Final Report - Volume 6, Enabling autonomy and access

Volume 6 – Enabling autonomy and access

Summary

Background

The Disability Royal Commission’s Final report tells the Australian Government what changes need to be made to prevent violence against, and abuse, neglect and exploitation of, people with disability.

We recommend change so people with disability can enjoy all human rights and freedoms fully and equally.

Our Final report has 12 volumes.

This video is a summary of Volume 6 – Enabling autonomy and access.

Autonomy is a person’s right and freedom to make decisions, control their life and exercise choice. Autonomy and access are essential to a more inclusive society.

Volume 6 examines barriers people with disability face in exercising autonomy and how this forms systemic neglect.

Barriers can include lack of access to information and communications, or an independent advocate.

This volume looks at what governments, organisations and the community can do to enable autonomy and access.

There are six chapters in this volume.

Chapter 1 – Accessible information and communications

Chapter 1 focuses on information and communications.

Clear, timely and accessible information and communications can help keep people with disability safe from violence, abuse, neglect and exploitation.

People with disability need to be able to understand information from government agencies and service providers, and to communicate their views and preferences.

This chapter looks at how information is often inaccessible for people with disability and the impact this has – particularly in emergency situations, for example, bushfires or pandemics.

This chapter also explores the role of interpreters in supporting people with disability to understand and take part in decisions that affect them.

It highlights the shortage of Auslan interpreters and First Nations sign language interpreters, and how this can prevent Deaf people from accessing critical services.

In this chapter we recommend a national workforce strategy to address this shortage.

Chapter 2 – Supported decision-making

Chapter 2 is about decision-making. It examines how people with disability often have decisions made for them, and the negative consequences this can have.

One way this happens is through the guardianship and administration system, where others make decisions for people with disability. This is also known as substituted decision-making.

To enable autonomy of people with disability, society must recognise that people with disability are able to make decisions and may sometimes need support to do so. This is called supported decision-making.

This chapter recommends moving away from substituted decision-making towards supported decision-making.

It also recommends how to change attitudes, policies and practice to better recognise and enable supported decision-making.

Chapter 3 – Advocacy and informal supports

Chapter 3 is about advocacy and informal supports.

Informal supports are relationships and connections that people with disability have with peers, support networks and the broader community.

Informal supports are a critical part of advocacy. They can help a person with disability to self-advocate, and can also advocate on behalf of a person with disability.

Advocacy is essential for many people with disability to understand and exercise their rights.

This chapter looks at issues preventing people with disability from accessing safe and timely advocacy.

It recommends changes including more funding to ensure people with disability can access advocacy support.

Chapter 4 – Health care and treatment

This chapter focuses on the health care system. Access to safe and high quality health is critical for people with disability to live the kind of life they choose.

Evidence shows people with cognitive disability experience systemic neglect in the Australian health system.

This chapter examines the barriers to health care experienced by people with disability.

Too often people with disability receive poor care, the wrong care or no care. This leads to poor health outcomes, trauma and distress.

We heard the health system is complex. Health services are not designed for people with disability and health workers do not have enough disability-specific knowledge and skills.

This chapter describes significant changes needed.

They include making service systems ‘person-centred’ and ensuring health professionals treat people with disability better.

Chapter 5 – Reducing and eliminating restrictive practices

Chapter 5 examines restrictive practices. A restrictive practice is any practice or intervention that restricts a person’s rights or freedom of movement.

They include giving a person medication to calm them down, handcuffing a person to a bed, holding a person down on the ground or keeping a person in a room by themselves.

Many people with disability are subjected to restrictive practices. They can cause lasting physical pain and mental harm.

When restrictive practices are overused, people with disability are denied autonomy and dignity.

In this chapter, we recommend reforms to reduce and eliminate the use of restrictive practices. 

Chapter 6 – Involuntary sterilisation

Chapter 6 addresses involuntary sterilisation.

Involuntary sterilisation is sometimes known as ‘forced’ sterilisation. It is a surgical procedure that can’t be reversed. It permanently prevents pregnancy.

This chapter looks at the circumstances in which involuntary sterilisation is legal in Australia, and what we have heard about this issue.

We recommend changing legislation to ban involuntary sterilisation in most circumstances.

