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A Sociological Perspective on Acquired Brain Injury in Modern Ireland

Anne O’Loughlin

Principal Social Worker

National Rehabilitation Hospital, Dublin

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Acquired Disability

The impact of a sudden physical trauma on an individual’s life creates overwhelming physical, psychological, social, vocational and economic effects.

Hanoch Livneh, 1997

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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

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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)

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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

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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

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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

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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

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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”:

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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

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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”

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Immigration

Our population has grown by 14% to 4.1m from 1996-2006

Approximately 2/3’s 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

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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 Person’s Grant – inequities exist and it remains a very lengthy process

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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

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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

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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”

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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

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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

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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

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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

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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

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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

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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 forall – 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