Disability  -  Abuse  -  Therapy
Disability and Abuse	Disability and Therapy*
People with disabilities are vulnerable to abuse, neglect, exploitation, and undue influence.  Because of this vulnerability, they may experience abuse at a higher rate than people without disabilities.  Estimates regarding the rate of abuse of people with disabilities depends on the type of abuse and the type of disability involved in the analysis.  Thomas F. Coleman, executive director of Spectrum Institute, has reviewed a wide range of prevalence studies that have been conducted over the past few decades.  Coleman is the primary author of "Abuse of People with Disabilities: Victims and Their Families Speak Out" (Spectrum Institute - 2013).  The report analyzed data from the 2012 National Survey on Abuse of People with Disabilities.   A book published in 2016 reviewing 31 research studies on abuse of children with disabilities, prompted Coleman to make the following observation: “This meta analysis makes one thing clear – the relationship between disability and abuse is very complex and quite nuanced. It calls into question the usefulness of broad generalizations about the rates of abuse of children who have disabilities. It suggests that awareness of subtle distinctions in the data will better serve those who develop responses to abuse of children with disabilities, and those who devise methods to reduce the risk of such abuse.” The Center for Research on Women with Disabilities has taken a similar position with respect to women:  "Caution is advised when citing the prevalence of violence against women with disabilities. . . Our position is that violence issues, such as prevalence, risk factors, and interventions, vary to such a high degree across disability types (sensory impairment, physical impairment, psychiatric impairment, cognitive impairment), that it is best to focus on one group at a time and speak of findings for that group only. It is very difficult to generalize statistics to the population of women with disabilities as a whole . . . . In our national study comparing women with physical disabilities to women without disabilities, rates of physical, sexual, and emotional abuse were equally high in both groups." Regardless of the comparative rates of abuse of people with and without disabilities, abuse is a serious problem that needs greater attention by government officials as well as legal, medical, and mental health professionals. Below are links to commentaries written by Thomas F. Coleman on the prevalence of abuse of people with diabilities. A Review of the Association Between Childhood Disability and Maltreatment: Comments on a New Meta-Analysis (Spectrum Institute - 2017) Disability and Abuse: Evidence-Based Data Should Drive the Narrative (Spectrum Institute - 2019) Clarifying Data on Disability and Crime Victimization (Spectrum Institute - 2020)	The constitution protects the right of adults to make their own medical decisions. (Cruzon v. Missouri (1990) 497 U.S. 261, 262; Thor v. Superior Court (1993) 5 Cal.4th 725, 731) People with disabilities have the right to full participation in society and to equal access to health care services. (ADA Section 12101; Wash. Rev. Codes Section 71A-10.030) When courts give the power to make health care decisions to guardians or conservators, these fiduciaries must be pro-active. They must become aware of the need for and arrange for appropriate mental health treatment for adults under their care. Many individuals with intellectual and developmental disabilities experience chronic trauma and may also have trauma-related medical conditions as a result of abuses they have experienced. They need trauma-informed therapy. Many also have a dual diagnosis due to mental health conditions arising from other causes. They need appropriate and effective mental health therapy. There are a wide range of mental health therapy options available for people with intellectual and developmental disabilities, including therapies to treat trauma, depression, anxiety, and PTSD. Individuals with intellectual and developmental disabilities have a right to prompt medical care and treatment. (Cal. Welf. & Instit. Code Section 4502(b)(4)) Failure to provide such care is neglect. Additional qualified professionals are needed to provide therapy for individuals with intellectual and developmental disabilities. Those already working in this field, such as the 450 therapists approved by regional centers in California, should improve their skills with in-service training. Trauma-informed therapy should be included in all training programs. Care providers who deprive necessary health care services to dependent adults in their custody or care are guilty of dependent adult abuse. (Wash. Rev. Codes Section 74.34.020(16)) Medical care includes mental health therapy. Deliberate indifference to medical and mental health needs is unconstitutional. (Doty v. County of Larsen (9th Cir. 1994) 37 F.3d 540, 546) People without disabilities have access to a full range of mental health therapies. It is disability discrimination for guardians, conservators, or other care providers to deprive individuals with disabilities access to a full range of mental health therapy options. (Federal Law: Americans with Disabilities Act; State Law: Cal. Gov. Code Section 11135; Wash. Rev. Codes Section 49.60.030) Trauma-Informed Justice: A Necessary Paradigm Shift for the Limited Conservatorship System (Spectrum Institute - 2018) Conservatees Are Legally Entitled to Better Therapy Options (Daily Journal - 2020)
Intellectual and Developmental Disabilities: A Bibliography on Trauma and Therapy Part One - Books / Part Two - Articles (Spectrum Institute - 2020)
* Endorsements.  The legal right to mental health therapy for people with developmental disabilities has been endorsed by the following organiztions: Arc of California, California Siblings Leadership Network, Autistic Self Advocacy Network, TASH, Washington Autism Alliance and Advocacy, Disability Rights Legal Center, Mental Health Advocacy Services,  Louisiana State Nurses Association, and the West Virginia Developmental Disabilities Council.
Legal Protections.  For references to legal protections against discrimination in health care services, click here.
Guardianships.  Guardians and conservators have a duty to ensure that the adults they care for are receiving proper health care.  For a description of their duties, state by state, click here.  For national health care standards of practice for guardians and conservators, click here.
Video: Interview with Thomas F. Coleman. To watch an interview of Thomas f. Coleman about the origin and evolution of his advocacy on issues involving disability, abuse, and guardianship, click here.
Elder Abuse.  Thomas Lee Wright, Family Guide to Preventing Elder Abuse (Skyhorse Publishing – 2017).  This book has two chapters written by Thomas F. Coleman. “If You Suspect Abuse: How to Report a Problem” is found at Chapter 6.  “Pursuing Justice,” which is found at Chapter 9, focuses on steps that can be taken to improve remedies for abuse against seniors and people with disabilities in conservatorships in California.