Bob Sapey

Increases in wheelchair use and perceptions of disablement

Between 1986 and 1995, there appeared to be a 100% increase in the number of wheelchair users in England and Wales. This article reports some of the findings of a study designed to explore the social implications of this increase. Specifically, it examines the various explanations for the increases and concludes that whilst demographic changes or research methodologies are not responsible, the more likely causes are changing prescription practice, medical advances and changing attitudes to disablement. The article then explores the latter explanation by examining perceptions of wheelchair use, contrasting clinical and user views gained from in‐depth interviews. It also reports findings from part of a large‐scale postal survey of wheelchair users, which examined their attitudes toward different models of disability. It concludes that the responses of a large majority of wheelchair users of all ages are better explained by the social model of disability than any other.

Disabling Homes: a study of the housing needs of disabled people in Cornwall

This research was carried out between January and July 1993. The study was an evaluation of housing need of disabled people who were wheelchair users through a process of consumer consultation. It was concerned to find out the extent and nature of that need whilst also testing out consultation through the use of research methods in comparison with a non-consultative approach taken by the local authorities. The nature of need was found to be qualitatively different to that found through the study of normative needs. A significant number of disabled people were being made more dependent by their housing and this was being reinforced by the agencies that were intended to help them. In particular, the failure to consult disabled people was leading the local authorities to make inappropriate plans for new build housing while the major need for adaptations was being undermined by their operation of the Disabled Facilities Grant. The findings support the call from other writers that the solutions to housing prob...

Out of touch: local government and disabled people's employment needs.

In autumn 2003 we contracted to undertake a study in two district council areas of ways in which they could meet their Local Public Service Agreement (LPSA) targets in respect of disabled people returning to work. We undertook a literature review of barriers to work, interviewed a number of people involved in working with unemployed people and a number of disabled people in these areas. All the employment organisations we had contact with were working to an individual model of disability and the need to change their orientation became the central recommendation of the first phase of this study. This was rejected by those funding the study. At the end of the first year none of the organisations active in this area was able to identify a single disabled person who had returned to work as a result of their help. We conclude that central government policies are doing little to change the perception of the employment needs of disabled people within local government.

Disablement in the Informational Age

There is considerable evidence to suggest that at this point in history, we are in the midst of a global economic revolution. There is also a considerable literature to suggest that the industrial revolutions have shaped and constructed the nature of disablement in the twentieth century. This paper examines employment data from the USA and UK on the process of informationalisation, in order to ascertain if it is having a particular impact on the construction of disablement. It finds that disabled people are more likely to be excluded from employment in the informational sector and that the current reforms of welfare may remove some of the safety net provision that have been part of the hegemony of care established under industrialisation. It concludes by suggesting that social exclusion, which removes the notion of deservingness, may replace disability as a social process in the twenty-first century.

Communication, culture and competence in social work education

This paper argues that the managerialist influence on the DipSW has meant that both the models of social work and of social work education that have come to dominance since it was first approved in 1989 are incompatible with the development of anti-racist practice. We explore the potential of reformulating social work as a communicative activity and the implications of this for the education of social workers. We argue that this would require an approach that incorporates three main elements: an analysis of the way in which power and disadvantage is distributed between racial groups and the ways in which this affects their ability to represent their own needs in political debate; an understanding of the ways in which the wider discourses of racial domination find expression in culture; and the development of our understanding of how intrapsychic representations of race and power come to be inscribed in mental life. It is through the interrelationship of these domains that anti-racist practice can become i...

Impairment, disability and loss: reassessing the rejection of loss.

Psychological theories of loss and grief, which suggest that people must go through stages such as shock, anger, denial, and despair before finally reaching a recovered stage of acceptance, have often been applied to understanding the experience of disability. However, this has also been firmly rejected within the U.K. disability studies literature, which draws on the experience of disabled people from a critical perspective. The result is not just a rejection of ways of understanding loss but a high level of caution in exploring disability from a psychological perspective. This article explores these debates and then considers if more recent theorizing about loss and grief has in any way addressed these criticisms. The disenfranchised grief, dual process, and meaning reconstruction models are each considered and questions are raised about their potential to contribute to disability studies.

