Barriers to finding and maintaining open employment for people with intellectual disability in Australia

Everyone has the right to employment. Work is important for health, well-being, and social, economic, and financial inclusion. However, it is often difficult for people with intellectual disability to find and maintain work, especially in the open labour market. Policy challenges remain about who can access open employment (also sometimes called competitive or supported employment) and how often people with intellectual disability do so. Greater understanding about the barriers that people with intellectual disability encounter when they try to find and keep work in open employment is needed. Drawing on research with 51 people with intellectual disability in Australia, this paper examines the systemic barriers they report to finding and maintaining work in open employment. The findings highlight that the barriers they experience stem from narrow, dismissive, and discouraging attitudes to their work in open employment and from a spectrum of experiences of stigma and discrimination in open workplaces. The paper thus provides new knowledge about reasons that people with intellectual disability may either reject or not continue in open employment and take up less inclusive work options. The paper discusses the implications of the findings, including the need for policy development for attitudinal change, designing more varied roles for employees with intellectual disability, ensuring access to industrial relations protections, and increasing and better regulating and funding requirements on support to people with intellectual disability who are seeking work in open employment.     

Indigenous Australians and Impaired Decision‐Making Capacity

This article explores issues associated with impaired decision‐making capacity for Indigenous Australians. There is very little published on the subject of impaired decision‐making capacity in Australia, particularly in relation to Indigenous people. To gain some insight into this subject, this article looks at some indicators of impaired decision‐making capacity for Indigenous Australians such as rates of intellectual disability and mental illness. The Australian state‐based Guardianship and Administration system—the legislative framework designed to provide for decision‐making for people with impaired capacity—is briefly described before looking at the cultural relevance of this Western system and its constructs for Indigenous Australians. Future investigation should be directed at exploring existing and alternative strategies to support Indigenous Australians with impaired capacity and their carers.     

Experiences of National Disability Insurance Scheme planning from the perspective of adults with intellectual disability

The Australian National Disability Insurance Scheme (NDIS) is attempting to address long‐term inequalities experienced by people with disability. Planning is central to the NDIS. People with intellectual disability will be the largest group of NDIS participants, and their perspectives are underrepresented in the literature. It is important to understand how they experience and perceive NDIS planning. Ten adults with intellectual disability participated in semi‐structured interviews to explore their experiences of NDIS planning. Data were analysed using Braun and Clarke's (2006, Qualitative Research in Psychology, 3, 77) six stages of thematic analysis. Six themes were identified: planning preparation not fit for purpose, creating goals, goals not met, planning not meeting real needs, lack of choice and control and importance of relationship with planner. In principle, the NDIS presents a real opportunity to increase the choice and control, social and economic participation, and independence of people with disability; however, this does not always translate into practice for people with intellectual disability.     

Challenging the exclusion of people with mental illness: the Mental Health Housing and Accommodation Support Initiative (HASI)

Without appropriate support, people with mental illness can be excluded from stable housing and social and community participation. Transitional models of support for people with acute mental illness have addressed clinical symptoms and hospitalisation, but they have not facilitated stable housing and community integration. In contrast, individualised housing models aim to improve mental health, housing and community outcomes. These programs are costly and require collaboration between agencies. This article discusses the evaluation findings of one such program – the NSW Mental Health Housing and Accommodation Support Initiative (HASI). The longitudinal mixed‐method evaluation assessed whether HASI supported people with high levels of psychiatric disability to improve housing, mental health and community participation. We discuss the challenges clients within the program faced prior to joining HASI and the changes experienced while in HASI. We conclude by drawing policy implications for programs supporting people with mental illness to live in the community.     

