Received 29/10/18 011
Uniting Country SA
Liz Malcolm
General Manager Operations
Uniting Country SA
60 Florence St
Port Pirie SA 5540
The Secretary, Social Development Committee
GPO BOX 572
Adelaide 5001
Re: Submission for Inquiry Regarding Mental Health Services & the NDIS
I am writing on behalf of the Board and Management of Uniting Country South Australia (UCSA) to address some of the terms of reference for the inquiry regarding mental health services and the NDIS.
Introduction
UCSA fully support the NDIS and the benefits it can bring to the lives of people living with a mental illness but would like to address uncertainties that accompany this transition to NDIS for people with a psychosocial disability.
In this submission we are covering the following terms of reference:
- The gap between the Federal Government’s predicted and realised percentages of mental health clients receiving NDIS support;
At full roll out the Federal Government predicted that 64,000 (or 13.9%) of people entering the NDIS will have a primary psychosocial disability. This number to date is lower than projected by the Productivity Commission. Latest figures show that only 6.4% of scheme participants have a primary psychosocial disability which is less than half that originally forecast by the Productivity Commission in 2011 (University of Sydney, 2018).
In the DSS Newsletter (May 2018) it was reported that the NDIS data had shown that around 20% of PHaMs clients may not enter the NDIS and is higher than the five to six percent originally estimated.
Coggan (2018) reported that by July 2018 only 10 per cent, or 2,030 people, from PHaMs had transitioned to the NDIS, out of the estimated 690,000 people living with a severe mental illness in Australia.
Our experience is showing there may be more than 20% of PHaMs clients ineligible, so the gap may be even greater.
This financial year we have serviced 80 clients in PHaMs to date and currently 62 are active clients. Of the 80, 20 have been deemed eligible for NDIS so far with 23 still waiting for an access decision or a review which means we already have more than 20% of clients ineligible. We also continue to receive referrals and we currently have 7 new referrals to be assessed for eligibility and then assisted to access NDIS.
PHaMs has a contractual obligation to support their existing clients to access the NDIS but what there is a service gap for clients who do not currently access services or those new to psychosocial disability?
According to Mental Health Australia’s literature review (2018) the low levels of engagement have been attributed to a number of factors including that current policy parameters do not adequately provide for the support needs of people with psychosocial disability. The current support packages are designed to meet a broad set of outcomes, for any type of disability and the profiles, prognoses and support needs for people with psychosocial disability are not optimal for supporting individuals to attain improved recovery-oriented outcomes and functioning.
PHaMs eligibility criteria, although in line with functional limitations similar to NDIS eligibility, are not as rigid. There does not need to be a full impairment in at least one domain to meet PHaMs eligibility. Many clients are deemed eligible for PHaMs because they have functional limitations over several domains, which, combined, show a need for psychosocial support. This however does not equate to eligibility for NDIS. In Pro Bono news, (Michael, Jan. 2018), Greens Senator Rachel Siewert stated “If they had properly consulted the sector in the first place, the sector would have said ‘those assumptions are false’ because they had concerns right from the start around eligibility issues and people not trusting the system. And if you talk to mental health providers… they were aware there were going to be problems with people transitioning into the NDIS.”
The new streamlined access process will be utilised to test eligibility again for some of our participants who were deemed ineligible and may be willing to try again, and to speed up the access process for those who have not yet received a response.
We are continually learning and the Transition Support Project Workshops and Webinars have been an excellent resource to update our knowledge around access requirements as they become more and more refined. It is unfortunate that we did not have this knowledge a year ago before roll out.
- The reduction in funding to the Personal Helpers and Mentors program and Mental Health Respite Carer Support program and the impact this will have on people with mental illness;
The reduction in funding to PHaMs was anticipated to align with clients successfully transitioning to NDIS thus being exited from the program. But transition has been slower than expected.
The reduction in funding has already happened and has forced a reduction in staff numbers and therefore also a reduction in support hours provided to current clients. In our organisation, staffing in PHaMs went from 7.8FTE in 2016/17 financial year to 3.8FTE in 2018/19. We lost valuable skilled staff in this process. For clients who lost their mentor as a result of funding reductions, it caused unnecessary trauma and distress despite trying to prepare them for the change as best we could. These clients had to adjust to a new mentor who needed to rebuild trust and rapport and familiarise themselves with the client’s journey without having to retell their story in order to continue to provide a service. Available support time was also reduced as a result of higher caseloads, needing to provide continuity of service to all our clients but in a reduced capacity.
For people with psychosocial disability these experiences directly and substantially affected their mental health and therefore their psychosocial disability. Some clients became very unwell while others disengaged and left the service because they lost their mentor. Many clients state they are not receiving the same level of support they were used to but understood it was no longer possible due to our reduced capacity.
