3. Intellectual Disability & Acquired Brain Injury
The following is some basic information about the relationship between homelessness and two types of disability, intellectual disability and acquired brain injury. Although the term disability is an overarching term that may refer to any physical or mental impairment that limits or restricts a person’s ability to perform life activities this section will focus on those disabilities defined as:
- Intellectual disability
- Acquired Brain Injury
The information presented in this section has a special focus on how these disabilities intersect with the experience of homelessness. Although the origins of the disabilities are different and both can manifest in different ways, many of the challenges that they present to the person with that disability, in terms of perceptions and access to services, can be the same.
The information provided here is aimed at providing the reader with a general awareness of the issues relating to these two disabilities. Always seek professional advice if you are concerned about someone you believe may have a disability and who made need to be connected to some form of specialised support.
The social construction of disability
The meaning of ‘disability’ is often a hotly debated subject. Some disability advocates argue that disability is a social construct where disability occurs not as a result of physical or mental deficits but as a result of societal attitudes and reactions toward people who give the appearance of being outside perceptions of the ‘norm’. That is to say, it is the attitudes of others that is disabling rather than the disability itself. This theory supports the belief that if society were to change its attitude toward people who have a disability together with other aspects of society such as access to employment or social networks a person would no longer experience disability as disadvantage.
Attitudes are important
However, it is generally recognised that even if society were to radically change its attitudes, the nature of some people’s impairments do require the provision of specialised supports to ensure that they enjoy the same access to services, the right to participate and individual autonomy as those who do not have a disability.
Intellectual Disability
Intellectual disability is a condition that can be present since birth. It is not an illness and is therefore not medically ‘treatable’ and it not something that can be ‘cured’. Generally intellectual disability refers to a slowness to learn and process information that can impact upon a person’s ability to function in society in the same way as people who do not have this disability.
Intellectual disability is NOT a mental illness
In years past, people used to confuse intellectual disability and mental illness. These are quite distinct and separate conditions. People with a mental illness generally don’t have any difficulty learning and usually no cognitive impairment.
The fact that intellectual disability occurs during the developmental stage in a persons life, 0-18 years, is a distinguishing factor when comparing it with Acquired Brain Injury which may occur at any stage in a persons life. Although there is no one identifiable cause of intellectual disability some of the reasons known are:
- Brain damage occurring before birth as a result of: conditions of the mother such as rubella, drug or alcohol abuse, dietary problem.
- Brain damage resulting from a lack of oxygen during birth
- Brain damage after birth due to an illness or accident.
- Abnormal chromosome count resulting in Down Syndrome.
People with intellectual disability can and do learn
Although intellectual disability refers to a slowness to learn this should not be interpreted as an inability to learn. People with intellectual disability can and do learn a wide range of skills throughout their lives. With the right levels of support and access to educational opportunities people with intellectual disabilities have the ability to participate actively in society and in decisions that affect them.
Acquired Brain Injury
Acquired brain injury applies to any type of injury to the brain that occurs after birth. As with an intellectual disability, Acquired brain injury is not a disease that can be treated medically or something that you can catch. Acquired brain injury, in simple terms, is a loss of brain function that may be caused by a number of factors such as; accidents, poisoning, a stroke, brain tumours, infections or lack of oxygen. Acquired brain injury results in permanent damage to a persons function and may manifest in cognitive, sensory, physical, behavioural or personality changes. Some examples are:
- Short and long term memory loss
- Difficulty in initiating and/or completing activities
- Difficulty in problem solving and decision making
- Poor concentration
- Headaches, fatigues, chronic pain
- Reduction in or hypersensitivity of the five sensory capabilities
- Anxiety, depression,
- Hypersensitivity to noise, crowds, light or temperature
- Changes in sexual desire
- Exaggerated or inappropriate reactions
- Rigid or inflexible thought patterns, getting stuck to one idea
The challenges to people with acquired brain injury in terms of equal participation are similar to those faced by people with intellectual disability. However, with the right supports many people maintain a healthy and enjoyable lifestyle, work and participate actively.
Issues for people with an intellectual disability or an acquired brain injury
People with an intellectual disability or an acquired brain injury can experience stigma and have some of their human rights abused or ignored in many aspects of their every day lives. This may occur as a deliberate act or as a result of ignorance around the realities of both of these conditions and the real ability of people who have either one of these disabilities.
Disability discrimination
If you try to restrict a person’s ability to exercise their rights, because they have a disability, you may be discriminating against them in terms of the Federal Disability Discrimination Act (1992). Disability discrimination can be either direct or indirect.
