Who's to blame for adult abuse? Recognising the structural discrimination

Author: Jonathan Parker, Bournemouth University, Bournemouth

Over the last five decades, we have heard an increasing amount about the abuse and neglect of adults at risk.

Safeguarding processes and procedures have been built around a range of identified types of abuse. In the UK we have been fortunate to move, albeit slowly, towards legislation that seeks to safeguard adults from abuse and neglect and to identify roles and duties that help professionals in discharging their legal responsibilities towards people at risk and promoting healthier lives and well-being. However, the focus of these measures concerns individuals who have experienced or perpetrated abuse, looking at individual risks and aspects of blame. These developments have been very useful to heighten awareness of the prevalence of abuse, neglect and discrimination against adults but such an individual approach deflects attention from external factors that may exacerbate or cause that abuse to occur, things beyond the individual, their families and those they live among.

In a recent article for the Journal of Adult Protection I wrote about structural abuse and discrimination in respect of older residents in care homes during the COVID-19 pandemic. Structural discrimination is understood ‘as an in-built, unquestioned devaluation of people through policy and practice based on certain characteristics’. As such it extends the concept of individual discrimination from simple prejudice or bias, often consciously displayed, to something that has informed the ways in which we have built and developed society and the public organisations within it. In this, it has similarities with the concept of ‘institutional racism’ that stemmed from the MacPherson inquiry into the Metropolitan Police handling of the death of black teenager Stephen Lawrence in the 1990s. When applied to adult abuse, however, it relates to the different treatment individual adults receive from the hands of health, social care and criminal justice systems depending on their characteristics. For instance, in the article I argued that the age and health status of people in care homes led to abuse through a lack of personal protective equipment (PPE), through denying visits from relatives and loved ones, whilst care home staff were equally abused through a lack of training, support, remuneration and PPE. What happened in these care homes, including the proportionally increased death rate of residents compared with the general population, was exacerbated by the ways in which older people are viewed in society, which leads to differential and less treatment, and, during the pandemic, allowed such abusive and ageist conditions to remain largely unquestioned.

The concept applies to all people in different ways. For instance, we applied the thinking behind structural abuse and discrimination to the gender divide in couples in receipt of Universal Credit where the male in heterosexual couples is generally paid the benefit and how, by doing so, women in abusive and violent relationships become financially trapped. The concept is now being explored in respect of the climate emergency and the ways in which societal responses affect different groups. In respect of older people approaches to housing, heating, transport, and benefits have an impact on how individuals can manage increasing temperatures and, on the other hand, insulate homes for warmth; how environmentally friendly approaches to heating and transport can exclude older people from everyday life.

If the concept of structural abuse and discrimination helps us to extend our understanding of the ways in which people experience the world, and how negative experiences can be exacerbated by the very structures and organisations we develop to help, we need to ask what this might mean for policy and practice. It’s important to note that individual practitioners in health, social care, criminal justice or education cannot, on their own, tackle or be expected to tackle the implications of structural abuse. However, being mindful of and reflective about one’s actions, the reasons for them and the consequences they might have is a key part of professional practice. It raises questions to be fed back to employers and in reporting. So, individual practitioners do have a role. However, it is with policy-makers, educators and researchers that the main responsibility lies.

Recognising that policies have consequences, anticipated and otherwise, and ensuring these are considered is important, but it is incumbent on policy-makers to include a range of people who may be affected by any proposal to gain important insights. Much structural abuse and discrimination, of course, stems from long-standing, already existing policies, institutions, organisations and practices, and reflection on these in a similar way should be built into the policy process.

Developing a citizens’ assembly approach to policy and project evaluation would represent a first-step on the way to acknowledging the potential for structurally abusive and discriminatory policies and practices and begins the listening process that would lead to positive change in our public institutions and helping organisations and, in respect of our ageing population, inculcate a caring approach based on well-being.

Read the full article: Structural discrimination and abuse: COVID-19 and people in care homes in England and Wales, Journal of Adult Protection, Vol. 23 No. 3, pp. 169-180.