A Sociological Perspective on Acquired Brain Injury in Modern Ireland

1. A Sociological Perspective on Acquired Brain Injury in Modern Ireland Anne O’Loughlin Principal Social Worker National Rehabilitation Hospital, Dublin SW Department, NRH, 2006

2. Acquired Disability The impact of a sudden physical trauma on an individual’s life creates overwhelming physical, psychological, social, vocational and economic effects. Hanoch Livneh, 1997 SW Department, NRH, 2006

3. The sociological perspective Sociology considers how many seemingly “personal troubles” which affect individuals and their immediate relations with others are more appropriately understood as “public issues” which link to the institutions of society as a whole. C. Wright Mills, 1970 SW Department, NRH, 2006

4. Disability and Social Change • Medical advances – lead to a rise in the number of people with disabilities and increased life expectancy (Harris et al,1971) • As a society becomes more technologically and socially complex, so the number of people with impairments increases as does the degree of severity of impairments (Albrecht, 1992) SW Department, NRH, 2006

5. Changes in Western Society • New Family Structures/definitions • The political mobilisation of people with disabilities • Increasing emphasis on the political and social dimensions of disability • Increase in migration/travel • The commodity of communication • Understanding of health as a resource affecting physical mental and social well-being SW Department, NRH, 2006

6. Family Structures “Over the last century, there have been important changes in family life and organisation, There are more lone-parent households, fewer children per household, and many more older people” Barnes, Mercer and Shakespeare, 1999 SW Department, NRH, 2006

7. The “Celtic Tiger” • Employment rose from 55.1% in 1996 to 67.1% in 2005 – employment rates for women increased by almost 15 percentage points • Increased Housing Costs/numbers renting • Increase in Alcohol/drug use • Greater expectations of Health Services SW Department, NRH, 2006

8. The Irish Family • The number of lone parent families with children aged under 20 years increased by almost 80% between 1996 and 2005 • 3 out of 5 of births registered in the first quarter of ‘06 were to mothers aged 30 or over – 25.1% were to mothers over 35years • Increase in rates of marital breakdown: average annual increase of 8.1% in the years 1991 - 1996 SW Department, NRH, 2006

9. The Changing nature of how we view disability • Shift in emphasis away from the physical limitations of the individual and onto the ways in which the physical and social environment imposes limitations • Move from the Medical Model to viewing disability as “socially created”: SW Department, NRH, 2006

10. The Disabling Environment - Blaxter • Lack of technical Aids and Adaptations • Poor housing, transport, accessibility • Reliance of social services on informal voluntary support of (generally) female relatives • Clear link between poverty and disability SW Department, NRH, 2006

11. The Commission on the status of People with Disabilities, 1996 “Whether their status is looked at in terms of economics, information, education, mobility or housing (people with disabilities) are treated as second class citizens” SW Department, NRH, 2006

12. Immigration • Our population has grown by 14% to 4.1m from 1996-2006 • Approximately 2/3’s of the increase in population between April ’05 and ’06 was accounted for by migration • Net migration into Ireland was 8,000 in 1996 and 53, 400 in 2005 • 26,200 moved to Ireland from the10 new EU countries in 2005 SW Department, NRH, 2006

13. Housing as an example….. • Massive increase in housing costs • Young people remaining in the rental sector or in family home for longer • Lack of suitable housing for people with disabilities in both the public and private sector • Disabled Person’s Grant – inequities exist and it remains a very lengthy process SW Department, NRH, 2006

14. Cultural Aspects • Young workers from other countries generally have no/few family supports, temporary housing and English as a second language • High risk grouping for Acquired Brain Injury • Culture effects how we understand illness and disability and the ways in which grief and coping skills are manifested SW Department, NRH, 2006

15. The Concept of Double Jeopardy Disability and • Member of a racial/ethnic minority • Another disability • Gender • Ageing e.g. ABI and Drug addiction ABI and a mental illness SW Department, NRH, 2006

16. The Commodity of Communication • Speed of modern communication • Knowledge seen as increasingly specialised • Difficulties in using emotional cues / understanding personal interaction can greatly effect social life, status and identity • Attitudes to “cognitive impairments” SW Department, NRH, 2006

17. Acquired Brain Injury in Modern Ireland • Increasing level and severity of disability 13,000 per year, 10,000 of whom are admitted to hospital with significant injuries • High reliance on family carers although there are fewer women at home and parents are having their children later • Heavy reliance on voluntary agencies • Poor transport and housing facilities for people with physical disabilities SW Department, NRH, 2006

18. The Picture in Ireland • Lack of national, co-ordinated approach to ABI services including rehabilitation • Fragmented and insufficient Community Services • The Entitlements Maze • Poor data basing for Acquired Brain Injury • Poor public awareness of the scale and consequences of Acquired Brain Injury • ABI now a Chronic Care issue SW Department, NRH, 2006

19. New trends • Service user as consumer, not passive recipients of care • Rights based legislation e.g. Disability Act • Client Centered Policies seen as good practice • Inclusion of people with disabilities as a right: from charity to choice • Accountability / Value for Money • Advocacy SW Department, NRH, 2006

20. Case example • Single mother living with elderly parents • Acquired Brain Injury as a result of anoxic brain injury • Requires constant supervision as she is vulnerable sexually • Concerns re parenting of her 5yo son • Wants to move out of parental home • Unable to work SW Department, NRH, 2006

21. Case example • 19 year old male in Minimally Conscious State • Traumatic Brain Injury as a result of assault • Family moved to Ireland 6 months ago • Parents separated but both are involved • Family live in rented accommodation • Both parents and an older sibling work SW Department, NRH, 2006

22. The Benefits of Rehabilitation The under funding of Rehabilitation has led to more frequent stays in Hospital, more likelihood of entry into residential care and more expensive and complex packages of care for those who do go home Sally Davis, 2006 SW Department, NRH, 2006

23. The Health Strategy “The principal which underpins policy is to enable each individual with a disability to achieve his or her full potential and maximum independence, including living within the community as independently as possible.” Quality and Fairness: A Health Strategy for all – Department of Health and Children, 2001 SW Department, NRH, 2006

24. The Challenges ahead • Resources • Attitudes/Education • Infrastructure • Social Policy/legislation: an integrated approach, bringing together health, housing, social welfare, education and employment • The issue of capacity and ABI • Decisions as a society SW Department, NRH, 2006