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-*Address to the Social Work Division, American Association on Mental Deficiency, San Francisco, California, May, 1969.-

-**Professor of Human Development, The Florence Heller Graduate School for Advanced Studies in Social Welfare, Brandeis University, Waltham, Massachusetts 02154-

At last year's Social Work Luncheon, Dr. Stanley P. Davies -1- who better than anyone qualifies for the title Elder Statesman in our field, presented a masterful, sweeping survey of the historical development of social work's role in mental retardation. For those who were ready to listen for a challenge to action, he left a weighty message with the statement that "The Mentally Retarded are not the cause for our social ills, -- our social ills are the cause of mental retardation." Some of you may argue that this ignores the clearly biological causation of some of our cases but no one can dispute that within the context of Dr. Davies' remarks even there the social impact, the social consequences loom much larger in significance than causative biological facets.

But perhaps Dr. Davies' message can best be circumscribed by citing the change in title of his book, undoubtedly social work's first major contribution to this field. Originally entitled "Social Control of the Mentally Deficient", the book's later edition was changed to "The Mentally Retarded in Society."

With your permission, I would like to continue where Dr. Davies left off and try to discuss with you some of the action implications which present themselves today to social workers in the field of mental retardation in general and specifically to those working in residential facilities, in the light of the recent draft statement of the revised Standards for Social Service Departments in Institutions for the Retarded, just presented to our Division for consideration.

The theme of the AAMD Conference this year is "Social Issues and Social Action." It is a challenging topic and one to which all of us are ready to respond, and the draft document appears to fall well in line.

In its first section, entitled Philosophy, is set forth that "The social worker will decide in each problem situation whether his attention needs to be directed toward internal difficulties experienced by the individual, toward the process of social interaction, toward the relevant environment, or some combination of all three. Intervention in order to be effective needs to go beyond the maintenance of the status quo. Changes may be desirable in social organizations and institutions as well as in individual and family functioning."

In section IV, entitled Indirect Services, the second paragraph reads as follows:

"Social service engages in appropriate activities to see to it that its policies, plans and administration lead to the realization of its goals in the most effective and efficient manner possible. It contributes its particular expertise to the making of policy, the planning and the administration of the residential facility as a whole. It engages in evaluation of its own programs and those of the residential facility and fosters timely program innovations and development."

Let me say here in all sincerity that last Spring I most likely would have been quite content with these formulations. Here were certainly all the words I had come to accept as beacons toward a more adequate recognition of broad social issues and the action pattern required to meet them. But then something happened to me last fall -- I encountered for the first time as university teacher, a group of the young social work students. Those of you who heard Vice-Chancellor Billingsley yesterday will remember his reference to the new dynamism young people have brought to our universities. Perhaps I can best compare their first impact with a sudden breeze coming through an open window and blowing one's papers about, annoyingly disturbing the orderly process of one's accustomed daily work. One hears from those young students slogans such as "lack of relevance" -- "advocacy" -- "establishment" -- "rights" -- "protest action", which sound quite familiar and one wonders at first what all the noise is really about. But then, lo and behold, one discovers that far from "sloganeering" these young people are trying to communicate to us not just their concern, their growing discontent with what they see on the social scene, but also their grim determination to veer away from our traditional ways of doing things which they consider ineffectual, toward some new action patterns which to them have promise of coming at least closer to the mark. They are not so much seeking to create conflict as they are seeking to confront effectively the existing conflict situations which we have tended to avoid. Their allegiance does not lie with the profession -- they want to relate directly to the people in need, and feel they have common cause with them against an establishment which they think is as eager to suppress their motivation as it is to keep the client in a state of dependency.

This is not the time and place to dwell at length on the phenomenon of the student protest; let me just say that, I, for one, have been deeply impressed by our young students' sincerity of purpose, their commitment to action and their skill in ferreting out the inefficiency of present methods, and in developing not only new strategies but also new and vital allegiances with groups which until then had merely been objects of concern.

