Australian Services Union SA+NT Branch Submission to Social Development Committee Inquiry Into Mental Health and the NDIS

Introduction

The Australian Services Union SA+NT Branch (ASU) welcomes the opportunity to provide this submission as this is a key issue impacting our members. Our branch represents a range of workers across diverse industries. We are the union for non-government community and disability sector workers and this is the fastest growing area of our membership. These members work hard every day supporting people experiencing or at risk of experiencing crisis, disadvantage, social dislocation or marginalisation. Many of our members work in community mental health programs.

In developing this submission, the ASU surveyed our members working in community mental health to hear their frontline stories of the impact of funding cuts to community mental health programs, like the Personal Helpers and Mentors (PHaMs) and Partners in Recovery program, and the transition to the NDIS. The responses of our members point to a range of crucial issues for the committee to consider, including the increased hospitalisation of community mental health clients following funding cuts, the loss or casualisation of jobs and the need for increased funding for community mental health programs to deliver the best outcomes for South Australians with mental health issues and the skilled, passionate workforce that supports them.

The ASU would be happy to arrange for a presentation to the committee by ASU members working on the frontline of community mental health services and the NDIS.

1. The gap between the Federal Government’s predicted and realised percentages of mental health clients receiving NDIS support.

ASU members continue to report that the Federal Government’s predicted uptake of NDIS packages by people with mental health issues continues to fall short. The assumption has been that

community members currently accessing these programs will be able to access services under the NDIS. Community sector organisations who have been focusing on getting their clients assessed over the past 18 months have reported that only 25-30% of participants are found to be eligible for NDIS funding. This is a major gap compared to the Federal Government’s expected uptake of over 70%.

ASU members report that the NDIS has been well designed to support people with permanent disability, but not to support people with mental illness that is episodic in nature. This is further complicated as mental health clients may present in interviews as being well, while suffering from episodes of severe mental distress. The below account from an ASU member describes the complexity of people suffering from mental distress have in accessing the NDIS:

“Many (mental health clients) don’t open letters, answer calls and may present at their planning meetings as well but in reality they are not able to function well at all. NDIS does not seem to take this into account” – ASU member.

The NDIS does not currently cater well for these clients with extremely complex needs. Conversely, block funded psychosocial programs with a trained mental health worker are able to break down these barriers with regular visits to clients.

2. 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.

Community mental health programs like PHaMs, Mental Health Respite Carer Support and PiR fill a service gap in the community. ASU members are already reporting serious impacts of funding cuts to these programs on people with mental illness and the community mental health workforce.

The impact of funding reductions and service cuts on the mental health of clients cannot be overstated. ASU members have reported significant increases in mental distress following funding cuts, as highlighted below:

“Significant increase in hospital admissions…increase in crisis, increase in distress over loss of regular support team and reduced support. Inability to access programs and services which were free and easy to access and now require NDIS eligibility and NDIS funding. Clients experiencing insecurity and at risk of self-harm and suicide,” – ASU Member.

Twenty workers in the sector reported being aware of mental health clients previously receiving support through PHaMs presenting to emergency departments in the weeks and months following the funding cuts. This is an inexcusable outcome for vulnerable South Australians and demonstrates that this funding should be reinstated. Prior to the March State Election the SA Labor Party committed to funding the gap created by federal government cuts to PHaMs. In the continued absence of federal action the new SA Liberal Government must step in. Programs like PHaMs and PiR are proven to work, and as is evidenced by recent experience, reduce the stress on the hospital system by providing early intervention and a stable form of care delivered by highly skilled and qualified workers.

The ASU also has significant concerns for the mental health of carers following funding cuts to the Mental Health Carer Respite program. This program filled a gap and this cut will result in yet another service gap in South Australia.

Cuts to community mental health programs and the transition of mental health services into the NDIS have had a major impact on South Australia’s community mental health workforce.

ASU members have confirmed that cuts to community mental health services have resulted in the direct loss of jobs as well as formerly permanent/permanent part-time jobs being made casual. Seven respondents to the ASU’s survey reported losing their job, while 21 respondents reported that a colleague had lost their job. Others have reported that their job has been made casual. With the full defunding of programs like PHaMs expected to take place on June 30 in 2019, many ASU members are reporting they have been told they will lose their job on this date and are being encouraged to apply for other work.

There is a broader issue with the impact of the NDIS on the workforce, with NDIS pricing not providing the required funding to employ trained mental health workers. Currently, community mental health workers employed through programs like PHaMs are employed on level four of the Social, Community, Home Care and Disability Services (SCHADS) award. Most NDIS plans are based on the provision of core support and core support workers are generally employed at level 2 of the SCHADS award. This pay cut will have a serious impact on maintaining a skilled and qualified community mental health workforce in South Australia. Once these workers leave the sector, they are unlikely to come back. One ASU member describes the impact of these working conditions below:

I have also seen advertising through my workplace for specific NDIS roles that are casual and at a level one and two, which are not even close to the pay rate and conditions of current IPRSS and PHaMs staff at a level four pay. One of the largest impacts has been the impact on staff moral and mental health. Lots of staff have ‘moved on’ to work in other programs, and the ones that have stayed have appeared to be more ‘stressed’ and had their own mental health suffer as a result, ASU member.

