Indigenous Australians and Impaired Decision‐Making Capacity

Abstract

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.

How well does the National Disability Insurance Scheme respond to the issues challenging Indigenous people with disability?

“…The historical impacts of colonisation on Indigenous individual, family and community continue to challenge the lives of many Indigenous people with disability and their trust in governmental systems (Ariotti, 1999;Clements, Clapton, & Chenoweth, 2010;Gething, 1994;Gilroy, 2009;Gilroy, Donelly et al, 2016;Hollinsworth, 2013;Kendall & Marshall, 2004;King et al, 2014). Services generally organised pursuant to the medical model provide support to people with disability from a health perspective and do not take into account the cultural and lifelong needs of Indigenous people with disability and their families (Ariotti, 1999;Farrelly & Lumby, 2008;Greenstein, Lowell, & Thomas, 2016a, 2016b.…”

“…Caring for a person with disability in Indigenous society is traditionally assigned to family members (Ariotti, 1999;Clements et al, 2010;Farrelly & Lumby, 2008;Gething, 1994;Gilroy, Donelly et al, 2016;Green et al, 2014;Kendall & Marshall, 2004;Lin et al, 2012;Nagel et al, 2008;Roy & Balaratnasingam, 2014;Sloane, 2003;Stephens et al, 2014). The care requirements can burden family members when the person with disability has complex and multiple requirements, or there are many persons in the family in concurrent need of such care, or other problems currently exist for the family (e.g., poverty and unemployment).…”

“…Indigenous people with disability face additional barriers when assessments and instruments do not satisfactorily take cultural diversity into account (Clements et al, 2010;Hersh, Armstrong, Panak, & Coombes, 2015;Roy & Balaratnasingam, 2014). The study findings of Bohanna, Catherall, and Dingwall underline the financial and political supports needed to develop "reliable, valid and culturally acceptable instruments", such as the Kimberley Indigenous Cognitive Assessment that has primarily succeeded in assessing dementia in Indigenous Australians (Bohanna et al, 2013, p. 587).…”

“…A literature search also reveals a significant lack of cultural competence and cultural diversity in the workforce in service settings Clements et al, 2010;Gething, 1994;Green, 2013;Green et al, 2014;Greenstein et al, 2016b;Hersh et al, 2015;Kendall & Marshall, 2004;Roy & Balaratnasingam, 2014). Several references make recommendations about cultural awareness training to staff, further investment in skills and qualifications of employed community members and more flexible working conditions being offered to health workers and carers (Dew et al, 2014;Gilroy, Dew et al, 2016;Gilroy, Donelly et al, 2016;Green et al, 2016;Hersh et al, 2015;Stephens et al, 2014;Wolstenholme, 1996).…”

“…Due to social and attitudinal barriers, communication issues often challenge the capacity of Indigenous people with disability when trying to express their needs (Clements et al, 2010;Green et al, 2014;Kendall & Marshall, 2004;Roy & Balaratnasingam, 2014;Sloane, 2003). In some remote areas where English is not the first language of Indigenous people, lack of accessible information regarding disability services is also reported (Farrelly & Lumby, 2008;Greenstein et al, 2016b;Stephens et al, 2014).…”