Disability in the Family

The social model of disability can be a useful and sensitising perspective in considering the implications of disability for family life. There are three ways in which the ‘disability relationship’ discussed in the previous chapter is important here. To begin with, the disablement of an impaired individual may be exacerbated by the way he or she is treated by the family, as with the way some disabled children are overprotected by their anxious parents. In addition, family structure and stability may be adversely affected by one of its members becoming disabled, though it is important to note that such an occurrence may strengthen rather than weaken familial ties in some situations. Finally, there is the question of the way society treats families, through social policy provision, where there is a disabled member.

Living with Disabilities

In the previous chapter, one of the main difficulties that disabled people faced at all ages was how to maintain relationships with their families while also achieving a level of independence and autonomy within them. Leat (1988) suggests that the pressures of dependency within families is the most significant cause of disabled people having to enter residential care, though this analysis was part of the Wagner report into residential care which was concerned to promote its positive use but failed to consider the impact of poor community services on these relationships. This impact may also account for the fact that disabled adults are far more likely than non-disabled people to be living alone. In 1986, 30 per cent of disabled adults were living alone (Martin et al., 1989) which compares with just 11 per cent of the whole population at the time of the 1991 census. As would be expected, the proportion rises with age but even if only those under 65 years are considered, some 16 per cent of disabled adults are still living alone. This has significant implications for the provision of both housing and personal assistance which would enable these individuals to live independently, but also for the provision of support to those within families.

Compounding the trauma: the coercive treatment of voice hearers

For more than a hundred years, voice hearing has been treated as a symptom of serious mental illnesses with biological origins. Pharmaceutical companies have expanded the range of products targeted at treating these illnesses and the diagnosis of schizophrenia now underpins a multi-billion dollar, world-wide business. Throughout the western world, nation states have vested an authority in psychiatry to compulsorily treat people who meet a set of diagnostic criteria that is widely discredited. There is considerable evidence that more effective ways of responding to people experiencing psychosis can be provided without coercion. These approaches differ in essence to traditional Kraepelinian psychiatry in that they acknowledge the role of peoples life experiences in creating the problems they face, and the professionals work in partnership with the service users. The approaches recognise that people have histories which often include considerable trauma and social workers are in an ideal position to work with voice hearers to help them understand their experiences and to develop ways of coping. The authority vested in psychiatry is not static and within Europe mental health professionals can contribute to changing what is meant by ‘unsound mind’ and extending the right of liberty to voice hearers. In doing this, social workers can ensure that they do not compound the trauma by devaluing and discrediting peoples experience.

Listening to voice hearers

Summary This article considers what the Hearing Voices Network can offer to mental health social work. It combines an extensive literature review of voice hearing by Bob Sapey and the expertise by experience of Peter Bullimore who runs a peer support group for voice hearers. Findings The re-framing of auditory hallucinations as voice hearing has significantly changed the way many voice hearers have been able to understand their experience. This new approach to working with voices was developed at the University of Maastricht, principally by social psychiatrist Marius Romme. By moving away from biological explanations of brain disease to psychological understandings of emotions, Romme and his colleagues have found ways of helping people cope with voices, rather than trying to get rid of them through medication. This has led to a network of voice hearing groups throughout the world. There is much of what happens in these groups and within the social psychiatric responses known as the Maastricht approach that can be practiced by social workers. Applications The Maastricht approach to working with voices challenges the basis of pharmacological responses to psychosis and moves beyond anti-psychiatry by offering positive alternatives to the current biomedical treatment of schizophrenia. This approach can be undertaken by experts by experience and mental health professionals. We describe these approaches and argue that in adopting them, social workers can help voice hearers cope both with the content of their voices and the stigmatising responses to being diagnosed with schizophrenia.