Supported Residential Services: Supporting, or Exploiting
I remember being kicked out of my accommodation when living in East Timor. My mental health had worsened and my ability to do the basics, like keeping clean and looking after myself had diminished. I don’t hold it against the people who made the decision, but it was tough.
Embarrassed and alone at 22, in a country I didn’t know whose language I was only beginning to speak, I was forced to move from repeatedly into different temporary accommodation. I ended up in odd places, like teaching at a school so I could get accommodation. I remember, sharing a less-than-double sized foam mattress with another adult male teacher, rudely woken up by some nipping only to see a rat on me bigger than my shoe on me. This experience, but more broadly the dull anxiety of housing insecurity, hinted to me the strong connection between having a home and having mental wellbeing.
You don’t need to go to East Timor to find less-than-perfect accommodation for people in distress. In fact, there are disturbing examples closer to home. Supported Residential Services (SRS) exist across Australia, with thousands of Victorians currently residing in them. Through the Supported Residential Services (Private Proprietors’) Act 2010 for-profit providers charge between 85- 95% of a person’s disability support pension per fortnight in exchange for accommodation and support.
In advocacy with people who have lived experience of mental health issues and/or emotional distress, I’ve often heard about SRS being unsafe and unsuitable environments. It wasn’t until I spoke with Muriel Cummins from the Private Congregate Care Alliance (PCC Alliance) – an informal alliance of advocates and service providers seeking to highlight issues in SRS – that I had seriously turned my attention to it.
A good starting point for myself and readers, is to get a good understanding of the issue. So Muriel has been gracious enough below to answer some important questions.
Could you tell me a little about yourselves and the PCC Alliance?
Muriel: Around 15 years ago I started a new job working for a community health centre. One morning I came to work to find a man sitting on the front doorsteps of the office, with a sack full of his belongings. He told me he’d come from an SRS and couldn’t go back. “They took my money, my privacy and my humanity away” he said. I quickly learnt that this lived experience was not uncommon in these environments. Shockingly, fast forward 15 years, not much has changed. Despite the dawn of the NDIS, and various attempts to regulate and subsidise the sector, SRS continue to lack capacity to meet the needs of people with complex disabilities, including psychosocial disability [1][2][3].
A few years ago, a group of concerned individuals founded the PCC Alliance. The PCC Alliance is a group of organisations working towards the goal of systemic recognition of the unmet needs of people with disability who live in PCC settings, with a current focus on Supported Residential Services (SRS) in Victoria. The PCC alliance has a diverse membership -including legal, advocacy, lived experience disability representative, mental health, allied health, and housing organisations. For example, the alliance includes Mind Australia, the Victorian Mental health Awareness Council, the Victorian Office of the Public Advocate, and others.
What are SRS and what are they meant to do?
Private Congregate Care (PCC) residences are privately operated businesses that provide accommodation and support with daily living for people with disabilities and others who cannot live independently, retaining many features of institutional care. [2] PCC exist Australia-wide, and include Supported Residential Services (SRS) in Victoria. SRS are State regulated and in theory, prevent homelessness for people who have nowhere else to go (for example, people discharged from psychiatric hospitals or the justice system; people with disabilities who need support).
In reality, and as Dearn et al 2022 have demonstrated, the institutional aspects of SRS limit the ‘choice and control’ residents can exercise in daily life [2]. Indeed, Dearn et al 2022 go as far as to argue:
SRS were found to be a type of closed environment; that is, not all residents could be considered to have chosen to live in SRS, and nor could residents be considered able to move of their own volition. Indeed, some residents were accommodated in SRS on the basis of legal orders that removed their autonomy to live where they wished….SRS are an institutional form with an intermediate degree of closure, the purpose of which can be described as an “end in itself” (p12)
Sharing bedrooms and bathroom facilities is common in SRS, and some residents share rooms with only a curtain between them for privacy. Staffing levels are low 1:30, and staff other than the SRS proprietor are not required to have any training. There are quality of life concerns, concerns regarding loss of daily living skills, as well as safety concerns, including those raised by the Office of the Public Advocate[3]. A report commissioned by the Disability Royal Commission published earlier this week [5], highlights the segregated nature of these type of accommodations, and that this model no longer fits with contemporary community expectations; the objectives of the NDIS and its underpinning legislation; and Australia’s human rights obligations under the UNCRPD. The report recommends closure of group-home, trans-institutional housing models and the provision of pathways to more suitable accommodation options. McVilly, like other researchers highlight the risk of violence abuse and neglect in congregate living arrangements.
Recently in the 26th Hearing of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disabilities, the Commissioners heard evidence on issues in the SRS sector. What stood out to you?
What stood out most was the bravery of those sharing their lived-experience evidence. We heard from Georgia Wilson, whose mother sadly passed away while residing at an SRS. Georgia’s mother lived with a long-term psychosocial disability. Georgia described attending the SRS to identify her mother’s body and found her covered by a tarpaulin lying on the ground, outside in the yard. Her hair was matted and unkempt, her clothes dirty, and there was further evidence indicative of neglect. She had been paying most of her disability pension for 24/7 care, and the SRS proprietor was allegedly also billing to her NDIS plan.