Direct discrimination: occurs when a person is – or is about to be – treated less favourable than others because the person – or his or her associate – has a disability.
Indirect discrimination: occurs when a condition stops a person with a disability, or an associate of a person with a disability, from doing something.
Disability discrimination also includes asking for information which can:
- Be used to discriminate against a person
- Would not be asked of a person without a disability in the same situation
Community Attitudes, Access and Participation
People communicate in various ways, they often use multiple tools, oral and written, to enable effective communication. This creates barriers for those people who are not able to fully utilise standard tools of communication or who use them differently.
In addition, people whose behaviour and ability to express themselves sits outside of societal norms will often experience significant disadvantage. Because both of the forms of disability discussed above impact or may impact upon the way a person communicates, expresses their needs or their behaviour etc, they are not always easily understood and are often misinterpreted. This can cause frustration for them and for others the expression of which often further complicates difficult situations and can compound disadvantage. Some people with an acquired brain injury have reported that they are sometimes accused of being intoxicated (because their speech may be difficult to understand or slurred).
Challenging enough, these issues become more critical when a person is experiencing homelessness and is surviving in a crisis situation, trying to get their needs met whilst struggling to articulate that need effectively. Furthermore, the interpretation of need may often differ between someone who desires to offer assistance and the person who is the object of that offer of assistance.
Accommodation
It has been understood for more than two decades that people with impaired cognitive ability should not be institutionalised. The NSW Council for Intellectual Disability calculates that in NSW approximately 2,400 people with intellectual disability live in large institutions. Many people with intellectual disability or brain damage also live in supported accommodation such as group homes. The choices available to people with a disability are limited by the resources in place to support those choices. Therefore, whilst it is entirely possible for people with intellectual disability or brain damage to live alone, or to at least choose who they live with, this does not always happen because of the special support that may be needed to enable this.
There are limited places for the supported accommodation that does exist. This has resulted in some people being accommodated in places that don’t have appropriately trained or equipped staff to meet their special needs, such as crisis accommodation services, boarding houses or, worse still, homeless on the streets.
Criminal Justice
The criminal justice system is also poorly equipped to address the rights and needs of people with impaired cognitive ability, as victims, witnesses and offenders.
As victims, people with intellectual disability or alcohol related brain injury may not have access or know how to access appropriate support. They may be in quite vulnerable situations and are not always able to report their abusers and when they do they are not always believed.
As witnesses, to their own or others abuse, they are not always perceived as credible witnesses and their testimony may not be viewed as credible.
People with intellectual disability or brain injury are over represented in the prison population. People may end up in gaol not only as a result of offences committed but as a result of lack of appropriate support and assistance. For example, they may need to be adequately represented when interviewed by the police and they need to be aware of this right; they need to be able to understand and comply with bail or bond conditions as failure to do so may result in incarceration. Lack of post release accommodation and support might also contribute to re-offending and re-incarceration.
Health
Where a person has limited ability to communicate effectively, this can have a significant impact upon their health. Some may suffer from undiagnosed health conditions or existing health conditions might be inappropriately managed. Lack of effective supports may mean that a person is not engaging regularly in health checks and follow up. These situations arise from a range of factors including a lack of communication skills, memory problems, access to health professionals, and inadequate access to free or subsidised health services.
Homelessness and Intellectual Disability or Acquired Brain Injury
People with an intellectual disability or acquired brain injury who become homeless may become entrenched in homelessness if the right support and assistance is not provided. Those with such disabilities who have no or few family supports may find it difficult to negotiate with community support providers, rental agents, health services etc.
Financial Protection or Guardianship
Some people have decision making difficulties, which may sometimes include people with intellectual disability or acquired brain injury., In some of these cases financial protection orders and/or guardianship orders can be made to assist them to manage their lives. In NSW applications can be made for financial protection to the Protective Commission. Some people with a mental illness (as opposed to an intellectual disability) can also have protection orders made by the NSW Mental Health Review Tribunal. Some people with intellectual disability or acquired brain injury may be particularly vulnerable to unscrupulous people who may try to take advantage of their finances. A protection order might assist some people to sustain their housing.
Guardianship orders which may be made for someone who requires a substitute decision maker for any number of reasons (for health decisions, housing decisions, care decisions etc). These orders are made by the Guardianship Tribunal.
Links
- Fact sheets about brain injury - Brain Injury of NSW
- NSW Council for Intellectual Disability
- Department of Disability, Ageing and Home Care
- Homelessness and Mental Health Linkages: Review of National and International Literature - Acquired brain injury
- Office of the Protective Commissioner
- Guardianship Tribunal