The reduction in funding has also curbed referrals despite reassurances of continuity of support arrangements. Our guidelines require us to prioritise those people who may be eligible for NDIS and we were advised to refer people who were seeking support for their mental illness (who may not be eligible for NDIS) to the Local Area Coordinator (LAC). The LAC for our region does not have an office
where a person can meet face to face with someone. There is an expectation that people with psychosocial disability are able to make a phone call to a 13 number to ask for support. When asked, the LAC advised that they were not sure where to refer people to as they were busy with planning meetings with those eligible for NDIS.
Programs such as PHaMs and PIR, as well as IPRSS and ASP, have become familiar to community members as well as services, as a program that people with mental illness can easily refer to.
The reduction in funding has prematurely forced a reduction in services for people with mental illness.
- The ongoing requirements for block funded mental health services provided by the State Government after the NDIS transition;
In our region block funded state mental health services include Accommodation Support Program (ASP), The Individual Psychosocial Recovery Support Service (IPRSS) and Intensive Home Based Support Services (IHBSS).
Our organisation provides the State Government funded Accommodation Support Program (ASP) which offers psychosocial support to clients who are also receiving clinical support for their mental illness. This program also currently assists these clients to access support through NDIS. After full roll out, there will still be people becoming unwell, accessing clinical support and programs such as ASP, IPRSS and IHBSS will continue to be needed to offer that additional psychosocial support.
Some current clients are also ineligible for NDIS. These clients do not want their service to change.
Block funded mental health services are needed for those who do not fit NDIS requirements and without them, pressure on mainstream and clinical supports will increase.
The State Government has committed an extra $80 million dollars towards the National Psychosocial Support Measure. We are yet to discover what this will look like but is an essential first step to meeting the needs of people with psychosocial disability who are not supported by NDIS and are not engaged with transitioning Commonwealth programs. We are concerned that there is an assumption that Partners in Recovery will provide an adequate level of service to cover shortfalls and our experience for this area is that Partners Recovery provide only very minimal services and a high number of clients are unable to access these services.
- The effects on South Australians with mental health issues who are deemed ineligible to receive NDIS funding;
Existing Commonwealth clients who are not eligible for the NDIS will be provided with Continuity of Support (CoS). The Government announced in its 2018-19 Federal Budget that it is providing an additional $92.6 million over 4 years for CoS arrangements (DSS, May 2018). As stated in Mental Health Aust (2018) Report, the mental health sector, including consumers and carers, are yet to hear any details relating to CoS including exactly what services will be on offer, less that a year from Full Scheme.
Despite the promise of CoS, being deemed ineligible impacts client wellbeing as their psychosocial disability wasn’t able to be validated, in some cases due to a lack of evidence, and clients disengage from the service over time. Many people were deemed ineligible because of lack of evidence or lack of the right evidence, which is hard to obtain for people who are disconnected and/or don’t have access to services such as people in rural, regional and remote areas (University of Sydney, 2018). Difficulties with obtaining the right evidence cause clients more distress and often results in a
refusal to go through a review process. For those clients who do go through a stressful review process, they may well still be unsuccessful which further adds to deteriorating health.
The Snapshot series explains that the NDIA assists people who are not eligible for individualised NDIS support to obtain information about relevant services in their community and general support is available from a Local Area Coordinator (LAC) to assist people to access a range of supports within the mainstream and community sector. As PHaMs providers we have considered referring new people referred to us for support, being referred to the LAC for support. LACs in our region do not know what to do with such referrals and who to refer these people to as they do not have the local knowledge and for regional areas PHaMs fills the gap for those not wishing to, or are ineligible for, mainstream mental health services.
There is already an increase in emergency department presentations with acute mental health problems, and many don’t have a provider in the community they can access for support (ABC News, October 2018). We need to ensure mental health services such as PHaMs are still readily available in the community to support those people not
- The sufficiency of services provided to people with mental illness who are accepted into the NDIS;
Capacity building support services: Core support items largely predominate plans with little or no capacity building support items which Providers are keen to deliver but plans are not matching the needs of these participants. This would provide greater capability to participate in the community and even to exit the NDIS either temporarily or permanently.
Support Coordination is also not included in plans. Values driven Providers like us are spending many hours helping people understand and implement their plans This time is unbillable and hence not sustainable in the medium term.
Mental Health Aust. recommended in their 2018 report that support coordination, capacity building, carer support and respite, and provision for urgent and unplanned needs due to episodes of illness and disability be discussed in every planning conversation with NDIS participants with psychosocial disability. This is not yet happening but would be a welcome addition to improve outcomes in plans for these clients.
