Consumer enablement guide

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People with Specific Needs

All people should be supported to become the best they can be at managing their health. You can modify some of the strategies and approaches in this guide to support people with specific needs, such as cognitive impairments, intellectual disability or mental health problems.

What are specific needs?

Specific needs that can impact enablement include cognitive impairments, mental health conditions and disabilities, including physical, intellectual and sensory disabilities.

It is important to enable families, carers and guardians of people with specific needs. Families, carers and guardians of these people are often actively involved in decisions about healthcare, or may make decisions on behalf of the person. It is important to help them:

  • understand the person’s health condition and improve their own health literacy
  • be involved in shared decision making with healthcare professionals
  • have access to peer support or psychological support, to integrate their caring responsibilities with their own life.

Learn more about enablement in:

Strategies and approaches

The following strategies and approaches may be useful when working with people with specific needs.

  • Health coaching - a strength-based approach that recognises the person’s strengths and abilities to overcome problems and reach their goals.
  • Patient reported experience measures to help you understand what is important to the person and what will motivate them to manage their health.
  • Care coordination to make sure the person receives continuous care by the same health professionals over time, where possible.
  • Shared decision making to help the person choose the strategies that will help them achieve their goals.

The person’s capacity for making decisions and participating in shared decision making needs to be considered on an individual basis. If the person is temporarily injured or unwell, it may be better to wait until their health stabilises before building self-management skills.

Enablement for people with cognitive impairments

Cognitive impairment is when a person’s ability to think, communicate, understand and remember is reduced, either temporarily or permanently.

Cognitive impairment can be caused by different conditions, such as:

  • brain injuries
  • neurodegenerative conditions such as Parkinson’s disease, Huntington’s disease, Alzheimer’s disease and other dementias
  • stroke
  • mental illness
  • a history of alcohol dependence
  • reactions to infections, medications, or
  • vitamin deficiencies.

People with cognitive impairment have difficulties with attention, memory and problem-solving, which often impacts their ability to function on a daily basis. They often feel lost, unable to follow conversations and instructions, overwhelmed, and unable to engage with treatment and care of their health.

Enablement for people with cognitive impairment usually requires working closely with families, carers and guardians using different communication styles and techniques.

Consent and decision making for people with impaired ability

People should be encouraged to be involved in and make decisions about their own healthcare and treatments as much as possible. By helping people weigh up their options and communicate their choices, you can help them maintain control over their own health and wellbeing.

However, in some circumstances this is not possible and substitute decision making is appropriate. Substitute decision making is where someone other than the person (such as a family member, carer or guardian) makes health and medical decisions on their behalf.

Remember, even if a substitute decision maker has been appointed by the Guardian Tribunal or Supreme Court, it doesn’t mean the person cannot make any decisions at all. They may need a guardian to make complex decisions, but can make other decisions themselves with the right support.

Can they make a decision?

A person’s decision-making ability can be affected by a number of factors, including:

  • mental illness
  • dementia
  • brain damage
  • intellectual disability
  • drugs or alcohol
  • ill health
  • medication side-effects
  • shock or trauma
  • personal or social issues like stress or grief
  • the environment where they are making a decision.

To assess the person’s decision-making ability at a particular time, consider whether they can:

  • understand the facts involved
  • understand their choices
  • weigh up the consequences of their choice
  • understand how consequences affect them
  • communicate their decision to you.

Things to consider

If someone’s decision-making ability is impaired, it is a good idea to talk to their family, carer or guardian and find out the best way to communicate with them, so you can help them stay involved in their healthcare and make decisions to the best of their ability. Here are some other things to consider.

  • Are they able to make this particular decision? Decisions that are easy for some people may be harder for others.
  • Is it the best time to make a decision? Cognitive ability can be better or worse at different times or on different days.
  • Are there environmental barriers? Consider whether the environment they are in is noisy, busy or distracting.
  • Have they had enough time to make a decision? If it is not urgent, give them time to discuss with their family, carer or guardian.
  • Do you need to use alternate communication methods? These may include word or picture boards, sign language, an interpreter or a speech therapist.
  • Would a combination of visual, written and spoken communication help them understand the information and options available?
  • Have you used techniques like teach-back, to see if the person has understood the information you have provided?

Keith’s story

After mum was diagnosed with dementia, I wanted to do everything I could to help her. I thought taking over responsibility for making decisions about her health and other things in her life was the best way to do that, so I became her enduring guardian.

I started going to medical appointments with mum, and was doing all the talking and decision making about treatments and medications. Mum didn’t want to be a burden, so she didn’t speak up when I made decisions she wasn’t comfortable with, especially when she started to have trouble articulating when she wasn’t happy.

After a few months, mum’s GP retired and we started seeing Clare. Clare would always talk to both of us instead of just me, and she was really good at breaking things down for mum so that decisions were manageable for her. Her old GP would ask mum to agree to the treatment or medication, but if mum didn’t answer straight away, the GP would turn to me.

Instead, Clare finds different ways to help mum communicate, like getting mum to point to pictures that show where her pain is or how she feels about something when she can’t find the words. I still go to appointments with mum, but now I don’t just step in and make all the decisions.

Clare made me realise that because I’m the one who knows mum best, the most important thing I can do is help her communicate what she wants and needs, so she can make her own decisions as much as possible and take care of her own health.

Enablement and mental health

Enablement can be hierarchal, which means certain needs often need to be met before a person can progress to a higher level of enablement. A person may need to focus on their psychological, social and emotional wellbeing before they can get better at looking after their health.

Which psychology service?

  • Clinical psychologists assess, diagnose and treat psychological problems and mental illness across the lifespan, with a focus on science-based approaches and psychopathology.
  • Counselling psychologists assess, diagnose and treat psychological problems and mental illness across the lifespan using focused psychological therapies with a person-centred approach.
  • Geropsychologists help older adults manage mental health disorders and psychological distress, overcome challenges of aging and age-related illnesses, and achieve psychological wellbeing.
  • Neuropsychologists have expertise in diagnosing and providing interventions to manage brain dysfunction, including neurodegenerative disorders.
  • Health psychologists provide coaching for lifestyle change and disease prevention, manage psychological impacts of disease and dying, and assess and treat chronic conditions with psychological factors such as pain and sleep disorders.

Read more about psychological support for young people and older people.