Situation 1:

Imagine for a moment... that the simple liberties of clipping a pod in the Nescafé Dolce Gusto Oblo Coffee Machine turns into a trolley visit (with the typical whiny twisted wheels) and in the background a care worker shouting at the top of her voice as she walks down the hallway peeping unperturbed into one room after another; ‘trid te sabiha?’

……….

Situation 2:

A typical institutionalized conversation in an old people’s home:

Care worker 1:  Postok fuq dak is-siggu sabih

[With a pleading tone in his voice…]

Wenzu:                Imma hawn irrid noqghod ta u ma rridtx niekol fil-hamsa.  Anzi irrid grokk Brandy u sigarru’ bhalissa.   

[…in the most patronizing of tones…]

Care worker 1:  Le hanini t-tabib ma takx permess u jekk ma tobdinix nugzak lin-nurse! Ejja kul, ghandna l-minestra llum. 

……….

Situation 3:

A young disabled man and his girlfriend who live in a residential home and want to have sex but cannot because they are being relentlessly surveilled by the care workers.  

Care worker 1:                  Jahasra xi hlew ihobbha ta’.

Care worker 2:  Isa he oqghod pingi maghha.  

[…a few moments later…]

Care worker 1 […in the typical demeaning of manners]: Time-up he, issa ghidilha bye l-gharusa.

Stuart:                  Imma jien irrid inbusha.

Josianne:             …u norqod hdejh.

[…both Care workers laugh as Stuart and Josianne are dragged away from each other…]

………

10,000 people in Malta and Gozo, ‘as we speak’, are living in residential homes away from their community, their family and friends, the people they have been brought up with, the grocery shop, the butcher, the streets, the neighbours, the sounds and the smells they are used to and have been brought up with.  Just like the Harry Potter’s invisibility cloak, institutionalization makes you conveniently invisible.

Let us not be tricked, these people truly struggle to make the ‘institution’, the ‘residence’, whatever political correct way we choose to call it, their ‘home’; whether it is inmates in a prison cell, patients at MCH, children in homes, old people in residences, disabled persons and people with mental health challenges in units, migrants in their prefabricated abodes, women victims of violence in some secluded townhouse, sex–workers and homeless people in hostels – and the list could go on.

I do understand that some of these people ‘in care’ might not have any other option. I also recognize that at face value people live in institutions because something in their life did not work out as it should. 

But most of the 10,000 are carted-out against their wishes and if we are not watchful, this risks becoming the new normal in our social welfare system, because we think we are doing the right thing as we embalm people!

I am convinced that many did not choose this life for themselves. 

Then again, no flower arrangement or fresh smell of detergent or elegant reception or new bedsheets or some other privilege will unstiffen the pain of being away from home. No ‘home away from home’ or ‘offering hope & comfort’ tacky slogans will do it for me. 

From where I stand the people who are in out-and-out, need for residential accommodation should be much less than the thousands of people who have been unloaded in these residences. 

For example, are we sure these people should be confined to such lodgings had our communities been more hospitable?

-          That old lady, Marija, who lost her lifetime partner, developed symptoms of dementia and is ‘certified’ unable to live on her own;

-          or that young man, Massimo, who due to his heroin addiction he has slipped into needs to be treated away from his family because of the dangers there are in the neighbourhood;

-          or that young mum, Shirley, who has been punched so many times in her face by her husband that she cannot remember the names of her parents and now has to live in a shelter because the ex-husband still resides in the matrimonial home;

-          or that young girl, Irene, who came from Lithuania hoping to find a better quality of life but ended up working as a sex worker to survive and has now been abandoned by her pimp because she got pregnant and is now residing in a shelter with no money she can call hers;

-          or that that priest, Fr James, who after dedicating his life to his parish is placed in a hostile looking home for old clerics because he is of no more need to the parish;

-          or that Somali man, Jaamac, who left his village back home after his parents and sister got murdered and is now living in a prefabricated box at Hal-Far;

-          or that little boy, Jackson, who was the victim of abuse and abandonment, left alone at home so many times and deprived of schooling, good food and love and notwithstanding he is just 8-years-old had to be admitted to a Church residential home because no other members of the family ‘wanted to get involved’;

-          or that 14-year-old, Sharon, who doesn’t know who her father is and all she knows about her mother is that she is a cocaine addict and is now having to live with 6 other girls she doesn’t know and doesn’t like because no one else will take her in;

