From violence to neglect: investigating the mistreatment of disabled people within health and social care facilities in the UK

Context There have been many cases of mistreatment towards disabled people within health and social care facilities (herein termed care facilities). Mistreatment includes: physical violence (including the inappropriate use of restraints); verbal violence (from insults to threats); the inappropriate use of medication to pacify individuals; and neglect. It has even led to premature deaths in some cases. This mistreatment is typically understood as individual acts or institutional negligence. Yet, this project considers how the mistreatment may be indicative of societal practices, processes, and beliefs. Aims and objectives: To develop an understanding around the causal pathways that can lead to the mistreatment of disabled people within care facilities; to investigate at what level (individual, institutional, and/or societal) the responsibility for this mistreatment lies; to suggest avenues for developing strategies for the prevention of future mistreatment. This project aims to reframe the mistreatment of disabled people in care facilities as disablism (the oppression of disabled people), so to illuminate the power dynamics existent within these settings and wider society. It also aims to provide a unique synthesis of perspectives, including those of: Émile Durkheim; Michel Foucault; Judith Butler; Rosi Braidotti; and Zygmunt Bauman. In identifying a common concern between these authors (the potentially oppressive aspects of modern life), their theories can be brought together to generate further understanding about the mistreatment of disabled people within care facilities. By drawing on Foucault, Butler, and Braidotti in relation to disability, this project aligns with recent disability studies research. It aims to develop theory here by considering how ableism (privileging an ideal type of self/body) produces a notion of 'the human' that may create and justify disablism in care facilities. Documented mistreatment in care facilities seems to suggest that perpetrators think of disabled people as 'less than human.' To understand what this means we need to explore how being 'human' is understood. This project will explore how mistreatment unfolds and the ways in which disabled people are understood by those involved. I will look at this in relation to the wider contexts of mistreatment, including: resources (and austerity), staffing arrangements, and changing social attitudes to disabled people. Method This project will begin by exploring the nature of the mistreatment of disabled people in care facilities. Documents relating to critical cases will be analysed, including: Care Quality Commission reports; court and investigation transcripts and findings; and safeguarding reports (accessed through the Freedom of Information Act). The analysis will identify notions of 'the human' and 'less than human,' and how these operate in relation to other factors, such as: pressures on resourcing and staffing. Following on from this, theories will be generated about how care staff think of, and approach, disabled people in terms of their humanity, and how this is affected by other factors. These will then be tested out in focus groups and interviews. To allow for comparisons between different settings, at least three focus groups will be conducted with people who are paid to provide care to disabled people. One with National Health Service staff, one with agency homecare staff, and one with care home staff. To develop further insight, some participants may partake in a follow-up semi-structured interview. This project is not seeking to uncover mistreatment, nor will it imply participants are perpetrators of it. Impact This research aims to have an impact upon society by providing two levels of recommendations: one philosophical and one practical. The former may recommend a societal rethink of 'the human' to increase its inclusivity. Whilst the latter may suggest avenues that can be explored to prevent future mistreatment.