Let me remind you that a year ago, at AAMD's Annual Conference in Boston, Whitney Young -11- admonished us that too long had we been interested in methodology and techniques rather than in social impact. He emphasized that the leaders in the movement to eradicate chronic injustice and poverty in this country should be those people who have benefited most from the American System, and ended by quoting the Greek philosopher who said "We shall achieve justice in Athens when those who are not wronged are more indignant than those who are."

Our students are, indeed, indignant about the social neglect and injustice they see in the ghetto and other poverty areas, and are ready to push their protest even at the risk of such sacrifice as arrest and jail.

Leonard Duhl -2- addressing the Boston meeting following Whitney Young's challenging speech, said "The confrontation of the poor and of the Negro -and may I add, of the mentally retarded- in all our institutions has revealed that all bureaucracies, whether in health or education -and may I add, welfare- are inadequate because all too often the people within them are too preoccupied with the preservation of their own institutions and too little concerned with the problems they have to face.

Our young students have shown considerable acumen in identifying these organizational and bureaucratic roadblocks which interfere with appropriate and effective action response to stressful situations.

In the April 1969 issue of the journal Social Work David Weinman and Adrienne James -10- say in an article entitled "The Advocacy Challenge to Schools of Social Work" that there is need to broaden the advocacy will of social work, and that "a critical index of the integrity of the school of social work will increasingly be found in its willingness to engage in a re-examination of the relationship between its teaching and the action imperatives of its field work agencies." In facing this challenge, they say "the school finds its place in the crisis of higher education today in the confrontation between knowledge and social injustice."

The article goes on to explore the stance a school of social work should consider when e.g. students in field work placement are confronted with evidence of gross violation of a person's civil rights, gross injury inflicted on his body or gross neglect of his physical or emotional needs, and makes particular reference to placements in mental institutions.

Our young social work students are not content with merely stating that the new orientation in social work must stress clients' rights as much as clients' needs, they feel the obligation to give active support to, and work hand in hand with Mothers on Welfare and the Welfare Rights Movement, organizations which have caused much stress, puzzlement and fear in older workers and administrators.

And thus I return to the draft statement of the revised Standards for Social Service Departments in Institutions for the Retarded. Again stressing that I previously would doubtlessly have been willing to endorse this draft, with the insights I have gained from our young students I find this document wanting because it obviously is more oriented to the maintenance of our establishments than to protection of the rights of individuals, and because it suggests that the retarded person be helped to learn the roles that will enable him to relate constructively to the formal and informal system within the residential facility, even though Robert Edgarton's -4- study, The Cloak of Competence, Stigma in the Lives of the Mentally Retarded, proves so compellingly how destructive this complaint role playing is to the individual.

I find the document wanting because it suggests that the social service department helps the family to develop trust in the residential facility and helps the family to engage in a counselling relationship which they can explore and communicate troubled feelings and actions in relationship to the retardate and the residential facility, but fails to recognize that there may be no sound basis for developing trust in an institution and that parents may rightfully resent being pushed into a casework-counselling relationship when they try to air grievances and concern about their child's treatment (or lack of it). .

I find the document wanting because it speaks only of needs, not of rights, and because of its lack of recognition of the advocacy role social service must assume on behalf of the retarded person and his family rather than a mere "liaison" role as is suggested. I find the document wanting because it not only fails to recognize the advocacy role of the social worker but fails to take any cognizance of the existence of associations for the mentally retarded which on their part have played a far-reaching advocacy role, granted that this has been done in some localities with less effectiveness than in others.

The strange lack of responsiveness of the social work field in general to the problem of mental retardation, even in the face of extraordinary manifestations of public interest, has been documented elsewhere. Let me merely add here that the lack of reference to the associations for the retarded in this draft document reflects a widespread tendency on the part of administrators and professional workers, particularly those in institutions, to look upon these associations as little more than donators of birthday parties and needed equipment the state fails to provide.

These rather lengthy introductory remarks were necessary to put into proper perspective a document I want to introduce into this discussion on human rights for the mentally retarded as a challenge to social action. In June of 1967 the International League of Societies for the Mentally Handicapped, which has in its membership over 50 parent sponsored associations around the globe, assembled in Stockholm a Symposium on Legislative Aspects of Mental Retardation. In attendance were delegates from Belgium, Denmark, England, Finland, France, Germany, Ireland, the Netherlands, Norway, Spain, Sweden, Switzerland, the U.S.A. and Yugoslavia. Let me share with you one part of the published Conclusions of this Syupusium5 which is particularly germane to our topic today.

