Working with institutionalized clients

Abstract

David has become institutionalized to the extent that his original diagnosis is mild in comparison to the debilitating state in which he now finds himself. Other than on the issue of his independent living, David is obedient, compliant and complacent to an extraordinary degree. His mask-like features would persuade the observer that he was suffering from Parkinson’s disease. This would be equally supported by the blank expressionless eyes and the shuffling gait. The giveaway clues of his actual disability can be easily observed when his chair in the day room is taken by an unsuspecting stranger, or a new care assistant changes his routine for some reason. It is then that his blank eyes become expressive and David becomes animated, for his security and safety are threatened.

Some years ago David was admitted to hospital with a diagnosis of anxiety/depression, following an attempt to commit suicide. David remained in hospital for over 15 years, yet this was not due to his anxiety or depression but because the institution was the only place he felt safe and secure. More recently David has been ‘decanted’ into the community into a residential care home. However, any attempt to converse with him about the subject of living more independently is met with a blank stare, an anxiety attack or an aggressive response. Although he now lives in the community he remains ‘institutionalized’.