Submission on Victoria s next 10 year mental health strategy:

Transcription

1 Submission on Victoria s next 10 year mental health strategy: Elder abuse and mental health and wellbeing September 2015 Cybele Stockley Project Officer Seniors Rights Victoria Level 4 Block Arcade 98 Elizabeth Street Melbourne VIC 3000 Phone: (03) srvproject@seniorsrights.org.au

2 Contents Executive Summary... 3 Introduction... 5 About Seniors Rights Victoria... 6 Elder Abuse... 7 Effects of Elder Abuse on the Health of Older People Mental Ill Health of Elder Abuse Perpetrators Older People as Carers of their Mentally Ill Adult Children Poor Mental Health as an Elder Abuse Risk Factor Living Arrangements as an Elder Abuse Risk Factor Case studies Acknowledgements The author thanks Jenny Blakey, Pam Morton, Philippa Campbell and Melanie Perkins for their input in preparing this submission. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 2

3 Executive Summary Seniors Rights Victoria (SRV) welcomes the opportunity to make a submission on Victoria s next 10 year mental health strategy. SRV is the key statewide service addressing and responding to older people experiencing, or at risk of experiencing, abuse known as elder abuse. Elder abuse includes physical, sexual, emotional or psychological, financial or social abuse and neglect. In SRV s experience, the abuser is a family member in 92.3% of the cases and, in two thirds of these, it is the older person s adult son or daughter. Elder abuse is a real and devastating family violence issue and, in the words of the World Health Organisation (WHO), a serious social and public health problem. Elder abuse interacts with mental health and wellbeing in a number of ways. Primarily, abuse has devastating psychological effects on an older person, including depression and anxiety. These effects can in turn contribute to a decline in an older person s decision-making capacity. Elder abuse might also decrease an older person s life expectancy compared to their non-abused peers. Equally important is the mental ill health of elder abuse perpetrators 13.2% of SRV s clients identify their perpetrator as having mental health issues. Where an older person lives with the perpetrator of abuse including in their capacity as a carer the consequences can be particularly serious leading to situations where an older person fears for their personal safety or is forced from their own home. Pre-existing mental ill health might make an older person more vulnerable to elder abuse and this merits further research so that the risk can be better understood and moderated. An older person who is depressed, stressed and anxious (due to abuse or otherwise) and showing signs of cognitive decline can be assumed, because of their age, to have dementia and be medically misdiagnosed. This might then mean that an older person unfairly loses autonomy and control of their life and finances to an attorney, guardian or administrator. Finally, an older person s living arrangements are a significant elder abuse risk factor both when they live with the perpetrator and when they live alone. The following recommendations aim to address the ways in which elder abuse interacts with mental health and wellbeing and to ensure that Victoria s next 10 year mental health strategy responds effectively to the needs of victims and perpetrators of elder abuse alike. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 3

4 Summary of recommendations 1. The Victorian Government ensures the provision of tailored elder abuse counselling services and evaluates such counselling services for effectiveness. 2. The Victorian Government leads and collaborates with services such as SRV to establish elder abuse community support groups and evaluates their effectiveness. 3. The Victorian Government prioritises the development of service pathways via which family members can access mental health treatment for someone close to them, taking into account the complexities associated with elder abuse, prior to a crisis occurring. 4. Older adults who become or remain carers of their grown up children with mental health issues are given adequate support by mental health services such that abuse is prevented or early intervention occurs. 5. The Victorian Government researches the extent to which an older person s mental ill health is a risk factor for abuse. 6. The Victorian Government takes steps to improve public and professional understanding and diagnosis of treatable mental illness as opposed to dementia in an older person. 7. The availability of safe, supported and linked-in housing options is an important policy consideration for safeguarding the mental health and wellbeing of older generations. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 4

5 Introduction In Australia, it is estimated that between 2% and 6% of older people experience abuse, mistreatment and neglect at the hands of someone they know and trust, be that a family member, carer or friend. 1 This is known as elder abuse. Elder abuse interacts with mental health and wellbeing in a number of ways. This submission explores: The devastating effects of elder abuse on the mental health and wellbeing of an older person; Mental ill health of perpetrators as a causative factor of abusive behaviour; How older people who are carers of their mentally ill adult children struggle when they are not adequately supported by service systems; Whether an older person s pre-existing mental health condition might make them more vulnerable to elder abuse; and The living situation of an older person as a major risk factor of elder abuse and therefore an important policy consideration for government. This submission contains six recommendations for the development of the Victorian Government s next 10 year mental health strategy which aim to better meet the needs of both victims and perpetrators of elder abuse. The recommendations are based on the expert knowledge of SRV in the area of elder abuse and seven years of experience working with older people. SRV also endorses the separate submission of its parent organisation, Council on the Ageing (COTA) Victoria. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 5

