RECOMMENDATIONS Article 25 -
That Australia conducts a national review of the state of health of men, women, boys and girls with disability to identify the gaps between people with disability and the rest of the community in relation to a broad range of health indicators including nutrition, dental, exercise, physiological and mental health.
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That a Public Health Strategy be developed to promote preventative approaches and early diagnosis of health issues among people with disability who may not access work place health check programs available to those in the mainstream workforce.
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That Australia resources the creation of a national network of intellectual disability health specialists as a resource to enhance the capacity of mainstream services to cater to the specific needs of people with intellectual disability.
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That the National Disability Strategy identify gender specific actions to address the health inequity experienced by women with disability that intersect with actions contained in the National Women’s Health Strategy.
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That the National Women’s Health Strategy include a commitment to rectifying health inequities between women, particularly through identifying the specific health needs and issues of girls and women with disability with specific attention to women with disability from Aboriginal and Torres Strait Islander communities and those living in rural and remote areas.
article 26 — HABILITATION AND REHABILITATION STATUS IN AUSTRALIA -
Under the Disability Services Act 1986 (Cth) (DSA) there is no right to disability services. Rather, the focus has been on funding services which provide disability support. The DSA provides that the Minister may approve eligible organisations and state and territory governments to provide services for people with a disability.
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State and territory governments also fund and implement their own disability services, but the level of service provided varies widely from state to state. This structure prevents all people with disability from accessing the same level of support across Australia. The lack of portability is a barrier to people with disability to be able to freely choose where to live. (See also Article 18)
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The National Disability Agreement (NDA) is the funding agreement between the Federal, State and Territory Governments for the delivery of specialist disability services.531 This includes supported accommodation, community support, community access, respite, employment, advocacy, information and print disability.532
Access to Therapy or Allied Health Services -
The accessibility and affordability of services provided often depends on how a disability is acquired, whether it is covered by an insurance scheme, whether a person has started school, is an employed adult or someone over the age of 65. This lack of coherence has a real effect on the services and therefore quality of life for individuals.
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The fragmented system leads to gaps and overlap between the various sectors and programs meaning that a person can miss out on necessary support. Limitations on health sector funding for appropriate therapy or allied health services can lead to a long term requirement for disability support. Interaction between the Home and Community Care (HACC) program and NDA services can mean that someone accessing services under one Program will be regarded as ineligible to access a service under the other. Budget caps on Programs have led to strict eligibility criteria limiting the capacity of a Program to respond to individual need.
Underfunding of Disability Services -
More than half the submissions to the recent ‘Shut Out’ report noted that aspects of disability services and programs acted as a barrier to, rather than a facilitator of, their participation in society.533 The service system is seen as chronically underfunded, under resourced and crisis driven with large unmet need. For school children, there have been reports of an inability to access relevant and ongoing support services such as occupational therapy, speech therapy or physiotherapy which has impacted on, among other things, their educational outcomes.534
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This has been verified by the Productivity Commission most recently in its Report on Disability Care and Support where it says “the current disability support system is underfunded, unfair, fragmented and inefficient and gives people with disability little choice and no certainty of access to appropriate supports”.535
Health Services and Rehabilitation Programs -
Many of the shortfalls of rehabilitation programs provided through the health sector are similar to those of the health sector in general and have been addressed in Article 25. Often rehabilitation services will be provided in a separate location to acute care hospitals, causing delays in obtaining rehabilitation assessments and commencing programs. The lack of community based therapy services seriously inhibits the ability of these services to meet the needs of those needing assistance to improve, maintain or minimise deterioration in their level of functioning. Most therapy providers cannot access the Medicare system thus limiting the access of low income people to their services.
Case Study
Erin has Down syndrome. At 25 she was living a full life, attending a day program and had two part time jobs until she suffered a stroke. The emergency department was slow to diagnose the stroke due to Erin’s young age. By the time she was transferred to a ward she was unable to speak, was alert and frightened. Her mother had to deal with questions such as “Before the stroke, could she speak? Was she continent? How well could she walk?” After three days the hospital wished to send her home, while still paralysed, unable to swallow or talk, without memory and in great pain.
