Explore the vast range of titles available.

The dominant idea in debates on social inclusion of people with intellectual disabilities is that social inclusion requires recognition of their ‘sameness’. As a result, most care providers try to enable people with intellectual disabilities to live and participate in ‘normal’ society, ‘in the community’. In this paper, we draw on (Pols, Medicine Health Care and Philosophy 18:81–90, 2015) empirical ethics of care approach to give an in-depth picture of places that have a radically different take on what social inclusion for people with intellectual disabilities looks like: places known as ‘sheltered living institutions’. We argue these places can be seen as ‘communities of difference’ catered to the specific needs and capacities of the residents. We then contend that these communities raise questions about what a good life for people with intellectual disabilities looks like and where and how it ought to be realised; questions not posed very often, as they get muzzled by the dominant rhetoric of normalisation and the emphasis on sameness.

Since the 1980s, “personalisation” is at the centre of the evolution of disability policies and more generally of the Welfare state. It refers on one hand to the question of self-determination through the allocation of personalised budgets, and on the other to the adaptation of care to the specificities of a given person, through the development of “person-centred” care. In this article we study the issue of the personalisation of care from a point of view intermediate to these two dimensions, that of the transformation of social care organisations. Using the example of care provided to people with multiple impairments in France, we analyse how new social care organisations have addressed the diversity and specificity of the needs of these people. This analysis thus proposes a new way to think about the personalisation of policy responses implemented by the welfare state.

ObjectivesIt has been suggested that since 1990, de-institutionalisation of mental healthcare in Western Europe has been reversed into re-institutionalisation with more forensic beds, places in protected housing services and people with mental disorders in prisons. This study aimed to identify changes in the numbers of places in built institutions providing mental healthcare in Western Europe from 1990 to 2012, and to explore the association between changes in psychiatric bed numbers and changes in other institutions.Settings and dataData were identified from 11 countries on psychiatric hospital beds, forensic beds, protected housing places and prison populations. Fixed effects regression models tested the associations between psychiatric hospital beds with other institutions.ResultsThe number of psychiatric hospital beds decreased, while forensic beds, places in protected housing and prison populations increased. Overall, the number of reduced beds exceeded additional places in other institutions. There was no evidence for an association of changes in bed numbers with changes in forensic beds and protected housing places. Panel data regression analysis showed that changes in psychiatric bed numbers were negatively associated with rising prison populations, but the significant association disappeared once adjusted for gross domestic product as a potential covariate.ConclusionsInstitutional mental healthcare has substantially changed across Western Europe since 1990. There are ongoing overall trends of a decrease in the number of psychiatric hospital beds and an increase in the number of places in other institutions, including prisons. The exact association between these trends and their drivers remains unclear. More reliable data, information on the characteristics of patients in different institutions, long-term pathway analyses and effectiveness studies are required to arrive at evidence-based policies for the provision of institutional mental healthcare.

Normalisation theory made perfect sense at the onset of de-institutionalisation. To map its influence on mental health facilities, research was conducted and began with ten facilities within England (UK) and France, followed by a further two in England and four in New Zealand. A checklist tailored to mental health facilities was used to measure the extent to which the facility looked domestic or institutional. Hence, the mental health checklist architecturally measured domesticity versus institutionalisation in psychiatric architecture. It consisted of 212 features, grouped into three main categories—context and site; building; and space and room—and was based on a pre-existing checklist designed for hostels for those with learning disabilities. The mental health checklist was developed and piloted in Europe and reflected European de-institutionalisation principles. Cross-country comparison revealed that patient acuity was potentially not a determinant of institutional buildings for mental health. Institutional facilities in France were detected, and some of the most domestic facilities were within England, with the most recent sample having a greater tendency towards the more institutional end. Those in New Zealand tended towards the most institutional. Across all 16 facilities, there were very few universal institutional and domestic features, raising the ambiguity of a clearly defined stereotype of facilities for mental health service users. Consequently, the current fluidity of design across and within countries provides a significant opportunity for designers and mental health providers to consider non-institutional design, particularly at the planning stage. The use of the mental health checklist facilitates this debate. Future research in other geographical areas and through further consideration of cultural differences provides further opportunities to extend research in this area, with the potential to enhance and improve the lived experience of users of mental health services.

We begin with a critique of the ontological underpinnings of the mainstream business model literature with its origins in design-science and offer instead insights from sociology and organisational institutionalism to argue for a more accurate representation of actual processes of organisational transformation, especially necessary where scholarship is concerned to address societal mission-oriented normative cares beyond the objectives of efficiency and profit maximisation. We propose the foundations of a new theoretical construct: the Normative Business Model (NBM) distinguishing deep institutionalisation as the embedding of values (normative orientations) into the design, practices and identity of organisations. The NBM comprises four cornerstones: (a) normativity, (b) (de)institutionalisation and deep institutionalisation processes, (c) institutional entrepreneurialism and (d) economic and financial governance. A case overview of Arizona State University is used to highlight that the NBM refers to the full range and variety of organisation types, not exclusively businesses.

