Southern Adelaide Local Health Network Submission: Parliament of South Australia: Social Development Committee - The provision of services for people with mental illness under the transition to the National Disability Insurance Scheme (NDIS) | External submission

SOUTHERN ADELAIDE LOCAL HEALTH NETWORK

SUBMISSION

Parliament of South Australia: Social Development Committee

The provision of services for people with mental illness under the transition to the National Disability Insurance Scheme (NDIS).

October 2018

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Introduction

The Southern Adelaide Local Health Network (SALHN) thanks the Parliament of South Australia’s Social Development Committee for the opportunity to provide a submission on the provision of services for people with mental illness under the transition to the National Disability Insurance Scheme (NDIS).

Transitioning to the NDIS for people with disability, and for service providers within the disability, mental health and broader health and social sectors, is difficult and complex. The opportunity to identify and address the impacts of the transition is acknowledged.

Background

There is ‘in principle’ support for the NDIS across a wide range of sectors, communities and political spheres. There is the view that, at full NDIS implementation, the lives of people who meet the NDIS access criteria will be positively affected. This includes people with psychosocial disability. For people with psychosocial disability, the challenge of this major reform is the facilitation of ‘system reform’, to ensure there is a comprehensive response to the issues of availability, accessibility and affordability of services for people with a mental illness that will enable recovery and participation in education, employment and community connectedness. The proactive intersection of the NDIS and the supports it funds via registered and non-registered NDIS service providers; mental health services spanning the primary, secondary and tertiary health sectors; and services of the social and welfare sectors, is key to improving the social and economic outcomes for people with mental illness. Viewing the impact of the NDIS transition in isolation of these other key system players amplifies the risk of perpetuating the experience of the service system of people with psychosocial disability as fragmented, complex, and creating additional psychosocial burden at times when psychosocial stress should be minimised.

The ‘system’ for people with psychosocial disability must achieve the right balance and network of clinical treatment readily escalated during episodes of acute mental illness; as well as community mental health/psychosocial rehabilitation and disability support.

The consideration of transition to the NDIS for people with mental illness must recognise the broader environmental context within the NDIS transition is occurring. Features of the environmental context include:

the role of the Primary Health Networks (PHN) and the evolution of the primary mental health care and general practices it commissions;
the federal government’s recent announcement of more than $52 million in funding to HeadSpace centres for young people with mental health issues;
state and commonwealth broader health, social, welfare and aged care reforms;
state commitment to establishing a new SA Mental Health Care plan;
SA Health’s investment in and expectation for Local Health Network community mental

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commitments of both state and federally funded mental health programs to ‘continuity of support’ during and post NDIS transition; and
the challenges in finding a balance between efficiency, public value and sustainability from the perspective of the South Australian Government and community across multiple service sectors.

SALHN response

SALHN provides this submission with its primary frame of reference being our observations of the impact of the NDIS transition on consumers with severe and complex mental health issues; and as the state’s key public mental health service provider for people with mental illness living in the southern suburbs of Adelaide.

SALHN urges the Social Developmental Committee to consider the variety of perspectives on this complex issue with particular reference to people with a mental illness, carers and peak bodies in the mental health and psychosocial disability support arena.

In this context, this submission provides the following response to the seven Terms of Reference (ToR) of the inquiry:

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

The full extent of the gap between the Federal Government’s predicted and realised percentages of mental health clients receiving NDIS support is yet to be identified. The June 2018 COAG Disability Reform Council report1 documented that on a national level, 10% of participants who received an NDIS funded support plan had psychosocial disability. This represented a 3 % growth in the proportion of participants with psychosocial disability compared to the previous quarter. However, on a South Australian level, 227 participants, out of a total of 17,751, were identified as people with psychosocial disability. This represents 1% of the total SA NDIS participant cohort. The report graphs that average annualised cost of support commitments to NDIS participants with psychosocial disability on a national basis is in the range of $50,000 - $55,000, and yet within the South Australian context the figure is lower at approximately $40,000. Approximately 50% of ‘committed’ supports are being expended by SA NDIS participants. It is difficult to glean from this report the comparison of numbers of people with psychosocial disability receiving approved NDIS plans and the level of funded support for people with psychosocial disability compared to actuarial estimates for this state in transition. Given that 227 South Australians with psychosocial disability are accessing NDIS funded supports, and approximately 4,500 people with a psychosocial disability in South Australia being projected to eligible for the NDIS², a significant uplift in transition of South Australian’s with psychosocial disability is required. From the perspective of people with psychosocial disability who live in the southern suburbs of Adelaide and are within SALHN’s catchment, a considerable gap exists

1 Report to the Council of Australian Governments and Australian Disability Reform Council, June 2018, accessed at www.ndis.gov.au 26/10/18

2 https://www.pc.gov.au/__data/assets/pdf_file/0016/217204/sub0203-ndis-costs.pdf

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between the current SA figure of 227 NDIS participants with psychosocial disability and the number of SALHN consumers with mental health challenges. Thus, the conclusion is drawn that a significant proportion of South Australians with a mental illness still require some form of clinical, psychosocial and disability support.