Advocacy services — support coordinators cannot advocate for their clients when things go wrong or are not working. Often support coordinators have the best understanding of how the implementation of the plan is working for the clients and hence can be best placed to provide insight and improved understanding which would result in better outcomes for the client. We understand the issues of conflict of interest, but they cannot very readily be dealt with.
There were discussions in 2016 regarding consideration of several mental health specific support items to be considered for approval on the support items list, in particular a support worker with a minimum Cert IV in Mental Health qualifications (NDIS, 2016). Current Disability Support Workers are often under qualified to effectively support NDIS participants with psychosocial disability. A level of qualifications and skills are needed in order to effectively engage and work with participants who have psychosocial disability.
Case Management services — how do we ensure holistic support when services do not have the
capacity to communicate with one another when support coordination is not available and funds dry up due to changes in needs without other services notified and therefore funds run out before plans do.
Alternatively, limited choice or limited guidance as to what is available in regional areas means some plans are not utilised fully. This may equate to less funds available in future plans on review.
- The effects on South Australians with mental health issues undertaking the application process for the NDIS;
As stated in Mental Health Aust (2018) report, psychosocial disability differs from most other forms of disability, especially because it directly affects and is affected by the individual’s NDIS service experience, with poor experiences impacting on both participant and carer wellbeing.
The application process is complicated and time consuming with a strong focus on deficits. This is contrary to the support model for psychosocial support needs clients and consumes many hours of an already limited support budget which further impacts negatively on the clients wellbeing..
People with psychosocial disability are often unable to navigate the complexity of the access process alone and even with support, there are repeated examples across the country of people withdrawing their applications due to their experience of a highly stressful and at times traumatising process (Uni of Sydney, 2018). We have supported all of our clients through access and it has still been a highly stressful experience for them. Clients state they are happy with the support they are receiving and yet they need to validate/prove they are eligible for support, despite explaining that they will be eligible for support without NDIS.
Waiting time for responses is also detrimental to the client’s wellbeing.
When deemed ineligible due to a lack of evidence, clients often become distressed at the fact that their psychosocial disability wasn’t able to be validated and will refuse to go though a review process which may cause further distress and may still be unsuccessful.
Liz Malcolm
General Manager Operations
29 October 2018
ATT - References
References:
ABC News (2018). Emergency departments in ‘crisis’as mental health patients left waiting:new report. Downloaded on 8th October 2018 at http://www.abc.net.au/news/health/2018-10-08/emergency-department-mental-health-crisis/10344852
Aust. Govt Dept of Social Services (May 2018). Personal Helpers & Mentors & Mental Health Respite: Carer Support Transition to the NDIS — information and advice for service providers. Downloaded 3rd October 2018.
Aust. Govt Dept of Social Services (2018). Continuity of support for clients of Commonwealth disability programs 2018 Budget. Downloaded 4th October 2018 at https://www.dss.gov.au/sites/default/files/documents/05_2018/d18_13641_budget_2018-19_-_factsheet_-_continuity_of_support_for_clients_of_commonwealth_disability_programs_1.pdf
Coggan, Maggie (October 2018). Psychosocial Disability Stream Added to NDIS. Pro Bono Australia News. Downloaded on 12th October 2018 at: https://probonoaustralia.com.au/news/2018/10/psychosocial-disability-stream-added-ndis/
Mental Health Australia (May 2018). National Disability insurance Scheme: Psychosocial Disability Pathway. Downloaded on 3rd October 2018 at https://mhaustralia.org/report/ndis-psychosocial-pathway-project-final-report.
Mental Health Australia (July 2018) Literature Review: Support for people with psychosocial disabilities participating in the NDIS. A working document for the Optimising Support for Psychosocial Disability project. Downloaded 5th October 2018 at https://mhaustralia.org/report/literature-review-support-people-psychosocial-disabilities-participating-ndis
Michael, Luke (Jan 2018). People With Severe Mental Illness Struggling With NDIS Transition. Pro Bono Australia News. Downloaded 5th October 2018 at https://probonoaustralia.com.au/news/2018/01/people-severe-mental-illness-struggling-ndis-transition/
NDIS (2016). IAC advice on implementing the NDIS for people with mental health issues. Downloaded 20th October 2018 at https://www.ndis.gov.au/about-us/governance/IAC/iac-advice-mental-health.html
NDIS (2018). Snapshot 5 — NDIS and other services supporting your mental health. Mental Health Access Snapshot Series. Downloaded 3rd October 2018 at https://www.ndis.gov.au/medias/documents/mha-services/Mental-Health-Access-NDIS-and-Other-Services.pdf
University of Sydney (2018). Mind the Gap: The National Disability Insurance Scheme and psychosocial disability. Final Report: Stakeholder identified gaps and solutions. Downloaded 2nd October 2018 at http://sydney.edu.au/health-sciences/documents/mind-the-gap.pdf