A Sociological Perspective on Acquired Brain Injury in Modern Ireland

1
A Sociological Perspective on Acquired Brain
Injury in Modern Ireland

• Anne OLoughlin
• Principal Social Worker
• National Rehabilitation Hospital, Dublin

2
Acquired Disability

• The impact of a sudden physical trauma on an
  individuals life creates overwhelming physical,
  psychological, social, vocational and economic
  effects.
• Hanoch Livneh, 1997

3
The sociological perspective

• Sociology considers how many seemingly personal
  troubles which affect individuals and their
  immediate relations with others are more
  appropriately understood as public issues which
  link to the institutions of society as a whole.
• C. Wright Mills, 1970

4
Disability and Social Change

• Medical advances lead to a rise in the number
  of people with disabilities and increased life
  expectancy (Harris et al,1971)
• As a society becomes more technologically and
  socially complex, so the number of people with
  impairments increases as does the degree of
  severity of impairments (Albrecht, 1992)

5
Changes in Western Society

• New Family Structures/definitions
• The political mobilisation of people with
  disabilities
• Increasing emphasis on the political and social
  dimensions of disability
• Increase in migration/travel
• The commodity of communication
• Understanding of health as a resource affecting
  physical mental and social well-being

6
Family Structures

• Over the last century, there have been
  important changes in family life and
  organisation, There are more lone-parent
  households, fewer children per household, and
  many more older people
• Barnes, Mercer and Shakespeare, 1999

7
The Celtic Tiger

• Employment rose from 55.1 in 1996 to 67.1 in
  2005 employment rates for women increased by
  almost 15 percentage points
• Increased Housing Costs/numbers renting
• Increase in Alcohol/drug use
• Greater expectations of Health Services

8
The Irish Family

• The number of lone parent families with children
  aged under 20 years increased by almost 80
  between 1996 and 2005
• 3 out of 5 of births registered in the first
  quarter of 06 were to mothers aged 30 or over
  25.1 were to mothers over 35years
• Increase in rates of marital breakdown average
  annual increase of 8.1 in the years 1991 - 1996

9
The Changing nature of how we view disability

• Shift in emphasis away from the physical
  limitations of the individual and onto the ways
  in which the physical and social environment
  imposes limitations
• Move from the Medical Model to viewing
• disability as socially created

10
The Disabling Environment - Blaxter

• Lack of technical Aids and Adaptations
• Poor housing, transport, accessibility
• Reliance of social services on informal voluntary
  support of (generally) female relatives
• Clear link between poverty and disability

11
The Commission on the status of People with
Disabilities, 1996

• Whether their status is looked at in terms of
  economics, information, education, mobility or
  housing (people with disabilities) are treated as
  second class citizens

12
Immigration

• Our population has grown by 14 to 4.1m from
  1996-2006
• Approximately 2/3s of the increase in population
  between April 05 and 06 was accounted for by
  migration
• Net migration into Ireland was 8,000 in 1996 and
  53, 400 in 2005
• 26,200 moved to Ireland from
  the10 new EU countries in 2005

13
Housing as an example..

• Massive increase in housing costs
• Young people remaining in the rental sector or in
  family home for longer
• Lack of suitable housing for people with
  disabilities in both the public and private
  sector
• Disabled Persons Grant inequities exist and it
  remains a very lengthy process

14
Cultural Aspects

• Young workers from other countries generally have
  no/few family supports, temporary housing and
  English as a second language
• High risk grouping for Acquired Brain Injury
• Culture effects how we understand illness and
  disability and the ways in which grief and coping
  skills are manifested

15
The Concept of Double Jeopardy

• Disability and
• Member of a racial/ethnic minority
• Another disability
• Gender
• Ageing
• e.g. ABI and Drug addiction
• ABI and a mental illness

16
The Commodity of Communication

• Speed of modern communication
• Knowledge seen as increasingly specialised
• Difficulties in using emotional cues /
  understanding personal interaction can greatly
  effect social life, status and identity
• Attitudes to cognitive impairments

17
Acquired Brain Injury in Modern Ireland

• Increasing level and severity of disability
• 13,000 per year, 10,000 of whom are admitted
  to hospital with significant injuries
• High reliance on family carers although there are
  fewer women at home and parents are having their
  children later
• Heavy reliance on voluntary agencies
• Poor transport and housing facilities for people
  with physical disabilities

18
The Picture in Ireland

• Lack of national, co-ordinated approach to ABI
  services including rehabilitation
• Fragmented and insufficient Community
  Services
• The Entitlements Maze
• Poor data basing for Acquired Brain Injury
• Poor public awareness of the scale and
  consequences of Acquired Brain Injury
• ABI now a Chronic Care issue

19
New trends

• Service user as consumer, not passive recipients
  of care
• Rights based legislation e.g. Disability Act
• Client Centered Policies seen as good practice
• Inclusion of people with disabilities as a right
  from charity to choice
• Accountability / Value for Money
• Advocacy

20
Case example

• Single mother living with elderly parents
• Acquired Brain Injury as a result of anoxic brain
  injury
• Requires constant supervision as she is
  vulnerable sexually
• Concerns re parenting of her 5yo son
• Wants to move out of parental home
• Unable to work

21
Case example

• 19 year old male in Minimally Conscious State
• Traumatic Brain Injury as a result of assault
• Family moved to Ireland 6 months ago
• Parents separated but both are involved
• Family live in rented accommodation
• Both parents and an older sibling work

22
The Benefits of Rehabilitation

• The under funding of Rehabilitation has led to
  more frequent stays in Hospital, more likelihood
  of entry into residential care and more expensive
  and complex packages of care for those who do go
  home
• Sally Davis, 2006

23
The Health Strategy

• The principal which underpins policy is to
  enable each individual with a disability to
  achieve his or her full potential and maximum
  independence, including living within the
  community as independently as possible.
• Quality and Fairness A Health Strategy for
• all Department of Health and Children, 2001

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The Challenges ahead

• Resources
• Attitudes/Education
• Infrastructure
• Social Policy/legislation an integrated
  approach, bringing together health, housing,
  social welfare, education and employment
• The issue of capacity and ABI
• Decisions as a society