Received 29/10/18 010
Subject: Mental Health Services & the NDIS Submission to the Inquiry by the Social Development Committee
Overview
Country SA PHN (CSAPHN) welcome the opportunity to provide a written submission for the Inquiry into Mental Health Services and the National Disability Insurance Scheme (NDIS).
This response to the inquiry has been developed from our experience as the lead agency for the Country North SA Partners in Recovery (PIR) program and through the development of the National Psychosocial Measure (NPS) for our region.
The Terms of Reference addressed include the ongoing requirements for block funded services, the effects on South Australians who are deemed ineligible and the sufficiency of services for people who are accepted into the NDIS. These three aspects are particularly relevant to our experience and knowledge.
The ongoing requirements for block funded mental health services provided by the State Government after transition to the NDIS
Block funded services will be important in reducing escalation into secondary services for many people with severe mental ill health who may not be eligible for the NDIS. It is anticipated that there will be increased pressure on Emergency Departments once these services are withdrawn. There is a growing concern that people who are not able to access the NDIS will become more unwell and their level of need will escalate. The NPS measure alone will be unable to address the psychosocial needs across all of Country SA.
The other key area that will need the support of block funded mental health services is the availability of assertive engagement that is often required with this cohort. PIR (for example) implements a number of strategies to ensure a safe environment for clients which is flexible and supportive. This is necessary to build trust and to work with the episodic nature of mental illness. Once services have transitioned the NDIS, there will be no funding for service providers to actively engage with clients and provide additional support and help in accessing the NDIS.
It is clear that the NDIS cannot be the only system for clients in this cohort. The State Government needs to consider what the consequences will be long term by reducing available block funded services that currently exist in the community.
The effects on South Australians with mental health issues who are deemed ineligible to receive NDIS funding
The eligibility for NDIS is creating considerable concern among community members and service providers, particularly in respect to the potential lack of services that will be available to the cohort that is out of scope. Currently it is estimated that approximately 30% of the clients in the Country North PIR program will be deemed ineligible for the NDIS. This is not taking into consideration the number of people who have exited the PIR program once they have been directed to the most appropriate services and supports who may also not be eligible.
For individuals experiencing a high level of mental distress, the availability of a range of psychosocial and treatment services is critical to support recovery and wellness. Early and adequate evidence based psychosocial support can promote recovery and improve lives. Many of the current programs are able to be accessed without stringent criteria and so are more broadly available for people with a wider range of psychosocial need.
The sufficiency of services provided to people with mental illness who are accepted into the NDIS
CSAPHN has been receiving feedback on a number of issues relating to the sufficiency of services:
- Availability to the range of services on the client’s plan
- Access and transport options
- Quality of delivery
- Concerns with skills and expertise of the workforce
Availability
There have been reports from consumers and carers in country locations that they are unable to draw down on their full plans as the services are not available. It is acknowledged that this may be due to the limited plans that have been developed in South Australia at this point in time. Consequently, there is no market force to ensure sustainability for delivery of safe, quality services for providers. It is anticipated that as more people move onto a plan that this will change, although it is not anticipated that remote locations will reach a ‘market viability’ level that can ensure sustainability. The market in this locations is so thin that the provision of services within the NDIS pricing structure are unable to be delivered. Service provision in remote locations is expensive, time consuming (as the workforce often fly in and fly our) and there are minimal skilled workers available who live locally. The NDIS is unsuited to remote locations.
Access and transport options
Service providers have raised concerns about the ability to provide access to clients when long travel times and distances are required to provide an ongoing service. Regional centres may be able to provide options but for individuals living in more isolated locations, the ability to provide services will be limited.
Quality of delivery
There have been concerns regarding the quality of the services that are delivered. CSAPHN is aware of the Quality and Safeguarding Framework but it is still unclear what local measures will be in place to ensure quality and safety of delivery. There have been reports from the disability sector regarding poor quality of care from some contractors but limited other options available to utilize in more isolated communities.
Workforce skills and expertise
This issue is connected to the concern regarding quality of delivery as many of the available assistance in isolated communities is provided by individual contractors who may have limited experience supporting an individual with a severe mental illness. Service providers are finding it difficult to recruit appropriate workers in some locations, particularly in areas of workforce shortages.
Recommendations
Recommendation 1:
Continue grant based funding for psychosocial services to support the cohort of people who do not have functional needs that meet the requirements of the NDIS but are a significant risk.
Recommendation 2:
Provide funding/incentives and support for service providers to set up businesses in rural and remote locations.
Recommendation 3:
Support the development of regional contractor cooperatives that ensure quality and safety, financial management and workforce support.
Compiled by: Tania Manser – Mental Health & AOD Manager
Date: 26/10/2018