Unit 2: Disability and Carers

Unit 2 examines disability, impairment, and the experience of carers from clinical, social, and cultural perspectives. Understanding these concepts shapes how medical professionals communicate with, advocate for, and support patients with disabilities and their whānau.

Disability is defined as any self-perceived limitation in activity resulting from a long-term condition or health problem lasting or expected to last 6 months or more, not completely eliminated by an assistive device. Importantly, disability is not synonymous with illness — some illnesses result in impairment or disability (e.g. arthritis causing restricted mobility), but many people with disabilities do not consider themselves sick. Impairment refers to a reduction in function relative to an individual or group standard; unlike disability, many impairments can be eliminated by an assistive device (e.g. glasses for visual impairment, crutches for mobility impairment).

Three models of disability shape clinical practice. The medical model focuses on physical abnormalities that cause disability, aims to overcome or minimise these effects, and regards the individual as a victim requiring treatment and care — potentially constraining their sense of identity and autonomy. The social model redefines disability as the outcome of an oppressive relationship between people with impairments and a society designed only for able-bodied living. It locates the solution in societal change (accessible environments, inclusive design, equitable employment and education) rather than individual rehabilitation alone. The Whānau Ora model sees the person with a disability within the context of their whānau (extended family), adopts a strengths-based approach, and assumes the whānau has potential to create positive change when appropriately supported.

Mental disorders are characterised by a clinically significant disturbance in cognition, emotional regulation, and/or behaviour associated with significant distress, impairment of functioning, or risk of self-harm. Neurodevelopmental disorders (including intellectual disabilities, autism spectrum disorder, and ADHD) arise during childhood and affect adaptive skills across conceptual, social, and practical domains. Learning disabilities affect specific academic areas (reading, writing, comprehension) but typically do not reduce overall intelligence.

Ableism is a framework that prefers certain body and mind types, viewing disability as inferior — rooted in the medical model. It creates institutional, environmental, and attitudinal barriers (stereotyping, stigma, exclusion from building design, employment, and social participation). Language matters: use people-first language (a person with a disability, not a disabled person); follow each individual's preferred terminology.

Carers are unpaid whānau members primarily responsible for supporting another whānau member's personal and healthcare needs. Young carers are under 18. Caregivers are paid. Carers face high risk of depression and impaired physical, emotional, social, and financial wellbeing, and may experience isolation. Clinicians can support carers by providing emotional support, educating about support agencies (Carers Society Otago), financial supports (Supported Living Payment, Disability Funding), and facilitating environmental modifications.