-          or that 35-year-old man, John, who has lived in a mental health institution because 12 years ago he lost his parents and slipped into a depression, had no support and ended up in a crowded ward with many other people he did not know and did not choose to live with;

-          or that 70-year-old man, Grezzju who was widowed a year ago and all he did was cry for the loss he had endured of his lifetime companion and his family thought it would be better for him to be ‘settled’ in a residential home because his children were busy with their careers;

-          or that young Belarussian man, Timofei, who thought it was ok to act as a drug mule and got himself into so much trouble he ended up in prison, never once getting a visit;

-          or Marika, who is disabled and has been placed in a home because her parents cannot cope with her and raising the other siblings - so she ‘was chosen’ to go;

-          or Wistin, who is repeatedly sent to solitary confinement whilst he is doing his prison sentence.

Surely there were other alternatives we could have at least considered instead of having people lugged out of their private residences;  

-          MCH should be much smaller, alternative community models applied more aggressively and the mental health strategy implemented speedily;

-          families with disabled members should have more access to top notch community individualized services;

-          SVPR should never exist to that extent (an estimated 1,800 residents with the new extension) turning that part of Malta into a settlement for the aged most of whom are miles away from home;

-          we should be investing in more speckled community services for children to remain with their families, keep strengthening fostering services and make it easier for couples to adopt local children;

-          we need to reduce the number of people who reside in prisons by giving alternative punishments instead of incarceration when sentencing is less than 2 years;

-          we need to support Dar tal-Provvidenza by providing resources so that more residents are placed in community homes or helped to relocate in smaller apartments;

-          we need to give more psychological and community help to all those who are homeless and provide them with the tools to make a life for themselves. 

I am troubled that institutionalization has taken on a new meaning in present-day social welfare and at times is being considered as the be-all and end-all of our welfare safety net. 

Once again, I do understand that there are circumstances that make it increasingly difficult for people to be comforted and taken care of at home; maybe in severely challenging situations or the abusive contexts, but other than that I believe it is more an issue of our ‘modern lifestyle’ that leaves very little space for people to engage in the needs of others. Life’s currency is turning out to be about ‘me’, ‘my’ career and ‘my’ aspirations – what comes in the way we toss it to the side. 

As a society we are slowly turning our welfare system into barbicans with overlooking turrets. We are transforming our support programs in bricks and mortars, paternalistic clinician-patient relationships and pathologising of difference.  And where adaptive behavior is not possible, according to our sophisticated and politically correct protocols, the easiest way of sorting things out will be to erase them from our collective conscious.  One way of doing this is that, instead of focusing on community services, we find it easier (albeit costlier) to create homes and residences, speaking about ‘cases’ rather than people and negotiating costs of ‘bed care’ rather than seeking creative solutions that are possibly already implanted in our (very resourceful) communities. One good step in the right direction is that, at least, we are introducing measures and standards to safeguard quality.

But let’s call a spade a spade.

People in care suffer loneliness, deep-seated agonizing solitude, lose an interest to live, give up on their ambitions and simply live in a world of memories. Their social world changes and life becomes twisted and unrecognizable. This situation has a toll on these individuals. This leads to self-mortification which is the result of restriction of the simple liberties that give quality to our lives. The ordinary social roles are dismembered.  Whether it is residing in a mental health institution, a prison or some other residential home, the impact is equally devastating. That is why I am advocating that residential care if at all comes as the very last option in a properly planned continuum of services.   

The amount of buildings and residential settings we are developing for old people, disabled persons and people in mental health is way out of proportion.

The impact of being away from one’s community is colossal and it is negative, as research has shown along the years.

There is another pitch to this issue.

We really need to be vigilant as residential care has also become a luscious business whereby residential services have been commodified and have become a cash cow.   

Our welfare merits a stronger discourse around personal choices (not sure this comes into the equation often enough) and the right to receive services in the least restrictive environment possible. When one considers the advances in medicine and medical procedures and alternative care in the community, I cannot understand why we are so trigger happy when it comes to placing people in ‘homes’.

Now is the time to take our welfare services to the next level and provide the necessary tools and care wherever people are living. 

Oh, and politicians should dodge the temptation to value their effectiveness with how many residential units they inaugurate, but instead measure their success by the number of people who return back into the community. In the process, we need to discourage the heroics of pseudo-social operators keener on leaving a legacy rather than doing what is best for the population segment they believe they represent. 

In other words, I would like to advocate for a national policy on de-institutionalization. 

Still loads of work to do but I am sure we can find the political will, the academic acumen and the policy insights to take this forward.