Culture shock

Citation

Johnson, R. (2014), "Culture shock", Housing, Care and Support, Vol. 17 No. 2. https://doi.org/10.1108/HCS-03-2014-0008

Culture shock

Article Type: Editorial From: Housing, Care and Support, Volume 17, Issue 2.

A journal which looks at the role of housing in pubic health and community care is not, on the whole, going to be read by tenants and homeowners. Our readership is those who wish – or who need – to be informed by research and debate, inspiration and challenge, over housing and health as key areas of social policy. It is tempting, then, to assume that the important thing is to get the messages right between these groups of professionals – and indeed, getting communication between different professional cultures, in this increasingly compartmentalised world, is challenging enough.

However, it is also good to recall the dictum of the Irish playright George Bernard Shaw (1911), that “all professionals are a conspiracy against the laity” – that is, a defensive wall to keep at a distance the ordinary, common people, those outside the specialist circle of experts. When it comes to housing, or health, or community care, however, it is the ordinary public whose experiences we the professionals are there to enhance; and the ultimate test of the views of the professional elite is not the judgement of their peers, but the satisfaction of the public with what we have offered them.

Dr Ivy Shiue’s brief paper, which begins this collection, notes that there is an assumption amongst some policy makers that the view of housing improvement as central to improving public health is broadly shared by citizens, and thus voters. But how far is this true? How “evidence based”, as we must now say? More pragmatically, how strong is the mandate for public investment, as policy?

Notwithstanding some intriguing anomalies, her overall conclusion is that the people of the more impoverished countries, and those with poor self-related health, are most inclined to see a link between housing improvement and better health. This would then suggest that there would indeed be a popular mandate to efforts to tackle health via investments in housing.

It is always necessary to exercise some caution in drawing conclusions from statistical analysis of a single data set. But, as organisation such as the World Health Organisation look towards a more international perspective on health improvement, Shiue’s paper may mark the beginning of a dialogue with national and also more global policy makers.

A concern to verify the enthusiasms of research and policy makers against the actual lived experience of service users also motivated Anne Gray’s study. As more progressive social landlords – and also some in the private sector – are now keen to espouse the principles of resident and tenant engagement, in hopes to reap the reported benefits in health and wellbeing, how far does this actually reflect the reality, or even the wishes, of the customer/tenants whose housing they provide?

Gray’s research had begun, framed by an initial research question concerned with how the benefits claimed for user empowerment (as against the relatively passive “customer satisfaction”) in co-housing retirement villages might also be extended to those without the means to purchase – and/or for those living already in established schemes, with less focus on engagement.

How far might more “democratic” mechanisms such as consultative committees replace individualistic, one-to-one tenant-staff interactions focused more re-actively on problem-solving? How far might enhanced social capital and empowerment fill the gap left by the reduction in the use of resident “wardens” – a common feature of such developments in the UK, for example, which fell out of favour with policy makers (who questioned whether this constant on-site availability was un-necessarily feeding dependency). Such doubts left the warden role especially vulnerable to “economies”.

Using focus groups on 16 estates – further supplemented by postal surveys on half of them – to ascertain the actual experience of tenants, Gray found that many found this offer of active citizen empowerment not liberating but burdensome. The key intermediary factor, she finds, is social cohesion: “Whilst the social cohesion associated with strong social activities is not a sufficient condition of wanting to express a collective voice on landlord's policies”, she concludes, “it may be a necessary one”.

Her study then raises further qustions over the loss of the on-site resident warden role, and the extent to which more “personalised” or individual-focused support services where enabling in the same way, a sufficiehnt basis for strengthened socil capital. Sheltered housing, she argues, is “a collective good”; and its benefits are not solely in individual support offered, but in the support of a natural shared social life, which then brings the benefits to individual health and wellbeing.

The need for a more frank recognition of potential conflicts of perspective when introducing change also appears in the paper from Deidre Wild and colleagues: in this case, in the introduction of new (i.e. information) technology in a care home setting. A number of studies and reports suggest that there is considerable benefit in the introduction of telecare into ordinary homes, both in costs savings and in enhanced peace of mind, combined with privacy. It may then be natural to anticipate similar benefits from the introduction of such technologies into residential care. But this assumption needs testing, especially since the care home resident population now represents a far higher level of health impairment, and thus a significantly different cohort.

In the light of these developments, Wild et al. here re-visit a learning exercise conducted originally in 2004 with ten care homes in one locality in the west of England, which aimed to explore the meanings that staff, residents and their relatives, in a sample, attached first to their “own home” and second to the care home as a “home”. This triple perspective account was an innovation at the time; and does not seem to have been repeated since. Yet the results clearly indicate differences that would need to be taken into account, when assessing the feeling of home, and the value of any changes to be introduced.

For example, by contrast to the sheltered accommodation scenarios described by Gray, the activitivation programmes offered in the care home environment did tend to be focused on group activities; and this, combined with the higher levels of impairment, Wild et al. suggest, may cast in a different light the meaning of being alone. Solitude here is not necessarily equated with being lonely, as we find so often in community settings, but may mean, for some, an opportunity to retreat into peaceful contemplation.

The original exercise on which this paper is based worked with a relatively small sample of staff, residents and relatives; and as they suggest, would need repeating on a larger scale. The author’s principal conclusion however is that the care home environment is one of considerable social and emotional complexity. If the potential benefits of design and new technology – still largely being developed by a younger population to meet their own concerns – are to be realised, more attention will need to be given to the differences in meaning that the key players, the residents, give to their experiences.

