Models of Disability

Overview

When considering models of disability, it can be helpful to reflect upon a well known quote attributed to British statistician George Box:

All models are wrong, but some are useful

There are different models of disability, each offering a different way of understanding disability – from focussing on the individual, to focussing on society, relationships and rights.

The most well known models are:

  • Medical Model – primarily used by medical professionals, and considers disability as arising from biological impairments or conditions.
    Useful when: identifying medical needs, diagnosis or treatment.
  • Social Model – widely adopted by disabled people’s organisations, and recommended by the Government Equalities Office since 2014. It considers how people can be disabled by societal or environmental barriers.
    Useful when: improving accessibility and removing barriers.

Well known modern models:

  • Biopsychosocial Model – Used by the World Health Organization (WHO) and can be used to inform person-centred practice.
    Useful when: understanding the full picture of someone’s needs.
    Considers:
    • biological
    • individual (including psychological)
    • social or environmental factors
  • Social-Relational Model – disability arises through social relationships and interactions.
    Useful when: understanding lived experience and the impact of every day interactions.
    It considers:
    • exclusion and unequal treatment
    • the impact this has on people (e.g. confidence, wellbeing)

Other models:

  • Human Rights Model – focusses on equality, inclusion and human rights.
    Useful when: shaping policy, rights and fair treatment.
  • Charitable Model – disabled people are often seen as objects of pity who need help or care.
    Useful for: understanding how certain attitudes can be unhelpful.

Models are different lenses – each offers a different way of understanding:

Using different models together can lead to better understanding and support.

Medical Model

The medical model is primarily used by medical professionals, and is how disability has been viewed historically. It views disabilities within the individual in the form of personal, physical or mental impairments to be fixed, cured, rehabilitated, or requiring specialist services.

Many people with support needs who identify as being disabled as per the Equalities Act 2010 view their ‘disabilities’ as differences which do not need to be ‘fixed’. As such, adopting the medical model can be seen as unhelpful, with a preference for adopting alternative strengths based approaches.

Social Model

The social model was developed in the 1970s by disabled people and has been adopted by most disabled people’s organisations. It describes how people are disabled by barriers in society, and not by their impairment or condition.

Barriers can be physical, like lack of accessible toilets. Alternatively they can be caused by other things such as people’s attitudes to differences, lack of support, and exclusion.

According to the Parliamentary and Health Service Ombudsman :

In August 2014 the social model was endorsed by the Government Equalities Office who recommended the model for use by all government departments in the way that they interact with disabled people.

Limitations of the social model are that it doesn’t consider the individuals or the direct effects and consequences of medical conditions. Mike Oliver, Professor of Disability Studies, who named the social model, addresses this in his talk, Disabled Students Campaign – Social Model of Disability with Mike Oliver. Mike explains how the social model is a tool for understanding which was never meant to be all encompassing.

Social Model – YouTube

Social Model of Disability, Shape Arts
Duration: 2 minutes 43 seconds
This short video summarises the medical and social models of disability.

Social Model Animation
Duration: 1 minute 26 seconds
A short animation illustrating the social model within the setting of a hypothetical town where all the residents are wheelchair users.

Biopsychosocial Model

From the late 1970s, American psychiatrist George Engel promoted the move from a medical model to a biopsychosocial model of health which combines elements of the medical and social models of disability.

The biopsychosocial model can be used to inform person-centred practice, as described by the Health Foundation in their article on Person-centred care: from ideas to action.

This model takes into consideration of the influence and interaction between different perspectives:

  • biological
  • individual (including psychological)
  • social / environment

The World Health Organization’s (WHO’s) International Classification of Functioning, Disability and Health (ICF) is a framework for measuring health and disability, and is based on the biopsychosocial model.

It’s considered the preferred model for good medical practice, according to a British Medical Journal (BMJ) response of Introducing the Biopsychosocial Model for good medicine and good doctors to the question What is a good doctor and how can we make one?

Social Relational Model

The social relational model of disability was developed by a Carol Thomas, a British sociologist, in 2004.

The model describes how disability happens:

  • when society treats people with differences in ways that exclude them, while giving advantages to those seen as ‘normal’
  • and the impact this has on individuals, including how it affects their opportunities, confidence and wellbeing

This includes both what people experience around them, and how those experiences affect them.

Human Rights and Charitable Models

Human Rights Model of Disability – Featuring Ellie the Equality Emu
Duration: 3 minutes 15 seconds
This animation is in the form of a short story illustrating different models of disability – medical, charitable, social and human rights.

References

Social Model

Biopsychosocial Model