Reflections on Deinstitutionalization in the United Kingdom

Deinstitutionalization has been the hallmark of public policy for people with intellectual disabilities within many countries in the developed world for the past 40 years. Although within Britain deinstitutionalization is set to be completed by the end of 2008, beyond the simple closure of hospitals, the success of this initiative can at best be seen as uncertain. Although huge structural change has been achieved, the initiative's outcomes in terms of reduced distress, mainstreamed services, and enriched networks of relationships, require further examination. In order to reinstate the possibility of transformation in the lives of people with intellectual disabilities, it is necessary to return to an analysis of the relationship between people with intellectual disabilities, their supporters, formal services, and the community as a whole. One way of reflecting on these relationships is through an examination of the discourses that characterize them. The authors reflect on the themes of protection, power and humanity, and the manner in which these have survived the physical closure of long-term care hospitals. The continuation of deinstitutionalization is understood as requiring consideration of the institution in terms of the discourses that were prevalent within it. The transformation of services now depends on changes within these discourses and change now needs to be focused on relationships that challenge institutional discourses.