Death Does Not Become Us

Abstract

The social issues of death, dying and bereavement represent important but neglected research areas, and such issues need attention both for practical reform and for deciphering what living with intellectual disability entails. The difficulties which life poses for people with intellectual disabilities may well persist in the times before and after death. As research issues they offer not only potential practical significance, but also a means of determining the social status and value of people with intellectual disabilities. This paper reviews the issues of death and dying from the viewpoint of sociological research and seeks to identify the ways death and dying have been treated within the research literature on living with intellectual disability. It is suggested that these issues have been discounted with some important consequences for the way intellectual disability is perceived. Important areas for research in this area are highlighted.     

Allocating Homes for People with Intellectual Disability: Needs,Mix and Choice

Allocation of housing and support services for people with intellectual disability is based on three major sets of criteria: an assessment of the applicants' needs; considerations of social mix; and the applicants' own choices. This article examines the philosophical and institutional rationales underlying each of these notions and the tensions arising when seeking to achieve a balance between them. The first section of the article is based on a review of related studies in the UK, the USA and Australia, mainly on allocation policies in mainstream social housing. The second section presents original empirical work carried out in the state of Victoria, Australia, in 2007–08, illustrating some of the implications of a new balance that was created between needs, mix and choice in allocation of housing and support for people with intellectual disability. The article argues that the concepts of needs, mix and choice should be redefined in a way which reflects the interdependencies between them. Further, the article calls for more extensive mutual learning between studies of mainstream social housing and housing for people with intellectual disability.     

A critical review of mental health and mental health‐related policies in China: More actions required

In China, there are over 170 million people suffering from mental illness. However, there is a lack of a critical review of the policies governing the provision of mental health services. Drawing on the framework of mental health policy developed by the WHO, this article critically examines mental health policies regarding legislation, financing, model of care and delivery, as well as manpower and the training of mental health professionals in China. This analysis raises a number of policy‐related questions concerning the lack of community‐based psychiatric services, inadequate coverage of mental health services in the rural areas, poor standard of education and an insufficient number of trained mental health professionals, and insufficient protection of the human rights of people with mental illness. The article ends by urging the various levels of governments to make a firm commitment to improve mental health care for people with mental illness in China.     

Recurrent grief in mothering a child with an intellectual disability to adulthood: grieving is the healing

Much of the literature on mothering a child with a disability focuses on grief in the context of diagnosis, with a paucity of longitudinal studies focusing on ongoing grief as the child moves through the life stages. This qualitative study explores the existence of recurrent grief within the lived experience of six women, in mothering their children with intellectual disability through to young adulthood. Informed by the differing theories of grief and disability, the study considers mothers' perception of the experience of recurrent grief as influenced by personal and societal factors, with a focus on its triggers, its manifestation and its amelioration. The findings have relevance to social work practice, policy and research in revealing the necessity for ongoing support and advocacy for mothers of children and young adults with intellectual disabilities.     

Aging with a severe mental illness: challenges and treatments

Severe mental illness (SMI) impacts many different facets of individuals' lives. As they age, those with SMI experience increased physical illnesses, functional impairment, cognitive deficits, and social disability. To promote more effective social work practice with this population, this article highlights the major biopsychosocial and family issues of aging with a psychiatric diagnosis. In addition, intervention approaches that have demonstrated efficacy are summarized along with ways to coordinate services across multiple service delivery sectors. Finally, future directions in practice and research are presented to develop additional methods of support for older adults with SMI and their families.     

Older family-carers' views on the future accommodation needs of relatives who have an intellectual disability

Over the past 20 years, research across the developed world has identified trends towards ageing of the population with learning/intellectual disability. Alongside is the recognition that family-carers are also ageing. Recently, the UK government has sought to identify the future housing needs of dependents with intellectual disability residing with older carers. Consequentially, a city council commissioned this qualitative study involving 28 older carers. The findings indicate a need for information about housing options, a lack of practical support and feelings of marginalisation. The conclusions suggest key roles for social services in providing proactive support and advice to family-carers, and a greater degree of joint working between social services departments and housing agencies. These resonate with similar international studies and provide the opportunity to focus on the perspectives of family-carers. Their experiences are real, and if welfare professionals are to work with people with intellectual disability and their family-carers, acknowledging their views is essential.     

