role of social worker changes from care management, to brokerage and advocacy. A potential care broker will provide assistance to obtain and manage a support package, drawing on individualised funding. It can be questioned if social workers who are mostly accountable to local authorities are reliable to perform this task whilst working across three sectors. (Wilson at al.: 2008)

In conclusion, there is a shift from a paternalistic stance of social workers to viewing service user as experts of their own lives. From institutional care, through service led and needs led, to outcomes focus provision. A fundamental part of working with older people is to recognise and respond to the way in which they may be marginalized. This can be achieved by a deeper understanding of the process of ageing, and the issues that older people may face. Working with older people, based on new premises, will be focused on to maximise resources, and the role of the social worker will be transferred from care management to advocacy and brokerage. One may expect that active involvement and participation of older people in service provision will have a crucial role not only by exercising more control and choice but also in challenging social exclusion.

The aim of this assignment is to discuss the strengths and limitations of the social model of disability and how nurses can promote anti-discriminatory practice in relation to people with disabilities. Defining disability is said to be very difficult due to the fact that disability is a ‘complicated, multidimensional concept’ (Altman 2001). Furthermore Slater et al (1974) has gone as far as stating that constructing a definition that would fit all circumstances is in ‘reality nearly impossible’. However attempts have been made by various different people, legislation and models in different ways.

According to Altman (2001) these attempts are the reason why there has been a lot of ‘confusion and misuse of disability terms and definitions’. The Disability Discrimination Act defines a disabled person ‘as a person who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day to day activities’. (DDA 2005) However the medical model of disability sees disability as the individual’s problem and that it should not concern anyone other than the disabled person, for example, if a student who is in a wheelchair is unable to get into the building due to the steps, the medical model would assume that it is due to the wheelchair rather than the steps. Whereas on the other hand the social model would say that the steps are acting as a barrier to the student, therefore the barrier should be removed.

The social model of disability was brought about by activists in the Union of the Physically Impaired Against Segregation (UPIAS) during the 1970s. This model is seen as the main theory which tests disability politics in Britain (Shakespeare et al 2002). The UPIAS argued that there is a major difference between impairment and disability. They defined impairment as ‘lacking part or all of a limb, or having a defective limb, organ or mechanism of the body.’ They have also defined disability as ‘the disadvantage or restriction of activity caused by a contemporary social organization which takes no or little account of people who have physical impairments and thus excludes them from participation in the mainstream of social activities’ (Giddens 2006).

The social model of disability can be defined as an idea that it is society that disables an individual with the way everything is constructed to meet the needs of the majority who are not disabled (Shakespeare et al 2002). Whereas, the social model can be compared with the medical model of disability which tends to focus purely on finding a cure and that to be able to fully participate in society they need to treat their ‘impairment’ (Crow 1996).

The model has several key points. First it describes disabled people as an oppressed social group (Shakespeare et al. 2002) meaning that on top of their impairment, disability is something more deep that excludes and isolates them from participating in society (Oliver 1996). The difference between the impairments that people have to deal with and the oppression which they experience is fundamental to the British social model. Finally, the model defines disability as a form of social oppression, not a form of impairment (Shakespeare et al. 2002). Therefore the aim of the model is to empower disabled people so that they don’t feel as though their condition is the problem, but that society is the problem due to the number of barriers it places on disabled people (Giddens 2006). For example, everywhere you go there will be steps, steps to get into a building, steps to climb floors and it is this barrier which causes problems for disabled people therefore the social model provides a solution saying that ramps and lifts should be fitted in all buildings, the problem of not being able to stand for too long should be tackled by placing more seats in public places. It is barriers like these that the social model aims to find solutions to.

The British disability movement has found great importance in the social model in various different ways. Hasler (1993) describes it as the ‘big idea’ of the British disability movement. For example, identifying a political strategy to remove barriers in society that played a large role in disabled people’s lives, which was also the main strength of the social model (Shakespeare et al. 2002). Examples of barriers that disabled people faced in all areas of life were the inability to access public transport systems due to the fact that a person was in a wheelchair or had visual or hearing impairment, their inability to find work because employers felt that the disabled person was incapable of doing the job, housing problems and so forth (Thomas 2004). The removal of such barriers would mean that if those people with impairments felt disabled by society then by taking away these barriers would help to empower and promote the ‘inclusion of people with impairments’ (Shakespeare et al. (2002).