III. INDIVIDUAL RIGHTS

The Symposium considered that no examination of the legislative aspects of the problem of mental retardation would be complete without general consideration being given to the basic rights of the mentally retarded, not only from the standpoint of their collective rights and those of their families, but also from that of the individual rights of the retarded person as a human being. The Symposium affirmed the following:

III.I General principles

a. The mentally retarded person has the same rights as other citizens of the same country, same age, family status, working status, etc., unless a specific individual determination has been made, by appropriate procedures, that his exercise of some or all of such rights will place his own interests or those of others in undue jeopardy. Among the rights to which this general principle may apply are: the right to choose a place to live, to engage in leisure time activities, to dispose of property, to preserve the physical and psychological integrity of his person, to vote, to marry, to have children, and to be given a fair trial for any alleged offence.

b. The retarded person has furthermore, a right to receive such special training, rehabilitation, guidance and counselling as may strengthen his ability to exercise these rights with the minimum of abridgement.

c. Some persons may be able to exercise all these rights, in due course, even though they are, or may have been, at one time or another, identified as mentally retarded. Others may, as a result of a serious degree of mental retardation, be unable to exercise any of these rights in a meaningful way. There remains a number of retarded persons for whom modification of some or all of these rights may be appropriate.

d. When modification or denial of rights is necessary, certain compensating special or alternative rights should be acquired. In cases where a number of fundamental rights are to be abridged, the special rights include the right to have a guardian appointed, who will have the legal and moral obligation to make necessary decisions on behalf of the retarded person who cannot act for himself."

Let me interpolate here a further provision mentioned in a later section on guardianship.

"d. The guardian appointed should be one who will render conscientious service to the ward in the light of modern understanding of the nature of his condition; no person should be appointed who is responsible for rendering a direct service to the retarded person."

"e. In respect to any right which it is proposed to deny or modify, the retarded person is entitled to the benefit of special procedures, in accordance with the general legal code of his country, which will ensure that:

1. an evaluation of his social capabilities to exercise the rights in question has been made by persons professionally qualified to do so;

2. both he and members of his family or other interested persons are advised in advance of the process;

3. rights of appeal to higher authorities, and especially the courts are kept open;

4. the benefits of these and related legal provisions are not limited by the economic status of the retarded person;

5. the possibility remains of restoring at a later date any right which is denied, should the circumstances later justify restoration;

6. there is provision for periodic review of the necessity to restrict rights;

7. the physical and psychological integrity of his person is preserved."

These findings of the Symposium have since been formalized and ratified by the Fourth Congress of the International League, held in Jerusalem in October 1968, as The Declaration of General and Special Rights of the Mentally Retarded. -6-

I have little doubt that the majority of the persons here assembled and, indeed, the majority of staffs in the social service department in our state residential facilities for the retarded, would declare their general agreement with either one of these two documents, particularly the second one, approved in Jerusalem, (1) because some conservative voices prevailed in the League's Council to leave off two items most difficult for the general public to accept: 1) the right to marry, and 2) the right to vote. But such acceptance of either statement would, indeed, be of little consequence unless it is coupled with a most fundamental change in the functioning of the social service departments in these institutions along the lines I have already indicated.

We face a strange phenomenon in this country. On the one hand a Presidential Committee -8,9- for two years in succession has criticized in strongest terms the inhuman treatment to which individuals in many of our State institutions are exposed. To the contrary, we are over and over assured that once we get more money to hire more staff and repair some buildings there is not much to worry about. Those of you who know the conditions in some of the California institutions must, indeed, have marvelled at the nonchalant attitude with which the Director of the Human Relations Agency, Mr. Spencer Williams, glossed over the very conditions which are a matter of such deep concern to the President's Committee and, of course, to countless parents and informed citizens who know so well what Mr. Williams professes not to know. We must recognize, of course, that Mr. Williams' task is in the political area. But what about the Social Service Departments and their professional responsibility? . What is their responsibility in the face of flagrant violations of a resident child's or adult's human rights which come to their attention? What about willful concealment of the true nature of a child's death or serious injury, caused by gross negligence of the institutional staff? What about continuing exposure of young children to vicious sexual assaults because of the administration's refusal to take appropriate action?

