Objektista osallisuuteen – vammaisten henkilöiden keskeneräistä yhdenvertaisuutta

Vammaisuuden käsite on muuttunut viime vuosikymmenten aikana huimasti. Myös paradigma on muuttunut – vammaisuutta on ryhdytty käsittelemään sosiaalisesta näkökulmasta.

Vammaisia henkilöitä ei enää nähdä vain pelkästään objektina, eivätkä he ole enää pelkästään hyväntekeväisyyden, lääkehoidon tai sosiaaliturvan kohteita vaan oikeuksien haltijoita, subjekteja, jotka voivat vaatia oikeuksiaan ja tehdä omaa elämäänsä koskevia päätöksiä vapaasti ja tietoon perustuvan suostumuksen nojalla, oman yhteiskuntansa aktiivisina jäseninä.

Samalla pyritään vammaisen henkilön täyteen osallistumiseen. Tasa-arvopolitiikan tavoitteena on yhdenvertaisten mahdollisuuksien turvaaminen. Silti pakottavan lainsäädännön puute vaikeuttaa esteettömyyden ja saavutettavuuden toteutumista.

Asenneilmastossa on tapahtunut muutos: vammaisten ja vammattomien lasten ja nuorten kohtaamiset päiväkodeissa, kouluissa ja vapaa-aikana ovat muuttaneet asenteita positiivisemmaksi ja koulujen suvaitsevaisuuskasvatuksella on ollut vaikutusta myönteisemmän asenteen muodostumisessa vammaisia ihmisiä kohtaan. Vammaisia henkilöitä pidetään silti monesti yhä edelleen ”kohteina” ja ihmisinä, jotka viihtyvät pelkästään omissa ryhmissään. Vammaisista ihmisistä on stereotyyppinen ja homogeeninen kuva. Näin heitä ei heti nähdäkään yksilöinä tarpeineen, ominaisuuksineen, rooleineen ja elämäntilanteineen.

Suomi allekirjoitti YK:n yleissopimuksen vammaisten henkilöiden oikeuksista heti sen astuttua voimaan vuonna 2007. Tällä hetkellä sopimuksen on allekirjoittanut 144 jäsenvaltiota ja 85 valtiota on ratifioinut sen. Suomi ei ole niiden joukossa. Lainsäädäntö on vasta muuttumassa, valitettavan hitaasti.

”Tämä on sopimus, jota ei olisi pitänyt tarvita, koska vammaisilla henkilöillä on samat oikeudet kuin kenellä muulla tahansa”, sopimuksen hyväksyneen YK:n yleiskokouksen puheenjohtaja suurlähettiläs Don MacKay on kommentoinut sen merkitystä.

Todellisuus on silti jotain muuta. Vammaiset henkilöt niin Suomessa kuin kaikkialla muuallakin Euroopassa ja maailmassa kohtaavat jatkuvasti syrjintää ja epätasa-arvoista kohtelua elämän kaikilla alueilla.

”Vammaisyleissopimus täydentää jo voimassa olevia ihmisoikeussopimuksia, mutta sen saavuttaminen oli silti hiljainen vallankumous, jossa määritellään isoja asioita. Ne on saatu yllättävän vaivattomasti sopimukseen. Sillä vahvistetaan, että kaikki ihmisoikeudet ja perusvapaudet kuuluvat kaikille vammaisille henkilöille ja heidän on voitava nauttia niistä”, painottaa Ann-Marie Lindqvist, yksi Suomen harvoista vammaistutkijoista.

Hän on tutkinut lisensiaattityössään kehitysvammaisten henkilöiden osallisuutta tutkimuksessa ja hoivajärjestelmän yhteydessä kansalaisuusnäkökulmasta tarkasteltuna (Delaktighet för personer med utvecklingsstörning i en forsknings-och omsorgskontext granskat ur ett medborgarperspektiv).

”Tutkimuksessani kehitysvammaiset henkilöt olivat kanssatutkijoita, jotka olivat mukana myös tulkinnoissa”, hän kertoo. Harvinainen tutkimusmenetelmä pysyy samana, kun Lindqvist tällä hetkellä syventää tutkimusaihettaan väitöskirjaksi. Siihen hän ottaa mukaan hoitohenkilökunnan sekä asiakkaan ja hoitajan välisen dialogin.

