Just as the Japanese Samurai in Hamamoto learned that people from any background can achieve honour in life, so we in the UK hold fast to the principle that people with learning disabilities and autism have the right to exercise choice and control in their lives.
So Dimensions was excited to welcome specialist Japanese social worker Hitoshi Nakanishi to the UK, on a visit to learn about the differences in practice between our countries. Hitoshi picked England due to its reputation for high quality autism support.He visited a number of Dimensions services during his visit. Here are his thoughts:
Tell me about where you work in Japan?
I work as a social worker in a residential facility for about 70 people with learning disabilities and autism.
Some of them have challenging behaviours such as shouting, hitting and eating inedible objects. Some also have mental disorders or physical disabilities.
At the facility we support people with their daily living, with day activities, with work, and with counselling. Although daily routines are similar between England and Japan, in Japan there’s only about one member of staff to every four people supported.
Wow. That’s a lot of people in one place. In the UK we’ve gone down a road of person-centred support in the wider community rather than in large homes. Can you tell me how you see the advantages and disadvantages of both systems?
Person-centred support is a concept which is only now being introduced in Japan. People have personal support plans, of course. But Japanese culture is very different from English culture.
In Japan, the group is seen as a more important unit than the individual and I think this is reflected in our approach to support planning. There are many similarly large facilities.
Apart from emphasising the group as the central unit of life, our larger homes also have advantages in terms of health and safety. But it is true that individuals’ choice and control over their lives are diminished and, for that reason I don’t think our approach would be popular in Britain. It is also true that this approach makes community integration very difficult.
That is interesting. If people with autism are kept away from the wider community, how are such people viewed by the general public in Japan?
There is widespread lack of understanding of the condition and general disdain for people with autism. Anti-discrimination laws were only enacted in 2013. But the issue is now frequently in the Japanese media so I think the situation is improving, especially amongst younger generations.
Do staff in Japan go through a long training period?
In my facility, we get three days of induction training. Most of the training is in the form of lectures, and I was really interested in the e-learning approach Dimensions has. I hope to introduce this into my facility. We can also get specialist training after a number of years of support work.
I’m interested in how you support people into work and activities. Can you tell me a bit more about this?
Very few people engage with their wider community, partly due to the staff ratios. Work is offered in-house, at the facility. Depending on their abilities, people can make bread, make artwork, or do agricultural work. The pay is just around £10 per month. It is not a good wage. But my company manages its own grocery store, cleaning company and restaurant. I think such a model could work in the UK too.
Activities also happen on-site but, rather like in England, budget cuts are stripping away day services.
It’s a radically different approach from ours in England. How would you sum it up?
Whatever the budget and wherever daily living, activity or work takes place, I want the people I support to keep healthy and live happily every day.
We must all find ways to achieve this and different cultures find different solutions. Japanese culture puts synthesis and harmony as a higher goal than personal achievement, and for better or worse, this is reflected in our group living environments and approaches.