External regulation Force and coercion Karl Elling Ellingsen

Harsh terms - harsh realities A specific Norwegian law regulating “force and coercion” in services to persons with IDD has as its goal to prevent persons with IDD from harming him/here self or others and limiting and reducing use of force and coercion. The overall reason, justification or argument is to: avoiding situations of emergency and serious risks of harm and damages basic needs and care that can be life-threatening if not safeguarded A deceptive, not normative definition; If a person oppose – it is force and coercion if the person then are being physically hold, verbally denied or forced to do something Is there a difference between restrain and seclusion and force and coercion? 2016 ©Professor Karl Elling Ellingsen, PhD

Two studies In 2010 (Ellingsen & Kittelsaa) – interviewed 17 persons with IDD as part of a national longitudinal survey on living condition. Two important findings; Restricting one selves due to fare and risk of bulling and harm consulting others almost as a rule In 2015 (Ellingsen & Berge) – interviewed 13 persons with IDD about their experience with being exposed for force and coercion from service providers about how that influence them and how their self-determination is effected by it. Findings; stories about episodes that indicates traumatic events feel of harm, pain and uncertainty staff members make the final decision 2016 ©Professor Karl Elling Ellingsen, PhD

Motivation and regulation Humans regulates and motivates biologically and physiologically - controlled by the brain. psychological processes and cognition are sources for intrinsic motivation, biological motivation, needs and purpose are often stronger Emotions and cognition are integrated processes; Dysfunction in the one effect the other The brain functions by neurons that fires (electronically), regulated by signal stuff, enzymes, hormones etc. activated by our senses, mind/ thoughts, biological needs etc. Signals runs through low and high road The integrated process is often called the High road where cortex and subcortical parts of the brain are activated, while the subcortical part of the brain counts for rapid reactions like fight, flight and freeze reactions. 2016 ©Professor Karl Elling Ellingsen, PhD

Two ways of emotion processing. The high road (blue) goes via the cortex, where emotion regulation and cognitive processing is integrated. The low road (red) involves subcortical structures, and represents rapid emotional responses, such as the fight or flight pattern. 2016 ©Professor Karl Elling Ellingsen, PhD

Surroundings/ environment Self-determination Quality of Life Mental health Participation Emotion Social inclusion Emotion and Self regulation Social competence Cognition Surroundings/ environment 2016 ©Professor Karl Elling Ellingsen, PhD

Fear is survival Amygdala and how fear is stored in our memory (cortex and subcortical; high and low road). Decoupling emotional activation and reactions from an experience (aversive/ trauma) - exposing therapy. requires the ability to remember or recall events that lead to the fear or trauma in therapy Persons with severe IDD will have difficulties in doing this due to cognition impairment (cortex). Therefor 1) reduce the risk of trauma and/or life-events that is dramatic or harmful and 2) give (external) support, briefing/debriefing, teaching and therapy that helps the person to be able to regulate his/here emotions. 2016 ©Professor Karl Elling Ellingsen, PhD

A reaction of fear Self harm, challenging behavior, withdrawal are connected to some mental health diagnoses, and a symptom of PTSD, anxiety or trauma Avoid activating these responses force and coercion towards persons known to have a cognitive impairment. 2016 ©Professor Karl Elling Ellingsen, PhD

The dysfunction of “force and coercion” If using force and coercion is the only way to save a person from dying or sever harm, it seems the right ting to do! If it is potential a situation where the person or others are at risk, the price that the person self has to pay, may be un-proportional. Fore persons with a cognitive impairment, the possibilities to help or threat the person from the side effects are limited, but also rarely available. 2016 ©Professor Karl Elling Ellingsen, PhD

Implications In the first of the two studies, we discuss the need for a safe environment to ensure a high degree of self-determination for persons at risk Including crime prevention (police) Safeguarding (all of the time) Need for a strong law in force In the second of the two studies, we discuss the risk of misinterpreting behavior, not seeing it as communication about an underlying condition, but as a problem itself Increasing a serious problem to a complex trauma by use of force and coercion (short term solutions – long term effects) 2016 ©Professor Karl Elling Ellingsen, PhD

Preventing social inequalities or increasing them? All social advantages stem from the interest that people have in each other; Looks, intelligence, strength, prowess, energy, liveliness, the very attachment to life – are unequally distributed. Yet, it is these qualities that we find most interesting, and that determine our chances in the world. To prevent social inequalities, therefore, we must ensure that people are not free to exploit their natural powers. Only a massive program of social engineering could succeed in bringing this about. Ref: Roger Scruton (1999) “Rousseau and the Origins of Liberalism”. In “The Betrayal of Liberalism” by Kramer & Kimball 2016 ©Professor Karl Elling Ellingsen, PhD

2016 ©Professor Karl Elling Ellingsen, PhD