"The Unexamined Unit is Not Worth Running": A Critical Analysis of the Illinois Guardianship and Advocacy Commission

This is a qualitative study that used organization theory to analyze the institutional logics that various healthcare facilities and healthcare providers use when being investigated by on Illinois state advocacy agency that mobilizes the Mental Health and Developmental Disabilities Code to protect the rights of those with psychiatric, intellectual and developmental disabilities. For this study, I analyzed 430 publicly available investigation reports published by the Human Rights Authority division of the Illinois Guardianship and Advocacy Commission. These reports are summaries of the Human Rights Authority’s investigations into facilities and different service providers who violated the state law—the Mental Health and Developmental Disabilities Code. I used grounded theory and a critical content analysis of the investigation reports as well as facilities public responses to the Human Rights Authority’s findings to uncover the institutional logics of the hospitals, nursing homes and other facilities investigated. I began with open coding and then used thematic coding and magnitude coding to analyze the data. During this process, the institutional logics that the Human Rights Authority division of the Illinois Guardianship and Advocacy Commission also became evident. My findings indicate that various healthcare facilities and providers employ different institutional logics that are sometimes, but not always, at odds with the logics used by the Human Rights Authority. Also, I find that the Mental Health and Disabilities Code is a law that is not static. Instead, the investigations conducted by the Human Rights Authority and the conflicting institutional logics held by facilities lead to a dynamic, fluid process during which the state Code is interpreted differently by different social actors. Furthermore, I found that in some instances chemical restraint and physical restraints were used by facility to staff to control patients who were not a danger to themselves or others. I argue this amount to a form of violence in which patients are stripped of their bodily autonomy and self-determination, which is similar to previous research that found some patients experiences “sanctuary harm” in psychiatric hospitals.