People making choices: the support needs and preferences of people with psychosocial disability: project summary

The aim of this project was to improve understanding of the choices that people with psychosocial disability would make about support for priority life goals if they were offered individualised funding packages. This was timely given the inclusion of psychosocial disability in the National Disability Insurance Scheme (NDIS), which has been designed to enable Australians with disability the opportunity to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports (Commonwealth of Australia, 2013b).

Consumer choices about mental health support services

 The implications of psychosocial disability being included in the National Disability Insurance Scheme (NDIS) are not yet fully understood. It is anticipated that approximately 57,000 people with continuous and enduring psychosocial disability across Australia will be eligible for support under Tier 3 of the NDIS. They will be able to make choices about the supports that are “reasonable and necessary” to meet their needs. While there is some work currently being undertaken to prepare staff in the sector for the change, until now there have been few projects focused on the implications of the NDIS from the perspective of people with psychosocial disability.
In response Mind Australia has funded an innovative research project that has sought to:
• provide the CMMHSS and other stakeholders with an understanding of support needs and preferences of people with psychosocial disability and the types of changes needed to develop more responsive services in the transition to NDIS.
• give people with psychosocial disability the opportunity to have a voice in stating their preferences for support.

Does disability status modify the association between psychosocial job quality and mental health? A longitudinal fixed-effects analysis

BACKGROUND: People with disabilities have difficulties in obtaining work. However, evidence suggests that those with disabilities derive substantial mental health benefits from employment. This paper assesses how the relationship between work and mental health is influenced by psychosocial job quality for people working with a disability. METHODS: The study design was a longitudinal cohort with 13 annual waves of data collection, yielding a sample of 122,883 observations from 21,848 people. Fixed-effects within-person regression was used to control for time invariant confounding. The Mental Component Summary (MCS) of the Short Form 36 (SF-36) measure was used as the primary outcome measure. The main exposure was a six-category measure of psychosocial job quality and employment status (including 'not in the labour force' [NILF] and unemployment). Disability status ('no waves of disability reported' and 'all contributed waves with reported disability') was assessed as an effect modifier. We also conducted a secondary analysis on respondents contributing both disability and non-disability waves. RESULTS: For those with no disability, the greatest difference in mental health (compared to optimal employment) occurs when people have the poorest quality jobs (-2.12, 95% CI -2.48, -1.75, p < 0.001). The relative difference in mental health was less in relation to NILF and unemployment (-0.39 and -0.66 respectively). For those with consistent disability, the difference in mental health when employed in an optimal job was similar between the poorest quality jobs (-2.25, 95% CI -3.84, -0.65, p = 0.006), NILF (-2.84, 95% CI -4.49, -1.20, p = 0.001) or unemployment (-2.56, 95% CI -4.32, -0.80, p = 0.004). These results were confirmed by the secondary analysis. CONCLUSIONS: Efforts to improve psychosocial job quality may have significant mental health benefits for people with disabilities. This will contribute to the economic viability of disability employment insurance schemes in Australia and other high-income countries.

The evolution of the Australian life insurance industry

The life insurance industry in Australia has traditionally been an important source of long term finance for both the public and private sector. However, very little historical analysis has been undertaken into an industry that constitutes a fundamental part of the economy's financial sector. The present climate of deregulation has initiated an irrevocable process of change within the industry. To comprehend the full implications of this change it is necessary to have an understanding of how the industry has evolved. This paper seeks to provide a background account of the growth of the life insurance industry in Australia highlighting the influences that have determined the structure of the industry.

Physical disability and sexual esteem

The current study investigated the impact of physical disability on sexual feelings, sexual experiences, and sexual esteem. Thirty-five respondents (18 males and 17 females), with physical disabilities between 19 to 60 years (SD = 10, mean = 38) participated in focus groups where they discussed how their physical disability impacted on their sexuality. They also responded to a series of questions that were designed to examine disability-specific issues in sexual esteem using a four-point Likert-type scale. The data demonstrated that the participants struggled with many social and sexual barriers that were associated with having a physical impairment. This appeared to lead to increased feelings of negativity in many participants, including a belief that they were less sexually desirable than an able-bodied person and that having a disability seriously limited their sexual expression. The implications of these findings for practitioners and suggestions for future research are discussed.

The impact of physical disability on body esteem

The current study investigated the impact of physical disability on body esteem. A total of 35 people (18 males and 17 females) with physical disabilities between 19 to 60 years (mean = 38 years, SD = 10), participated in focus groups where they discussed their feelings about how their disability affected their body esteem. They also responded to a series of questions that were designed to examine disability-specific issues in body esteem using a four point Likert-type scale. The data demonstrated that the body esteem of the participants was commonly affected by physical disability. It also suggested that feedback from the social environment is a likely mediator of body esteem. Suggestions for future research and implications for clinicians are discussed.