Recent media releases have outlined the National Disability Insurance Agency’s work with Mental Health Australia to improve the experience and outcomes of NDIS participants with psychosocial disability, with a focus on community program, pathways and access to reasonable and necessary supports. Tangible specifications as to how this will occur, and for what likely quantum of people with psychosocial disability lacks visibility in these documents.

ToR 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:

It is projected that without the Personal Helpers and Mentors program and Mental Health Respite Carer Support program, people with mental health issues requiring support will present in increasing numbers to Local Health Network (LHN) Emergency Departments, and referrals to LHN Community Mental Health Services will inevitably increase. Current collaborative discussions between SALHN Mental Health Services and the Adelaide PHN are aiming for the development of new pathways that could partially assist with this cohort of individuals. However, even with such new pathways, a gap is projected to occur if the funding for the Personal Helpers and Mentors program and Mental Health Respite Carer Support program is reduced.

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

To date, 227 South Australians with psychosocial disability with the most significant and severe impact on the person’s ability to participate in community life have met the access requirements for the NDIS. The majority of people experiencing either a once-off mental ill-health issue or recurrent episodes, but where they do not meet the access requirements for the NDIS, require services and support to enable recovery. Thus the majority consumer cohort will still require State Government-funded mental health services.

The experience of Local Health Networks or their equivalents in other jurisdictions for patients/consumers with newly acquired disability of any type or change in support needs for people with disability, lengthy time periods for a person’s NDIS eligibility to per considered and funded support plan approved. This has resulted in people who no longer require acute (mental) health care having to stay in hospital until alternative (NDIS) arrangements are activated. The implication is that block funded mental health services provided by the State Government after NDIS transition are essential.

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

As per the response to ToR 3, to date, from data referenced in NDIS reports to COAG, only people with psychosocial disability with the most significant and severe impact on the person’s ability to participate in community life have met the access requirements for the NDIS. The majority of people experiencing either a once-off mental ill-health issue or recurrent episodes, but where they do not meet the access requirements for the NDIS, require services and support to enable recovery. Thus, the majority consumer cohort will still require State Government-funded mental health services.

Rejection of applications for NDIS could be perceived by individuals as demoralising and discriminatory and have an adverse effect on the individual’s health and wellbeing. With the uncertainty of state service provision, this will add another layer of complexity to meeting individuals needs and recovery oriented focus.

Continuation of investment in improving accessibility, quality and outcome from state-funded mental health services is critical.

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

The NDIS’ systems and approach is entirely centred on the person with disability. With the person with disability’s NDIS application and subsequent access interviews taking place not necessarily involving current mental health service providers, an LHN (or any other provider) involved in the provision of care and services to people with psychosocial disability, does not receive a comprehensive document outlining the NDIS funded supports an NDIS participant has on their approved plan. Thus making a determination as to the sufficiency of services provided to people with mental illness is fraught with difficulty. This can result in under/over delivery of service provision. Coordination of care and facilitation of a person with mental health issues to navigate the complex system of NDIS funded supports/services; Commonwealth funded primary health and/or social services; State funded health and/or social supports; is extremely difficult for all stakeholders, but especially the person with mental health challenges.

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

SALHN’s observations of a number of mental health consumers are that a selection have refused to engage in the NDIS application process because of the fear of losing their current services and relationship with state funded service providers. In addition, the delays experienced with the application process causes distress to individuals and results in increased requirements for service provision from state-funded Mental Health Services and other state-funded service providers.

Furthermore, South Australians with a mental illness who have, or are currently making applications to access the NDIS are experiencing inconsistent approaches in both eligibility assessment and support need assessment/approval. It is SALHN’s view that a contributing factor is that the NDIS assessment and planning process is undertaken by NDIS staff/contracted agencies who do not have the required professional expertise.

ToR 7. Any other relevant matters:

People with a mental illness are faced with a situation at a time of their greatest vulnerability with needing to be aware of, and understand the eligibility, referral process and roles of:

the NDIS, and the network of NDIS registered and non-registered NDIS providers of ‘supports’ that may assist them to participate in community life;
the primary mental health care and primary health care services as commissioned by the PHNs;
state funded mental health services;
GP services (Commonwealth funded via Medicare); and
other community health, social and welfare centres.

The above system players each have their own decision-making processes and approaches to assisting a person with mental health challenges. A person with mental ill health may find they are deemed ineligible:

for NDIS,
for PHN commissioned services,
community mental health teams,

and yet still require support.

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SALHN suggests that an NDIS-centric approach is limited and limiting for the person with psychosocial disability/mental health issues. A person-centred approach to achieve a navigable mental health/psychosocial support/recovery oriented system for people with once off/episodic/long term mental illness should be the goal. A system underpinned by a philosophy of ‘one person, one team, one system’, supported by technology to enable rapid, secure communication amongst team players including, critically, the person with psychosocial disability/mental illness, is vital.

A clear plan, underpinned by:

ongoing increased financial commitment to the sustainability of South Australian Non-Government Organisation (NGO) funded programs who provide supports to enable a person with psychosocial disability (of short or long term or episodic duration) to self-manage their illness and engage with community life, concurrent with:
continued investment in state-funded acute and non-acute mental health service reform,

is strongly recommended.

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