Personal Responsibility and its relationship to Social Rehabilitation

Paper from:

Anne Hawker
New Zealand

August 2003

Distributed in Rehabilitation International Social Commission Seminar in RI Regional Conference "The Renaissance in African Disability", Durban, South Africa, 2 October 2003

Introduction

To be able to explore this topic it is important to get some handle on the definition of the terms.

Personal: Personal is defined in the Oxford English Dictionary as: " one's own; individual, private." Implicit in this definition is the identity of a person and all, that involves.

Responsibility: Is a very interesting aspect. According to Oxford English dictionary this is :" Charge for one is responsible. Being responsible. " Therefore it is important to define responsible. Responsible has been defined in the Oxford English dictionary as "Liable to be called to account; answerable; morally accountable for actions

Consequently when we start to put these to two definitions together it raises the questions of the accountability as an identity a person has. This accountability is environment specific because we are talking about "social rehabilitation"

Social Rehabilitation defines the context of that accountability. Rehabilitation can be variously defined, but the essential elements are that it is a team process in which the central player is the person with the impairment. Rehabilitation is about a new life with new hopes and dreams.

Social implies that starting life anew is within Society and not apart from society.

Taking the question as a whole this implies that what is important, especially for a person as they adjust to a new identity, is how they interact with society in this new role and their ability to have a significant amount of decision making as this occurs. This concept will have significant impact on the current roles and relationships within the rehabilitation process.

The ICF Model

The ICF model provides a theoretical framework in which in explore some of the major tensions that arise when one starts to look at the very issue of personal responsibility and the whole area of social rehabilitation

Sir William Ostler said it is "far more important to know the person than to know what sort of disease the person has. " I think all those involved with rehabilitation will acknowledge that while the impact of the impairment is important initially, it is not what allows a person to return to participation in society.

While the ICF model has honed discussion onto the two crucial areas of community participation and functional activity or limitations, the relationship between these requires further refinement. Most of tools that have been used to assess a person's needs for community participation have taken as their basis functional limitation. Many therapists are much more comfortable talking about functional limitation than truly coming to understand the aspirations of the person.

For social rehabilitation to be truly effective it can only be in the context of person's aspirations, without this social rehabilitation has no meaning to that person. This implies that it must also have meaning, in a cultural sense. This bring with it challenges when most of the tools and the thinking about rehabilitation has been driven in a very mono-cultural context.

It is interesting to note that Jenny Morris and Michael Oliver in their discussions on rehabilitation highlight the impact of these different perspectives. The Independent Living Movement is a classic example of some of the differences and some of the challenges that still exist if disabled people are to be fully included in society. The Independent Living movement was a response to the pressure from people involved in the rehabilitation process to get people as "independent as possible in their functioning." The impact of this was that many people were unable to do any other activities other than get up in the morning and get dressed. What was important for disabled people was being able to make decisions about who provided them with what support so they could have fulfilling and meaningful life roles.

Many governments at both a national and an international level have been involved in developing strategic plans that state quite clearly that central to a new vision for people with disabilities is nothing about us without us and that people should be able to determine their own aspirations. While this may well be accepted at a strategic level it will be interesting to see how it impacts at a community; service provider and funder level.

Values

Implicit in the discussion on personal responsibility is the various values that the players bring to the team process. Where there is an element of ableism, then the person with the impairment may be perceived as having little value in terms of the social roles that they play. Therefore their aspirations may well be contained not by their vision but by the beliefs of others.

The importance of values can not be underestimated especially where people are considered to have little ability to make their own decisions. Attitudes to disabled people have shaped the current rehabilitation process. If this is to endorse and operationalise these changes, then significant changes will need to be made to the current assessment tools which have as their basis a functional abilities /limitations approach. This is an important area of change if a truly inclusive society for people with disabilities is to exist.

When one considers values, there is an assumption that those values are explicit. Often the most discriminatory beliefs are those that are implied. For disabled people these are often the most difficult to address especially in a decision making process. A true client centred approach will require trust and a change in the power relationship for many involved in the rehabilitation process. Without this change then many people will not be able to exercise nor benefit from the advantages of personal responsibility.
Questions raised by the exercise of personal responsibility

" Starting from a strategic level:

What role does RI and DPI play in initiating this changed approach to rehabilitation at both an international, regional and national level?
Is this approach not consistent with the vision contained in the Charter for the Disabled?

How will this change be reflected in a change in the ICF model?

" From a funding perspective:

How will the impact on the current funding mechanisms be explored? It is interesting to note that there are some international trends that may will help accelerate these changes. These include:

" Shortage of trained staff
" Increased self management of people of their own health

" From an operational level:

How will the inevitable change in current practice especially around assessment be managed?

What will be the responses of those who have an investment in maintaining the current processes, tools and especially power relationships?

How will a less mono cultural perspective be reflected in both the rehabilitation processes and tools.

" From a disability movement perspective

How will the movement raise the aspirations of people with disabilities especially where they themselves may have been implicitly involved in ableism prior to them becoming disabled or where they have been historically impacted on by ableism.

How will the speed of these changes be monitored and by whom?

What strategies will be put in place to address potential sabotage?