Central to these is the question of whether services are about maintaining or developing their service users’ levels of functioning.
Work is a good example of this. If you ask anyone in mainstream society why they work, they invariably link it to self-fulfilment and to earning a salary that allows them to pursue familial and recreational aspects.
The offshoots of work include the possibility of developing new skills which, when added to existing skills, prepares the person for entry into a new level of work, or career progression.
This fosters further self-fulfilment and enhances self-confidence. It also helps to enhance others’ perception of the person’s potential contribution to society — a concept called social role valorisation. These are the structures within which people in mainstream society work.
Now consider the person with intellectual disability, whether working in a sheltered workshop, engaged in craftwork in a day centre, photocopying in an office or packing bags in a shop. Do the same structures apply to them?
For most of these people, their work is seen to be a voluntary activity which has an occupational or therapeutic aspect. It is often repetitive work with little self-fulfilment and results in a salary that is viewed in the way pocket money is to a child. Many commentators have referred to the fact that if such a person earns a viable salary, he or she will lose social benefits such as medical card, travel pass and care allowance.
This essentially ties down the potential for people with intellectual disabilities to further their development as it prevents them from fulfilling the familial and recreational aspects of their lives.
The lack of any real workplace structure also precludes them from developing skills and building a career. What career development is possible for a person with intellectual disability who engages in repetitive tasks daily? Can they progress to management, if they have the skills?
If these people are compelled to carry out tasks outside a framework of real work, they will remain invisible and non-valued; members of an underclass in society where they are tolerated, but not really accepted.
The current status quo of social supports, which prevents the possibility of real work and inclusion of these people in society, aims to maintain and not develop these people to their full potential.
Lecturers in Intellectual Disability Nursing
School of Nursing and Midwifery Trinity College Dublin