”Mitä tehdään arjessa? Miten syntyvät ratkaisut kehitysvammaisen henkilön asumisesta, rahan käytöstä, vapaa-ajasta, pukeutumisesta? Miten hänen toiveensa ja tarpeensa tuleva ymmärretyiksi – vai tulevatko ne? Kaikki tapahtuu jossain kontekstissa, joka vaikuttaa lopullisiin päätöksiin.”

”Osallistujat ovat parhaimpia esittelemään ongelmia ja kuvaamaan elämäntilanteitaan ja tutkija paras analysoimaan koottua aineistoa. Tutkimus tuleekin nähdä kuin yhteisenä seikkailuna tutkijan ja osallistujien välillä.”

Lindqvist on tehnyt pitkän työuran vammaispalvelun sosiaalityöntekijänä. Perspektiivi tutkimukseen hänellä onkin sosiaalityöntekijän. Lisäksi hän pohtii, miten tutkimusta voidaan hyödyntää käytännön työssä sekä käytäntöä tutkimuksessa. Lindqvistiä kiinnostaa kuinka kehitysvammaisen henkilön osallisuutta voitaisiin yhä lisätä.

Medikalisoinnista ihmisoikeuksiin

Simo Vehmas on kuvannut vammaistutkimuksen historiaa teoksessaan Vammaisuus (2005). Euroopassa ja erityisesti Englannissa akateemisen yhteisön ulkopuolella toimineiden vammaisaktivistien kirjoituksilla on ollut merkittävä osuus vammaisuutta käsittelevien sosiaaliteoreettisten mallien kehittymisessä. Englantilaisen vammaisliikkeen peruspilariksi muodostunut ajatus ja lähestymistapa, joka erottelee fyysisen vamman ja vammaisuuden sosiaalisena tilanteena, on levinnyt laajasti myös muualle.

Sosiaalisen vammaistutkimuksen piirissä käydään edelleen keskustelua periaatteiden sisällöstä ja oikeellisuudesta. Tärkeä muutos oli siis tutkimuksellisen painopisteen siirtymisessä medikalisoinnista sosiaalisiin ja yhteiskunnallisiin tekijöihin. Myös eettiset kysymykset ovat tulleet yhä enenevässä määrin vammaistutkimuksen kentälle. Muun muassa sikiötutkimus ja -seulonta ovat innoittaneet eettispainotteisia tutkimuskysymyksiä.

Sosiaalinen vammaistutkimus on 1970- ja 1980-luvuilla lähinnä Yhdysvalloissa ja Englannissa syntynyt akateeminen oppiaine. Se on saanut alkunsa pitkälti vammaisten ihmisten poliittisesta aktivoitumisesta sekä kyllästymisestä perinteisiin tieteellisiin selitysmalleihin vammaisuuden luonteesta.

Sosiaalisen vammaistutkimuksen lähtökohtana on vammaisuuden ymmärtäminen sosiaalisena, poliittisena ja kulttuurisena ilmiönä. Vammaistutkimuksessa käytetyt metodit ja teoriat ovat pitkälti sosiologiasta johdettuja. Englannissa painotus on ollut marxistinen, kun taas Yhdysvalloissa vammaistutkimus on saanut vaikutteita pragmatismista, jossa tutkitaan ihmisten toiminnan ehtoja ja merkityksiä.

Myös sosiaalisen konstruktionismin periaatteet, poliittisuus sekä sitoutuminen vammaisten etujen ajamiseen ja heihin kohdistuvan syrjinnän poistamiseen ovat voimakkaasti esillä vammaistutkimuksessa. Nykyään on esillä vammaisuuden tarkastelutapana myös ihmisoikeusmalli. Päähuomio tulisi näkökulman mukaan kiinnittää vammaisten ihmisoikeuksiin ja näiden toteutumiseen ja toteuttamiseen. Myös YK:n yleissopimus perustaa tähän lähtökohtaan.

Ilka Haarni on tehnyt vammaisten henkilöiden hyvinvointia ja elinoloja koskevan raportin vuonna 2006. Hän päätyi siihen, että kokonaiskuvan saaminen vammaisten henkilöiden asemasta, elinoloista ja hyvinvoinnista on hankalaa tiedon pirstaleisuuden, erilaisten tietolähteiden vertailuongelmien ja tiedon puuttumisen vuoksi.

