Institutional abuse

Last updated May 01, 2024

Institutional abuse is the maltreatment of a person (often children or older adults) from a system of power.^[1] This can range from acts similar to home-based child abuse, such as neglect, physical and sexual abuse, and hunger, to the effects of assistance programs working below acceptable service standards, or relying on harsh or unfair ways to modify behavior. Institutional abuse occurs within emergency care facilities such as foster homes, group homes, kinship care homes, and pre-adoptive homes. Children who are placed in this type of out of home care are typically in the custody of the state. The maltreatment is usually caused by an employee of the facility.

Background

Institutional abuse can typically occur in a group home, nursing home, acute hospital or in-patient setting and can be any of the following:^[2]

Typical of the institutionalized bigotry that coincides with abuse, it is said that it can be considered to mainly apply to four categories of people:^[3]

Children – see also child abuse
Adults with learning difficulties
Adults with mental health problems
Older people – see also elder abuse.

This perspective often written into educational material seeks to excuse perpetrators with the "explanation" that the abused adults are all somehow mentally inept.

Institutional abuse can be divided into three categories:^[1]

Overt abuse – similar to familial abuse in its overt physical, sexual, or emotional abuse by a foster parent or child care worker
Program abuse – unique to an institutional situation, in which a program must operate below acceptable conditions or improperly use power to modify the behavior of person
System abuse – involves an entire care system that is stretched beyond capacity and causes maltreatment through inadequate resources.

These issues range from personal abuses to situational maltreatment and differ greatly in their causes. Most institutional abuses are the result of difficult and stressful working environments, where those with the least training often have the most contact with the participants, and have the hardest schedules, least payment, and most undesirable working conditions.^[1] The high-stress working environments of care workers combined with low-quality hiring and screening practices of workers can create abusive situations through lack of experience or knowledge on the worker's part.^[1] Lack of proper training for workers can conflict or hurt institutional goals for patients through improper implementation of treatments, compounded by organizational structures that may only have doctors and psychologists on site for short hours.^[1] In overstressed situations, power over the patients can bring feelings of control and significance, leading to stress being a predictor of abuse in institutional and familial settings.^[1] isolation from the community can have similar effects.^[1]

Often complicating worker issues is lack of organizational goals or policy. In childcare situations, lack of curricular recreation for children can lead to more acting out behavior, causing more stress for workers, and more inclination toward mistreatment.^[1] Patients can often be difficult to manage through inability or behavioral issues, and those who are more difficult for staff to work with are often the victims of abusive situations. It is proposed that most abuse rises of out frustration and lack of ability to properly control the patient, not intentional maltreatment.^[1] Institutional child abuse also happens intentionally in the troubled teen industry where residential treatment centers and schools market themselves as therapeutic to families who are then duped into colluding with the abuse. The outcomes of these types of abusive settings resemble cult like circumstances and are devastating to the survivor of abuse. More and more programs are getting shut down through a movement called "Breaking Code Silence" started by Paris Hilton in 2020 where she publicly spoke about her abuse at Provo Canyon School in Utah. The exposure led to a lot of changes in the industry. There is a lack of state legislation defining or prosecuting institutional abuse, leading to difficulty in investigation or dealing with abusive situations.^[1]

Historical perspective

Institutional abuse is also present in situations outside those of child and elder care. The Nuremberg Code was developed during the Nuremberg Trials to create a universal ethical code for the treatment of humans from an institutional standpoint.^[4] Though this Code is not formally adopted by any organization, its standard for human rights has been used as a guide for more specific ethical codes.^[4] However, history has still shown the abuse of the vulnerable members of society through medical and psychiatric institutions.^[4] Under the Nazi regime of the early 1940s, this abuse took the form of sterilization of those purported to be "mentally ill", and general medical experimentation without consent or will to leave, and eugenics.^[4] The political nature of these policies lead to them being enforced by law under an ideology of purifying race of genetic deficiencies.^[4] Eugenics and sterilization campaigns have also been run outside of political dictatorship, including a number of states in the United States, Denmark, Finland, and Sweden.^[4] But it is the shift from sterilization to euthanasia of the mentally ill or other politically undesirable groups in Nazi Germany that lead to the actions of the Holocaust.^[4] Japanese soldiers of the time also would use these groups as research subjects for infectious diseases and poisons, while Stalin's regime in Russia used the guise of mental illness to torture and punish political dissidents.^[4]