3. The ongoing requirements for block funded mental health services provided by the State Government after the NDIS transition

Block funded mental health services provided by the State Government will continue to be essential to the community. As previously stated, the NDIS currently does not adequately cater for the provision of mental health services due to their episodic nature. The ASU does note the recently announced psychosocial stream of the NDIS, which is a step forward, however no funding increase was tied to this announcement to ensure the care is provided by qualified mental health workers.

Block funded mental health programs fill a clear gap in South Australia and the nation’s health system and must be continued.

4. The effects on South Australians with mental health issues who are deemed ineligible to receive NDIS funding.

ASU members report a serious impact on South Australians with mental health issues if they are deemed ineligible to receive NDIS funding. Rejection can be extremely distressing and compound existing mental health issues.

With Commonwealth Programs like PHaMs and PiR due to end on June 30, 2019 ineligibility for the NDIS could lead to the complete loss of a support service for current clients. Currently ASU members are reporting that larger service providers are taking clients onto their own books to try and maintain a level of care in response to funding cuts. Clearly, this is not a sustainable approach and is already resulting in increased case loads for remaining staff. In the worst cases, ineligibility for an NDIS package and the loss of community mental health services can result in clients presenting to emergency rooms, self-harm, suicide, homelessness and other impacts. ASU members are already reporting these impacts from the first round of funding cuts to community mental health services as previously noted. If state programs were defunded, these impacts would be compounded further.

5. The sufficiency of services provided to people with mental illness who are accepted into the NDIS

Currently, the services provided to people with mental illness through the NDIS are not sufficient. The NDIS was largely designed for ongoing, permanent disabilities whereas psychosocial mental health programs are geared toward rehabilitation. The cuts to block funded psychosocial programs actually take away the ‘choice and control’ from clients when the NDIS is not providing a like service.

As referenced earlier in our submission, one of the fundamental issues with the NDIS providing sufficient mental health services is the NDIS pricing regime which does not provide the necessary funds to cover a qualified mental health worker. 84% of ASU members surveyed said that NDIS pricing was not sufficient to support a well trained, qualified mental health workforce in South Australia.

A worker paid at level 4 of the award generally has specific training and experience which enables them to provide a high level of care to vulnerable people without supervision – for

example, Bachelors Degree in Social Work (or similar), or, more commonly, a Certificate 4 in Mental Health or Mental Health Peer Work - whereas a Level 2 employee will generally have a Certificate 3 or 4 in disability or community support, which provides a basic level of training in standard support duties, but provides limited scope to exercise the level of flexibility and initiative required to work unsupervised and adapt to the needs of the participant at each step of the way.

Example of the difference in skill level needed in this kind of program:

A participant presents with a range of co-morbidities including low body weight.
It is identified that the participant is not willing to cook for themselves and so often goes hungry.
A level 2 support worker is engaged to prepare healthy and nutritious meals for the participant on an ongoing basis.
A level 4 support worker uses the skills and experience needed to explore why the participant is reluctant to cook for themselves and discovers the participant has a fear of knives as a result of childhood trauma.
The support worker develops a recovery program for the participant to help overcome this trauma and gain confidence around knives.
After many months of working with their carer, the participant becomes confident cooking and preparing meals for themselves, improving their health but also strengthening their independence.

This de-skilling of workers in these programs will ultimately reduce the effectiveness and quality of care provided in these programs, which are designed to keep participants in recovery and out of emergency rooms, institutions and the correctional services system.

6. The effects on South Australians with mental health issues undertaking the application process for the NDIS

ASU members have reported clients being extremely distressed through the process of undertaking an application to access the NDIS, especially if they do not qualify.

“So many being denied access on their first attempt is causing distress/anguish. Loss of long term supports/services (is) causing distress/decline in wellness (and an) increase in symptoms due to stress,” – ASU member.

ASU members have told us that due to the NDIS being designed around permanent disability, in contrast to mental health care being based around recovery, means clients are forced to shift how they think about their illness to tick boxes for the NDIS. This can cause clients serious distress.

Many ASU members also report that their organisations are supporting people in mental distress to apply for the NDIS, despite not being funded to do so. The application process needs to be improved significantly to reduce stress on community members with mental health issues.

7. Any other relevant matters

Much more needs to be done to support social and community sector workers. The sector faces short term funding cycles which leads to job insecurity and the NDIS is resulting in a the casualisation of the workforce.

The South Australian Government could support the workforce by implementing a portable long service leave system. Most ASU members working in the community sector have never been able to take long service leave due to frequent changes of role and workplace. Workers have to follow funding cycles, often moving being organisations every few years. A similar scheme is in effect in the construction sector, has recently been announced in Victoria and was committed to by SA Labor before the 2018 election.

For further information or to arrange for ASU members and officials to present to the committee, please contact Daniel Spencer at dspencer@asu-sant.asn.au or call the union office on (08) 8363 1322.