Raportista käy ilmi, että tutkimustieto on pirstaleista ja kaikki tutkimus ei täytä tieteellisen tiedon kriteereitä, mikä osoittaa vammaistutkimuksen marginaalisuuden myös tutkimuksen kentässä. Vammaistutkimus on Haarnin mukaan vaarassa syrjäytyä erilaisten sosiaali- ja terveyspoliittisten selvitysten tekemiseksi ellei sen itsenäistä asemaa vahvisteta. Tietoa vammaisten palveluista on tarjolla enemmän kuin vammaisten henkilöiden elinoloista. Palvelujärjestelmän rinnalle tarvitaan kokonaisvaltaista ihmisoikeudellista ja yhteiskunnallista ajattelua. Hän katsoo monitieteisen vammaistutkimuksen tutkimusohjelman tarpeelliseksi, jotta vammaistutkimuksen asema vahvistuisi ja vammaisten olosuhteet saataisiin perusteellisesti tutkittua.

Tällä hetkellä vammaistutkimus on vähäisten ja satunnaisten projektirahoitusten sekä tutkijoiden harrastuneisuuden varassa. Tutkimukselta puuttuu institutionalisoitunut asema ja riittävä, pysyvä rahoitus. Vammaistutkimustyötä on Suomessakin tehty lisääntyvästi eri tieteen aloilla, vaikka omana oppiaineena vammaistutkimusta ei toistaiseksi Suomessa ole.

Osallisuus syntyy osallistumisen kautta

Ann-Marie Lindqvistin lisensiaattityön keskeisin johtopäätös oli positiivisen erityiskohtelun tarve.

”Jotta kehitysvammaiset henkilöt voivat osallistua, tarvitsemme erilaisia tukimuotoja ja tämä ei onnistu ilman positiivista erityiskohtelua”, hän näkee. Positiivisella erityiskohtelulla Lindqvist tarkoittaa muun muassa tilannetta, jossa ryhmää tuetaan erityisin toimenpitein tai -järjestelyin, jos hän on ilman niitä vaarassa jäädä eriarvoiseen asemaan.

”Osallistumista ei voi antaa, kuten ei valtaakaan, vaan se tapahtuu ainoastaan osallistumalla. Tämä vaatii henkilöltä itseltään toimintaa, jotta tämä on mahdollista ja sitä varten tarvitaan tukimuotoja ja positiivista erityiskohtelua.”

Lindqvist kysyykin, mitä kehitysvammaisen oikeuksille merkitsevät esimerkiksi tietoon perustuvat käytännöt. Onko selkokielisiä materiaaleja tarjolla? Saavatko kehitysvammaiset henkilöt tietoja oikeuksistaan ja velvoitteistaan esimerkiksi hoito- ja tukisuunnitelmia tehtäessä? Miten he ovat mukana tuossa prosessissa?

”Ennen kokousta asiakkaan pitäisikin tietää mistä on kyse, jotta hän voi vaikuttaa siihen. Tässä tulee esiin juuri ajatusmalli siitä, että vain osallistumisen kautta syntyy osallisuus”, Ann-Marie Lindqvist painottaa. Hän tuo tilanteen käytännön tasolle.

”Suunnittelukokoukseen osallistuu iso ryhmä: omaiset, työntekijät asuntolasta, sosiaalityöntekijät. Tällöin on tärkeää pohtia, miten asiakas voi olla mukana siinä niin ettei keskustelu mene yli ymmärryksen. Monet asiat käsitellään nopeasti ja siksi onkin tärkeää, että asiakas on mukana kun kokouksen asialista laaditaan.”

Kehitysvammaisella on usein niin puheentuottamisessa ja ymmärtämisessä kuin muussakin kommunikaatiossa vaikeuksia. Tämä tuleekin ottaa huomioon.

”Täytyy käyttää erilaisia kommunikaation tukikeinoja, kuten kuvia ja viittomia, jotta asiakas ymmärtää olevansa mukana ja käsittävänsä kyseessä olevan päätöksenteon omista asioita. Viime vuosina on tullut hyviä apuvälineitä, muiden muassa keskustelumatto, talking mats, jolla kuvien avulla voi keskustelua viedä eteenpäin, joiden avulla asiakas kertoo mieltymyksensä.”

Talking Mats -menetelmä on kehitetty tukemaan mielipiteiden ilmaisemista ja keskusteluun osallistumista silloin, kun henkilö hyötyy puhetta tukevasta ja korvaavasta kommunikoinnista. Menetelmässä havainnollistetaan käsiteltäviä asioita ja niiden merkityksiä kuvilla, mikä samalla jäsentää myös itse keskustelun kulkua. Lindqvistin mukaan keskustelumatto on alue, jota voisi kehittää yhä enemmän. Omassa ammatissaan hänellä on siitä pelkästään positiivisia kokemuksia. Tuki- ja palvelusuunnitelman laatimisen jälkeen Lindqvistin mukaan on oleellista saattaa sekin vaihtoehtoiseen muotoon eli kuviksi tai selkokieliseksi tekstiksi.