The model tries to bring about change in society to suit the individuals need rather than taking up a medical view where you try and look for a cure, or rehabilitation (Shakespeare et al.2002). For example, people who have schizophrenia have to take medication in order to live normal lives. However it is argued that the social models complete view of changing society has become too simplistic or rather an over- socialised explanation. Furthermore, Vic Finkelstein (2004) argues that the social model looks at enabling people to be ‘human’ in a society rather than having access to their ‘rights’.

However the medical model of disability has a different perspective. They believe that people with disabilities need to be assessed, that they are incapable of making their own decisions, that they are the problem and that people with disabilities have to be adapted to fit into the world, but if this is not possible then they are placed in specialised institutions or ‘isolated at home’ where only basic needs are met (Rieser, 2009).

A second strength seen from the model was the actual impact on the disabled people themselves. The social model made disabled people feel free as they lifted the view of a medical approach, where the problem was the individual and placed it on society saying that social oppression was the root of the problem. This as a result made people feel liberated and empowered as they were made to believe they were not at fault: ‘society was’, that society was in need of the change: not the individual (Shakespeare et al. 2002). The social model helped to bring disabled people to ‘come out’ like raising feminist consciousness in the seventies, or lesbians and gays ‘coming out’ (Shakespeare et al. 2002).

The social model has played a very important part in many disabled people’s lives, however, despite these strengths to the model there are a number of limitations. Firstly, the social model has been criticised for being unable to deal with the realities of impairment (Oliver, 2004), meaning that the model is not about peoples personal experience of impairment (Oliver, 1996) but about peoples collective experiences of disablement in society (Oliver, 1990).

Another point criticised is that other social divisions such as race, gender, ageing, sexuality and so on are not incorporated in to the social model (Oliver, 2004). However Oliver (2004) that just because the social model hasn’t incorporated these divisions does not mean that they are unable to. Oliver (2004) states that those who criticise the model are the ones who should try and ‘forge the social model into action’ when dealing with issues such as race and gender and age and sexuality.

Cultural values have also been pointed out to be ignored by the social model. There is an argument about the issue of otherness, meaning that it is the cultural views that people hold which place disabled people as ‘others’, not the physical and environmental barriers (Oliver, 2004).

Furthermore, another limitation of the social model is that it clearly neglects and ignores the experiences of impairments and disability which are the main cause of problems in most disabled people’s lives (Giddens, 2006). Shakespeare and Watson (2002) argue that ‘we are not just disabled people, we are also people with impairments, and to pretend otherwise is to ignore a major part of our biographies’. Against this accusation, Oliver (2004) finds it difficult to accept that disabled peoples experiences are not considered because it is after all the main reason why the model emerged to begin with-due to a number of disabled activists in the 1970’s. Furthermore defenders of the model argue that the social model merely focuses on social barriers that disabled people face rather than denying them of everyday experiences due to their impairment (Giddens, 2006).

The social model has been criticised as being ‘inadequate as a social theory of disablement’ (Oliver 2004). Corker and French (1998) talk about social model theorists and then conclude that the social model is not a theory, however Oliver (2004) argues that how can people criticise the social model for something it has never claimed to be? Oliver (2004) states that most people who have developed the social model have claimed that they have said the social model of disability is not a theory of disability.

Leading on from the strengths and limitations, there is a substantial amount that nurses can do to promote anti-discriminatory practice in relation to people with disabilities by maintaining a positive attitude towards people with disabilities as they are constantly involved with the treatment and care of people with physical or intellectual disabilities (Klooster et al. 2009). Nursing schools as like other professions, tend to be based around the medical model of care where they aim to diagnose and treat diseases (Klooster et al. 2009). However as Byron et al (2000) has stated that not all disabled people are unwell and may not have a disease.