6 About Seniors Rights Victoria Mission Statement Seniors Rights Victoria seeks to empower older Victorians so they can take steps to live in safety, with dignity and independence. Background SRV is the key statewide service addressing and responding to older people experiencing, or at risk of experiencing, abuse. We operate under the principles of empowerment of older people and recognition of their rights. SRV provides information, support, advice and education to help prevent elder abuse and safeguard the rights, dignity and independence of older people. Established in 2008, SRV is a program within COTA Victoria and governed by its board. Funding is provided by the Department of Health and Human Services, the Commonwealth Attorney-General s Department and Victoria Legal Aid. SRV works in partnership with Justice Connect and Eastern Community Legal Centre. SRV s services include a Helpline, specialist legal services, short-term support and advocacy for individuals and community education. SRV also provides leadership on policy, systemic advocacy and law reform and works with other organisations and groups to better identify, address and prevent elder abuse. SRV assists Victorians who: Are 60 years of age or older (45 years and over for Indigenous clients), or people approaching 60 years of age with age-related disabilities and illnesses; Are experiencing or are at risk of experiencing elder abuse, mistreatment and/or financial exploitation within a relationship of trust; 2 Have issues relating to ageing; and Have capacity to give legal instruction (capacity is presumed unless demonstrated otherwise). Seniors Rights Victoria Submission to the Royal Commission into Family Violence 6

7 Elder abuse Definition The WHO defines elder abuse as: A single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person. 3 The definition used in Victoria was adopted from the Australian Network for the Prevention of Elder Abuse (ANPEA): 4 Any act occurring within a relationship where there is an implication of trust, which results in harm to an older person. Abuse may be physical, sexual, financial, psychological, social and/or neglect. Abuse of older people can be subtle or extreme, intentional or unintentional, made up of one or many acts and change or escalate over time. The defining characteristic of elder abuse compared to other forms of interpersonal violence is its intergenerational nature; that is, the younger generation perpetrates abuse against the older generation. Sometimes elder abuse is the continuation of long-standing patterns of physical or emotional abuse within a family. It can also be the result of stressful situations including where an adult child is the carer of their parent or, inversely, where a parent is a carer of their adult child. Abuse can also be the result of personal characteristics of the perpetrator such as substance abuse, gambling addiction or mental illness. Forms of elder abuse Elder abuse takes many forms. Mistreatment Mistreatment involves the denial of a person s right to live safely and independently. Mistreatment can involve: Seniors Rights Victoria Submission to the Royal Commission into Family Violence 7

8 Denying a person privacy or intimacy; Withholding information; Denying a person access to other relatives and friends by stopping visitors or interfering in phone calls; Restricting a person s freedom by not letting them leave the house; Intercepting a person s mail. Neglect Neglect occurs when an older person is deprived of the basic necessities of life. There are two types of neglect, active neglect and passive neglect. Active neglect Active neglect is the deliberate withholding of basic care or necessities, it can include: Leaving an older person in an unsafe place or state; Stopping access to medical treatment; Abandonment; Not providing adequate clothing or sufficient food and liquids; Not treating illnesses; Over or under medicating. Passive Neglect Passive neglect is the failure to provide proper care due to carer stress, lack of knowledge or ability. It may occur unintentionally and may simply require getting additional support to assist the carer and older person. Financial Abuse Financial abuse is the illegal or improper use of a person s property, finances and other assets without their informed consent or where consent is obtained by fraud, manipulation or duress. It usually occurs between an older person and a family member but can also occur with carers or friends. Financial abuse may involve: A family member taking a loan with a promise of repayment but not paying the money back; Stealing money or using an older person s banking and credit card without consent; Coercing an older person into changing their will or other legal document; Sale of any property or assets without authority or consent; Forced transfers of property. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 8

