The Balance between Choice and Control: Risk Management in New Zealand Intellectual Disability Services

Abstract

Support for people with intellectual disability (ID) in New Zealand has been through great changes in the past 20 years, many of them positive and driven by a vision for real participation in the community for all New Zealanders. Movement from a service model of institutional care to a model that supports community participation, flexibility, and choice has been steady and in many cases has shown positive change in people’s lives. There is growing concern, however that the pace of progress has slowed, and that people with intellectual disabilities continue to experience barriers to living an 'ordinary' life in New Zealand. Approximately 17% of New Zealanders report that they have a disability, of which 5% (33,700) have an intellectual disability. The Ministry of Health is responsible for strategic planning and funding needs assessment and disability support for adults with disability, including approximately 6,500 people with intellectual disability who require 24 hour residential support. Studies completed in New Zealand, as well as international studies, suggest that people with intellectual disability experience greater vulnerability to poor health outcomes, higher behavioural support needs, and are at greater risk of abuse or neglect, compared to the general population. This report examines the approach to risk management in New Zealand, particularly in the context of services for people with intellectual disability. It reviews the development of the philosophy of service provision to provide necessary background, followed by an analysis of how risk management is perceived and applied by a number of stakeholders, including people with intellectual disability and their families. Both individual and systems level risk is explored.