Nurses have an important role, like other health professionals, in influencing a disabled person’s response to treatment (Oermann &Lindgren, 1995). Therefore Carter et al (2001) has stated that inappropriate attitudes and behaviours from staff are the biggest barriers which disabled people face, which has led to further research indicating that nursing students should move away from the medical model of care when working with people with disabilities and should focus on a more social model perspective (Scullion, 1999).

Further research has indicated that nursing student’s attitudes towards disabled people may be improved by educational programmes which can help nurses to be in direct contact and to work with disabled people (Oermann &Lindgren, 1995). However, the research literature suggests that this is currently not happening in nursing practice (Klooster et al 2009). For example, Brillhart et al (1990) found that nursing students had more negative attitudes then the person with the disabilities themselves.

Nurses can help to provide clear information as Hammel (2003) states that professionals need to ‘listen to what people are telling them’ and that ‘actions and non-verbal messages can speak very loudly’. Nurses can form strategies to communicate with disabled people in order to make their life easier (Hammel, 2003). However it is common that fewer health care professionals are reluctant to provide services for disabled people as they age (Hammel, 2003).

By providing clear information nurses also involve other people who are important in the disabled person’s life and ensuring that they are informed about options and benefits for the disabled person as well as themselves. Nurses can also act as advocates for disabled people so that they have equal use of services or even provide information of advocacy groups for the disabled person for example Centres for Independent Living (Hammel, 2003).

Furthermore, where young people are concerned nurse can give advice to families about possibilities for independence and can also refer them to community resources that may help young people pursue further education, find a job and live independently (Blomquist et al. 1998)

Lastly the Disability Discrimination Act is a guide for nurses to help them provide better care for people with disabilities and also how they can develop their practice (Aylott, 2004).

There are many aspects with which nurses can help promote anti-discriminatory practice in relation to people with disabilities however, nurses need to keep a positive attitude towards people with disabilities in order for the anti-discriminatory practice to work.

In conclusion for there to be equal rights for people with disabilities, Oliver (2004), states that people spend too much time discussing the strengths and limitations of each model therefore he suggests that both models should be integrated, ideas of both models should be put together and used in concordance so as to actually help people with disabilities. Oliver (2004) claims that ‘if we imagine that throughout history carpenters and builders of the world had spent their time talking about whether the hammer was an adequate tool for the purpose of building houses, we would still be living in caves…’. Therefore there is a hammer in the disability movement and if it was used properly then the social model of disability can become the ‘hammer of justice and freedom for disabled people’ (Oliver 2004).

References

Altman, B.M., (2001). Disability definitions, models, classification schemes and applications. In G.L. Albrecht. & K.D. Seelman, & M. Bury, (eds.) (2001). Handbook of Disability Studies. Sage, California. Ch.3.

Aylott, J., (2004). Learning disabilities. Autism: developing a strategy for nursing to prevent discrimination. British Journal of Nursing, 13(14), 828-833.

Blomquist, K.B., Brown, G., Peersen, A., and Presler, E.P., (1998). Transitioning to independence: challenges for young people with disabilities and their caregivers. Orthopaedic Nursing, 17(3), 27-35.

Brillhart B.A., Jay H. & Wyers M.E. (1990) Attitudes toward people with disabilities. Rehabilitation Nursing. 15(2), 80-82. 85.

Byron M. & Dieppe P. (2000) Educating health professionals about disability: ‘attitudes, attitudes, attitudes’. Journal of the Royal Society of Medicine, 93(8), 397-398.

Carter J.M. & Markham N. (2001) Disability discrimination. British Medical Journal, 323(7306), 178-179.

Crow, L., (1996). Including all of our lives: Renewing the social model of disability. In C. Barnes. & Geof Mercer, (eds.) Exploring the divide. Leeds: The Disability Press, pp.55-72.

Finkelstein, V., (2004). Representing Disability. In J. Swain., S. French., C. Barnes., and C. Thomas, (eds.) Disabling Barriers- Enabling Environments. 2nd edition. Sage, London. Ch.2.

Giddens, A. (2006). Sociology. 5th edition. Polity Press, Cambridge.

Hammel, J., (2003). Technology and the environment: supportive resource or barrier for people with developmental disabilities. The Nursing Clinics of North America, 38(2), 331-349.

