From hospital to home: the drive to support people with intellectual disabilities in the community

Abstract

For over a hundred years, institutional care was the predominant form of state provision for people with intellectual disabilities. This began to change in the second half of the twentieth century as the extent of abuse and deprivation suffered by long-stay hospital residents was repeatedly exposed, and as the legal, civil, and human rights of people with intellectual disabilities came to be recognized. As the drive to develop systems of care and support in the community has gathered pace, different interpretations of ‘community care’ have become apparent. Many residential services, from large residential homes to small group homes, claim to provide community care yet replicate the oppressive and controlling institutional culture of the old long-stay hospitals, while, in other places, innovative and creative support services enable people with intellectual disabilities to determine how, where and with whom they live. It is argued that being properly supported to live ordinary lives as part of their local community, and to access the same facilities, services and opportunities as other citizens, is key to success for people with intellectual disabilities. Living in the community may never be risk-free, but with the right support, it offers levels of self-determination, satisfaction, and safety that cannot be matched.