Since the 1970s, psychiatric care in the western world has undergone fundamental changes known as de-institutionalisation. This has changed the living conditions for people with severe mental illness. The purpose of this study was to investigate the living conditions and utilisation of care and social services for a group of people in Sweden with diagnosis of psychosis over a 10-year period, 2004–2013. During this period, psychiatric care decreased at the same time as interventions from the social services increased. Half of the persons in the studied group did not have any institutional care, that is, neither been hospitalised nor dwelling in supported housing, during the last 5 years, and just over 20% had no contact with either psychiatry or the municipality's social services during the last 2 years of the investigated period.

Notwithstanding the legal milestones observed in the Portuguese child protection system (CPS), several concerns call for political action to ensure the effective guarantee of children’s rights. In this context, it is imperative to discuss proposals for reforming the CPS. Agreement on these proposals by the stakeholders in the system is key to validating and improving the system. Therefore, the main research questions of the present study are (1) what is the level of agreement among stakeholders in the CPS on certain proposals for child protection reform? and (2) what are the positions on those proposals? Mixed methods were conducted based on an online survey (n = 292), supported by Qualtrics, and eight focus groups involving stakeholders as former beneficiaries, families, practitioners and academics (n = 18). Findings show a harmonious alignment with the proposals, justifying an urgent reform of the CPS and the need to strengthen a child-centred system. Three themes emerged: promotion of quality family-based care and promotion of adoption; development of child-friendly terminology; and improvement of the CPS administration. The conclusions highlight implications for policy and practice.

Protection and promotion of child rights are referred to as a central purpose of the European Union (EU). Therefore in 2021, the EU Strategy on the Rights of the Child and the European Child Guarantee were published to enable children to have the best possible life in the EU and worldwide. Member states were invited to implement the directions of both documents into practice. The present study analyses and showcases the evidence on how to progress implementation of the Strategy and the Guarantee regarding alternative care in Portugal. A literature review was conducted based on international literature. Evidence-based recommendations for the Portuguese transition process towards quality, family and community-based care are stated. De-institutionalisation and strengthening specific services—kinship care, special guardianship, and foster care—are advocated, namely specialising the workforce, and promoting training for kinship carers and prospective special guardians. To conclude, the revision and monitoring of the measures for children in need of alternative care are suggested as well as integrating and publishing data from the diverse services of the alternative care system.

Danièle Hervieu-Léger gives an account of religion as a chain of memory, that is, a form of collective memory and imagination based on the sanctity of tradition. According to her theory, in the postmodern world the continuity of religious memory has been broken and all that remains are isolated fragments guarded by religious groups. This twofold study aims at showing, firstly, in what sense religion can be conceived of as memory which produces collective meanings (Part One) and, secondly, what may happen when individualised and absolutised memories alienate themselves from a continuity of tradition, thus beginning to function as a sort of private religion (Part Two). Being the first part of the study in question, this article is dedicated to a historical-theological analysis of religious memory as a source of collective meanings, as seen from a Christian perspective. Firstly, it situates Hervieu-Léger’s definition of religion against the background of the most topical religious contexts in which the notion of memory appears today. Secondly, the dialectics of individual and collective memory is discussed, notably through the lens of Ricoeur’s original proposal. This is followed by an overview of the traditional functions of memory in Christianity. Lastly, the interpretation of the way in which Christian tradition, in its premodern continuity, served as a source of collective cultural meanings, is recapitulated. What underlies this analysis is the conviction that to comprehend, and even more so to challenge mechanisms based on which the dominant purveyors of meaning (such as economic and information market) function in our day, one should have a clear understanding of what they attempt to substitute for. In brief, before exploring how memories become religion, one ought to be able to conceive of religion as memory.

Abstract The purpose of this chapter is to examine the consequences of closing institutions for people with disabilities and accommodating them in Supported Residential Services. Issues that had been raised by an advocacy movement included shortcomings in privacy, dignity, control and meaningful activity in institutions, which led to their closure. The study applied a quality of life measurement which was commensurate with the ethical paradigms of welfare, autonomy and communitarianism to investigate whether community living in supported residences produced fulfilling lives and better outcomes than the institutions they replaced. Twenty-seven people with a disability and/or mental health issue in Supported Residential Services in Victoria, Australia were interviewed using the ‘Lehman Quality of Life Questionnaire’. An investigation into the Quality of Life of one group of de-institutionalised residents revealed that issues remain. People in the Supported Residences appear to be no better off than when they were in institutions. The study identified that it was common for a resident to have no phone, no friends outside the residence, little or no family contact, no disposable money and no job. However, since there was no research conducted before de-institutionalisation, the impact of the policy change is difficult to determine. Applying ethical measures, such as the Capabilities approach, reveals that issues remain. Practical implications from this study are first, that positive measures need to be added to de-institutionalisation to achieve satisfactory outcomes and second, that policy makers would be better informed and likely more effective if data were collected before and after significant changes.