Yhteinen maailma kaikille

Julkisen sektorin kasvaessa kaikissa kehittyneissä teollisuusmaissa 1970-80 -luvuilla nousi esiin keskustelu asiakkaan osallisuudesta. Samanaikaisesti syntyi useita yhteiskunnallisia liikkeitä eri ryhmille: homoseksuaaleille ja värillisille, naisille, ja vammaisille. Suomessa vammaisten henkilöiden oikeuksien ajamiseen herättiin verrattain myöhään.

Kymmenen vuotta täyttävä Me Itse -yhdistys on kehitysvammaisten henkilöiden valtakunnallinen uraa uurtava järjestö. Sen keskeisimpinä tavoitteina on omien oikeuksien tunnistaminen, toiminta niiden puolesta, hyvä elämä muiden joukossa ja siirtyminen vajaavaltaisuudesta itsemääräämiseen.

Yhdistys painottaa sitä, että muut ihmiset ovat hoitaneet asioita liian kauan kehitysvammaisten henkilöiden puolesta: ”Meidän täytyy oppia itse hoitamaan asioitamme. Me tarvitsemme tukea, mutta emme holhousta. Haluamme vaikuttaa meitä koskeviin suunnitelmiin. Toiveisiimme ja tarpeisiimme tulisi suhtautua vakavasti. Haluamme esteettömän ja turvallisen ympäristön kaikille”.

Me Itse -johtoryhmän puheenjohtajana toimii Tommi Kivimäki, hyvinkääläinen 34- vuotias kansalaisaktiivi. Hän mukaansa yhdistyksen toiminnassa on tärkeintä se, että saa vaikuttaa ja tuoda esiin kehitysvammaisten hyvää ja tasapuolista elämää valtaväestöön nähden. YK:n vammaisyleissopimusta yhdistys ei ole Kivimäen mukaan käsitellyt vielä kovin hyvin.

”Yritämme kuitenkin vaikuttaa siihen, että Suomi sen mahdollisimman pian ratifioisi.”
Hän näkee sopimuksen tärkeällä tavalla yksityisyyttä, itsemääräämistä ja ihmisarvoa parantavana. ”Eli kehitysvammaisella on samat oikeudet kuin muillakin.”
Jokaiselle kehitysvammaiselle henkilölle tehtävä tuki- ja palvelusuunnitelma on hyvin keskeinen tekijä, joka määrittää hänen jokapäiväistä elämää. Millainen tapa tehdä palvelusuunnitelma on Kivimäestä hyvä ja asiakasystävällinen?
”Sellainen, jossa päämiestä kohdellaan ihmisenä, ja että hänen mielipiteillään on arvoa. Mutta tärkeimpänä on se, että hän saa itse kertoa mitä todella haluaa, eikä vain lähihenkilöt kerro tätä.”

Voimassa olevasta lainsäädännöstä huolimatta useista syrjinnänkielloista ei vielä turvaa riittävällä tavalla vammaisten ihmisten oikeuksia eikä takaa riittäviä ja toimivia keinoja syrjintä- ja oikeuksien loukkaamistapauksiin puuttumiseksi. Tämän vuoksi tarvitaan lainsäädännön uudistamista ja yhtenäistämistä sekä valvonnan kehittämistä. YK:n vammaisyleissopimuksessa on velvoite osallistaa ja ottaa mukaan vammaiset henkilöt ja heidän järjestönsä valvontaprosessissa täysimääräisesti. Sopimuksella vahvistetaan, että kaikki ihmisoikeudet ja perusvapaudet kuuluvat kaikille vammaisille henkilöille ja heidän on voitava nauttia niistä.

Me Itse -yhdistys linjaa: ”Meillä on oikeus elämään, vapauteen, onnen tavoitteluun ja yhdenvertaiseen kohteluun muiden ihmisten joukossa. Keskeinen ihmisoikeus on tulla ymmärretyksi. Useat meistä tarvitsevat tukea tullakseen ymmärretyksi. Meidän täytyy saada myös tietoa ymmärrettävällä kielellä. Tuen saaminen ei voi perustua kuntien määrärahoihin vaan meidän tarpeisiimme.”

© Teksti: Juha Säijälä / Kulttuurivihkot

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