People with Disability Australia Incorporated

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Case Studies

CASE STUDY ONE: LL

The LL case has been persistently highlighted by the public guardians in the NT Health Department’s Ministers and Executive. It demonstrates both the extent of need amongst the subject clientele and the unresponsiveness of the Department of Health to this need.

LL falls into the cohort of clients who are receiving no services, presumably in anticipation that she will sooner or later become eligible for Part IIA or recidivist imprisonment. It is equally likely that she will become a fatal victim of violence.

LL has a foetal alcohol related intellectual disability and has suffered a horrific life of sexual abuse and neglect from her infant years. Her case is well known to the Department of Health Disability Services staff, who despite their best endeavours, do not have the resources to achieve any meaningful outcome for her. With the tokenistic funding they are offered, they can only repeat a meaningless cycle of dead end referrals and assessments.

Attempts at seeking Executive level action have not been successful.

Advocacy was made to relevant ministers, hoping for some action. Although numerous meetings resulted in assurances that action would be forthcoming, nothing has changed for LL.

To some extent, some of the Department’s neglect of clients such as LL can be understood in terms of the intractable problems facing the NT government in responding to Aboriginal people with a cognitive impairment, complex needs and an offending history

The area of high needs disability, though small in terms of the numbers affected, has, through years of neglect, reached a point where it is of serious concern both domestically and internationally.

After two years of continuous advocacy, LL's shocking reality remains unchanged. This young woman, with the intellectual capacity of a young child continues to be homeless and vulnerable to abuse. Desperate, she often seeks out the only source of social inclusion on offer, the fringe of riverbed drinking camps, where she is routinely sexually abused by other people who are inebriated. Her only way of being temporarily accepted in the camps and avoiding rape, is to provide alcohol, for which she does not have the required ‘cash money.’
Recently, alone on a town hillside, without bedding or shelter, and sniffing petrol and smoking to ward off the early morning cold, she accidently set her legs alight. She staggered to a nearby roadway, collapsed and was almost run over by a car. After initial treatment, she absconded from hospital, lacking the capacity to understand her need for continued medical care. Given the risks of her situation, urgent action was required.

The guardian made a decision that since there was neither accommodation nor physical support for her in Alice Springs, the only possible option was to have LL placed ‘out bush’ with her young sister, where hopefully the community clinic staff would attend to her wounds.

The Executive of the Department of Health were resistant to this idea, as it did not fit the “support plan” for LL, but reluctantly agreed to the action taken.

CASE STUDY TWO: MM

This case example comes from the ‘Bath Report’ – a forensic examination of the events that lead to MM being incarcerated in the Alice Springs Correctional Centre on a Custodial Supervision Order for the manslaughter of his uncle. By the age of six it was clear that MM has global developmental delays and significant behavioural problems

Between May 1997 and August 2007, there were six Child Protection notifications for MM.  The first child protection notification concerned neglect and resulted in a family support referral.  In 1998 MM entered care in a voluntary Temporary Custody Agreement although it is unclear what precipitated this as it was not documented.  The placement lasted for six weeks and was apparently terminated due to the family expressing concerns for MM’s safety due to the fact that he kept absconding.  At this point concerns were identified about the family’s capacity to provide care for him and respond to his special needs and his behaviours of concern.

During this time MM’s behaviours continued to be challenging and he is reported as being hyperactive, easily distracted, impulsive, destructive and aggressive.  He had periods of head banging, running away and drinking his own urine, terrorising younger children and the elderly and being cruel to animals.  There are reports of him dismembering a puppy and biting the head off a snake.

In August 1999, there was a fourth notification as MM had killed a puppy and dismembered its legs. He was also sighted walking around a member of the community with an axe in his hand.  This resulted in a Family and Children’s Services Protective Assessment, which found that MM was a 'Child in Need'.  The notification resulted in a psychiatric assessment and placement in the Boylan ward at Adelaide’s Women and Children’s Hospital.  The assessment noted that MM had an intellectual disability, secondary hypoxia with uncontrolled seizures.  The psychiatrist recommended an increase in supervision on community as well as periods of respite off the community.  Behaviour intervention strategies were developed however it was acknowledged that these were difficult to implement on community, that MM was unsupervised during the bulk of the day and that no person had responsibility for supervising him.