The Army and CIA of the United States also have histories of testing psychiatric drugs on unwilling patients or soldiers. LSD was tested by using prostitutes to trick men into taking the drug, and various combinations of depressants, hallucinogens, and stimulants would be given to unconsenting soldiers for observation of the effects.^[4] In response to many of these unethical experiments, specific ethical codes were developed to protect the rights of the participants and require informed consent.^[4]

Abuse of children

Abuse in childcare institutions falls most commonly into the categories of overt abuse, program abuse, and system abuse, which arise from the staff, program, or childcare system.^[5] As children are still in development as institutional abuse occurs, the definition of institutional abuse for children is often widened to include harming a child's development, altering a child's identity, or devaluing them as a person.^[5] Child maltreatment is also often defined as foreseeable or probable harm or injury to a child's physical, social, emotional, or developmental well-being.^[5] Researchers found incidents ranging from 39 to 85 abuse cases per 100 children living in full-time housing, with only 85 in 1000 cases being reported to authorities.^[5] Children in mental disorder clinics were more likely to report abuse than those in mental disability clinics.^[5]

Model of abuse

A number of researchers have tried to model the factors that cause abuse and maltreatment in childcare facilities. The acting factors in this model are the caregivers, children, the care-giving environment, and any other exogenic factors.^[5] Risk factors towards abuse are associated with each of these, such as the stress of the working environment can be to caregivers.^[5] These factors have all been organized into a model of concentric circles, with maltreatment at the center, and each circle further out influencing those within.^[5] There are ordered from inside out: maltreatment, child factors, caretaker factors, organization and environment factors, and exogenous factors.^[5]

Caretaker risk factors

A number of high-risk factors for the institutional abuse of children include lack of caretaker competence or training and adherence to only one treatment methodology, lack of supervision of caretakers, and much time for unstructured activities.^[5] The probability of a caretaker to be abusive is positively correlated with their job stress, age, lack of job satisfaction and facility status.

Child risk factors

Children who are more likely to be abused often display characteristics of being difficult for workers to deal with and needing more one-on-one supervision, isolation from their family, and previous victims of abuse. Children with disabilities or chronic illnesses are especially at risk of institutional abuse due to their reliance on healthcare institutions such as hospitals.^[6] Male children are more likely to be abused, and are more often abused physically and neglectfully, while females are more likely to be sexually abused.^[5]

Other factors

Incidents of abuse are most often reported at the beginning and end of the school year, and there are conflicting reports as to unemployment rates' influence on abuse.

Abuse of older adults

There is not a definitive definition of institutional abuse of older adults, with psychologists differing with legal definitions, and differing depending on the measures used.^[7] Definitions often include institutionally caused physical, psychological, financial, or sexual abuse or neglect.^[7] Among the abuse that happens among elders, most is concentrated on those who are more frail and need more assistance.^[8] In a review of Canadian assistance homes, over 70% of workers reported acting in an abusive way towards patients, frequently in the form of psychological abuse or neglect.^[8] In a study of American assistance homes, there was a rate of 20% for employees stealing from residents, with employees acknowledging that it was the residents that were more difficult or abusive that were more likely to be robbed.^[8] Further, in Sweden, assistance home employees reported witnessing abuse at 11%, while participating in elder abuse at 2% rates.^[8] This abuse was most commonly physical abuse, followed by psychological abuse and neglect.^[8] Rates of abuse differ across surveys, countries, and homes, but certain facts are consistent across studies. Victims of abuse are also susceptible to threefold greater mortality rates than their peers.^[7]

Several frameworks have been developed to model the risk factors for institutional elder abuse. In one model, risk factors are divided into three categories: validated factors, possible factors, and contested factors. Factors that have been shown to be risks for abuse include lack of consistent organizational policies, low-quality enforcement of standards, lack of trained staff, vulnerability due to dementia.^[7] Possible factors include gender, personality of the victim, and race.^[7]

Sexual abuse is one of the lower occurring and under-reported forms of institutional abuse. Women are disproportionately represented among victims, and most often abused by other residents of the home.^[8] The majority of victims also suffered from a form of dementia or cognitive impairment.^[8] However, institution-based sexual abuse crossed all gender, race, and cultural barriers.^[8]

Risk factors of institutional abuse of older adults has been found to be related to the size of the housing, with larger organizations more susceptible to abuse.^[8] Staff factors such as unionization, short staffing, and work stress are also predictors of abuse.^[8] Patients with severe dementia are also more susceptible to maltreatment such as being constrained.^[8]

Researchers do not have a definitive answer for the cause of elder abuse. Workers in assistance homes have suggested that program factors such as understaffing, focus on making money over human welfare, and ageism contributing to institutional abuse, aggravated by patients who may be difficult or struggling with mental health issues.^[8] Most studies have focused on the interaction of stressed workers with difficult patients.

