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Why Innovative Action?

From: Changing Patterns in Residential Services for the Mentally Retarded
Creator: Robert B. Kugel (author)
Date: January 10, 1969
Publisher: President's Committee on Mental Retardation, Washington, D.C.
Source: Available at selected libraries

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The Problem


In 1967, the President's Committee on Mental Retardation took stock of the national effort being made to combat mental retardation. In its report, MR 67 (President's Committee, 1967), one of ten points emphasized was the poor status of residential care. In fact, residential facilities were described as a disgrace to the nation.


Unfortunately, there is little good news when writing about residential facilities in the United States, although considerable and even outstanding progress is being made in some areas of mental retardation. Among these are the growth of day centers for severely handicapped individuals and of employment opportunities for retarded and handicapped individuals in general. Throughout the country, programs in public education have helped to dispel some of the darkness of the past. Research -- biological, sociological, and behavioral -- is a hallmark of the American scene. Volunteer efforts for both the retarded and the physically handicapped have been outstanding. Innovations in behavior shaping are pointing the way for better management. Diagnostic services for the retarded also have been among the outstanding successes.


Why, then, have residential facilities in this country lagged so far behind these other areas in which advancement has been considerable? What are some of the problems which seem to confront our residential facilities?


Typically, public residential facilities have been plagued by a triple problem: overcrowding, understaffing, and underfinancing. To complicate matters further, the public, long accustomed to knowing little about mental retardation, often held inaccurate information, and there was a mystique about the retarded and other handicapping conditions involving feelings of hopelessness, repulsion, and fear. Gradually a change in attitude has been occurring as various significant efforts have been made to enlighten lay and professional people alike. But despite these efforts, the residential facilities of this country have languished. I would like to analyze briefly some reasons why public and, to some extent, private residential facilities throughout the country are so far behind.


In the mid-19th century, there was a wave of optimism about the care of the mentally retarded. The belief developed at that time that, through educational efforts, the retarded could be helped, and that most of them could be made self-sufficient citizens. When this concept, so noble in its beginning, appeared to have failed, decision-makers became committed to locating institutions away from the population centers of the state. This unfortunate decision seems to have been motivated in part from the conviction that mentally retarded persons were best cared for in a more bucolic setting; in part out of fear that the retarded, being a scourge to society, should be removed as far from society as possible; and in part to satisfy demands to locate employment opportunities in underdeveloped areas in order to provide jobs and income to the surrounding communities.


Still later, the scourge notion grew, especially with the publication of poorly designed studies like that of the Kallikak family by Goddard (1912). The mentally retarded were soon to overpopulate our land, according to Goddard, and segregating them from society was the most important service to be rendered. As a consequence, further building programs for institutions were really a continuation of the out-of-sight, out-of-mind concept, and institutions for the retarded began to be considered as colonies where the undesirable members of society would be segregated and separated. Although this concept also proved to be fallacious, the country soon entered World War I, which was followed not long afterwards by the Great Depression, and these events permitted the mold to set, so that very little in the way of changes occurred for many years. For whatever reason or combination of reasons, most of the nation's public residential facilities, and also many private ones, are located in out-of-the-way communities. Being so located has meant ever-increasing difficulty in obtaining qualified professional staff, who frequently prefer to live in larger communities. Similarly, the core of any institution, i.e., the ward or cottage personnel, have been increasingly difficult to recruit as the population has shifted from rural to metropolitan areas.


When citizens become concerned about an issue, such as where to locate a new highway or whether to build a new school, it has always been useful to be able to show these citizens, their legislators, and others in decision-making positions what the problem is all about by having ready access to a good existing example. This has been a problem for those trying to change the plight of the institutions, because it is doubtful whether there is a single exemplary model of care for the severely and profoundly retarded anywhere in this country.


To visit institutions, exemplary or otherwise, citizens in the past had to make a great effort, and then they often went only once. In part, this is so because, of the distance involved for many, and in part because they were repulsed by what they saw. Many legislators have appropriated large sums of money to support their public facilities, but have never visited a single institution for the retarded, either to see the need firsthand or to ascertain how the money was spent. There are physicians who refer families to these residential facilities but who have never seen the facility and do not know the professional personnel caring for the clients whom they refer. This is an odd paradox since one cannot imagine a physician referring a patient to a hospital for an operation if he knew nothing about the place and people involved.

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