9 Physical Abuse Physical abuse includes any form of assault such as hitting, slapping, shoving, pushing and burning. It also includes physical restraint such as tying a person to a chair or bed, or locking a person in a room. Sexual Abuse Sexual abuse is any sexual activity or behaviour for which the older person does not consent or is incapable of giving consent (e.g. a person living with dementia). Sexual assault and abuse includes a range of offences such as rape, indecent assault and sexual harassment. It can also include sexually exploitative or shaming acts such as: Leaving a person in a state of undress; Forced viewing of sexually explicit materials or images; Sexually suggestive comments; Exhibitionism; Inappropriate touching; Uninvited sexual approaches. Psychological & Emotional Abuse Psychological and emotional abuse is the infliction of mental or emotional anguish by threat, humiliation or other verbal or non-verbal conduct. Psychological and emotional abuse can include: Verbal assaults; Humiliation; Threats; Harassment; Intimidation; Other abusive behaviours which result in emotional or psychological distress. Psychological abuse may make the older person feel ashamed or powerless and often occurs in combination with other forms of abuse. Social Abuse Social abuse is preventing a person from having contact with relatives, friends, service providers and other people or restricting the person s activities, thereby increasing their sense of isolation. Social abuse can include: Seniors Rights Victoria Submission to the Royal Commission into Family Violence 9

10 Confining a person to their home or room; Preventing a person from answering the phone or door; Deprivation of access to transport; Intentional embarrassment in front of others; Stalking. Prevalence of elder abuse The WHO notes that there is little information regarding the extent of abuse in older populations, that it is underreported and that prevalence rates or estimates exist only in selected developed countries ranging from 1% to 10%. 5 In 2011, the WHO European Office published a report on elder maltreatment (defined as physical, sexual, mental and/or financial abuse and/or neglect of people aged 60 years and older ) showing that, in the previous year in the European Region, about 2.7% of older people had experienced maltreatment in the form of physical abuse, 0.7% had suffered sexual abuse, 19.4% had experienced mental abuse and 3.8% had been subjected to financial abuse. The prevalence of elder maltreatment was observed to increase among people with disability, cognitive impairment and dependence. The report also stated that perpetration is most often carried out by caregivers who are partners, offspring or other relatives. 6 In the Australian context, research indicates that elder abuse is experienced by approximately 2% to 6% of people aged 60 years and over. 7 There is no prevalence data for Victoria. However, in , SRV received 2236 telephone calls on its Helpline. Of these, 1206 related to issues of elder abuse. SRV subsequently provided advice (legal and advocacy) to 343 older people. 8 An analysis of SRV s Helpline data for a recent two year period showed that 92.3% of alleged perpetrators were related to the older person including by marriage or in a de facto relationship with two thirds of abuse being perpetrated by a son or daughter of the older person (40% and 26.8% respectively). 9 Elder abuse is therefore a family violence issue. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 10

11 Effects of elder abuse on health Effects of elder abuse on the health of older people In Active ageing: a policy framework, the WHO observes that: Elder abuse is a violation of human rights and a significant cause of injury, illness, lost productivity, isolation and despair. 10 Recognised by the WHO as a serious social and public health problem, it can be the cause of both physical and psychological injuries. According to the WHO: Elder abuse can lead to physical injuries ranging from minor scratches and bruises to broken bones and head injuries leading to lasting disabilities and serious, sometimes longlasting, psychological consequences, including depression and anxiety. For older people, the consequences of abuse can be especially serious because their bones are more brittle and convalescence is longer. Even relatively minor injuries can cause serious and permanent damage, or even death. 11 In its 2002 World report on violence and health, the WHO considered the consequences of elder abuse in domestic settings and said: a higher proportion of abused elderly people suffer from depression or psychological distress than do their non-abused peers. Other symptoms that have been proposed as being associated with cases of abuse include feelings of helplessness, alienation, guilt, shame, fear, anxiety, denial and post-traumatic stress. 12 A study cited in the same report concluded that elder mistreatment causes extreme interpersonal stress that may confer an additional risk of death. 13 The Global status report on violence prevention 2014 represents the progress countries have made in implementing the recommendations of the 2002 World report on violence and health. It reiterates that elder abuse can lead to serious physical injuries and long-term psychological consequences, including depression and anxiety. 14 Observing that depression is a significant health issue strongly associated with elder abuse, Cornell University researched the potential effectiveness of an adapted Problem-Solving Therapy (PST) and Seniors Rights Victoria Submission to the Royal Commission into Family Violence 11

