Re: the NDIS and with mental health clients
I wish to make some comments about this issue because mental health client issues are often not represented adequately, and many mental health clients are quite vulnerable, and usually they are neither really able nor willing to represent themselves adequately. Although there are exceptions to this, this is how I see the situation in my 15 years of experience in working as an occupational therapist with mental health clients in various community teams i.e. the Western Psychosocial Rehabilitation (previously called the Day Programs), and inpatient unit, Cramond Clinic, and the Western and also the Eastern Community Mental Health teams, and I am currently working in the Queenstown Intermediate Care Centre.
The focus of care in mental health treatment is around recovery – and so we (community mental health workers) do not really talk about the fact that the person’s condition is likely to be “permanent”. If we did do this, I am sure this would serve to undermine the client’s motivation and determination to improve their situation which in turn would not likely assist them to work towards their own recovery. However, one of the essential criteria to be accepted/ approved for support via NDIS initially is to provide good evidence that their diagnosed psychiatric condition results in the person having a psychosocial disability, which results in them having impairments that reduce their functional capacity. And this needs to be determined by a health professional (usually psychiatrist or GP) and deemed to be a “permanent” psychosocial disability for that person.
For some mental health clients who are receiving services through Mental Health Services and who are being followed up by a community Mental Health Team, and possibly receiving some support through an NGO, it would be possible that they could get assistance to get the evidence required to make an access request to NDIA for support in the future by NDIS; however, they are likely to need assistance and also perhaps need some encouragement to do this and to follow it through. But for many mental health clients, this task would not seem to be necessary because, in their mind, they do not need to do it. This is mainly because their insight into their condition is so poor. For many mental health clients, they feel that there is nothing really wrong with them,
and they do not accept the diagnosis, but may accept treatment – either voluntarily, or because they are on a Community Treatment Order requiring that they have treatment from the Community Mental Health Services team in their local area. For this latter group, they are unlikely to see the relevance of the aspect of the ‘permanence’ of their condition, and also highly unlikely to engage in the process of applying for access to get support possibly at some time further down the track in the future. This latter group of people are firmly rooted in their thinking in the here and now, and are not really able to reflect on their past, nor able to make realistic plans for their future. They are also the group of mental health clients who receive the least support because of the very chronic nature of their condition. Furthermore, they are likely to be socially isolated, heavy smokers and so quite unhealthy physically, have very poor dental and oral health, and also very poor nutrition, be unable to adequately manage their finances to best maximise their health in the choices they make.
Many of these people would have substantially reduced functional capacity in many of the identified 6 life skill areas (social interaction, self-care, self management, communication, learning, mobility) that are the specific areas that are considered in the access application for the NDIS. Furthermore, this group of people are highly unlikely to apply themselves for access to NDIS, and they would need a great deal of encouragement and support from others who are motivated to assist them on an ongoing basis and who are also in a position to be able to do so, before any of these people would even consider applying. But this group of people do not receive any such support at all. So it seems to be the case that a large number of people with a mental health condition will have no real chance to benefit at all from the NDIS, and so will continue to be left out of mainstream society. The status quo will continue.
I find it difficult to accept as a mental health worker that many millions and billions of dollars will be spent over the next few years on the NDIS, and yet many people with severe and persistent mental health conditions will be no better off at all. For them the status quo will remain, and they will continue to be marginalised in our society.