This information is relevant to all those working with adults with care and support needs. It outlines different types of hidden disabilities and how staff should be aware of and respond to such issues.
SOUTH TYNESIDE SPECIFIC INFORMATION
September 2022: Section 2.2, Developmental / neurodevelopmental disabilities and Section 7, Training and Awareness have been revised. Section 6, Hidden Disabilities Sunflower Lanyard is new.
- 1. Introduction
- 2. Types of Hidden Disability
- 4. Working with Adults who may have Hidden Disabilities
- 5. Blue Badge Scheme
- 6. Hidden Disabilities Sunflower Lanyard
- 7. Training and Awareness
Not all disabilities can be seen from a person’s outward appearance. Hidden disabilities are sometimes also called invisible disabilities and include, for example, mental and physical health problems and developmental disabilities.
Following an investigation of three complaints against London Councils, the Local Government and Social Care Ombudsman recommended that local authorities should check their procedures to avoid disadvantaging people with hidden disabilities. This advice also applies to all organisations working with adults with care and support needs.
In each of the cases investigated by Ombudsman, the found that the local authorities did not do enough to help people with hidden disabilities to use their services. This included not making reasonable adjustments to help a woman with autism to repay overpaid housing benefit, and not helping a man with severe dyslexia to deal with parking tickets and permits.
2. Types of Hidden Disability
Whilst there is now a better understanding of some of the conditions that constitute hidden disabilities, it is vital that all interactions with adults, including assessments, are conducted with hidden disabilities in mind. This is to ensure all relevant care and support issues affecting the adult are identified, to ensure they receive the appropriate services relevant to their individual needs. This process is vital to ensure that people with hidden disabilities are not discriminated against, as a result of their disability being missed or reasonable adjustments not being made.
The lists below are not exhaustive; there will be other physical and mental health problems and other conditions that result in hidden disabilities.
2.1 Mental health
For many adults who suffer with mental health problems, their issues may not be immediately obvious and can be misunderstood. Without good working relationships and without a member of staff undertaking a comprehensive assessment with the adult, key aspects of the care and support that they require may be missed and their problems, therefore, could be compounded. Such issues may include depression, stress, bipolar disorder, psychotic and neurotic thought processes and suicidal thoughts.
2.2 Developmental / neurodevelopmental disabilities
Other conditions which can be hidden include:
- Dyslexia (development of literacy and language related skills affected);
- Dyspraxia (perception, language and thought processes affected);
- Attention Deficit Hyperactivity Disorder – ADHD (inattentiveness and hyperactivity-impulsivity);
- autistic spectrum disorder / ASD (communication, interaction and relationships with others can be affected).
Adults with such conditions often develop ways of coping which may make it difficult for staff to identify them as disabled. Even when someone can function well in many situations, this does not mean they are not disabled.
Issues to be aware of include:
- communication issues (verbal and non-verbal);
- understanding instructions;
- the speed at which they process things; and
- interpretation of social situations.
Some of these conditions may also co-exist with other hidden disabilities.
The Autism Act 2009 came into force in January 2010. Under the Act the Government has to publish and keep under review an Autism Strategy, as well as guidance for implementing the strategy which requires local authorities and NHS bodies to act (see Adult Autism Strategy: Supporting its Use; Department of Health and Social Care) and National Strategy for Autistic Children, Young People and Adults: 2021 to 2026 (Department of Health and Social Care and Department for Education).
2.3 Physical health issues
Not all physical health problems are clearly visible. There are many conditions which can be hidden to include hearing and sight impairments, chronic fatigue syndrome / myalgic encephalomyelitis (ME), chronic pain and chronic illnesses such as fibromyalgia, epilepsy, diabetes, kidney failure and sleep disorders.
Such conditions should also be taken into consideration as a hidden disability.
2.4 Other issues for consideration
2.4.1 Mental capacity
See also Mental Capacity chapter
Adult social care staff and other staff working with adults should be particularly mindful in considering mental capacity issues for adults with hidden disabilities when:
- assessing needs and make care planning decisions;
- conducting safeguarding enquiries;
- when there is a dispute over ordinary residence.
2.4.2 Human rights
Article 3 of the Human Rights Act 1998 imposes a duty to take reasonable steps to provide effective protection to children and other vulnerable persons whom the state knows or ought reasonably to know, are being subject to inhuman or degrading treatment (see also Z v United Kingdom Application No 29392/95, (2001) CCLR 310, ECHR).
3. Equality Act 2010
It is essential that people with hidden disabilities are not either directly or indirectly discriminated against, that is they should have the same level of assessment, care and support planning, care and support services and other opportunities as those who do not have a disability.
“The Equality Act 2010 requires councils to anticipate the needs of people who may need to access their services. This means when councils are alerted to the fact someone might need to be treated in a different way, they should ask that person what adjustments are needed, and consider whether these are reasonable…. We recognise the significant challenges faced by public service providers in adapting their processes to the needs of people who may require adjustments, particularly where the services have been automated. But this is a duty councils must meet and needs they must anticipate.” Local Government and Social Care Ombudsman
4. Working with Adults who may have Hidden Disabilities
Staff working with adults should be aware that they, or their carer, may have hidden disabilities, particularly those who are having contact with the service for the first time. It is important to not make quick judgments about a person based on initial communication.
Where there are communication issues or other factors are present that are not otherwise easily explained, staff should consider whether hidden disability / disabilities may be the cause and carry out further investigations as appropriate.
When a hidden disability is discussed with an adult and / or their carer, the member of staff should record both the discussion and the hidden disability in the adult’s case records (see Case Recording chapter). Where the adult already has a care and support plan, this may mean a review is required and adjustments to the plan may be required to respond to the newly disclosed / diagnosed disability which may change the person’s eligible care needs within the care and support plan.
5. Blue Badge Scheme
The Blue Badge scheme has been extended to include people with hidden disabilities, such as autism and mental health conditions, for example.
The criteria have been extended so that people are eligible who:
- cannot undertake a journey without there being a risk of serious harm to their health or safety or that of any other person;
- cannot undertake a journey without it causing them very considerable psychological distress;
- have very considerable difficulty when walking (both the physical act and experience of walking).
This is particularly important for adults who find leaving their house a challenge. This may involve detailed preparations and sometimes overwhelming anxiety about plans going wrong or not being able to find parking spaces. Some autistic people might be unaware of road safety issues or become overwhelmed by busy or loud environments.
For further information see: Running a Blue Badge parking scheme: Guidance for local authorities (UK Government) and Blue Badge Scheme (South Tyneside Council)
6. Hidden Disabilities Sunflower Lanyard
This is a symbol a person can wear if they have a hidden disability, or on behalf of somebody that does. For example, parents or carers may choose to wear lanyards for the people they support.
A lanyard helps to inform others, health professionals and members of staff in public places, that the person wearing it or someone with them has a hidden disability – this includes autism, chronic pain, dementia, hearing impairment.
Hidden disabilities that are eligible for sunflower lanyard include:
- a learning disability;
- sensory loss, including difficulty seeing or hearing;
- dementia including Alzheimer’s disease;
- anxiety or any other mental health condition;
- a physical disability that may not be obvious.
7. Training and Awareness
Local authorities and other service providers should ensure they have a disability policy, ensure that staff are aware of hidden disabilities and know how to respond appropriately. It should be addressed as part of general equal opportunities training.
Other associated training to consider include:
- autism awareness;
- disability awareness;
- mental health awareness.