12 anxiety management program for older women experiencing abuse. The program was found to be effective to reduce depressive symptoms and improve feelings of self-efficacy. 15 The Royal Australian College of General Practitioners (RACGP) recognises the detrimental effects of elder abuse on health as well as the pivotal role of health practitioners seeing elderly patients in recognising, assessing, understanding and managing elder abuse and neglect. In its clinical guidelines, the RACGP lists the following general signs and symptoms of elder abuse: 16 Being afraid of one or many person/s; Irritable or easily upset; Worried or anxious for no obvious reason; Depressed, apathetic or withdrawn; Change in sleep patterns and/or eating habits; Rigid posture and avoiding contact; Avoiding eye contact or eyes darting continuously; Contradictory statements not from mental confusion; Reluctance to talk openly. The signs and symptoms described by the RACGP show how abuse can negatively impact upon a person s mental state, mood and behaviour. In the experience of SRV s advocacy and legal staff, victims can feel overwhelmed, confused and that they are unable to cope with daily life in the same way that they normally would. As one of SRV s lawyers observes: Elder abuse has crippling implications for victims where the ramifications of disbelief and denial lead to profound changes in confidence and sociability. Older people (particularly women as mothers of adult children) struggle with a sense of failure and shame, and then withdraw from other family members and friends and gradually stop participating in their wider community. The family home closes down in many ways and becomes a place of retreat and not one of welcome. Others stop visiting to avoid conflict and strife. The older person becomes isolated, lonely and fearful. Taking steps to make changes appear insurmountable, and requires courage that overcomes an almost innate responsibility to protect one s child. 17 Seniors Rights Victoria Submission to the Royal Commission into Family Violence 12

13 Sometimes caught in a cycle of abuse that has gone on for months or years, constant distress, fear and worry can take over an older person s life and prevent them from carrying out normal activities and maintaining or forming healthy relationships with others. The serious and combined psychological effects of elder abuse can contribute to a decline in an older person s decision-making capacity. At the end of this submission is a case study ordinarily published on SRV s website about a woman in her late 80s called Vivienne whose middle-aged son, Steven, returns home to live with her and, due to substance abuse issues, acts abusively towards her. This abuse has negative consequences on her quality of life and mental wellbeing. The case study also shows how assistance from SRV helped to improve the situation and subsequently the client s psychological state. To assist those who are experiencing or have experienced elder abuse cope with the trauma they have gone through and move on with their lives, SRV submits that the Victorian Government s next 10 year mental health strategy should make tailored counselling services available and evaluate them for effectiveness. These services would have a specialist understanding of elder abuse and therefore be able to communicate with survivors in a meaningful way about their experiences and ongoing needs and hopes for the future. The dynamics of elder abuse in families is different to that of other forms of family violence such as intimate partner violence. For example, it is often the keen desire of an elder abuse survivor to preserve or reestablish a loving relationship with the perpetrator who is their adult son or daughter. This is quite different to domestic violence situations where indefinite separation of a couple is usually a preferable outcome. It is this kind of understanding of the dynamics of elder abuse that is required in order to provide appropriate support to elder abuse survivors. Recommendation The Victorian Government ensures the provision of tailored elder abuse counselling services and evaluates such counselling services for effectiveness. Contact with others who have had similar experiences might assist older people who are stuck in a pattern of abuse or to recover from their trauma. Support groups enable victims and survivors to share their stories, give and receive peer support, and also reduce social isolation. SRV is in the process of investigating how elder abuse support groups could be established and welcomes leadership from and collaboration with the Victorian Government in this regard. Support groups should be evaluated to determine their effectiveness and ongoing viability. Recommendation The Victorian Government leads and collaborates with services such as SRV to establish elder abuse community support groups and evaluates their effectiveness. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 13