The Citizenship of Excluded Groups: Challenging the Consumerist Agenda

The language of consumerism suggests that through involvement in consumer processes, consumers can influence policy formation and service provision. This paper examines, as illustrative cases in Australia, how two groups of consumers, people with a mental illness and older people, engage with these consumer processes. It finds they critically evaluate the opportunity offered by consumer processes for inclusion in policy and programmes. Both people with a mental illness and interviewed older people indicated how they acted as "agents involved in interpreting their needs", despite finding that in consumer processes their needs were predefined. Rather than allowing themselves to be constructed as passive objects, they positioned themselves as active citizens, having agency not as individual consumers but through drawing on networks. The responses of both groups go some distance toward dismantling power differences between professionals and "consumers", suggesting that social policy and programmes for both people with mental illness and older people can and sometimes do develop in a context of greater inclusivity.     

Aging With a Severe Mental Illness: Challenges and Treatments

Severe mental illness (SMI) impacts many different facets of individuals' lives. As they age, those with SMI experience increased physical illnesses, functional impairment, cognitive deficits, and social disability. To promote more effective social work practice with this population, this article highlights the major biopsychosocial and family issues of aging with a psychiatric diagnosis. In addition, intervention approaches that have demonstrated efficacy are summarized along with ways to coordinate services across multiple service delivery sectors. Finally, future directions in practice and research are presented to develop additional methods of support for older adults with SMI and their families.     

Are the Homeless Mentally Ill?

In Australia, it is widely believed that most homeless people have mental health issues and that mental illness is a primary cause of homelessness. This paper uses information from a study of 4,291 homeless people in Melbourne to investigate these propositions. The research found that 15 per cent of the homeless had mental health issues prior to becoming homeless. This challenges the community perception that mental illness is the primary cause of homelessness. The research also found that 16 per cent of the sample developed mental health issues after becoming homeless. Homelessness causes mental health issues for some people, particularly anxiety and depression. The claim that most homeless people are mentally ill sends the wrong message to policy makers about the services that are needed to assist homeless people.     

Employment status transitions among young adults,with and without disability

Employment is a crucial avenue through which young people with disability can experience material wellbeing and social participation. While the low employment rates of young people with disability are well established, little is known about the stability of employment status – that is, the degree to which individuals remain in or move in and out of employment. This article uses longitudinal data from a large Australian national data set to investigate the transitions between full‐time, part‐time and non‐employment for young people with and without disability. Considerable mobility was found between employment states for both young people with and without disability, with young people with disability more likely than their peers without disability to transition to reduced levels of employment and less likely to transition to increased levels of employment. Social background and contextual factors predicted employment for young people with disability; however, disability represented an additional penalty even after taking these factors into account. Findings suggest a need for social policy targeted specifically towards the barriers to maintaining and increasing employment experienced by young people with disability.     

小组工作在综合医院精神科精神疾病康复中的运用——以昆明M医院精神科“沟通小组”为例

随着精神疾病发病率的不断上升,精神疾病负担的不断加剧,精神健康与精神疾病越来越受到人们的普遍关注,众多学者也开始了对精神疾病康复模式的探索,笔者以社会工作专业视角,利用小组工作介入形式,为M医院精神科精神病人及其陪护开展"沟通小组"活动,开始了综合医院精神科精神疾病康复的探索与实践。     

Delivering decision making support to people with cognitive disability — What has been learned from pilot programs in Australia from 2010 to 2015

