After the Disability Royal Commission report, all Australian governments must now be held to account

Melissa Sweet
Alison Barrett
Friday, September 29, 2023

COVID-19, Justice and policing, Indigenous health, Cultural safety, Disabilities, Mental health, Health reform, Royal Commissions, Safety and quality of healthcare and aged care, Health inequalities, Human rights, Violence, Health and medical education

Alison Barrett writes:

The Australian Government has been urged to establish a Disability Rights Act to recognise, protect and advance the human rights of people with disability in the final report of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability published today.

Additionally, the report calls for a raise to the minimum age of criminal responsibility, cessation of certain restrictive practices in health and mental health settings, equitable access to healthcare for people with disability, as well as culturally safe support for First Nations people with disability.

Of note, the report includes some important information and recommendations relevant to the national COVID Inquiry.

Over 200 recommendations have been made in the Final Report as a result of the four-and-a-half-year Royal Commission that heard experiences and recommendations from more than 9,000 people with disability, their family, friends, supporters and advocates.

Significant change is required to ensure Australia is a more inclusive society and supportive of the independence of people with disability as well as their human right to live free from violence, abuse, neglect and exploitation, according to the report.

The Royal Commission said that “all Australian governments are now responsible for leading our recommendations for change”.

Below is an overview of some of the 222 recommendations in the report, with a focus on healthcare, justice, First Nations and COVID. Croakey will cover the DRC final report in more detail in the coming weeks.

The final report and other associated documents are available on the DRC website here.

Cease restrictive practices in healthcare

The final report of the DRC recommends that state and territory governments should take immediate action to ensure that the following restrictive practices must not be used in health and mental health settings:

using seclusion and restraint as a means to reduce behaviours not associated with immediate risk of harm
using seclusion and restraint as a form of discipline, punishment or threat
restrictive practices that involve or include deliberate infliction of pain to secure compliance
using prone or supine holds, using any restraint intended to restrict or affect respiratory or digestive function, or forcing a person’s head down to their chest
secluding a person who is also mechanically restrained
secluding a person who is actively self-harming or suicidal
using metal handcuffs or hard manacles as a form of mechanical restraint (unless under police or other custodial supervision while in the health facility)
vest restraints for older people
neck holds
drugs, or higher doses of drugs, that create continuous sedation to manage behaviour
seclusion of children and young people.

Equitable access to healthcare

People with disability who are victims of any form of exploitation, violence or abuse have the right to access protection services that promote their health, welfare, dignity and autonomy, according to the DRC report.

The report also recommends that the Disability Rights Act recognises the right of people with disability to equitable access to health services, which includes the right to exercise choice about healthcare options, and the right to the same range, quality and standard of free and affordable healthcare and programs as people without disability.

People with disability should also have the right to voice opinions and to make complaints about health services.

The report recommends that the right to equitable access of healthcare services should also be embedded in policy instruments including the Australian Charter of Healthcare Rights and National Safety and Quality Health Service Standards.

The Department of Health and Aged Care should expand the scope of work on an intellectual disability health capability framework and resources to apply at all stages of education and training. Related to this, the report recommends the DOH allocate extra funding to support the expanded scope of health workforce capability.

Accreditation standards and curriculum for registered health professions and peak professional bodes for non-registered health professionals should be reviewed regularly, as well as providing annual reports on implementation progress to the DOH.

Clinical placements in disability health services and post graduate training in cognitive disability healthcare should become more easily accessible.

The report recommends the Royal Australasian College of Physicians, Royal Australian and New Zealand College of Psychiatrists, Australian and New Zealand College of Anaesthetists, Royal Australian College of General Practitioners, Australasian College for Emergency Medicine and Australian College of Rural and Remote Medicine should develop specialised training content in cognitive disability health, as well as expanding and promoting pathways for sub-specialty training in cognitive disability health.

Consistent data collection is another important recommendation for health services. More specifically, the DRC report recommends federal, state and territory governments develop a national approach to data collection, led by the Australian Institute of Health and Welfare, with consistent use of definitions.

Culturally safe support

First Nations people with disability should receive healthcare that is culturally safe and recognises the importance of their connection to community and Country.

“The rights of First Nations people with disability are tied to physical, cultural and spiritual health and wellbeing,” the Commission said in an additional brochure that was published to describe what was heard from First Nations people with disability and some of the changes needed to create a country where First Nations people with disability are included.

The Commission heard that the experiences of First Nations people with disability “cannot be separated from the ongoing impacts of colonisation, intergenerational trauma and racism”.

Some recommendations include to:

strengthen the voices of First Nations people with disability through a First Nations Disability Forum
revise the Disability Sector Strengthening Plan under the National Agreement on Closing the Gap
develop disability-inclusive cultural safety standards for disability service provision
boost the First Nations disability workforces in remote communities.

Raise the age

States and territories that haven’t done so already should introduce legislation to raise the minimal age of criminal responsibility to 14, according to the report.

State and territory governments should also ensure the rights of people with disability who are in custody – one recommendation is for all corrective services and youth justice agencies to provide people with disability with the supports they require.

Additionally, the report recommends that timely screening and expert assessment are available for individual children with cognitive disability in the criminal justice system and to ensure they receive therapeutic and other interventions.

The report recommends that legislation should be introduced to prohibit solitary confinement in youth justice settings.

The report makes specific recommendations for the Department of Justice in Western Australia to review its youth justice staffing and recruitment model to “ensure sufficient, suitably trained staff are available to supervise children and young people to minimise lockdowns and prevent the solitary confinement of detainees”.

They also recommend that WA’s Department of Justice immediately ceases confinement practices at youth detention centres “amounting to solitary confinement of children with disability”, as well as raising awareness at every level of youth detention centre staff about the support needs of people with cognitive disability.

The New South Wales Government is urged to review its existing policy about the use of seclusion for adults with cognitive disability in the Justice Health and Forensic Mental Health Network.

Children with disability in youth detention facilities should have appropriate access to mental health services and the community equivalent standard of healthcare, especially if in isolation.

States and territories should ensure appropriate legal frameworks are in place in health, disability, education, and justice settings that people with disability should not be subjected to restrictive practices, “except in accordance with procedures for authorisation, review and oversight established by law,” the report recommends.

Governments should also establish targets and performance indicators to drive the reduction and elimination of restrictive practices over time. The report says these targets should be at national, state and territory levels for disability, health, education, and justice settings.

Police responses to people with disability also need to improve. Recommendations include collaboration between governments, police services and people with disability to co-design, implement and evaluate strategies to improve police responses. It is also recommended that police services introduce sufficient dedicated disability liaison officers.

COVID

During 2020 and 2021 as the pandemic escalated, the Royal Commission acted as a key communication channel between governments and people with disability to ensure swift and effective action was taken to protect people with disability.

A DRC hearing in August 2020 heard about the experiences of people with disability during the ongoing pandemic that resulted in a recommendation for the DOH to “ensure that an appropriately resourced unit or team has specific responsibility for developing plans and programs to protect the health and wellbeing of people with disability, including during emergencies such as the COVID-19 pandemic”.

Important to note for the national COVID Inquiry is evidence provided in public hearing five that people with disability experienced increased levels of economic hardship, domestic violence, and mental illness in the first few months of the pandemic.

The final report recommends that the DOH and state and territory counterparts review all policies to ensure people with disability are allowed to be accompanied by a support person in any health setting. This should apply at all times, including with in-person healthcare restrictions may be in place, as they have been during the pandemic.

In addition, the report recommends all levels of government to review national agreements, strategies and plans that affect people with disability, including for emergency management such as pandemics and natural disasters.