Studies indicate that social inclusion can act as a cessation towards elderly abuse. This method is not only intended to encourage diversity within hospital settings. It is also intended to ensure the individual needs of elderly patients are being met.^[9] Other intervention methods that are education based have high success rates in increasing awareness but less evidence of improving the welfares of elderly populations.^[10]

Notable institutions and investigations

Jimmy Savile sexual abuse scandal, concerning a British celebrity who is claimed to have targeted institutions

Youth Facilities

Care Homes

Orchid View

Hospitals

Other

Judge Rotenberg Center

Related Research Articles

Violence is the use of physical force to cause harm to people, animals, or property, such as pain, injury, death, damage, or destruction. Some definitions are somewhat broader, such as the World Health Organization's definition of violence as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation."

Abuse is the improper usage or treatment of a thing, often to unfairly or improperly gain benefit. Abuse can come in many forms, such as: physical or verbal maltreatment, injury, assault, violation, rape, unjust practices, crimes, or other types of aggression. To these descriptions, one can also add the Kantian notion of the wrongness of using another human being as means to an end rather than as ends in themselves. Some sources describe abuse as "socially constructed", which means there may be more or less recognition of the suffering of a victim at different times and societies.

Physical abuse is any intentional act causing injury or trauma to another person or animal by way of bodily contact. In most cases, children are the victims of physical abuse, but adults can also be victims, as in cases of domestic violence or workplace aggression. Alternative terms sometimes used include physical assault or physical violence, and may also include sexual abuse. Physical abuse may involve more than one abuser, and more than one victim.

Elder abuse is "a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person." This definition has been adopted by the World Health Organization (WHO) from a definition put forward by Hourglass in the UK. Laws protecting the elderly from abuse are similar to and related to laws protecting dependent adults from abuse.

Psychological abuse, often called emotional abuse, is a form of abuse characterized by a person subjecting or exposing another person to a behavior that may result in psychological trauma, including anxiety, chronic depression, or post-traumatic stress disorder amongst other psychological problems.

Reactive attachment disorder (RAD) is described in clinical literature as a severe disorder that can affect children, although these issues do occasionally persist into adulthood. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited form". In the DSM-5, the "disinhibited form" is considered a separate diagnosis named "disinhibited attachment disorder".

A form of child abuse, child neglect is an act of caregivers that results in depriving a child of their basic needs, such as the failure to provide adequate supervision, health care, clothing, or housing, as well as other physical, emotional, social, educational, and safety needs. All societies have established that there are necessary behaviours a caregiver must provide for a child to develop physically, socially, and emotionally. Causes of neglect may result from several parenting problems including mental disorders, unplanned pregnancy, substance use disorder, unemployment, over employment, domestic violence, and, in special cases, poverty.

Child abuse is physical, sexual, emotional and/or psychological maltreatment or neglect of a child, especially by a parent or a caregiver. Child abuse may include any act or failure to act by a parent or a caregiver that results in actual or potential wrongful harm to a child and can occur in a child's home, or in organizations, schools, or communities the child interacts with.

Child protection is the safeguarding of children from violence, exploitation, abuse, and neglect. It involves identifying signs of potential harm. This includes responding to allegations or suspicions of abuse, providing support and services to protect children, and holding those who have harmed them accountable.

Sibling abuse includes the physical, psychological, or sexual abuse of one sibling by another. More often than not, the younger sibling is abused by the older sibling. Sibling abuse is the most common of family violence in the US, but the least reported. As opposed to sibling rivalry, sibling abuse is characterized by the one-sided treatment of one sibling to another.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Child sexual abuse (CSA), also called child molestation, is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include engaging in sexual activities with a child, indecent exposure, child grooming, and child sexual exploitation, such as using a child to produce child pornography.

Research published from 2000 to 2020 illustrates increased prevalence rates of sexual violence against people with intellectual disabilities, compared to the general population.^:61 The World Health Organization (WHO) funded a study which concluded that 15% of the adult population worldwide in 2012 had a disability, putting them at increased risk of physical, sexual, and intimate partner violence. Of that 15%, 6.1% had intellectual disability with 5.5% experiencing sexual violence. In another 2012 report, the WHO found that worldwide, children with intellectual disabilities experienced a 4.6 times greater risk of sexual violence than those without disability.