The UNCRPD has generated debate about supported decision making as a way to better enable people with cognitive disability to participate in decision making. In Australia, between 2010–2015, a series of projects have piloted various models of delivering decision making support. A critical review was conducted on the program documents and evaluations of these pilot projects. The pilots were small scale, conducted by both statutory and non‐statutory bodies, and adopted similar designs centred on supporting a decision maker/supporter dyad. Primarily, participants were people with mild intellectual disability. Themes included: positive outcomes; uncertain boundaries of decision support; difficulty securing supporters; positive value of program staff and support to supporters; limited experience and low expectations; and varying value of written resources. The lack of depth and rigour of evaluations mean firm conclusions cannot be reached about program logics, costs or outcomes of the pilots. The pilots demonstrate feasibility of providing support for decision making rather than resolving issues involved in delivering support. They suggest that some form of authority may facilitate the role of decision supporters, help to engage others in a person's life, and integrate decision making support across all life domains.     

DISABILITY AND PRODUCTIVE EMPLOYMENT: A PREDICTION OF FAILURE AND A PROPOSAL FOR CHANGE

This article will argue that recent disability services legislation has selectively interpreted the concepts of normalisation and integration to focus on employment for people with an intellectual disability as a major policy goal. It will be contended that the nature of the contemporary labour market is such that this goal cannot be fulfilled and therefore that the aim of enhancing quality of life cannot be achieved. The article recommends an approach to the reorientation of policy which is based upon a critical analysis of the cultural position of people with disabilities. In this regard, the notion of cultural productivity is introduced as a framework within which some solutions may be found.     

Exposure to interpersonal racism and avoidance behaviours reported by Aboriginal and Torres Strait Islander people with a disability

Using the National Aboriginal and Torres Strait Islander Social Survey, this paper examines exposure to interpersonal racism and avoidance reported by Aboriginal and Torres Strait Islander people with disabilities. We find that in 2014–2015, 32 per cent of people aged 15–64 without a disability experienced racism compared with 42 per cent of those with a disability. Half of those living with an intellectual or psychological disability reported racism, and about 20 per cent of those with any disability avoided settings such as healthcare, education or the general public due to past instances of racism, relative to 11 per cent of those without a disability. After adjusting for confounding factors and complex survey design, presence of a disability was associated with a 1.6–1.8 odds increase in exposure to racism, more frequent racist exposure and avoidance. Disability was further associated with an approximate doubling of the odds of reporting multi-context avoidance and the likelihood of reporting both racism and avoidance in tandem. Severity of disability, higher numbers of disabling conditions and specific disability types were associated with increased odds of racism and avoidance. Independent of these effects, removal from one's natural family and identifying with homelands was strongly associated with racism and avoidance.     

Changes in attitude towards people with mental illness in P-city,S. Korea: a comparison between the years 2000 and 2010

The objective of this study was to investigate changes in the attitudes towards people with mental illness in a city located in South Korea (P-city) between 2010 and 2000. Since it was not accessible to raw data of 2000, to compare with 2000 results, the results from the previous research article were used. Results from t-tests and ANCOVA analyses showed positive changes in P-city residents’ attitudes towards people with mental illness, particularly in authoritarianism and social restrictiveness. Discussion includes the role of a successful community mental health centre in bringing about such positive attitudinal changes.     

Young people leaving care: health, well-being and outcomes

This paper focuses on the health and well‐being of young people making the transition from care to independent adulthood. It draws on findings from a wider study of outcomes for young people leaving care in England. Notably, the study used, as its key outcome indicators, measures of general and mental well‐being. In doing so, it was able to explore the interrelationship between these areas and young people's overall progress after care. The paper explores the extent to which young people experience difficulties related to physical and mental health, disability and emotional and behavioural problems. It will show that such difficulties can impact upon and be influenced by overall well‐being and post‐care progress in more traditional outcome areas such accommodation and career, and will suggest that the transition from care itself can adversely affect health and well‐being. The paper considers these issues within the context of a changing policy framework which has given increased priority to the health and well‐being of young people in and leaving care, particularly in light of the Children (Leaving Care) Act 2000. It considers the ways that young people are supported to address health and well‐being and the implications for and impact on leaving care services.