Shannon McDermott

‘They don’t treat you like a virus’: youth-friendly lessons from the Australian National Youth Mental Health Foundation

Young people experience high rates of mental health problems, but very few access professional mental health support. To address the barriers young people face in accessing mental health services, there is growing recognition of the importance of ensuring services are youth-friendly. Indeed, almost a decade ago, the World Health Organisation developed a youth-friendly framework for services to apply. Yet, this framework has rarely been evaluated against health initiatives for young people. This article begins to address this gap. Using 168 semi-structured, qualitative interviews with young service users, this paper explores the extent to which the Australian National Youth Mental Health Foundation, also called headspace, applied the WHOs youth-friendly framework which emphasises accessibility, acceptability and appropriateness (AAA). It argues that headspace was largely successful in implementing an AAA youth-friendly service and provides evidence of the importance of tailoring services to ensure they are accessible, acceptable and appropriate for young people. However, it also raises questions about what youth-friendly service provision means for different young people at different times. The findings suggest that youth friendliness should be applied across different stages of interaction (at initial engagement and in the ongoing relationship between patient and clinician) and at different levels (the environment the care is provided in, within policies and procedures and within and between relationships from receptionists to clinicians).

The Devil is in the Details: Self-Neglect in Australia

ABSTRACT Although elder self-neglect is of significant concern to adult protective service (APS) workers in the United States, minimal research has been conducted on this topic in Australia. Using qualitative research methods, this article examines how 24 Australian professionals understand situations of self-neglect. Unlike in the United States, where the term self-neglect is used in a broad and all-encompassing manner, participants in this research differentiated among self-neglect (the neglect of self), squalor (extreme neglect of environment), collecting (the accumulation of certain objects), and hoarding (the inability to throw objects away). It is argued that separating out the various behaviors that are classified under the broad umbrella of neglect can be useful in fostering reflective interventions in these situations.

Professional judgements of risk and capacity in situations of self-neglect among older people

ABSTRACT Over the past 50 years, self-neglect among older people has been conceptualised in both social policy and the academy as a social problem which is defined in relation to medical illness and requires professional intervention. Few authors, however, have analysed the concept of self-neglect in relation to critical sociological theory. This is problematic because professional judgements, which provide the impetus for intervention, are inherently influenced by the social and cultural context. The purpose of this article is to use critical theory as a framework for interpreting the findings from a qualitative study which explored judgements in relation to older people in situations of self-neglect made by professionals. Two types of data were collected. There were 125 hours of observations at meetings and home assessments conducted by professionals associated with the Community Options Programme in Sydney, Australia, and 18 professionals who worked with self-neglecting older people in the community gave in-depth qualitative interviews. The findings show that professional judgements of self-neglect focus on risk and capacity, and that these perceptions influence when and how interventions occur. The assumptions upon which professional judgements are based are then further analysed in relation to critical theory.

Older People Living in Squalor: Ethical and Practical Dilemmas

Abstract Studies highlighting diversity in ageing tend to focus on how retirement, illness, and the ageing process are experienced differently according to gender, age, sexual preference, location, or ethnicity. Although some research explores the multiplicity of the meanings of home, few studies have examined the diversity of living conditions that can be found in the homes of older people living in the community. Understanding the range of physical conditions that can exist within private residences is important given that, within the current policy context of ageing-in-place, the home is a site for the provision of services to older people. The present article focuses on older people in Sydney (NSW, Australia) who live in such extremely unclean conditions that they have been labelled as living in squalor. We first investigate the origin of the term “squalor” and the policy responses to these situations in the US and UK. We then focus on the Australian context and explore in detail the Squalor Program at the Eastern Suburbs Community Options Programs at The Benevolent Society in Sydney as an example of a program to address squalor. Finally, we examine two situations of squalor involving older people to highlight the complex issues that arise in these situations and to draw out implications for social work practice with older people.

Enabling self-determination for older workers with intellectual disabilities in supported employment in Australia.

BACKGROUND Promoting self-determination is recognized to be an essential element of disability service provision; however, the extent to which older people with intellectual disability working in supported employment are enabled to make intentional decisions about retirement is not well understood. METHODS This research explored the views of older people with disability and service providers to understand the elements that impact on peoples decision to retire. Seventy-six people participated in semi-structured interviews, including 33 older people with intellectual disability working in supported employment, 10 people who had retired and 30 service providers. RESULTS Service providers strongly supported the right of people to retire; however, people with disability almost never reported the ability to make self-determined choices about retirement. Barriers to self-determination included an association between retirement, poor health and meaningless activities, which was perpetuated through structural service gaps. CONCLUSION Although disability services and service providers emphasize the importance of promoting self-determination for people with disability, those working in supported employment are not currently enabled to make self-directed choices about retirement. To address this requires more flexible services, better information about retirement, exposure to real experiences and assistance to express preferences and participate in problem solving throughout the lifespan.

Ethical Decision Making in Situations of Self-neglect and Squalor among Older People

Current approaches to professional ethics emphasise the importance of upholding the ethical duties of autonomy, beneficence, non-maleficence, and justice in practice. All are prima facie duties, meaning that they must be respected on their own and, if the duties conflict, it is assumed that the dilemma can be resolved through rational decision making. There are, however, a number of limitations to this approach to professional ethics. This paper explores these limitations through an empirical study that examined the ethical dilemmas facing 24 professionals in their work with older people who were self-neglecting or living in squalor in Sydney, Australia. The research uncovered that two groups of professionals interpreted autonomy in different ways. Furthermore, when faced with difficult ethical dilemmas, participants agreed that the most satisfactory responses involved strategies that closely mirrored elements of alternative approaches to ethics, particularly the ethics of care and virtue ethics. The findings point to the relevance of a pluralistic approach to ethics in professional practice.