Klooster, P.M.ten., Dannenberg, J.W., Taal, E., Burger, G., and Rasker, J.J. (2009). Attitudes towards people with physical or intellectual disabilities: nursing students and non-nursing peers. Journal of Advanced Nursing, 65(12), 2562-2573.

Oermann M.H. & Lindgren C.L. (1995) An educational programme’s effects on students’ attitudes toward people with disabilities: a 1-year follow-up. Rehabilitation Nursing 20(1), 6-10.

Oliver, M. (1990). The Politics of Disablement. Macmillan Press, Basingstoke.

Oliver, M. (1996). Understanding Disability: From Theory to Practice. Macmillan Press, Basingstoke.

Oliver, M. (2004). If I had a hammer: The social model. In J. Swain., S. French., C. Barnes., and C. Thomas, (eds.) Disabling Barriers- Enabling Environments. 2nd edition. Sage, London. Ch.1.

Rieser, R. (2009) The Social Model of Disability [online article]. Available from < http://inclusion.uwe.ac.uk/inclusionweek/articles/socmod.htm> [accessed 6th January 2010].

Scullion P.A. (1999) Conceptualizing disability in nursing: some evidence from students and their teachers. Journal of Advanced Nursing. 29(3), 648-657.

Shakespeare, T., Watson, N. (2002). The Social model of disability: an outdated ideology?. Research in Social Science and Disability, 2, 9-28.

Thomas, C., (2004.) Disability and Impairment. In J. Swain., S. French., C. Barnes., and C. Thomas, (eds.) Disabling Barriers- Enabling Environments. 2nd edition. Sage, London. Ch.3.

In taking the time to observe how sociological and psychological influences may impact on a service user or client group, the social worker can remain mindful of the wider context of a situation and not just take what she sees at face value. This knowledge allows the social worker to remain objective and to make informed decisions in order to maintain professionalism in her work. By applying Sociological and Psychological theory to the ‘Bertram’s’ case study I aim to explore the wider social context, outside influence and psychological implications from the past and present. Through this exploration I will uncover the varying viewpoints and sometimes contradictory nature of these theories. To gain a Sociological perspective on the case study I will be applying Functionalist and Feminist theories. I will be able to scrutinise the Bertram’s current situation and apply the theory in order to gain a wider understanding of the social context. In order to maintain a balanced viewpoint, Psychodynamic theory and Maslow’s hierarchy will enable me to consider the psychological impact with a focus on human and emotional development.

By examining a situation from a Sociological perspective we can take into account how various aspects such as class, social structure, religion, disability can impact people from a wider social context. This is essential in gaining a holistic picture the situation.

Functionalism

By applying a Macro theory to the case scenario it allows us to look at the large scale features of society and how individual actions affect society as a whole and vice versa. Functionalism will enable me to contemplate the structure of society and how the Bertram’s fit within that structure. Functionalist theorists regard society as a system with interlocking parts. It is believed that each part needs to function effectively in order for society, as a system, to work as a whole. It is often rationalised using biological analogy. The social role of individuals is an integral part of the theory. Each person is thought to have their individual role to play within society. From a functionalist perspective it is very clear that Mrs Bertram is not fulfilling her role as a wife. Due to her alzemers she is unable to carry out the duties that would have been expected of her. Durkheim believed that everyone had their place, and a woman’s place was in the home. In the context of the 40’s, 50’s when Functionalism was at its peak, this viewpoint would not have been uncommon, if a little out-dated by today’s standards. None the less, it is not through choice that she has become dysfunctional within society. She has legitimate claim for not being able to carry out her societal role and Functionalism would automatically see her take on the ‘sick role’. This would enable her to function again within the system under a different guise.

