Deinstitutionalization: “Timijanik” or “Titanic”

Ilo Trajkovski

The topic of this column seems to me to be current. But not because of the acuity of the issues it raises, but because of their chronic character. It talks about problems with a disease of society from which it will not die, as specialists say about rheumatism patients, but it will die with it. A life with an ominous chronic disease, such as non-institutionalization or anomie, is closer to barbarism than to a civilized life worthy of either individual or society.

In its acute form, the subject opened sometime in June last year. It was manifested in the form of protests by residents of the Negotino village of Timjanik. They rebelled against the intention of the Ministry of Labor and Social Policy (MLSP) to move several children with intellectual disability in a facility in their village, which were until then placed in the Special Institute of Demir Kapija. This measure cause outrage among residents, who, for various reasons, objected to the decision to move these children to a small group home in their village. Then the ambitious Minister of Labor and Social Policy faced resistance on the spot from a part of the local community. Thanks to her professional readiness and demonstrated well-being, the episode with the resistance from illustration of, according to some of the evaluations, incivility and intolerance ended, so that “Timijanik” became a practical and symbolic example of the challenges and chances of the “National Strategy for Deinstitutionalization”.

This strategy is the second one so far. The first one was created in 2008 and lasted up to 2018, while the new one covers the time period between 2018 and 2027. So, in the period of twenty years, the Republic of Macedonia will act in the direction of what the Strategy calls “deinstitutionalization” of some of the public activities in the area of ​​social care. Deinstitutionalization, therefore, will become a chronic state of our community. Hence, new acute cases of rejection and resistance can be expected. Whether they will produce a new “Timijanik” or grow into our “Titanics” will depend on how the public and society as a whole understand the idea of ​​deinstitutionalization and, in particular, its ideological matrix, but also the practical effects of its implementation.

Here I urge the deconstruction of a very problematic understanding of the deinstitutionalization contained in the Government’s own strategy. In accordance with the accepted definition, deinstitutionalization is understood as “closing of institutions and simultaneous development of social services in the community”. Topographically speaking, it is about closing institutions in the field of social care and moving their current users into the community, then developing appropriate services within the community and preventing institutionalization. Particularly indicative is the last of the four strategic goals – the prevention of institutionalization! It is this goal that reveals that this is a project that, although it is taking place in the field of social work and social policy, he has specific ideological dimensions and ambitions. They, without a proper fence, can be understood as a call for closing or destroying everything that is institutional, which means everything social!

Institutions and institutionalization are the essence of society. From a sociological perspective, the institutions are an established, confirmed and accepted way of achieving socially legitimate values ​​and goals. There is no social order and regime without social institutions. There is no civilization without the institutionalization of the relations between people. There is neither law nor rights without it, yet only the will of the fittest, which means barbarism.

It is precisely from this awareness of the significance of institutions and institutionalism that the document of the Common European Guidelines for the transition from institutional care to the community, and which, as its source, calls for our Strategy, explicitly recommends the avoidance of the term “deinstitutionalization” and instead of using the term “Transition” from institutional care to the community. Institutions are essential for the social order. They could be changed, but they should not be “closed”, abolished, or replaced with any other non-institutional alternatives, while still maintaining civilization.

The absence of proper institutionalization of the relationship between people in society in general and in any particular sphere is recognized through the phenomenon of “weak institutions”, and strong individuals (personalities) or groups. That is precisely the main sociological problem of our social order. In such circumstances, people are guided by the motto “Get by if you can”. So, if you are powerful, impose and accomplish your will. Such behavior even becomes desirable, and the abnormal, the deviant becomes normal, i.e. recommended. Therefore, in such tenuous, unconstrained social circumstances, individuals who are “freer”, unscrupulous and more special than others are persons who disregard the social norms because there aren’t any, or there are no operative institutions to protect them. The non-institutionalized condition is a state of anomie, a state of selfish interest, and, ultimately, a war of all against everyone else.

For these reasons, the so-called new paradigm for deinstitutionalization of the social treatment of persons with disabilities, as well as other vulnerable categories, encounters serious ideological and practical criticisms. Ideologically, it turns out to be part of a broader neo-liberal ideological project for the privatization and liberalization of everything that is public or social. In the specific case for the privatization of public institutions in the field of social care.

Analyzes of the practical experience of the transition from a policy of care for the affected persons in institutions towards their care in local communities besides the expected benefits also point to numerous problems. It has been confirmed that, after their transfer from community institutions, many of them note an increase in their independence, improvement of the quality of their lives, reduction in the use of psychotropic drugs, increasing their socialization and adaptability to changes in the environment. But the analysis also shows that precisely because of insufficient institutionalization of care for these people in the community, after their transfer into it, many of them became homeless, isolated, victimized and stigmatized, some were reinstituted, and some lost their lives.

Emphasizing such empirical findings about the negative consequences of deinstitutionalization, some analysts recognize it as a psychiatric Titanic. Therefore, in order not to let our first Timjanik to obscure some new Titanic, it is necessary to critically consider the ideological basis of the very idea of ​​deinstitutionalization and, moreover, to monitor the specific effects of its implementation in the given Macedonian conditions in the local communities.