paternalism
pragmatic partnerships
equal citizens
health services , recovery is often still associated with no longer needing services and being able to work .
Professional beliefs about capacity for change determine who gets rehabilitation or recovery services . Yet , when these services are aligned with a person ’ s goals , rather than organisational , professional or political aims , lives are transformed . Questioning eligibility criteria is part of challenging ableism .
Attitudes
Our attitudes can form a barrier for disabled people , such as different understandings of independent living . In response to restricted institutional life , disabled people developed their vision of independent living , which means living on equal terms with non-disabled people ( Evans 2002 ; UNCRPD 2006 ).
In contrast to being able to perform occupations without practical help , independent living means being able to make autonomous decisions about how to live ( Tamaru et al 2007 ).
It takes time to develop the capacity for autonomous decisions . There are opportunities in occupational therapy to explore how to live when practice is based more on pragmatic than procedural reasoning .
Our professional origins are in pragmatism : seeking practical solutions for everyday problems while remembering the principle that participation in occupations can benefit health and wellbeing .
Clients , people , citizens
Being a citizen is the basis for equity , belonging to a society that negotiates together about shared resources . Evolving partnerships with disabled people are the middle ground between paternalism and citizenship , where we can negotiate with disabled people and be honest about realities ( see diagram above ).
If we are pragmatic , principles of recovery and independent living are interpreted for every situation we encounter .
Paternalism is always a possibility , where we limit the autonomy of the people we work with , perhaps by seeing them as clients for our services . Professional power gives us scope to determine how much to involve people in the occupational therapy process .
Profile of Dr Maggie Winchcombe , OBE FRCOT
Maggie ’ s allies , at the disabled people ’ s organisations and in local services , created opportunities for her .
She qualified as an occupational therapist in 1973 . As the independent living movement gained momentum in the early 1980s , Maggie started a new part-time role in a local charity , set up to provide advice to disabled people and their carers .
She had worked in mental health services prior to this , so learned about equipment issues directly from local activists and the people using the service .
At that time , equipment services were a low priority for local authorities . Occupational therapists prescribed equipment with limited choice , so that people were obliged to feel grateful for what help they could get .
In the 1990s , Maggie was seconded to work to improve regional equipment services in Hampshire , which led to work with the Disabled Living Centres Council . She took an innovative approach , setting up an advisory group of disabled people and carers . MPs had more mail about dissatisfaction with equipment services than most other issues , so there was interest from the government in improving the situation . She worked on Department of Health funded projects , developing good practice guidelines .
This work was ground-breaking , paving the way for the major policy change that created Integrated Community Equipment Services in the 2000s . Then , still based with the Department of Health , she developed the Trusted Assessor programme . Another project involved mapping user-led groups across the UK .
In 2004 , she set up a company called Years Ahead , with the aim of normalising and improving the availability of mobility and independent living products . All these roles involved working with many other people , mostly not occupational therapists .
She is now retired and says for many years she did not feel like a ‘ proper ’ occupational therapist , but realised that the profession was reflected in her work , being focused on autonomy and everyday life . Maggie ’ s career shows us how it is possible to work as an ally , challenging and changing practices which restrict the lives of so many people .
Winchcombe M ( 2001 ) Rights and responsibilities : can we take the risk ? British Journal of Therapy and Rehabilitation , 8 ( 4 ): 125-125 .
14 OTnews November 2022