“The Hôpital Général has an ethical status. It is this moral charge which invests its directors, and they are granted every judicial apparatus and means of repression: ‘They have power of authority, of direction, of administration, of commerce, of police, of jurisdiction, of correction and punishment’; and to accomplish this task ‘stakes, irons, prisons, and dungeons’ are put at their disposal.”Michel Foucault, Madness and Civilization (1961)
Standing haphazardly between the ideals of a healthy future democracy and the sobering trials of the past, is the continued prevalence of institutions in austerity Britain. It is seldom even acknowledged that they are, in fact, institutions. More often, ‘residential centre’ or ‘specialist services’ are the preferred terminology. For many familiar with either the state of mental health services or the process for seeking support for a mental disability, the use of floral-themed monikers has practically become a cliché. “Here at Willow House, we like to do things differently.” It is, at once, an acknowledgement of its own empathetic shortcomings, without fully lifting the curtain.
On the 22nd May, 2019, BBC Panorama aired an exposée into a culture of abuse by service staff towards disabled and neurodivergent people at Whorlton Hall, a specialist hospital in County Durham, north England. Instances of “intimidating, mocking, and restraining” service users, as well as torrents of “psychological torture”, were reported and detailed at length. Deliberate use of slurs, as well as violent threats, were heard and witnessed on multiple occasions. Female service users who were “afraid of men” were subjected to specific threats of “pressing the man button”, where supposedly the service user’s room would suddenly be “inundated with men”. According to the BBC report, no less than six care workers admitted to deliberately physically hurting service users, including “banging a patient’s head against the floor”.
The allegations at Whorlton Hall were followed by an eerily similar situation at Yew Trees, another hospital responsible for the care of disabled and neurodivergent people, based in Essex, in September 2020. CCTV footage from these incidents, once again, showed egregious abuse by service staff, including service users being “kicked, slapped and dragged”, as well as negative interactions where staff became “visibly angry with patients, threw items in the vicinity” of them, and stood very close to them “with intimidating body language”.
Neither of these incidents happened in a political vacuum. They combine, in the simplest terms, some of the most fundamental contradictions in contemporary neoliberal Britain. Without a strategy which guarantees meaningful life choices for many disabled and neurodivergent people, and with the British state unwilling to intervene as a matter of practice, the limitations of capitalism are reproduced in the violence of the institution. In the wider context of the ableised nature of British austerity, these instances of abuse are unsurprising. It has been made clear for more than a decade that not only is the British state uninterested in reversing its championing of punitive and humiliating practices for disabled people when we try to claim benefits or access support services, but will also turn a blind eye to violence aimed against us. Offloading this responsibility to private companies has allowed Conservative governments to not only wash its hands of individual situations such as this, but also of the last decade of austerity and its specific impacts on disabled people, which continues to be buried and forgotten. If they are unwilling to give £20 a week extra in Employment and Support Allowance (ESA), as members of Disabled People Against Cuts (DPAC) have been fighting for over the last few weeks, even as a token to offset the worst impacts of the pandemic, we know what they think of these incidents. An ‘unfortunate but inevitable’ tragedy. Nothing to see here.
In both situations, Cygnet Health Care was the culprit. They currently boast as many as 150 of these centres in the UK, and employ approximately 10,000 members of staff responsible for 2,900 service users. Built on the false claim they have built a reputation delivering “pioneering” services and “outstanding” outcomes for the people in their care since 1988, they represent one element of a large network of unaccountable and unsafe disabled healthcare services. According to the incident reports, the most commonly identified ‘mistakes’ were: a reliance on bank and agency staff, with less experience and training; a lack of accountability, with few service staff members ever reporting wrongdoing; and an oft-cited favourite – a failure to use “appropriate restraint techniques” (a phenomenon championed solely by neurotypical practitioners). Neoliberal consensus does not only favour the market-led direction of these facilities when abuse continues unnoticed, with no incentive to improve services, but also features heavily when they are eventually forced to admit their model is flawed. The primary independent regulator of healthcare services across the UK, the Care Quality Commission (CQC), may have closed both facilities in the immediate wake of the scandals, but had continued to rate them relatively highly in a majority of their reports. More to the point, while the events did evoke a certain outrage, encouraging even some in the mainstream press to condemn the company and its lack of attention towards its own areas for improvement, Cygnet still runs without many obstacles. Six of their facilities operate in Scotland, and four of these happen to be in Dundee alone.
Just as with other industries (and make no mistake, the reproduction of disability, and the conditions necessary to disable, function absolutely as an industry), the slow and gradual process of deregulation has left a hidden class of people with neither any room to breathe, nor any means to move past this reality. At the centre of it all is a force hellbent on delaying for as long as possible the granting of basic dignity to our disabled comrades. There is a material basis as to why the Judge Rotenberg Center in Canton, Massachusetts, continued to operate with its use of electric shock therapy on mentally disabled children and teenagers, for example, until as recently as this time last year. As Mike Oliver, the late Marxist whose work helped to situate the materialist fundamentals of the social model of disability, argued back in 1999, the prevalence of institutions remaining at the end of the 20th century retains much of the same functions as it does now. The key reasons for the success of the institution, on the basis of capital’s solution to disability, is that it combines perfectly the mechanisms of “social control” and “normalisation theory”. It is repressive, in that “all those who either cannot or will not conform to the norms and discipline of capitalist society can be removed from it”. And through its continuation under late capitalism, along with the false optics of ‘quality care’ or ‘pioneering services’, it doubly serves as a “visible monument” for all those who currently conform but may not continue to do so. In the most basic terms, if you do not behave, the institution awaits you.
The implications for these two incidents will become even more striking in the coming years, as we all attempt to situate and further theorise the many dimensions of neurodivergence and mental health under austerity. A political culture which sooner sweeps these stories under the rug than deal with the extant issues is not one adequately equipped to tackle them, and for this reason, we must refuse to see them in individualised terms or treat them as ‘awful’ but ultimately ‘inevitable’. It’s a narrative which allows these companies to continue to get away with what they do, and it’s no alternative to solidarity.
Normalisation theory: a theory developed primarily in the 1960s and 1970s by Scandinavian psychologists and psychoanalysts. It presupposes that the most appropriate way to tackle the specific plights of disabled people is through assimilation, integration and ultimately subsuming them into normative habits and structures. Its original theorists operated on the notion that, while institutionalisation was clearly not a good environment for disabled people, ultimately the onus should be placed on both disabled people and the ableist society they live in. It champions an objective and quantifiable definition of ‘normality’ in a physical and mental sense, and fails to acknowledge the full extent of how systemic ableism continues to oppress disabled people. It is the dominant theory which underpins not just institutions, but indeed many national and international standards of disability rights law and legal protections.
Social model of disability: a set of theories developed primarily in the 1960s and 1970s as a direct successor and opposition to the ‘medical’ or ‘individual’ model of disability (the idea that the disability itself is what oppresses us, and that the inability or difficulties for disabled people to live a life of basic dignity is the result of our own failings). The social model argues that, while people may have a specific ‘impairment’ (a term with its own historical baggage), what ‘disables’ us is overwhelmingly the society we live in and the specific hierarchical structures that society perpetuates. Proponents of the model vary from Marxists such as Oliver, to cultural theorists such as Paul Darke, to more liberal commentators such as Jenny Sealey. It has received its own criticisms, particularly from left critics in recent years, for not being adequately applicable to the full spectrum of the disabled community and for relying on an impairment/disability dichotomy.