What also stood out, was that the regulatory bodies provided evidence demonstrating that they are clearly aware of the safety issues facing residents, including those who are also NDIS participants [3]. Yet, there is an absence of a clear and transparent action plan to collaboratively address these issues; provide pathways out of SRS; or to decommission this outdated housing model. The regulatory framework is complex as it sits between the Victorian Human Services Regulator; the Department of Families, Fairness and Housing; and the NDIS Quality and Safeguards Commission. The SRS model is perpetuated, subsidised and supported. Clinical mental health services discharge people to these environments [6], despite the Victorian Mental Health Royal Commission (2021) identifying their unsuitability [1]. Also, PCC alliance members have provided anecdotal evidence of NDIS planners declining housing -support funding and recommending SRS to NDIS participants.
Who is holding SRS accountable for these issues? Are there places that residents can turn to in order to ensure they’re safe and their rights protected?
SRS are registered and regulated by the Human Services Regulator within the Department of Families, Fairness and Housing (DFFH), on behalf of the Victorian Government to ensure compliance with the Supported Residential Services (Private Proprietors) Act 2010 and Supported Residential Services (Private Proprietors) Regulations 2012.
The DFFH website recommends first making complaints directly to the SRS. If you are unhappy with the SRS' response to your complaint or if you witness or experience concerning practice at an SRS, notify an authorised officer at the DFFH by calling tel:1300310778.
Community Visitors are empowered by law to visit residents of SRS at any time. They can talk to residents to understand their experiences and identify any issues, liaise with staff and management to provide feedback and resolve issues. Community Visitors can also raise concerns with the department. Contact a Community Visitor via the Office of the Public Advocate (OPA) by calling 1300 309 337.
Also, concerned residents or families and carers, can contact the Victorian Mental Illness Awareness Council (VMIAC) for advice.
The existence of SRS’ raise real issues to me about whether Victorian Government decisions to manage and steward this market – that is create the conditions for the market to support rather than exploit residents – are compatible with the Charter of Human Rights and Responsibilities Act 2006 (Vic). Have you got a read from the Victorian Government about how they see the SRS’ and what they plan to do about them?
Simon, this is a great question. I’m not sure if the Victorian Government have formally or informally considered the SRS model and market from the Charter of Human Rights and Responsibilities Act 2006 (Vic) perspective. Perhaps we need to ask them. Given the subsidisation of these settings by both State Government under the SAVVI program, it is arguable that these settings could be considered Public Authorities, hence accountable under the Victorian Charter.
What is your view on the solution here? Should we reform, regulate, or replace SRS’?
There is a growing body of evidence that SRS are not fit for purpose, and are increasingly outdated from a human rights and disability policy perspective. While we acknowledge that creating housing solutions for people with disability is a huge challenge across Australia, it’s one that needs confronting. Pathways out of SRS are long overdue, as is the development of alternative housing options. Internationally, for example in Canada, there have been concerted efforts to replace these institutional models with more individualised, recovery-focused housing and support models delivered by not-for-profit organisations. [ED1]
More immediately, there are interim steps that can be taken to reform the NDIS to make living in SRS safer for participants with disability; and to ensure NDIS processes enable greater choice and control for these residents. For example, a mandated separation of housing provision and support provision, to prevent SRS proprietors ‘double-billing’ by charging NDIS plans for support the resident has already paid for through their disability pension. These are discussed in detail in our submissions [7]. We are hopeful the current NDIS Review will bring policy reform in this regard.
What’s one thing that readers can do if they want to support residents or your work?
Most importantly, challenge the complacent attitude that SRS are a sustainable and acceptable housing option! Do this in whatever capacity you can. We can and we must do better! Raise awareness, for example by sharing this blog. Get in touch with us, if your organisation would like to join the PCC Alliance (murielcummins@hotmail.com). And read our recent submissions, for example, no. 14 here Submissions – Parliament of Australia (aph.gov.au)
References
Victorian Mental Health Royal Commission (State of Victoria 2021, p. 409). Royal Commission into Victoria’s Mental Health System - Home (rcvmhs.vic.gov.au).
Dearn, E., Ramcharan, P., Weller, P., Brophy, L. & Johnson, K. (2022) Supported residential services as a type of “total institution”: Implications for the National Disability Insurance Scheme (NDIS). Australian Journal of Social Issues, 00, 1–17. Available from: https://doi.org/10.1002/ajs4.233
McVilly, K., Ainsworth, S., Graham, L., Harrison, M., Sojo, V., Spivakovsky, C., Gale, L., Genat, A., Zirnsak, T. (2022). Outcomes associated with ‘inclusive’, ‘segregated’ and ‘integrated’ settings: Accommodation and community living, employment and education. A research report commissioned by the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability. University of Melbourne, Australia. P.50, published March 07 2023
Submission no 14. NDIS Joint Standing Committee : NDIA Capability and Culture Submissions – Parliament of Australia (aph.gov.au)