Greater recognition of the complexity of psychological and emotional needs is growing in other areas of care and support housing, and especially in relation to homelessness. Yet in our next paper, in their introduction of what will be a two-part study of the introduction of “Appreciative Inquiry” (AI) into a high needs homelessness resettlement hostel, Suzanne Quinney and Leo Richardson quite consciously offer a challenge to the implied assumption that the “psychology” that informs a psychologically informed environment in homelessness resettlement should necessarily be drawn from those forms of psychology that have developed in order to help people with mental health problems – what they call “pathology-based psychologies”.

As Quinney and Richardson suggest, there are important areas of psychology outside of clinical practice, and one such is the field of organisation studies, and especially of organisational and community development. Here there is now a solid and indeed an ever-accumulating body of evidence for the effectiveness of “strengths-based”, “assets-based”, or similar approaches – which in fact chimes perfectly well with the schools of humanistic and positive psychology, in stressing not techniques and interpretations, but aspirations, hopes and relationships, even when working with those with serious and entrenched psychological problems.

Where the AI approach has most to offer, however, for those who do wish to develop more psychological sophistication in the running of a homelessness resettlement service, may be in the focus on the culture of the organisation as a whole – the environment, rather than just the training needs of staff.

Services and innovations operate within a complex ecology of opportunites, gaps and constraints. Through the introduction of modern management thinking into welfare provision, there has been increasing recognition of the role of leadership, not just in the efficient management of any existing resources, but in the constant adaptation and evolution of services. But leaders must also have – or rapidly find – a real understanding of the service environment in which they operate, if their efforts are not to be frustrated or frustratingly mis-applied. Differences in perspective which, if un-recognised, may lead to frustration and conflict appear in another paper which looks at internationalism of development efforts.

Here, in Kelli J. McGee’s thoughtful reflection on her time as a development consultant, brought in to help a rapid expansion of the De Paul charity’s work in the Ukraine, we have again organisational development, in pursuit of more creative responses to homelessness. McGee’s paper shows the organisation, starting in some cases, as here, from almost nothing – “going up a gear” in awareness, from simple – allbeit courageous – faith-based practice, with an urgent response to immediate need, to something more organised and systematic and – we trust – sustainable.

But here, the thinking that helped our author to understand the world she was in – and to re-examine her own assumptions – come not from any form of psychology, at least in any narrow sense, but rather from anthropology. All the social sciences now recognise that the researcher, or therapist, or “change agent”, must be conscious of the prior assumptions and values that they bring to any situation or encounter. But anthropologists seem to have done more than most to make this a central focus of their methodology.

The use of concepts derived from anthropology might well be seen as a natural resource for insights, when looking to understand the issues that might arise in international efforts at development. But McGee’s paper reminds us that there are cultural divides within the home community too; and when we are dealing with individuals and client groups marginalised and excluded from any mainstream society, we need to develop better awareness of the background assumptions of culture, which are rarely mentionned in a business plan, or in staff training – and especially when staff, users, and the host community alike may share some culturally formed attitudes that in themselves echo and so re-enforce, for example, the poor self-image, limited aspirations, passivity, etc. in the cultures of the users group.

A similar a blend of theory and actual experience also runs through Hans Oh and Sam Albertson’s viewpoint paper, based upon participant observation of a faith-based campaign to tackle homelessness in New York. In the USA, the current progressive thinking on homelessness seems to be mainly addressed through a rights-based discourse, which argues – with a well-evidence case – that access to housing is the first priority of resettlement services, other complex needs being addressed only later.

The New York campaign, which aimed to get homeless people into settled accommodation, was then intensively resourced, allbeit by volunteers. Yet still, according to Oh and Albertson’s account, relatively few of the intended targets completed the programme. From this, they begin to question whether the resources in volunteer time were best devoted to speeding direct access, or whether some approach that focused more on the importance of forming a human relationship might have helped address the underlying issues.

It was Christian thinkers such as Martin Buber who identified the authenticity of relationships between actual people (what Buber described as I/Thou attitudes) as being essential to the healing of the soul – though there have been many others, from all creeds and none, who have come to the same view. In fact, a renewed stress on the centrality of relationship threads throughout this issue – in Wild’s paper, on the need for more relationship-centredness in care homes; in Quinney and Richardson’s Appreciative Inquiry. It appears again in another form, in the Individuality/Collectivity and Power Distance polarities that Mc Gee was working with, in her development work.

Some at least of the renewed interest in relationships and related-ness may be traced to the work of the psychiatrist and developmental Psychologist Dr John Bowlby, whose thereorising first successfully united psychoanalytic thinking with anthropology and ethology, in a fully Darwinian framework. The fact that Bowlby’s theories lent themselves to empirical testing helped endear him to the experimentalist schools of scientific probity; and they have since proved most useful to understand, for example, the neuroscience of trauma. Similarly, in recent years we have seen the rehabilitation of the concept of personality as a legitimate subject for science, so that now primatologists and even those hardy souls who study lions will recognise different characters.

With culture, however, there is still a residual squeamishness. Can we really study something so pervasive, and so apparently unquantifiable, as the culture of an organisation? If all the papers in this issue touch, one way or another, on the subject of cultures – social, political, institutional – then that very breadth is perhaps both a strength and a weakness. But the concept might be more acceptable if we were to talk instead of the ecology of services, as here is a metaphor, or rather, an extension of the meaning, that might seem more scientifically respectable, but amounts to much the same thing.

At the time of writing (late March 2014), the Ukraine is constantly in the news, with the east- and west-facing cultures that McGee describes balanced on a precarious edge. Where once there may have been a cultural divide, there is now an abrasive polarisation, as geo-politics now adds new levels of meaning to the dynamics of personal, group, and national identity. We may only hope that the shock does not escalate further.

Robin Johnson

Reference

Shaw, G.B. (1911), “The doctor's dilemma”, available at: https://en.wikipedia.org/wiki/Conspiracies_against_the_laity