Abuse and neglect: the Australian Experience

1. Abuse and neglect: the Australian Experience Dianne Pendergast Adult Guardian – Qld 11 April 2011

2. We will talk about - • Context – work of the Office of the Adult Guardian –(Queensland) • What does the Adult Guardian do? • What do we see? • What does this mean for the Australian experience of abuse and neglect of adults with ID?

3. The role of the Adult Guardian • Protection • Of Adults • Who lack decision making capacity • From abuse, neglect and exploitation Guardianship and Administration Act 2000 s180

4. How? • Investigations. • Community visitors program. • Making decisions – guardianship. • Making decisions – restrictive practices. • Making decisions – statutory health attorney. • Education and advice.

5. Investigations • Allegations of abuse, neglect and exploitation. • Adults. • Who lack capacity to make decisions. Guardianship and Administration Act 2000 s180

6. Warrant • First time in four years. • Must have reasonable grounds that the adult is at immediate risk of harm due to neglect, exploitation or abuse. • Case Study– mid 40’s, ID, pension taken by relative, relative purchased house in joint names, property isolated, high fence, padlocked gate, adult locked in alone, unable to see anyone without relative present, phone removed when used to contact outside world, clear wish to leave, sense of entitlement =“I care for X so I am entitled to the benefit of their money”, no boundary between me and we.

7. Investigations – some data • 3,000 telephone enquiries • 300 investigations • Victims age group = 75 years and older. • Primary allegation financial abuse. • Reporting by family members, medical professionals.

8. What did we see?

9. Primary feature of investigations - • Significant under reporting.

10. Community visitors • Disability funded and provided services, hostels, mental health units including acute admission and forensic units. • Role = accept and resolve complaints.

11. Where did they visit?

12. Complaints

13. What did they see? • Visited 7250 adults. • Use of restrictive practices – containment, seclusion, chemical, physical and other without authorization. • Client safety. • Mismanagement of funds. • Inappropriate accommodation. • Insufficient staffing. • Inappropriate staff conduct. • Abuse and assault. • Inappropriate decision making arrangements.

14. Concerns and improvements - • Increase in abuse and assault. • Inappropriate accommodation. • Positively a decrease in restrictive practices particularly reduction in the use of chemical restraint – significant feature of the introduction of amendments to the Disability Services Act 2006 – over 300 adults removed from chemical restraint.

15. Guardianship • Appointed by the Queensland Civil and Administrative Tribunal • Order stipulates area of decision making and period of appointment (time limited) • Decision making framework – general principles – maximum participation, minimum restrictions, reflect views, wishes and values of the adult. • Model incorporates substituted decision making. • Only appointed if necessary to make a decision or to protect an adult.

16. Guardianship in Queensland • Predominant age group = less than 50 yo. • Unlike any other state in Australia, 49% of the people for whom we make decisions have an intellectual disability. • Queensland 49% • New South Wales 37% • Victoria 14%

17. 731 Legal matters involving our clients -

18. The experience of the Office of the Adult Guardian is - • Significant under reporting abuse and neglect. • Tolerance and acceptance by community of behavior toward those within this group that is otherwise not accepted. • Disinterest in the cohort – media. • Demonization. • Service delivery system that creates opportunities for abuse through in adequate co-tenancies but offers little opportunity to exit. • Police poorly equipped to deal with a cohort who want to be accepted, whose behavior is different.

19. Legal system provides barriers to justice – balance of proof beyond reasonable doubt, poor availability of Legal Aid. • Service system poorly resourced, relying on guardianship to leverage an outcome. • In the face of a staffing problem, application of the Catholic Church policy.

20. Reflections - • Aging – a multiplier effect? Over the next 40 years the number of people aged 65 – 84 years will more than double and the number of people 85 years and over will more than quadruple. • Guardianship – flexible, cheap, allows access to services otherwise unable to access because cannot provide consent. • Relies upon whistleblowing as opposed to regulation/supervision. • Assumes family/friends best decision makers – fails to recognize their lack of power in the service system, conflicts of interest and, in some cases, the private business of abuse.

21. Further reflections - • What does the differential in age groups subject to investigations and guardianship mean? • Catholic Church Solution – need to address power of the workplace. • Do people with ID vote? Need to engage the media. • “They” should be grateful. Quality of services can be unacceptably poor but is accepted.

22. Joint project – Adult Guardian and Public Advocate • Joint project measure the range and complexity of clients’ needs and levels of disadvantage, analyze the capacity of the service systems to respond, explore the needs and experiences of particular clients (for example intellectual disability), and identify hidden and emerging issues in the client base, family environments and service systems.

23. Thank you.