Child-to-parent violence (CPV), also recognized as abuse of parents by their children, constitutes a manifestation of domestic violence characterized by the infliction of maltreatment upon parents. This mistreatment commonly manifests in verbal or physical forms.

In the context of caregiving, neglect is a form of abuse where the perpetrator, who is responsible for caring for someone who is unable to care for themselves, fails to do so. It can be a result of carelessness, indifference, or unwillingness and abuse.

Disability abuse is when a person with a disability is abused physically, financially, sexually and/or psychologically due to the person having a disability. This type of abuse has also been considered a hate crime. The abuse is not limited to those who are visibly disabled or physically deformed, but also includes those with learning, intellectual and developmental disabilities or mental illnesses.

Professional abuse is "a pattern of conduct in which a person abuses, violates, or takes advantage of a victim within the context of the abuser's profession." This typically involves a violation of the relevant professional organization's code of ethics. Organizational ethics or standards of behavior require the maintenance of professional boundaries and the treatment of people with respect and dignity.

Trauma bonds are emotional bonds that arise from a cyclical pattern of abuse. A trauma bond occurs in an abusive relationship, wherein the victim forms an emotional bond with the perpetrator. The concept was developed by psychologists Donald Dutton and Susan Painter.

Patient abuse or patient neglect is any action or failure to act which causes unreasonable suffering, misery or harm to the patient. Elder abuse is classified as patient abuse of those older than 60 and forms a large proportion of patient abuse.

The influence of childhood trauma on the development of psychopathy in adulthood remains an active research question. According to Hervey M. Cleckley, a psychopathic person is someone who is able to imitate a normal functioning person, while masking or concealing their lack of internal personality structure. This results in an internal disorder with recurrent deliberate and detrimental conduct. Despite presenting themselves as serious, bright, and charming, psychopathic people are unable to experience true emotions. Robert Hare's two factor model and Christopher Patrick's triarchic model have both been developed to better understand psychopathy; however, whether the root cause is primarily environmental or primarily genetic is still in question.

References

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↑ Du Mont, Janice; Kosa, S. Daisy; Kia, Hannah; Spencer, Charmaine; Yaffe, Mark; Macdonald, Sheila (2020-06-05). Vidal, Edison I.O. (ed.). "Development and evaluation of a social inclusion framework for a comprehensive hospital-based elder abuse intervention". PLOS ONE. 15 (6): e0234195. Bibcode:2020PLoSO..1534195D. doi: 10.1371/journal.pone.0234195 . ISSN 1932-6203. PMC 7274390 . PMID 32502200.
↑ Baker, Philip RA; Francis, Daniel P; Hairi, Noran N; Othman, Sajaratulnisah; Choo, Wan Yuen (2016-08-16). "Interventions for preventing abuse in the elderly". Cochrane Database of Systematic Reviews. 2016 (8): CD010321. doi:10.1002/14651858.cd010321.pub2. ISSN 1465-1858. PMC 7169376 . PMID 27528431.
↑ The Texas boys were beaten, abused, raped. Now all they want is an apology," by Jason Wilson (The Guardian; December 20, 2017)

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Stallybrass L Queensland Government Actions to Compensate Survivors of Institutional Abuse: a critical and comparative evaluation - Law & Justice Journal Vol 4 No 1, 2004
Sunga S Meaning of Compensation in Institutional Abuse Programs - Journal of Law and Policy, vol 17 2002 pages 39-61
Tschan W Towards a safe institution: How to prevent Sexual Abuse in the Institutional Setting? - Presentation at the XIth ISPCAN European Regional Conference on Child Abuse and Neglect, Lisbon, November 18-21, 2007
Tsuzaki, Tetsuo (1997). "Socio-cultural Causes of Institutional Abuse in Japan: The Issues of Leadership, Authority and Power Relation". Early Child Development and Care. 133: 87–99. doi:10.1080/0300443971330107.