It could also be observed that Mr Bertram is a dysfunctional member of society. With his reckless behaviour, his outrageous spending, and the lack of care for his wife’s basic needs he is no longer fulfilling his role of husband. A main proponent of Functionalism was Emile Durkheim (1858-1917). He saw marital vows as obligations. “When I perform my duties as a brother, a husband or a citizen and carry out the commitments I have entered into, I fulfil obligations which are defined in law and custom which are external to myself and my actions” (Durkheim, 1982). He believed that if a member of society was deemed as dysfunctional, then he was considered to be a deviant member of society. Deviance occurs when people are not functioning correctly, according to the ‘norm’. This could be through crime, or anything which affects their ability to carry out their societal role. Deviance needs to be controlled or managed. If it was established that Mr Bertram was in fact deviant then he may need some persuading that by providing the care and attention that his wife needs his wife would not be removed from the situation. Through this resolution, therefore, they would both be able to function appropriately.

It could be observed that Mr Bertram had an alcohol dependency. If this was established then Mr Bertram too may take on the ‘sick role’. In which case a different method for resolving the issues within the house would need to be adopted. Talcott Parsons (1902-1979) believed that sickness was a social concept rather than a biological concept. So being ill meant acting in different, deviant ways to the norm. Being sick was therefore a form of social role (Haralambos and Holborn, 2004). Parsons believed the rights of a sick person to be exemption from normal social obligations, the right to be looked after and blamed for their social deviance as long as they were genuinely sick. Obligations of a person playing the ‘sick role’ would be to understand that they have to ‘get well’ as soon as possible in order to continue their normal function and in order to do this they must receive professional help. Mr Bertram’s condition would need to be treated or managed in order to enable him to function again. In that case Mr and Mrs Bertram would be able to stay at home under treatment and the issues about care could be dealt with accordingly. He would no longer be considered deviant member of society. A criticism of the ‘sick role’ would be that it is very difficult to apply to long term illness like that of Mrs Bertram. It is built on the assumption that the person gain help in order to gain function. This would not be possible for Mrs Bertram.

Feminism

From a Radical Feminist perspective it could be observed that Mrs Bertram has been oppressed by her husband. Through her devotion and his dominance she has succumb to subordination. Radical Feminists use the patriarchal social system as a concept to explain gender inequality. Patriarchy is the dominance of men over women in society. They view men as responsible for the exploitation of women from which they benefit greatly, through free domestic labour, sexual duties and so on. The case study describes how Mrs Bertram was swept off of her feet and totally devoted to Mr Bertram. In their current situation, Mrs Bertram is at home in squalled conditions and desperately in need of help. Mr Bertram is avoiding the situation by using diversionary tactic, selfishly seeking social activity and pleasure through drink. This further increases her oppression as she is fully dependent on her husband to provide the care and attention which she is desperately in need of.

“Shulamith Firestone, an early radical feminist writer argues that men control women’s roles in re-production and child bearing. Because women are biologically able to give birth to children, they become more dependent materially on men for protection and livelihood” (Giddens, 2006). Feminists could argue that for this reason Mrs Bertram has become vulnerable within her setting and just accepts this way of life. Jessie Bernard argued that “Men need marriage more than women” (pg 208 Gender). Perhaps this reliance on the domestic labour, comfort and sexual duties of a wife, which has been lost my Mr Bertram through his wife’s condition is attributing to his behaviour. Mrs Bertram is no longer fulfilling her duties as a wife and this could be disrupting his routine. It would appear that Mr Bertram has never had to control the household, take care of his wife or finances, and may lack the ability or may simply consider it beneath him. It could affect his masculinity to have to carry out such chores and duties believed to be part of a woman’s role. This may also be the reason why he is reluctant to accept help with the situation. He may feel he is being barraged and dictated to by his step daughters which may be resulting in a greater defiance. It is not clear from the case study, the nature of their relationship either. He may feel that family and professionals are undermining his authority as head of the household. Mr Bertram may be compensating for his lack of masculinity at home, by using his social appearance, bravado, drinking and defiance. This time away from the house for him may reaffirm his role as a dominant male within society whilst his dominant role as a man disappears at home. He no longer has command over his wife, no longer gets respect, adoration that he was once used to. Men are considered to have more influence within society; Mr Bertram has no influence over this situation or over his wife.