Substance abuse by offenders with mild intellectual disability

This study compared the rate of self-reported alcohol and other drug use in a sample of 30 young adults with mild intellectual disability whose offending behaviour had resulted in involvement in the criminal justice system, with a matched comparison group of 30 non-offenders. Performance on an alcohol and other drug knowledge test was also compared. The results indicated that many individuals with mild intellectual disability regularly consumed alcohol and used illicit drugs. Furthermore, the data suggest a possible link between substance abuse and offending behaviour in this population. Individuals who had offended reported greater use of both legal and illicit drugs than their non-offending counterparts and many reported that they had been under the influence of alcohol or illicit drugs at the time of committing the offence that had resulted in their current placement within the criminal justice system. Although deficits in knowledge were apparent in both groups, the offenders demonstrated greater overall knowledge about alcohol and other drugs.

Population based intervention to change back pain beliefs and disability : three part evaluation

Objective To evaluate the effectiveness of a population based, state-wide public health intervention designed to alter beliefs about back pain, influence medical management, and reduce disability and costs of compensation. Design Quasi-experimental, non-randomised, non-equivalent, before and after telephone surveys of the general population and postal surveys of general practitioners with an adjacent state as control group and descriptive analysis of claims database. Setting Two states in Australia Participants 4730 members of general population before and two and two and a half years after campaign started, in a ratio of2:1:1; 2556 general practitioners before and two years after campaign onset. Main outcome measures Back beliefs questionnaire, knowledge and attitude statements about back pain, incidence of workers' financial compensation claims for back problems, rate of days compensated, and medical payments for claims related to back pain and other claims. Results In the intervention state beliefs about back pain became more positive between successive surveys (mean improvement in questionnaire score 1.9 (95% confidence interval 1.3 to 2.5), P<0.001 and 3.2 (2.6 to 3.9), P < 0.001, between baseline and the second and third survey, respectively). Beliefs about back pain also improved among doctors. There was a clear decline in number of claims for back pain, rates of days compensated, and medical payments for claims for back pain over the duration of the campaign. Conclusions A population based strategy of provision of positive messages about back pain improves population and general practitioner beliefs about back pain and seems to influence medical management and reduce disability and workers' compensation costs related to back pain.

The subjective well-being of people caring for a family member with a severe disability at home: a review

This review concerns the life quality of people caring for a relative with a severe disability within their family. It involves the balance between the advantages such care brings to the care recipient and the costs borne by the family. A brief history indicates that the forces that encourage family care are minimally concerned with family welfare. Moreover, an analysis of both qualitative and quantitative data indicates that primary caregivers are at considerable risk of high stress, clinical depression, and abnormally low subjective quality of life. It is concluded that increased public expenditure directed to the care of people with severe disability is urgently required.

Factors that influence employer decisions in hiring and retaining an employee with a disability

This paper is based on results of a national study in Australia. Questionnaires were completed by 643 employers, each of whom had employed a person with a disability between 1996--1998. Employers rated the importance of several factors relevant to decisions to hire and retain a person with a disability. Individual factors were rated most important, with grooming/hygiene and work-performance factors rated highest. Management factors and cost factors were rated moderately important. Social factors were rated least important. Analyses of variance were conducted, identifying several employer differences in ratings. The paper discusses employer values as well as the need to include employers in a partnership approach.

Employer benefits and costs of employing a person with a disability

This paper is based on results of a national study in Australia. Questionnaires were completed by 643 employers, each of whom had employed a person with a disability between 1996-1998. Employers rated the importance of several factors relevant to decisions to hire and retain a person with a disability. Individual factors were rated most important, with grooming/hygiene and work-performance factors rated highest. Management factors and cost factors were rated moderately important. Social factors were rated least important. Analyses of variance were conducted, identifying several employer differences in ratings. The paper discusses employer values as well as the need to include employers in a partnership approach.

Case studies in learning disability: implications for instruction

A significant number of children with learning disabilities may hold negative attributions about themselves which not only impact on their willingness to learn but put themselves at risk of developing depression. A multi-disciplinary assessment team found evidence for the existence of at least two distinct patterns of learning disability. It was concluded that interventions must focus not only on content areas but on the individual attributions the child holds about his or her ability and potential.

Development and validation of the physical disability sexual and body esteem scale

The Physical Disability Sexual and Body Esteem (PDSBE) scale was developed to assess respondents' capacity to feel positive about their sexuality and their body while living with a physical impairment. The current paper presents four studies that were conducted to develop and assess the psychometric properties of the 10 item PDSBE scale. The first study was an exploratory factor analysis involving 348 participants with physical disabilities. The factors were: Sexual Esteem, Attractiveness to Others, and Body Esteem. The second study was a confirmatory factor analysis, with a total of 338 participants. This analysis confirmed the factor structure established in study 1. The third study revealed good test-retest reliability on a total of 47 participants with physical disabilities. The final study was conducted with 748 participants with physical disabilities and showed that the PDSBE had high reliability and good convergent and divergent validity. Mean scores showed that women scored significantly higher than men on the total PDSBE scale and on the Sexual Esteem and Attractiveness to Others subscales. Future applications for the PDSBE scale are discussed.