title: Reform and community care: has de-institutionalisation delivered for people with intellectual disability?
abstract: Reform and community care: has de-institutionalisation delivered for people with intellectual disability? In this paper we provide a post structural analysis of the theoretical shifts informing changes to service delivery over the past 150 years in relation to people with intellectual disability. We utilise the New Zealand experience of reform as it reflected global knowledge at any given period. Firstly, we address the historical modes of treatment and care, with reference to the eugenics movement, the concepts informing 'Prisons of protection' and moral treatment. Secondly the paper traces reforms commencing in the 1960s where changes from institutional care to community care were informed by humanistic ideals, a key driver being the concept of normalisation. Theorists offered competing discourses that formed the bases of arguments for the status quo whilst resistant voices advocated change. Covering such significant changes leads us to assess the state of de-institutionalisation' as it stands today and how it may be perceived in the future. We assert that Foucault's genealogical approach provides analytic tools to uncover the dynamics of changing attitudes and approaches to service delivery. In applying a Foucauldian lens to the trajectory of reforms concerning institutionalisation to de-institutionalisation we question whether a form of re-institutionalisation may be occurring.
authors.affiliation: Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand. beverley.burrell@otago.ac.nz
authors.forename: Beverley
authors.initials: B
authors.lastname: Burrell
authors.forename: Henrietta
authors.initials: H
authors.lastname: Trip
mesh_terms: D001294:Attitude to Health; D003156:Community Mental Health Services / Q000639:trends*; D003688:Deinstitutionalization / Q000639:trends*; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D007326:Institutionalization / Q000639:trends*; D008607:Intellectual Disability / Q000266:history*; D009520:New Zealand