Submission 68 — Insights Mental Health Ballarat — Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability | External submission

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Insights submission - based on the work

of Julie Spriggs

Compiled by Insights leadership team

Monday, July 4th , 2022

Finalised - Tuesday, September 6th , 2022

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Introduction

Insights Mental Health Ballarat offers the following submission in writing to the

Federal Royal Commission into Violence, Abuse, Neglect and Exploitation of those

with a disability.  Insights  is a non-for-profit advocacy group located in Ballarat,

Victoria, with a focus on support and recovery for those who identify as having a

lived experience of mental health issues. Our aim is to assist people to recover from

mental illness and explore the arts as a way of expressing themes of mental health and

recovenng.

Insights also invites those with lived experiences to develop the necessary skills to

address their concerns of abuse and the groups, systems and social structures which

assist people to live well in our community. Our service aims to integrate good mental

health and wellbeing into a person’s surroundings. We believe that it is a basic human

right that each individual has access to a safe home free from violence. Through this

policy submission we hope to develop awareness of the current situation and to

campaign for those who are at risk of experiencing abuse (physical, psychological,

sexual and neglect). This particular submission will primarily address the safety

concerns for those with a disability who reside within Supported Residential Services

and suggest ways in which these living arrangements might be changed to reflect a

more welcoming and inclusive society. It will identify the connection between the

health outcomes of those with a disability in this environment and the structural

barriers to increasing good health and wellbeing.

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Submission Summary

People who live with a disability are entitled to live in a home that is safe and that

promotes their health and wellbeing. Supported Residential Services (SRS’s) are

shared accommodation  facilities  for those with a disability who need help with

everyday activities such as providing meals, personal care, administering medications,

and help with mobility. The 2013 Census found that among those living in an SRS

79% have a disability while 21 % do  not. SRS residents  are some of the most

vulnerable members of the community, many of whom are on a pension level income

and most at risk of homelessness. Research by the Adelaide University found that

persons with a disability have a greater risk of homelessness than those without

(2012).

Some of the issues that arise within SRS’ s include a lack of supply for the housing

demand, concerns regarding the quality of care, quality of staffing and social safety.

The Australian government needs to immediately address the quality and safety

concerns of those residing in SRS’s, ensuring that the promotion of health and

wellbeing is at the forefront of their planning. Ultimately, Insights’ submission will

highlight the following key features.

Identifying those at risk ofhomelessness; pension entry residents and the impact on their health and wellbeing.
Demand vs Supply; the increasing demand for beds and space.
Quality of Care; level of satisfaction, daily activities, food.
Quality of Staff; level of qualification, job satisfaction among workers, client/worker ratios.
Safety and Care; free from abuse, complex behaviours, safety among residents. 3

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Insights believes that people with a disability should be free from abuse and that the

safeguards protecting the quality of services used by those with a disability are

integral to their self-determination.

Insights’ response to the terms of reference:

Matters that need to be satisfactorily addressed to resolve the current issues are stated

in the paragraphs below.

Risk to homelessness and its effect on mental health

There is an acute shortage of affordable housing for those with a psychiatric disability

in Australia. Evidence suggests that a lack of affordable housing leads to poorer

mental health outcomes. Many people who are at risk of homelessness or who have

mental illnesses are referred to supported residential services. Many of the consumers

who reside in SRS’ s are on the disability support pension. The average fortnightly

payment is approximately $967 including supplements (Services Australia, 2021),

which is just below Australia’s poverty line, whereas the average fortnightly cost for

to live in an SRS starts from $820 a fortnight (DHHS, 2020). This accounts for

approximately 85% of their income.

The current payment ofthe disability support pension barely covers the cost of

staying in an SRS and after the payments are made, not much is left over to afford

other necessities including daily activities outside the SRS. Because of this, many

residents experience isolation, social exclusion and discrimination. Many SRS ’s

accommodate between 20-50 people at any one time whereas the largest facilities can

house up to as many as 80 residents (SRS Census,

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2018), many with only a few workers onsite at any one time. Many SRS’s are

privately owned businesses that work on a fee basis. Many SRSs are under regulated

and do not operate on a government basis.

Social and economic stability is integral to mental health maintenance. There is strong

research to suggest that  stable housing  is preventative  in  further mental health

relapses. To achieve this, governments need to take into consideration the policies

that provide more suitable housing for consumers. They also need to consider the

safety measures within SRS ’s.

Individual barriers to making complaints on their behalf

(Behaviours, functional capacity, accessibility)

Difficulties with everyday living ( cognitive and functional deficits)
Poor literacy and numeracy skills
Mobility issues
Complex behaviours (aggression, violence, poor impulse control)
Lack of awareness of choices and rights Psychiatric disability accounts for the majority of the adults who reside in supported

residential services. People with serious mental illnesses including psychotic

disorders, mood disorders and personality disorders are most at risk for homelessness.