More information

For more information about our Final report, and to access all volumes, visit our website. Go to the ‘Publications’ section and click on ‘Final report’.

www.disability.royalcommission.gov.au

Volume 6 – Enabling autonomy and access

Recommendations

Background

The Disability Royal Commission’s Final report tells the Australian Government what changes need to be made to prevent violence against, and abuse, neglect and exploitation of, people with disability.

We recommend change so people with disability can enjoy all human rights and freedoms fully and equally.

Our Final report has 12 volumes.

This video summarises recommendations in Volume 6 – Enabling autonomy and access.

Autonomy is a person’s right and freedom to make decisions, control their life and exercise choice. Autonomy and access are essential to a more inclusive society.

Volume 6 looks at what governments, organisations and the community can do to make sure people with disability have access and autonomy.

There are 41 recommendations in this volume covering:

• accessible information and communications

• supported decision-making

• advocacy

• healthcare and treatment, specifically for people with cognitive disability

• restrictive practices

• involuntary sterilisation.

Accessible information and communication

We heard information is often inaccessible for people with disability and the impact this has – particularly in emergency situations, for example, during bushfires and the pandemic.

We recommend that the Australian Government and state and territory governments develop a national plan to promote accessible information and communication.

It should be co-designed by people with disability and finalised by the end of 2024.

We also heard about the shortage of Auslan interpreters, and how this can prevent Deaf people from accessing critical services.

We recommend that Australian Government and state and territory governments develop a workforce strategy to increase the number and quality of Auslan interpreters.

The strategy should be developed by September 2024.

Supported decision-making

People with disability often have decisions made for them. We heard how this can have negative consequences.

One way this happens is through the guardianship and administration system, where others make decisions for people with disability. This is also known as substituted decision-making.

We recommend moving away from substituted decision-making towards supported decision-making. Supported decision-making recognises that people with disability are able to make decisions and may sometimes need support to do so.

We make 17 recommendations in relation to supported decision-making. Recommendations involve changing laws, policies and practices to increase awareness and use of supported decision-making.

We recommend changes to state and territory laws to ensure guardianship and administration orders:

• are made only as a last resort and in a way that is least restrictive of a person’s rights and autonomy

• are consistent with supported decision-making principles, for example, decisions are directed by a person’s will and preference.

Advocacy

Advocacy is essential for many people with disability to understand and exercise their rights.

We recommend the Australian Government commits additional funding of:

• $16.6 million per year for the National Disability Advocacy Program

• $20.3 million per year for the National Disability Insurance Scheme Appeals Program. 

Healthcare and treatment, specifically for people with cognitive disability

Access to safe and high quality health is critical for people with disability to live the kind of life they choose.

Evidence shows people with cognitive disability are subject to systemic neglect in the Australian health system.

We recommend significant changes, including that service systems are ‘person-centred’ and health professionals treat people with disability better.

We recommend that accreditation authorities for health professional organisations:

• review and amend accreditation standards to address whether cognitive disability health is properly covered

• encourage education providers, such as universities, to develop specific cognitive health disability health content in their courses.

We also recommend:

• the Australian Government Department of Health and Aged Care improve access to clinical placements for students in disability services

• peak health professional organisations develop training content in cognitive disability health for different specialist areas, such as psychiatry or emergency medicine

• the Australian Government and state and territory governments identify and publish a list of adaptions and supports that enable people with disability to receive high quality health care, for example, dimmer lighting to reduce sensory loads.

Restrictive practices

Many people with disability are subjected to restrictive practices. These practices can cause lasting physical pain and mental harm.

We recommend changes to reduce and eliminate the use of restrictive practices.

In particular, we recommend state and territory governments ensure legal frameworks are in place in health, education and justice settings.

These frameworks should require that restrictive practices should only be used:

• as a last resort

• in response to a serious risk of harm to a person with disability or others

• after other strategies, including supported decision-making, have been explored and applied.

Involuntary sterilisation

Involuntary sterilisation is a surgical procedure that permanently prevents pregnancy.

We recommend all jurisdictions have laws that prohibit procedures resulting in permanent sterilisation of people with disability, except in specific circumstances.

We recommend that states and territories immediately stop several practices. This includes using restrictive practices as a form of discipline, punishment or threat.

More information

For more information about our Final report, and to access all volumes, visit our website. Go to the ‘Publications’ section and click on ‘Final report’.

www.disability.royalcommission.gov.au