Non-fiction Books

Abuse and neglect of children in institutions, 1979: hearings before the Subcommittee on Child and Human Development of the Committee on Labor and Human Resources, United States Senate, Ninety-sixth Congress
Beaulieu, Marie; Tremblay, Marie-Josée (March 1995). Abuse and neglect of older adults in institutional settings (PDF). Health Canada. ISBN 978-0-662-23475-3.
Barter, Christine (1998). Investigating Institutional Abuse of Children. London: National Society for the Prevention of Cruelty to Children. ISBN 978-0-902498-84-6.
Barter C Investigating institutional abuse of children An exploration of the NSPCC experience - 1998 London: NSPCC. ISBN 0-902498-84-3
Beker, Jerome Institutional Abuse of Children and Youth (Child & Youth Services) (1982)
Hanson, R (Ed) Institutional Abuse of Children and Youth. (Child & Youth Services Series: Vol. 4, Nos. 1 & 2) New York: Haworth Press, 1982
Westcott, Helen L. Institutional Abuse of Children - From Research to Policy: A Review (Policy, Practice, Research S.) (1991)

Novels

Abagnalo, George. Boy on a Pony (Moreland Press, 2001) (exploring privileged sexual abuse within the healthcare system).

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[Powers-1] 1 2 3 4 5 6 7 8 9 10 Powers, J. L.; A. Mooney; M. Nunno (1990). "Institutional abuse: A review of the literature". Journal of Child and Youth Care. 4 (6): 81.

[2] "Institutional abuse". Surreycc.gov.uk. 2007-01-18. Archived from the original on 2011-06-22. Retrieved 2010-01-24.

[3] Manthorpe J, Penhale B, Stanley N Institutional Abuse: Perspectives Across the Life Course (1999)^{[ page needed ]}

[Lopez-4] 1 2 3 4 5 6 7 8 9 10 Lopez-Munoz, F.; C. Alamo; M. Dudley; G. Rubio; P. García-García; J. D. Molina; A. Okasha (2008). "Psychiatry and political–institutional abuse from the historical perspective: The ethical lessons of the Nuremberg Trial on their 60th anniversary". Progress in Neuro-Psychopharmacology & Biological Psychiatry. 31 (4): 791–806. doi:10.1016/j.pnpbp.2006.12.007. PMID 17223241. S2CID 39675837.

[Nunno-5] 1 2 3 4 5 6 7 8 9 10 11 Nunno, M. A. (1997). "Institutional abuse: The role of leadership, authority, and the environment in social sciences literature". Early Child Development and Care. 133: 21. doi:10.1080/0300443971330103.

[6] Kendrick, Andrew; Taylor, Julie (March 2000). "Hidden on the ward: the abuse of children in hospitals". Journal of Advanced Nursing. 31 (3): 565–573. doi:10.1046/j.1365-2648.2000.01311.x. ISSN 0309-2402. PMID 10718875 . Retrieved 13 July 2022.

[Canada-7] 1 2 3 4 5 McDonald, L. (2011). "Elder abuse and neglect in Canada: the glass is still half full". Canadian Journal on Aging. 30 (3): 437–65. doi:10.1017/s0714980811000286. PMID 21910956. S2CID 7484119.

[McDonald-8] 1 2 3 4 5 6 7 8 9 10 11 12 McDonald, Lynn; Beaulieu, M.; Harbison, J.; Hirst, S.; Lowenstein, A.; Podnieks, E.; Wahl, J. (1 April 2012). "Institutional Abuse of Older Adults: What We Know, What We Need to Know". Journal of Elder Abuse & Neglect. 24 (2): 138–160. doi:10.1080/08946566.2011.646512. PMID 22471513. S2CID 32759079.

[9] Du Mont, Janice; Kosa, S. Daisy; Kia, Hannah; Spencer, Charmaine; Yaffe, Mark; Macdonald, Sheila (2020-06-05). Vidal, Edison I.O. (ed.). "Development and evaluation of a social inclusion framework for a comprehensive hospital-based elder abuse intervention". PLOS ONE. 15 (6): e0234195. Bibcode:2020PLoSO..1534195D. doi: 10.1371/journal.pone.0234195 . ISSN 1932-6203. PMC 7274390 . PMID 32502200.

[10] Baker, Philip RA; Francis, Daniel P; Hairi, Noran N; Othman, Sajaratulnisah; Choo, Wan Yuen (2016-08-16). "Interventions for preventing abuse in the elderly". Cochrane Database of Systematic Reviews. 2016 (8): CD010321. doi:10.1002/14651858.cd010321.pub2. ISSN 1465-1858. PMC 7169376 . PMID 27528431.

[11] The Texas boys were beaten, abused, raped. Now all they want is an apology," by Jason Wilson (The Guardian; December 20, 2017)

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