Part 2: Using the scenario describe two psychological theories that can be used to help your understanding of the service users’ situation
Humanistic theory – Maslow’s hierarchy of needs

Humanistic psychologist Abraham Maslow (1908 – 1970) argued that humans throughout life not only want to have their basic survival needs met they strive for more in terms of personal growth. He believed that once basic needs for survival had been met that human development progressed toward higher psychological needs. He argued that “people are motivated by the conscious desire for personal growth” (Rathus, 2004). Maslow believed what separated us from our so-called lower animals was our capacity for self-actualisation (Rathus,2004). He believed that this self- actualisation was as important as basic needs but could not be met unless other stages of human needs were completed. He organised these stages into the hierarchy of needs, often presented in pyramid format. Each stage must be satisfied in order to progress to the next. At the bottom of the hierarchy are physiological needs. These are the basic human needs we all have in order to survive, like food, water, shelter, oxygen. Once the first basic need has been satisfied, the following stage is safety needs, the need for security. The following stage in the hierarchy is love and belonging; the need to give and receive love, to overcome loneliness and achieve a sense of belonging in life. The fourth stage is ‘Esteem needs’; to feel self-confident, respected and not to feel inferior. Self-actualisation is the final stage in the hierarchy and can only be reached when all foregoing needs are satisfied and the person feels he has achieved everything he wants to in life and is the best that he can be.

In the case of the Bertram’s it is clear that Mrs Bertram is currently not even meeting the bottom of Maslow’s hierarchy of needs. It is noted that their flat is in an appalling state, she is unable to feed herself and left on her own for most of the day. You would expect most of her needs to be met within the context of her marriage to Mr Bertram; however, since he has neglected his role as a husband, he has placed her in a position of significant danger. Since not even her basic physiological needs are being met in the current situation then at present there would not be an opportunity to progress through the hierarchy of needs.

If Mrs Bertram was placed in residential care then her physiological needs would be met. She would have food, water and care of her basic needs. She could then perhaps progress to the following stage of safety. She would no longer be at risk of hurting herself and she would be in a more secure environment. Although it could be argued that for an advance Alzheimer’s sufferer, the unfamiliar setting would disorientate her and she might not actually feel secure there. Because of her diagnosis, Mrs Bertram is unlikely to meet the third stage of ‘love and belongingness’. Her advanced Alzheimer’s may mean that she fails to recognise her husband, family members and have a declining ability to communicate. Mrs Bertram would never reach self-actualisation. The best that could be achieved would be basic survival and safety needs, whether this was achieved at home with the compliance of her husband, or in residential care. Although it could be debated that residential care would not be the best option. As the GP states in the case scenario, “a move to residential care might well kill Mrs Bertram”.

It would appear from the case scenario that Mr Bertram’s basic needs are being fulfilled. However it is uncertain as to whether his s safety and security needs are being met. He certainly would not get a sense of love and belonging from his wife, in the latter stages of sever dementia. I would observe, however, there is some attempt from Mr Bertram to achieve a sense of self-esteem, since he spends the majority of his time with his compatriots at the golf club. It is clear that in this relationship and the current situation faced by the Bertram’s that he too has no way of reaching self-actualisation. Maslow observes that it is mainly social factors that hinder the personal growth of humans. Potentially at least the first two stages of Maslow’s hierarchy could be reached within the context of their marriage, with the right services in place.

Psychodynamic theory

Through the Psychodynamic theory of personality we could speculate about Mr Bertram’s past and how that has influence on his behaviour in the present. It would be difficult to achieve a comprehensive result in regards to Mrs Bertram because of her Alzheimer’s. Since her behaviour is wholly attributed to her condition.

Studying Sigmund Freud’s (1856 – 1939) theories, with a focus on psychosexual development, would be the most relevant to apply to the case scenario. Psychodynamic theory had been developed and evolved over the years. Freud’s idea of Psychodynamic theory depicted humans as largely driven by unconscious motives and desires. He proclaimed that humans come into conflict when their basic instincts come up against social pressure to follow, laws or moral codes. “At first this conflict is external, but as we develop it becomes internalised” (Rathus, 2004). Freud explains the conflict of personality using psychic structures. The id, which Freud believed is present at birth and located in the unconscious mind, and revolves around our basic biological drives and instincts. It operates on what Freud called the ‘pleasure principle’. It demands instant gratification regardless of laws or moral rules. Another feature in the structure of personality is the ego. Formed from the id, developed through learning and experience. This is the part where conscious thought takes place (Beckett and Taylor, 2010). The ego operates on the ‘reality principle’. This takes into consideration what is practical and possible in gratifying needs (Rathus, 2004). When the ego senses improper impulses arsing it can sometimes deploy a number of defence mechanisms. The third psychic structure is the superego. This is formed throughout early childhood and is developed through standards, values, parenting and moral standards. “Psychodynamic theory emphasises the way in which the mind stimulates behavior, and both mind and behavior influence and are influenced by the person’s social environment” (Payne, 2005)