At this time a second case conference was held and the Challenging Behaviours Team and Care Coordination was identified but these did not become fully operational.  At this time a community based project was initiated for a behaviour intervention project based on community began and this seemed to coincide with the cessation of involvement by family and Children’s Services.  An application to the Court to declare MM a ‘Child In Need’ failed to eventuate

In 2005, the Department of Health and Families divested itself of responsibility for the care and support of MM and funded MM’s community to provide support to him.  This is despite extensive experience around the fact that the community did not have the capacity nor the skills to manage such a complex individual.  The community then identified MM’s uncle as the person who had responsibility for caring for MM.  MM’s uncle was a good man who also had an alcohol addiction. 

Following the transfer of funding and responsibility for MM to his community there seemed to have been little involvement by Aged and Disability in monitoring the situation on community.  Between 2005 and 2007, MM seems to have experienced a significant period of instability where he did not access any education or disability programs.
In early January 2007, MM was again found dismembering animals on community.  There was no critical incident response and no escalation of the issue to disability management.  In late January, MM stabbed his aunt on community fracturing her arm.  Again there was no critical incident response and no escalation of the issue to disability management.  This situation involved ‘payback’ from the community to MM and his uncle and they were both beaten up as a result.

A psychiatrist’s report at this time stated that MM’s uncle was unable to provide care and support for MM and that MM’s uncle had asked that MM be taken off community. Disability Services advised that there was no alternative accommodation for MM.

In April 2007, MM destroyed all the property in his uncle’s house, throwing a metal tool at his uncle, which embedded itself in the fridge door.  Again there was no critical incident response and no escalation of issue to disability management.  Later in May 2007, MM assaulted a young girl on community with a pick-axe.  No critical incident response was initiated and no escalation of issue to disability management occurred.

In September 2007, MM was taken into custody and charged with the stabbing of his uncle, which resulted in his uncle’s death.  MM was then held in the Alice Springs juvenile detention centre from September 2007 until his transfer to the Alice Springs Correctional Centre in June 2009.

MM is currently the subject of a Custodial Supervision Order.  This Order resulted from his trial in 2009 where he was found unfit to plead and mentally impaired with diminished responsibility for the manslaughter of his uncle.  Judge Mildren then sentenced MM to be held in the Alice Springs Correctional Centre for the period of 9.5 years.  This sentence period did not include the two years that MM had already spent in the Alice Springs Juvenile Holding Centre waiting for his trial to commence.  In all MM will have been detained for a period of 11.5 years by the time the Custodial Supervision Order is completed.

Judge Mildren decided that MM needed to be supervised in the Alice Springs Correctional Centre, which is a maximum-security jail. Two significant issues determined his thinking.  The first issue is that no other secure accommodation and support option that provided treatment of significant benefit existed for MM at the time, and still does not exist.  The second is that a letter from the Acting Manager of Disability Services, Mr Arthur Firkin recommended Alice Springs Correctional Centre as the place to manage MM’s significant risk of serious harm to others.

In the first independent assessment of MM’s significant risk of serious harm to others, a report dated 19 February 2011 by Ms Cathy Leigh-Smith, found that whilst MM requires a high level of intervention and supervision to adequately manage risk:

  • The level of restrictive intervention (such as the use of mechanical restraints and high levels of supervision when accessing communal areas) and the restrictive living conditions MM resides under are not commensurate with the level of risk MM currently presents with
  • There is a lack of discussion and planning around a systematic and evidence based approach to reduce the level of restrictiveness over time
  • That less restrictive options have not been trialled with MM
  • That Mr Arthur Firkin’s (Acting Manager Disability Support Team, Aged and Disability) statement to the Supreme Court that MM would require rapid access to custodial officers and restraint as required to ensure community and client safety was not evidence based
  • That previous attempts at community based interventions have been compromised by the fact that they have not been comprehensive enough to adequately address the multiple and complex issues that contribute to MM’s offending behaviour
  • That being incarcerated over an extended period of time exposes MM to the risk of institutionalisation and will lack access to normal experiences and opportunities that enhance emotional well-being and facilitate skill development.

 

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PWD E-bulletin #62, June 2010