Normally, the treatment would be a rehabilitation ward and intensive therapy; however, the doctor said “look, she has Down syndrome, the road ahead will be very difficult, I think you should just take her home. Because really, how hard do you want to try?” Thanks to her family, Erin had six weeks of rehabilitation, after which she could return home. She has returned to her day program and delivers meals on wheels. She has regained her enjoyment of dancing, singing, reading and writing.536
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Generally disability is more common in rural and remote areas than in urban areas537 however people with disability living outside major cities are significantly less likely to access disability support services than those living within major cities.538
Aboriginal and Torres Strait Islander Australians -
It has been estimated that in 2002 the proportion of Aboriginal and Torres Strait Islander peoples with a disability was approximately twice that of the general population.539 Aboriginal Australians face significant barriers to accessing disability support services due to insufficient services in metropolitan and regional areas, social marginalisation, cultural attitudes towards disability and culturally inappropriate services.540
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For Aboriginal and Torres Strait Islander persons living in remote communities, access issues similar to those outlined under Article 25 exist. There is a lack of culturally and linguistically appropriate information about available community services and aids and appliances. Few disability services are specifically designed for or staffed by Aboriginal Australians541and there is a shortage of appropriate aids and equipment.542
(See also Article 20)
People from Culturally and Linguistically Diverse Backgrounds -
Only one in twenty people with a disability born in a non-English speaking country access community services, compared with one in five for the general population.543 A lower proportion use community support and access services.544 There is a shortage of accessible information regarding available services and a lack of culturally and linguistically appropriate services.545
People with Psychosocial Disability -
People with psychosocial disability are significantly overrepresented in areas of disadvantage such as homelessness, unemployment, poverty, substance abuse and incarceration rates.546 The focus of current mental health care is on acute hospital based treatment, rather than on providing the support necessary to live a good life in the community. As many as 40 percent of people occupying acute mental health inpatient facilities could be discharged if such support services were available.547
Case Study
“My brother is 40 years old, has schizophrenia and is on a community treatment order. He spends his time in a lonely flat waiting for his regular visits to his sisters. He paces the room or sits throughout the major part of the day, only leaving to buy take-away meals. He has little idea of normal etiquette and hygiene or housekeeping, having been ill for so long without treatment. No psychological or social rehabilitation has been attempted.”548
Data Limitations -
Data collection limitations make it difficult to assess the level of additional need for services. Data collection currently focuses on people with severe and profound limitations rather than on all those people requiring assistance to overcome barriers to community participation and inclusion. Data is not available on whether people are satisfied with the options, quality and quantity of services available. There is no consistency of data collection across the relevant funding Programs.
Aids and Equipment -
In 2003, 1.74 million Australians with a disability used aids and equipment.549 The provision of these is fragmented across a variety of government and non-government providers. More than 20 percent of submissions to the ‘Shut Out’ report revealed that a lack of aids and equipment created a barrier to community participation.550 (See also Article 20)
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Difficulties encountered include meeting the eligibility requirements, being unable to pay for upgrades or the gap between costs and government support, long waiting times for assistance and limited availability of appropriate equipment.
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Eligibility criteria can be quite strict. For example, people who require hearing aids are only eligible for services and equipment if they are a concession card holder or receive Centrelink sickness allowance or are referred by Federal Government-funded vocational rehabilitation services.551 Hearing and visual aids are also excluded from Medicare and people who are vision impaired are not covered by many government equipment schemes.552
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The ‘Shut Out’ report highlighted issues of poor quality of staff in disability services.553 Many people working in disability services were poorly trained and resourced and lacked understanding and sensitivity to disability issues. Problems of low pay, lack of training and poor working conditions means it is difficult to attract and retain trained staff, particularly in regional and remote areas.
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