The Empire strikes back: learning from practice on the margins Jennifer Creek

Contents of paper Terminology and key features of the margins The influence of the British Empire on occupational therapy Traffic between the centre and the margins Integration of occupational therapy into the mainstream What can be learned from occupational therapy theory and practice on the margins Improving mainstream services

Social movements of the late 19th and early 20th centuries Improving the lives of marginalised people: urban poor, immigrants, women, those with mental illness Women’s professions in the social sector Compulsory education Contributing to the war effort Career as an alternative to marriage for women Better housing for the poor The settlement movement

The settlement movement 1884 Toynbee Hall – London To offer amenities, education and guidance to people living in impoverished urban areas 1889 Women’s University Settlement – London To promote the welfare of the poorer districts of London, especially women and children 1889 Hull House – Chicago To integrate new immigrants into American society and to improve the conditions in the industrial districts of Chicago

Occupational therapy in the USA 1889 Hull House Settlement 1903 Chicago School of Civics and Philanthropy 1908 Course in Occupations for attendants in mental institutions 1915 Favell School of Occupational Therapy

Occupational therapy in Britain Elizabeth Casson: 1908 Housing manager for Octavia Hill 1913 Medical student 1919 Qualified as a doctor 1929 Opened Dorset House residential clinic in Bristol 1930 Opened Dorset House School of Occupational Therapy

Terminology Marginalised Situated on the edge, physically or socially; not fully integrated into the mainstream Marginal On or close to the margin below which something ceases to be possible or desirable Margin A physical place, a social space or a personal experience on the periphery of the social mainstream or dominant order. For every margin there is a centre or core that represents some form or position of authority, power and privilege.

Marginalisation The process of moving something or someone from the centre to the periphery, impoverish, depreciate or undervalue The process of marginalisation can be progressive and cumulative

British Empire at the beginning of the 20th century

1900 Campaign poster for the American Republican Party

Theoretical imperialism A process by which theorists develop and perpetuate theories that privilege their own perspectives while overlooking, ignoring or silencing the perspective of others (Hammell 2011)

The Standard Rules on the Equalization of Opportunities for Persons with Disabilities Adopted by the United Nations General Assembly, forty-eighth session, resolution 48/96, annex, of 20 December 1993

Occupational therapy on the margins The process is different from that described in textbooks Practice on the margins is qualitatively different from mainstream practice Practitioners on the margins share a particular set of characteristics

Occupational therapy process Perception of an unmet occupational need Recognition of how that need might be met Awareness that something can be done to improve the situation Awareness that the therapist has the skills and knowledge to bring about positive change Action by the therapist, with and on behalf of the people in need

Grandmothers Against Poverty and AIDS PERCEPTION OF NEED: When one or more parents dies from AIDS the grandmother may become the sole provider and supporter of the grandchildren RECOGNITION OF HOW TO MEET NEED: Provide useful information about such matters as HIV/AIDS, nutrition, bereavement and business skills ACTION: Organise a series of workshops

Qualities of occupational therapy practice Driven by particular ways of doing things, including models and procedures Focussed on the individual, who is seen as the locus of the issue Controlled by external forces, such as managers, employers and contracts Based in an institution, such as a hospital or prison

Qualities of occupational therapy practice on the margins Responsive to local conditions and needs Focussed on the collective, that is, on the community, family or work group Delivered by a professional who is able to make autonomous decisions about what to do and how to do it Based in the communities where people live and work

Enabling characteristics Agency is the capacity to take action towards an end Openness involves trying to understand what is there on its own terms Responsiveness means being willing to react in ways appropriate to the circumstances Commitment is the stamina to persist despite challenges and setbacks Resourcefulness is imagination and creativity in finding and making use of available resources

Conclusion The features and characteristics of practice on the margins make it more effective than institutionalised occupational therapy practice for people living with long-term, complex conditions As health and social care services struggle to deal with increasing numbers of such people, it is time for us to let go of established ways of thinking and practising and allow ourselves to learn new and more successful approaches from practitioners on the margins