Exercise of power in institutional community and residential settings create risk Internationally it is recognised that children and adults with learning disabilities in institutional settings are at greatest risk of being sexually abused.109 The report ’Institutions are places of abuse: The experiences of disabled children and adults in State care110 found that disabled people in Aotearoa were also subject to violence and abuse by those charged with their support and care in institutional settings. This has been reiterated by people sharing their experiences with the Abuse in Care Royal Commission.111 This abuse is caused by poor (or lack of) policy and practice and the attitudes of those employed to work with disabled people, including the devaluing of people needing safeguarding and support. In 2013, in Gisborne, Michael Roguski 112 carried out one of the first studies exploring disabled people’s experiences of abuse. The study identified a range of community settings in which disabled people experienced harm. These are: • • • 36 residential services – abuse occurring from either a staff member or service user associated with the organisation within, for example: nursing homes, specialist residences for people who have experienced brain injury (including stroke), mental distress or intellectual disabilities, and homes for people in need of care and support home-based environments – abuse within the home from home-based care workers, landlords and the individual’s partner, family or whānau. Managers of home care services were also described as sometimes facilitating abuse by failing to appropriately act on disclosures community settings – occurring either opportunistically by someone unknown to the victim or, for example, in the case of financial abuse, through local businesses and neighbours. Human Rights Commission The same study identifies a range of factors operating to silence disabled people and impede prevention and response including:113 • pressure not to report • negative consequences for reporting (being punished, isolated, ignored, missing out on things) • reports being ignored by third parties • credibility being questioned or undermined • normalisation of abuse /resignation to abuse as normal or deserved • collusion, within services, to deny or dismiss reports. Confirmation that disabled people remained at risk of abuse in disability service settings is provided by the ‘Putting People First’ report,114 a review conducted by Disability Support services within the Ministry of Health, about the adequacy of their systems for assuring quality and safety for disabled people. The report outlined very similar experiences to those identified by Roguski, including that disabled people have learnt to be silent about abuse through fear of retribution, fear of losing services they depend on, or perceiving they deserve to be abused.115 As a result, much violence remains invisible. Structural factors that increase risk of violence Structural factors that create risk for disabled people and tāngata whaikaha Māori, or that create situations where violence and abuse are less likely to be reported or identified, have been recognised by disabled advocates and researchers.116 These are: • the denial of disabled people’s rights. Many disabled people have had little opportunity to learn about their rights, including rights of sexual citizenship, and potentially limited exposure to situations in which those rights are actively upheld • the lack of accessible housing. People may not want to leave, or have options to leave, an accessible house