Freud believed there were four stages in psychosexual development. The first stage took place during the first year of a child’s life. This is known as the ‘oral’ stage. Much of the child’s development is explored by putting things into the mouth and sucking, biting chewing. Freud believed it was possible to have arrested development through trauma. And be fixated on one of the stages. From the case study we could surmise that Mr Bertram is fixated on the oral stage of psychosexual development through his ‘drinking’. We could speculate that he may have had a significant trauma at that stage which has left him with a possible alcohol dependency, thus fixated on the oral stage.

It could perhaps be identified that Mr Bertram is using psychological defence mechanisms in order to avoid the situation that he is currently facing.

Part 3: Reflect on your own background describe it and indicate 1 sociological and 1 psychological theory that can be applied to you, giving examples

The relationship I have with my father has often been fraught, difficult and tense. As a sufferer of a severe mental disorder, my father has often displayed irrational, delusional, paranoid and sometimes violent behaviour. Throughout his life he has had frequent hospitalisation. For me this is something I have grown up with and am used to dealing with on a day to day basis. I am acutely aware of how our relationship differs to that of my friends for example. I have as close a relationship as possible with him, and to that end I usually bear the brunt of his paranoia and aggression when he is unwell. I have witnessed first-hand the stigma attached to mental illness. I find it extremely difficult to trust anyone enough to tell them about the situation, and I strongly feel I shouldn’t have to tell everyone that meets him, this only leads to labelling him as mentally ill, thus changing the way in which they treat him; which only compounds his paranoia.

Some Sociological theorists believe that mental illness is a social construction in order to rationalise bizarre or irrational behaviour that cannot be in any other way explained. This is known as labelling theory. Scheff (1966) argued that people are labelled as mentally ill because their behaviour does not make sense to others. “Scheff points out that labelling of a person as mentally ill is facilitated by stereotyped imagery learned in early childhood and continually reaffirmed, inadvertently, in ordinary social interaction and through the mass media. Thus, when a person’s violation of social norms or deviance becomes a public issue, the traditional stereotype of “crazy person” is readily adopted both by those reacting to the deviant person and, often, by the deviant person as well” (Lamb. 2002). Erving Goffman suggests that when someone is labelled as mentally ill then they are treated differently. When an interaction takes place with that person it is with this knowledge of the mental illness, therefore creating what Goffman called a spurious interaction (Haralambos and Holborn, 2004).

From a behaviourist view, Schizophrenia could be viewed as a kind of learned behaviour. “From this perspective, people engage in schizophrenic behaviour when it is more likely to be reinforced than normal behaviour (Rathus, 2004). This could be the result of being raised in an unrewarding or punitive situation. It could also be observed that this kind of behaviour is reinforced within the hospital setting, where the schizophrenic behaviour is reinforced through attention from professionals within that setting. Cognitive theory argues that behavior is affected by perception or interpretation of the environment during the process of learning. “Apparently inappropriate behavior must therefore arise from misinterpretation. Therapy tries to correct the misunderstanding, so that our behavior reacts appropriately to the environment” (Payne, 2006)

I believe the experiences I have had with my father give me the ability to understand mental illness without stigmatising. It also helps me empathise with the sufferer and the family. An empathetic approach to someone who was hearing voices for example, would be to understand that to the person affect, they are very real. I fully understand the importance of having the right services in place in order for that person to thrive. My experience allows me to observe the wider context of a situation and realise that it is not only the primary sufferer of the condition that is affected. The wider family needs to be considered as they have a huge role to play in the well-being of the person concerned.