Royal Commission Interim Report

The Interim Report of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability was released on 30 October. At 561 pages, it is a long read, so when my colleague Sara asked for a ‘summary’, I nearly threw something at her. The truth is that it is impossible to condense such an extensive inquiry, so this article looks at the key issues identified in the report. We encourage readers to read either the full or 80-page summary report on the Royal Commissions website.

The report identifies a number of emerging themes as particularly pertinent throughout the inquiry. These are

• choice and control
• attitudes towards disability 
• segregation and exclusion 
• restrictive practices 
• access to services and supports 
• advocacy and representation 
• oversight and complaints 
• funding 

Each of these themes is explored in greater detail in the interim report. 

Key issues

Education and learning

The emerging picture in primary and secondary education is one in which students with disability can receive a different quality of education, without the same opportunities to realise their full potential as their fellow students. People have described the long-term impacts of poor education on their employment, health, independence and relationships, some calling the current reality neglect. In the Public Hearing, the Commission heard of physical, verbal and emotional violence and abuse in educational settings, including restrictive practices and pressure to medicate children to address behaviour. There were reports of ‘gatekeeping’ practices, mistreatment and bullying, a lack of adjustment, low expectations, the misuse of disciplinary action, poor communication and inadequate workforce capability to support students with disability. 

The Commission heard a range of different perspectives about the best way to structure Australia’s education system, from segregated settings to inclusive education. Some advocated that segregated settings enable specialist support and adapted curricula, whilst others asserted that segregation results in higher rates of violence, abuse and neglect, both within these settings and later in life. Some organisations and academics described these settings as based on seeing disability as a deficit, which perpetuates the exclusion of people with disability throughout their education and work lives. The stories in the report clearly illustrate how foundational these earlier educational experiences are in building enduring positive relationships and inclusive communities. 

The Commission will make further inquiries into 

• gatekeeping practices
• the mistreatment of students with disability
• restrictive practices
• barriers to adjustment, supports and individualised planning
• low expectations of students with disability
• the misuse of disciplinary measures in response to behaviours of concern
• relationships, communication and collaboration between schools and families and links to violence, abuse, neglect and the exploitation of students with disability 
• oversight and complaint mechanisms in educational settings 
• funding, resources and best practice funding models 
• teacher education and training
• existing data collection models and how to address gaps 
• the experiences of First Nations and culturally and linguistically diverse students with disability 
• measures to encourage more effective programs of inclusive education in mainstream schools

Homes and living

People with disability are more likely to feel unsafe in their homes, which is an awful and unacceptable reality. The Royal Commission’s early work focused on group homes, but it also heard about violence, abuse, neglect and exploitation occurring across a range of residential settings. In the Public Hearing and submissions, the Commission heard that group homes can emulate the cultures and practices of the large institutions of the past. People described being deprived of choice in shared supported accommodation, leading to a loss of control and autonomy and exclusion from social, economic and cultural life. The Royal Commission heard evidence that this lack of choice can also lead to residents in supported accommodation being exposed to violence, abuse, neglect and exploitation. 

The Commission will make further inquiries into 

• the potential reform of laws, policies and practices to enable people to exercise their right to autonomy 
• measures to improve the culture of service providers with the aim of eliminating the violence, neglect and exploitation of people residing in supported accommodation 
• how disability support workers can better meet the needs and wishes of the people they support, including considering the qualifications and experience of support staff 
• how the safety of people living in supported accommodation can be enhanced 
• alternatives to group homes 
• the forms of redress available to people with disability who are subjected to violence, abuse, neglect or exploitation while residing in supported accommodation

Health

People with disability often experience poorer health than people without disability and face significant barriers to accessing health care. The Commission heard that health staff often appear reluctant to provide adequate care due to perceptions about the value of people with disability and financial disincentives to devote the time necessary for treatment. People shared their experiences of the violence and abuse that occurs, including involuntary treatment and diagnostic overshadowing. People spoke about health staff not listening to patients with disability or talking about them rather than to them. The Commission also heard of the increased difficulties experienced by people with disability in accessing health care during the COVID-19 pandemic. The Royal Commission acknowledged that whilst the quality of health care provided varies, the evidence suggests there continues to be systemic neglect of people with cognitive disability in the Australian health system. 

The Commission will make further inquiries into 

• measures to enable people with cognitive disability to make informed decisions about their care and treatment and exercise choice and control in the health system 
• how negative attitudes towards people with cognitive disability within the health system reflect outcomes and inflict distress 
• improving (accessible) communication between health professionals, the person with cognitive disability, their support network and other health services
• barriers to adequate health care for people with disability living in regional, rural or remote areas 
• multiple forms of disadvantage experienced by First Nations people with cognitive disability and their barriers to adequate health care 
• independence and self-advocacy 
• measures to improve preventative health, oral health, transition to adult health care, mental health and palliative care for people with cognitive disability 
• the integration of health and disability services
• adjustments that should be made to the hospital, clinical environment and clinical procedures to minimise distress for people with cognitive disability 
• training and education of health professionals to achieve better quality health care and outcomes for people with cognitive disability 
• measures to improve the collection, analysis and publication of data
• other initiatives to improve health care for people with cognitive disability

Relationships 

The Royal Commission heard about domestic and family violence, sexual violence, child removal and child relinquishment. People with disability experience higher rates of domestic and family violence than people without disability. This has been amplified during the COVID-19 pandemic, where people were more isolated and less able to report and escape domestic and family violence. The Royal Commission heard stories about children who were removed from parents with disability and adults with disability who were removed from their families when they were children. Experiences were shared by First Nations families in the context of child removal practices. These experiences are, in part, responsible for the widespread mistrust of mainstream systems by First Nations families, resulting in families being less likely to access mainstream supports and services.