14 Mental ill health of perpetrators Mental ill health of elder abuse perpetrators It is not uncommon for older people accessing SRV s service to identify the perpetrator of abuse (often the older person s adult son or daughter) as having mental health problems. According to an analysis of SRV s Helpline data for a recent two year period, many of those responsible for physical and psychological abuse were identified as having mental health issues. Such perpetrators accounted for 13.2% of all cases. Relevant statistics extracted from the report about SRV s Helpline data are as follows: 18 Risk factors of alleged perpetrator Alleged perpetrator with mental health issues % all types of abuse % of financia l abuse % of psycholog ical abuse % of physical abuse % of social abuse % of neglect % of sexual abuse The experience of SRV is not unique. Indeed, common perpetrator characteristics encountered in SRV s work including mental health issues follow national and international trends. The Elder Abuse National Annual Report , prepared by Advocare and incorporating compiled information from ten elder abuse support agencies across Australia, states that perpetrators often have substance abuse, drug addiction and mental health issues. 19 Internationally, the WHO observes: research on family violence has shown that abusers who are physically aggressive are more likely to have personality disorders and alcohol-related problems than the general population. Similarly, studies restricted to violence against older people in domestic settings have found that aggressors are more likely to have mental health and substance abuse problems than family members or caregivers who are not violent or otherwise abusive. 20 Research from Canada shows that commonly identified risk factors specific to the perpetrator of abuse include mental/psychiatric illness, substance abuse, a history of violence or aggression, and dependence on the older abused person for things such as housing or financial support. 21 Similar evidence comes from other countries such as Israel. 22 Enclosed with this submission is a case study ordinarily published on SRV s website to illustrate how an adult child with a mental illness (in this instance, schizophrenia) and who is not taking any medication neglects and socially isolates his father, George. A concerned family member, Penny, Seniors Rights Victoria Submission to the Royal Commission into Family Violence 14

15 contacts SRV and says that she is not even allowed to talk to George on the phone. SRV is able to offer some suggestions for services to check on George s welfare. SRV s advocates and lawyers are often asked by a client to assist in resolving an abusive situation by obtaining help and treatment for their adult child s substance abuse, gambling or mental health problems. Clients implore SRV staff to talk to the adult child and encourage them to change their ways or seek help for their problems. While SRV can seek to improve the older person s situation in many ways, it is not within the ambit of the service s functions to approach, encourage or force an adult child to seek help for themselves including treatment for mental illness. The fact that SRV cannot offer such assistance can be a source of frustration for clients. SRV therefore submits that the Victorian Government s next 10 year mental health strategy should prioritise the development of service pathways via which family members can access mental health treatment for someone close to them who does not acknowledge their illness or is resistant to treatment. The complexities associated with being an elder abuse victim must be taken into account when designing such pathways. This is because being in a situation of family violence in combination with personal attributes of the victim associated with ageing can make it particularly difficult for older people to know about services and to be able to contact them (in both a physical and psychological sense). It is particularly important that service pathways and interventions exist pre-crisis stage. Recommendation The Victorian Government prioritises the development of service pathways via which family members can access mental health treatment for someone close to them, taking into account the complexities associated with elder abuse, prior to a crisis occurring. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 15

16 Older people as carers Older people as carers of their mentally ill adult children According to an analysis of SRV s Helpline data for a recent two year period, an older person experiencing abuse lives with the perpetrator in 43.08% of cases. 23 Commonly, this is the older person s adult child who never left home or moved back home. In some cases, it is due to a systemic failure of services to assist adults with mental health issues to sustain an independent lifestyle. Older parents remain or become permanent carers of their adult child, often with little support. SRV observes that mental health service systems can be quick to assume that living with parents is a satisfactory outcome for an adult patient upon their discharge from hospital. However, in practice, the results can be disastrous. If parents are not properly supported in providing care then all parties can find themselves in a difficult, stressed and potentially abusive situation. When public mental health systems discharge adults to return to live in the family home, there needs to be better availability of advice and support for the patient s parents. Should abuse occur, parents should be able to access supportive interventions by mental health professionals and, if necessary, obtain assistance to accommodate their child elsewhere. Recommendation Older adults who become or remain carers of their grown up children with mental health issues are given adequate support by mental health services such that abuse is prevented or early intervention occurs. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 16