What about the gross abuse of medication or other medical treatment which when used as a disciplinary measure without doubt constitutes cruel and unusual punishment, outlawed under the Constitution of the United States? (2)

Or the use of residents for peonage, involuntary servitude at long hours, again outlawed by the Constitution? (3)

What about denial or undue restrictions of visitation rights to parents, particularly parents from disadvantaged backgrounds who cannot effectively protest? What about measures deliberately designed to humiliate children such as keeping them naked for punishment or placing a child or adult in a group functioning at a much lower level, again solely for disciplinary reasons?

What about the withholding of a child from schooling -- an act which if committed by the parents would result in court action?

Who will be the child's advocate if not the social worker?

Who will convey to parents the true information or see to it that it is conveyed to them, if not the social worker?

These are not hypothetical questions -- I am referring to actual happenings in the recent past -- not in one State but in several.

And thus it has came to pass last week that the Pennsylvania Association for Retarded Children, having in vain communicated by letter, visits and telegrams with the Governor, the Secretary of Welfare, the Director of Mental Retardation and others to bring to their attention clear evidence of gross irregularities, including cases of negligence resulting in death of residents, decided in their Annual Convention by unanimous vote to authorize its Board of Directors to engage counsel to determine what kind of legal action may be taken to compel the State to remedial action.

Once again, the parent association and only the parent association came forth as advocates and defenders. Where was the Social Service Department? Safely barricaded behind the aforesaid mentioned roadblock that protects the bureaucracy in what is known to sociologists as system maintenance.

Who is being attacked? Who is the guilty party?

My friend and colleague, Dr. Roland Warren, reminded me just the other day that when an effort was made after Hitler-Germany's collapse to take to account the German industrialists who had made great profits from collaboration with Hitler's extermination policies, the point was made from our side that after all these industrial leaders were all honorable men.

It is always so -- "all honorable men". But the question still remains -- what about those whose fate is entrusted to the honorable men -- who will speak for them?

REFERENCES

1. Davies, S., Social Work and Mental Retardation -- Past, Present and Future. Address to the AAMD Annual Social Work Luncheon, May 2, 1968 (mimeo).

2. Duhl, L., Linkage between Poverty and Mental Retardation, Mental Retardation 3, 2 (April 1969), pp. 30-32.

3. Dybwad, G. , Prevention as a Goal of Social Work, Is Social Work Ready to Meet the Challenge of Mental Retardation? In: Proceedings -- 1968 Mental Retardation Institute Pittsburgh, Graduate School of Social Work, University of Pittsburgh, 1969.

4. Edgerton, R., The Cloak of Competence -- Stigma in the Lives of the Mentally Retarded. Berkeley and Los Angeles, University of California Press, 1967.

5. International League of Societies for the Mentally Handicapped, Legislative Aspects of Mental Retardation, Brussels, The League, 1967.

6. International League of Societies for the Mentally Handicapped, The Declaration of General and Specific Rights of the Mentally Retarded, Brussels, The League, 1969.i

7. Pennsylvania Association for Retarded Children, Resolutions of 19th Annual Convention, Pennsylvania Message, 5, 2 (June 1969).

8. President's Committee on Mental Retardation, M.R. 67, A First Report to the President on the Nation's Progress and Remaining Great Needs in the Campaign to Combat Mental Retardation. Washington, Superintendent of Documents, 1967.

9. President's Committee on Mental Retardation, M.R. 68, The Edge of Change. Washington, Superintendent of Documents, 1968.

10. Wineman, D., and James, A., The Advocacy Challenge to Schools of Social Work, Social Work, 14, 2 (April 1969), pp. 23-32.

11. Young, W., Poverty, Intelligence and Life in the Inner City, Mental Retardation. 7, 2 (April 1969), pp. 24-29.