Community participation

People with disability continue to face attitudinal, institutional, environmental and communicative barriers to community participation. People are excluded through the inaccessibility of buildings, public and private spaces and inaccessible information. The Royal Commission heard how access to information was unreliable and confusing during the COVID-19 pandemic and that many people with disability felt overlooked or left behind during the crisis. Some people with cognitive disability spoke of feeling unsafe in public spaces, such as when using public transport or negotiating hazards in public areas. The report highlights that inaccessibility takes many forms far beyond the understanding of the mainstream community.

Economic participation

People with disability experience high levels of socioeconomic disadvantage and are more likely to experience poverty, financial hardship and unemployment, with lower incomes and higher costs associated with living with disability. The Commission heard of experiences of physical, verbal and sexual abuse by colleagues and managers in the workplace, including in Australian Disability Enterprises (ADEs). In some instances, when these issues were raised, they were ignored or not addressed. The lack of meaningful work in ADEs, poor workplace conditions and difficulties in transitioning to open employment were also raised. In its future inquiries, the Commission will be examining the connection between poverty, unemployment and underemployment and violence, abuse, neglect and the exploitation of people with disability, as well as the effectiveness of employment policies and programs for people with disability.

NDIS

What the Commission has heard so far includes acknowledgement of some improvements under the NDIS, but also increased frustration that many of the intended benefits are yet to be realised. Some speakers told the Commission about the positive impacts that the NDIS had had on their lives; however, many more indicated that their experiences of the NDIS did not meet their expectations, both in its design and implementation. Some people felt that choice and control have been undone by how the NDIA acts as a ‘gatekeeper’ to how people with disability live their lives and how some providers now see people with disability as a ‘commodity’. 

Justice

The Royal Commission heard that people with disability are overrepresented in the criminal justice system and face a range of barriers to accessing support to protect their rights and interests. Experiences were shared of people being disbelieved when they made a report, being treated as the offender rather than the complainant and being approached by police or formally questioned inappropriately. People with cognitive or psychosocial disability are at higher risk of moving in and out of the justice system. This is often through repeated short-term prison sentences, as well as being subject to indefinite detention orders, meaning they can be held for a longer period than if they had been convicted. Further concerns were raised about the use of restrictive practices on people with cognitive disability, including the use of solitary confinement.

People with disability also come into contact with the civil justice system, for example, through guardianship and administration orders, which often limits people’s choices and control. These orders can have the unintended consequence of leading to increased abuse, particularly financial exploitation. On the other hand, the Commission heard that guardianship orders may be put in place in response to or to prevent abuses such as forced medical treatment. The Royal Commission will continue to examine these key issues through its ongoing work. 

First Nations people

First Nations people have told the Commission that their understanding and experiences of disability differ to those of the general population. There is no comparable term for disability in many traditional languages, and there is often reluctance to identify with the disability label. For this reason, the number of First Nations people with disability is thought to be substantially higher than the figures reported in official data. The report reflects on how First Nations people with disability face ‘double discrimination’ which is compounded by the ongoing effects of factors such as colonisation, intergenerational trauma, poverty and chronic health issues. First Nations people with disability are more likely to experience harm than the general population. Despite this heightened risk, the Commission heard that the experiences of First Nations people with disability have a relatively low profile in national policy discussions. The lack of culturally appropriate services and supports available for First Nations people with disability has emerged as an important theme in the Royal Commission’s work. 

Culturally and linguistically diverse people

The Royal Commission has developed culturally and linguistically diverse engagement principles to help ensure their engagement with culturally and linguistically diverse people is inclusive and culturally appropriate. The Royal Commission is in its early stages of engaging with culturally and linguistically diverse communities, and this will be developed further as the Royal Commission proceeds.

The interim report provides a glimpse into the complex, engrained issues that contribute to the violence, abuse, neglect and exploitation of people with disability. It highlights the systemic, cultural and cumulative disadvantages that many people experience throughout their lives and across a range of settings. At the end of the Royal Commission’s inquiry, the final report must identify best practices and recommend changes to laws, policies, practices and systems to prevent and respond to the violence, abuse, neglect and exploitation of people with disability. Whilst the Commission was scheduled to hand down its report and recommendations in 2022, an extension has been sort until September 2023. You can keep up to date on the progress of the Royal Commission on its website.