17 Older people with poor mental health Older person s poor mental health as an elder abuse risk factor In SRV s submission to the Victorian Government s Royal Commission into Family Violence, a number of potential barriers to access to justice and services by an older person experiencing abuse were identified, amongst which was diminished physical or mental health. Poor mental health may make an older person more vulnerable than they otherwise would be and hence expose them to abuse. An analysis of SRV s Helpline data for a recent two year period shows that 5.7% of clients were identified by legal and advocacy staff as having mental ill health. However, this was not amongst the main risk factors. The extent to which mental ill health may expose older people to a greater risk of elder abuse merits further research and study. Recommendation The Victorian Government researches the extent to which an older person s mental ill health is a risk factor for abuse. There is also scope to improve public and professional understanding and diagnosis of treatable mental illness as opposed to dementia in an older person. As already mentioned in this submission, depression, stress and anxiety may contribute to a decline in an older person s decision-making capacity. A decline in cognitive ability is at times attributed to dementia when the cause may in fact be a treatable mental illness. Regardless of the cause of the depression, stress and anxiety being experienced by an older person (whether due to elder abuse or some other reason such as the death of a loved one or serious physical illness) a misdiagnosis of dementia can have serious repercussions for an older person. Where a health professional makes a diagnosis of dementia and that the older person does not have decision-making capacity, the older person loses control of aspects of their life to an attorney, guardian or administrator. SRV has been involved in cases where abuse of powers of attorney held by family members has occurred following a misdiagnosis of dementia and lack of decision-making capacity in older adults. Recommendation The Victorian Government takes steps to improve public and professional understanding and diagnosis of treatable mental illness as opposed to dementia in an older person. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 17

18 Living arrangements Older person s living arrangements as an elder abuse risk factor SRV s data shows that the living situation of an older person is a major risk factor for abuse both when the older person lives with the abuser and when they live alone. As already discussed, intergenerational co-habitation can be problematic for an older person whose adult child has suspected mental health issues and is not receiving professional help for those issues, as well as in cases where parents are acting as carers of their adult children with mental ill health. Recommendations have been made for these specific circumstances. Living alone also appears to pose a high risk for an older person, accounting for 35.4% of SRV s clients. 24 Living alone might mean that an older person has less opportunity to talk about problems in their lives and seek support and/or make them more vulnerable to having someone intrude into their life and exert control over an aspect of it, for example, their finances. Having identified that living alone can be a potential risk factor for elder abuse, the government should take proactive and ongoing action to prevent social isolation of older people. Government strategies to tackle social isolation should respect the choice of older people to continue to live in their own home and alone while ensuring a level of community engagement and support that minimises risks to their safety so far as possible. Recognising that living with an abuser or living alone accounts for the living situation of approximately 80% of SRV s clients, it is SRV s submission that the Victorian Government should make the provision of safe, supported and linked-in housing options an important policy consideration for safeguarding the mental health and wellbeing of older generations. Recommendation The availability of safe, supported and linked-in housing options is an important policy consideration for safeguarding the mental health and wellbeing of older generations. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 18

19 CASE STUDIES Disclaimer: these case studies are based on Seniors Rights Victoria s actual work. All names and identifying details have been changed, however, and the photos are of models. CASE STUDY: Vivienne Facts Vivienne was in her late 80s and had been living with her middle-aged son Steven for a number of years. Vivienne received an aged pension but had no other income. She had a minor disability but was otherwise fairly independent and self-sufficient. Steven received a carer s pension but did not provide his mother with any real care or domestic support. Vivienne had originally asked her son to move in with her because she recognised he had a substance abuse problem, and thought he could recover with her help. In fact, Steven had continued to use drugs and this had led to him abusing Vivienne verbally and psychologically, sabotaging her disability aids, taking or misusing her possessions, and isolating her socially. He did not assist with housework, and did not contribute to the costs of the household. Vivienne s quality of life had suffered and she had become depressed and fearful. Action Seniors Rights Victoria met with Vivienne and assessed her situation. It was clear she wished to go on offering her son support in relation to his addiction, but felt she could no longer live with his abusive behaviour. Seniors Rights Victoria explained her legal options, including evicting her son, which she did not wish to do. As an alternative, Seniors Rights Victoria suggested the service could intervene by either a lawyer or an advocate writing to Steven on her behalf to request specific changes in his conduct, including that he seek treatment for his addiction. The letter would set a deadline for these changes, after which Steven would be facing eviction if he hadn t met the conditions in the letter. Seniors Rights Victoria also offered Vivienne ongoing advocacy support while her son made the changes in his life and behaviour that she had requested. Outcome Vivienne decided to proceed with a letter to Steven from a lawyer, understanding that she would receive advocacy support to manage the process. In the event this included the advocate meeting and phoning both Vivienne and Steven a number of times to help Vivienne negotiate the arrangement and improve her communication with Steven; and identifying supports and services Steven could access. Steven sought help for his addiction and modified his behaviour in other ways. Vivienne and Steven continue to live together, and both their relationship and Vivienne s psychological wellbeing have improved. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 19