The Australian Institute of Health and Wellbeing (2012) found that people with

psychotic disorders and mood disorders frequently experience poorer physical health

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outcomes. As many as 2000 Victorians live in supported residential services, 1600 of

which  have  psychosocial  disabilities  (SRS  Census,  (2018).  Residents  report

experiencing high levels of social isolation from the rest of the community as most

aspects of their lives take place within the SRS. Many of these residents do not

receive outside supports.

Individual barriers can be overcome with help from experienced staff and support

organisations that can advocate on the resident’s behalf. Addressing the structural

policies and providing quality care plans can further alleviate this by putting the

wellbeing of residents at the forefront of their recovery with greater choice and

control. Some ofthe structural barriers associated with receiving quality care include:

Structural barriers to quality of care

Staff to client ratios (understaffed).
Quality of staff, level of qualifications.
Cuts to funding for public SRS ’s ( adequate and quality services within SRS’s).
Social stigma and discrimination for those with serious mental illnesses.
Demand vs supply (shortage ofbeds, facilities)
Lack of privacy Much of the staff working in SRS ’s are personal care assistants that reqmre a

minimum of Certificate 3 in Individual Support (Aging and Disability). The quality of

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staff is integral to the overall functioning of the company. High levels of staff

turnover are prevalent within this profession with the average pay for a personal care

assistant being approximately $23 an hour, which is just above the average hourly pay

(O’Keefe, 2017). Casualisation of the workforce has also resulted in higher workplace

turnover. Perhaps making it a requirement for mental health training within these

environments would decrease the likelihood of further episodes of mental health

issues.

There is also an increasing urgency for beds within these facilities and an increased

need for more supports. Governments are failing to meet these demands.

Lack of privacy for residents and social stigma leaves many of the communities most

vulnerable people isolated. Without the necessary policies put in place to support

residents, violence and abuse will ensue.

Human rights, free from violence and abuse

Human rights apply to people of all ages and abilities. People should be free from

violence, emotional and sexual abuse  regardless of their background,  status  or

individual differences. Human rights have been the foundation for advocacy groups

meaning that people should have the choice in:

Where they choose to reside and whom they live with.
The right to safe housing, especially for women.
Free from violence and abuse.
Rights to have dreams and goals.
The right to self-determination. 7

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The 2012 report from the Office of the Public Advocate on sexual assault against

women in SRS ’s shows how vulnerable women are to assault in this environment

(Bedson, 2012). The report details how the inappropriate mixing of residents and

inadequate services and supports frequently puts women’s safety at risk. The report

also found that risks to residents are often not adequately managed and victims are not

appropriately supported following instances of abuse. The prevalence between mental

illness and drug abuse within these environments has resulted in tensions between

residents. Effective monitoring and reporting of incidents would be minimised if these

strategies are put in place more often.

The rollout of the National Disability Insurance Scheme (NDIS) as a

safety net

The introduction of the NDIS has given the individual greater choice as to how and

what supports they require to meet their everyday needs. The NDIS was established to

assist people with a disability to re-engage with the community, provide personal care

and to regain skills to re-enter the workforce. However, the NDIS struggles to fulfill

many of the issues listed in this policy submission inquiry. The NDIS is often hard to

access with many residents having no family and friends to help them to get through

the long and complex process of acquiring supports (Hancock & Smith-Merry, 2020).

This is often done by staff members within the SRS. It is becoming increasingly clear

that some residents will not receive NDIS funding supports. Choice and control are

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another big factor within the NDIS framework with many participants unaware of

their choices.

Conclusion

Failing to provide the necessary supports and quality of housing for those with a

disability particularly mental illnesses contributes to higher economic costs and

decreased  social  functioning  of the community.  This  results  in poorer  health

outcomes, increased use of health services and increased exposure to the criminal

justice  system. Government  policies  that have  privatised supported  residential

services have seen the quality of facilities become unregulated, a casualisation of the

workforce and a lack of housing  for  those with complex  disabilities,  leaving

vulnerable people stigmatised and excluded. The introduction of the NDIS is hopeful

in alleviating some of the hardships for those with complex disabilities, however

difficult navigation processes has left this scheme seemingly unattainable for many.

These issues will continue to prevail unless they are addressed on a structural, social

and economic level. A safe and secure environment free from violence and abuse will

ensure the prevention of mental health relapses and promote good mental health and

well being.

Other items to be considered in the submission

Insights would like to suggest that the age criteria for access to the NDIS could

be changed to allow membership for those over 65 years old - it seems to shut

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out those 65 years and over who can’t join the system but get poor support

through the aged care system.