20 CASE STUDY: George Facts Penny calls about her father George. She states her brother recently moved into her father s house. Her brother has schizophrenia and is not taking his medication. He is also in receipt of the carer s payment but is not looking after her father at all. Penny claims her father is scared of her brother and can t stand up for himself. She states her father has major health complications but does not have a cognitive impairment, and he has a Community Aged Care Package (CACP). Her brother won t let Penny or any service provider under the CACP into the house. Penny states her brother has been socially isolating her father for some time now. Her father s friends do not visit him anymore and her father never leaves the house. Every time Penny calls to speak to her father, her brother answers and hangs up. Penny is scared of her brother as he has a bad temper and can be violent at times. She is very concerned about her father. Penny wants advice. Action & outcome Seniors Rights Victoria informs Penny that this is quite a common complaint but that unfortunately Seniors Rights Victoria cannot go to the house to investigate: there is no mandatory reporting of elder abuse in the community in Australia. Seniors Rights Victoria clarifies whether Penny s father has any issues around his capacity as this will inform the advice provided. Penny confirms that her father is still very lucid. Seniors Rights Victoria recommends that Penny inform her father s CACP caseworker about what is happening and highlight her concerns about her father s health needs and safety. The CACP provider should take all reasonable steps to ensure that her father is safe and that his care needs are being met. Seniors Rights Victoria suggests that her father s caseworker contact the local police station and ask the police to do a welfare check, making reference to their You are not alone campaign. Seniors Rights Victoria also raises the possibility of her father s caseworker applying to VCAT for a direction from the Tribunal to have the Office of the Public Advocate enter the property with the caseworker and the police, so that the caseworker can carry out the service. Seniors Rights Victoria sends information out to Penny about its service and informs Penny that Seniors Rights Victoria is happy to meet with her father and to give him advice and possibly ongoing assistance for his situation. Seniors Rights Victoria also raises the issue of possible financial abuse which may need to be investigated down the track. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 20

21 Notes 1 National Ageing Research Institute in partnership with Seniors Rights Victoria, Profile of elder abuse in Victoria: Analysis of data about people seeking help from Seniors Rights Victoria Final report (July 2015) 6. 2 The existence of trust as the sole connection excludes relationships that are based on the exchange of money for services and, accordingly, SRV refers such calls to appropriate complaints agencies. 3 World Health Organisation, The Toronto Declaration on the Global Prevention of Elder Abuse (17 November 2002) 3. 4 Victorian Government Department of Health, Elder abuse prevention and response guidelines for action (2012) 1. 5 World Health Organisation, Elder Abuse: What is elder abuse? 6 World Health Organisation Regional Office for Europe, European report on preventing elder maltreatment (2011) viii. 7 Above n 1. 8 Seniors Rights Victoria, Annual Report Above n 1, World Health Organisation, Active ageing: a policy framework (2002) World Health Organisation, Elder abuse Fact sheet N 357 (December 2014) 12 World Health Organisation, World report on violence and health (2002) Ibid at World Health Organisation, United Nations Office on Drugs and Crime & United Nations Development Programme, Global status report on violence prevention 2014 (2014) J. Sirey et al., PROTECT: A pilot program to integrate mental health treatment into elder abuse services for older women, Journal of Elder Abuse and Neglect vol. 27, no. 3, 2015, pp. 4, Royal Australian College of General Practitioners, Abuse and violence: working with our patients in general practice (white book), Section 10.1: Elder abuse (4 th edition) practice/guidelines/whitebook/chapter-10-specific-vulnerable-populations-the-elderly-and-disabled/section- 101-elder-abuse/. 17 Pam Morton, Acting Principal Lawyer, Seniors Rights Victoria. 18 Above n 1, Advocare Incorporated, Elder Abuse National Annual Report , Above n 12, C. Walsh and Y. Yon, Developing an empirical profile for elder abuse research in Canada, Journal of Elder Abuse and Neglect vol. 24, no. 2, 2012, p A. Lowenstein et al., Is elder abuse and neglect a social phenomenon? Data from the first national prevalence survey in Israel, Journal of Elder Abuse and Neglect, vol. 21, no. 3, 2009, p Above n 1, Ibid. Seniors Rights Victoria Submission to the Royal Commission into Family Violence 21