The current reliance on Supported Residential Services means that people

with a psycho-social disability in Victoria are often placed in environments in

which neglect and possibility of abuse is high.

At the meeting in February, we discussed the notion of graded accommodation

as an alternative.

In other words, to create housing where people could start where they are at

and move between gradations of support

For example, someone just out of an SRS, an acute unit or PARC might require the maximum support possible - 24-hour round the

clock staff access

When that person had learnt enough skills, they might move to a lower level of care and take more responsibility for shopping,

cooking, accessing work and study, etc

This second tier of the model might involve staff being involved

during the day, but there being no staff at night and/or the ability to

have staff sleep over when required

3. When  the  person had  reached  the  ability  of  full  autonomy,

arrangements might be made for independent housing, rented or

owned, but with weekly access to a worker to discuss issues, make

sure the person was still on track with their mental health, etc

When the person no longer required that access, they might be discharged from the system, now with secure owned or rented

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accommodation, and with supports for mental health from the

private system.

1.  What would you  like to share with the Royal Commission about your

experiences or knowledge of violence, abuse, neglect or exploitation of people with disability?

See notes above. SRS’s seem set up as institutions in which abuse and neglect may be prevalent. Urgent action should be taken to move from SRS’ s to more cost-intensive, but more respectful and effective services that assist people to independence, but also which accept, protect and support those unable to make that transition.

Have you shared these experiences with anyone else? Who did you tell and what happened?

No, Insights is generally just happy to support and assist to recovery those who come to us. We haven’t made it our business to be an advocacy agency.

Are there any suggestions or recommendations you would like to share including any examples of what worked well or ideas for how things could be done better?

People generally come to Insights just to enjoy their lives and recover.

It is our belief that with more peer run initiatives like Insights and

other organisations like the Maine Connection, people with mental

health issues will show we can stand on our own two feet, coordinate

our own services, and work with like minded people who want those

with mental health difficulties to recover and prosper.

Is there anything else you would like to tell us? As Australian of the Year Professor Pat McGorry has said, there is a

health system in Australia for conditions like cancer where those who

need it get the best treatment in the world. Alongside that is a service

for those with mental illness which is rife with discrimination, under

funded and still allowing the abuse that happened in the old asylums to

happen to some. 11

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While most of the reforms of deinstitutionalization and of main streaming have

increased rights and outcomes for those with mental health issues, some have

been  left behind in the reforms and  suffer discrimination equal or worse

than was suffered by those in the old institutions.

It is hoped that with some practical, well-funded, structural reforms and with

some more investment in mental health peer support groups like Insights,

these issues will eventually be addressed.

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References

Baker, M. (2014). Mental illness linked to extreme risk ofhomelessness. Accessed

23rd of October from; https://www.adelaide.edu.au/news/news73702.html

Bedson, L. (2012). Sexual assault in supported residential services: Four case studies,

Office ofthe Public Advocate, Victoria

Cashin, A. (2014). Shortage of Supported Housing for People with Mental Illness:

Australia as an Exemplar of an International Problem. Issues in Mental Health

Nursing, 35(2), 148-151. https://doi.org/10.3109/01612840.2013.827287

Department of Health and Human Services. (2021). 2019-2020 Fees and

charges for supported residential services. Accessed 2!51 October

from; https://www.dhhs.vic.gov.au/supported-residential-services

Hancock, N. & Smith-Merry, J. (2020). It’s hard for people with severe mental

illness to get in the NDIS - and the problems don’t stop there. Accessed

23rd October, 2021 from; https://theconversation.com/its-hard-for-people

with-severe-mental-illness-to-get-in-the-ndis-and-the-problems-dont-stop

there-130198

Heyeres, M., Kinchin, I., Whatley, E., Brophy, L., Jago, J., Wintzloff, T., Morton, S.,

Mosby, V., Gopalkrishnan, N., & Tsey, K. (2018). Evaluation of a residential

mental health recovery service in north Queensland. Frontiers in Public

Health, 6, 123-123. https://doi.org/10.3389/fpubh.2018.00123

O’Keeffe, D. (2017). Aged care wages: tackling pay in ‘the forgotten industry’.

Accessed 23rd of October, 2021 from

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https://www. australianageingagenda. corn. au/features/ aged-care-wages-tackling-pay

in-the-forgotten-industry/

Supported Residential Services Census. (2018) accessed 15th October, 2021 from

http://www2.hea1th.vic.gov.au

Supported Residential Services Census. (2013). Accessed 21 st October, 2021 from;

https://www2.health.vic.gov.au/Api/downloadmedia/% 7BF7852F A3-B4A5