Reflections SA Government Social Development Committee inquiry: Central Adelaide and Hills Partners in Recovery
Thank you for the opportunity to respond to the Parliament of South Australia, Social Development Committee inquiry into the provision of services for people with mental illness under the transition to the National Disability Insurance Scheme (NDIS)
Please accept the below response from the Central Adelaide and Hills Partners in Recovery program in South Australia. Partners in Recovery is a federally funded service. The Central Adelaide and Hills region Partners in Recovery is delivered by a consortium of 7 non-government organisations working together: Neami National (the lead agency), Life without Barriers (LWB), Mind, Mission Australia, Skylight, Uniting Care Wesley Bowden (UCWB), and Uniting SA.
Central Adelaide and Hills Partners in Recovery (CAH-PIR) is a free service supporting people with severe and persistent mental illness with complex needs, as well as working with their carers and families. We currently have a maximum client load (MCL) of 218 consumers and we are working to support all of our consumers to test their eligibility for transition to NDIS. Funding for our services is expected to cease June 30th 2019. We are currently funded by the Department of health, but will transition over to our new funder, Adelaide Primary Health Network, in November 2018.
PIR Support Facilitators assist in bringing services together to work collaboratively and in a more coordinated and integrated manner. Service coordination can be useful when services people are receiving are not working well together, or if people are not receiving any services they need to live well in the community. In the Adelaide region, the NDIS for adults has rolled out in Northern Adelaide (01/07/17) and Southern Adelaide (01/01/18). It is due to roll out in Western, Eastern Adelaide and the Hills on the 01/04/18. During the NDIS rollout, CAH-PIR will continue to assist people who meet eligibility for the program. The program will also have a focus on transitioning people across to the NDIS by:
- Providing information about the NDIS to the community, with a focus on psychosocial disability. For more information about what we are doing in this regard please see the attached overview of the Central Adelaide and Hills Psychosocial NDIS Communities of Practice.
- Assisting eligible PIR consumers to gather the information necessary to determine if they meet access requirements. For people who don’t meet NDIS access requirements, or choose not to apply, CAH-PIR will continue providing a service.
- CAH PIR is funded until the 30 June 2019.
Eligibility
- A mental illness that is severe in degree and persistent in duration
- Complex needs that require substantial services and support from multiple agencies
- No existing coordination arrangements in place to assist with access to needed services, or where they are in place, those arrangements have failed
- Consent to being involved in PIR
- Aged between 18 and 65
- Reside in the Central Adelaide and Hills area
The gap between the Federal Government’s predicted & realised percentages of mental health clients receiving NDIS support;
We have concerns about the Federal Government’s current projections/estimates for the number of PIR consumers who will transition to the NDIS. Our sense is that significantly less will transition than has been predicted. There are certainly concerns about the impact of this on consumers and whether this means there will be a significant gap in funding for those who don’t meet eligibility for the NDIS. It is still difficult to tell how many of our consumers are going to transition exactly, but we are doubtful as to whether most of our consumers will meet the eligibility criteria. This is largely due to not having significant enough/or permanent impairment and also not being able to evidence trying all reasonable treatments effectively.
The Federal Government has repeatedly stated the NDIS is designed to complement, not replace, existing mental health services, and is only for those who have a permanent, or likely to be permanent, disability caused by a mental health issue. Whilst this is understood the concern is that many mainstream mental health services have closed (or will close) with the expectation that NDIS will support this cohort. PIR is one of those services set to close.
To date we have supported 115 clients to test their eligibility for NDIS. Of this number, 61 have been found eligible for NDIS, 28 have been considered in eligible and 26 pending decision. For those found ineligible the primary reason was that permanent disability could not be established. In a few cases we have been unable to determine the reason for eligibility not met. Of those found eligible (61), 44 are still waiting for their plans to finalised, with over half of these waiting over a 100 days.
From this data, the consortium has concerns for not only those found ineligible but also for those who may still be waiting for their plans to be finalised by the time PIR needs to withdraw.
The reduction in funding to the Personal Helpers & Mentors program & Mental Health Respite Carer Support program & the impact this will have on people with mental illness;
This reduction is of significant concern for the consortium as Personal Helpers and Mentors (PHAMS) has provided important support services for people in the community, most of whom are unlikely to meet NDIS eligibility. This reduction has meant that many people requiring mental health services will likely be without it.
There is lots of anecdotal evidence about declining mental health and increased hospitalisations since PHAMS has ended. With PHAMS ending we have limited (if any) pathways for referral into psychosocial case management services. We are hopeful that future services can ensure that there is as much continuity as possible from past PHAMS program/model as it has filled such a significant gap in the community for people not connected with clinical services. Gaps in community mental health is a serious regression in terms of national mental health services. The potential impacts on acute, in patient services are serious if we don’t continue to offer and maintain non clinical services. With a significant proportion of consumers not likely to transition to the NDIS, it is of concern that PHAMS funding has been substantially decreased.
Programs such as PHAMS and Respite Carer Supports (and also PIR) offer a flexibility of services to spend the time needed to navigate complex mental health service systems and support crisis/stabilisation which is a necessary part of service delivery. Without this support/advocacy consumers really struggle to navigate the complex a social service system. We are concerned that the limitations to the NDIS service delivery model in terms of this flexibility, that consumers may suffer a decline in services needed to navigate mental health services and manage crises as they arise.
Inconsistency of services available in the psychosocial space (e.g. services being funded/de funded) is very unsettling for consumers and their families/carers. For many consumers it is actually very difficult to reach out and engage with services. Lack of motivation, anxiety, and side effects from medication has an impact. It’s very difficult to find services and staff who are able to work through these engagement challenges.
The ongoing requirements for block funded mental health services provided by the State Government after the NDIS transition;
As outlined above we believe there will be a significant proportion of people who don’t meet NDIS eligibility criteria and for whom it is not suited. In light of this we believe it vital that block funding remains in place throughout this transition at close to current levels. Without this support we expect to see significant gaps in services and supports, including services which are needed to assist people with transitioning/testing eligibility. Care needs to be taken with any data modelling not to overestimate the number of people transitioning.
The service options available through the NDIS are currently inadequate and not replicating important aspects of previous services/models (for example case management and advocacy). So this aspect of the NDIS needs to evolve significantly if it is to meet the needs of people with complex needs. It seems block funding may always be required for people with complex needs as they do not have the capacity to participate as required in the NDIS.
There is currently a lack of services who can assist consumers to gather evidence for the NDIS application, collate it and lodge it. Nationally we know on average it is taking workers in the psychosocial sector 20 hours to help a person undertake this process. There are consumers who will have great difficulty accessing support to even lodge their access requests.
We understand that the 2017-18 Budget the Australian Government committed $80 million over four years for the National Psychosocial Support (NPS) measure. The purpose of the NPS measure is to provide psychosocial support services to assist people with severe mental illness resulting in reduced psychosocial functional capacity who are not more appropriately funded through the National Disability Insurance Scheme (NDIS).
Whilst this is welcomed, it is anticipated to be a very modest amount of money and unlikely to compensate for the gap in service delivery. The proposed Continuity of Support measure from June 2019 will support those deemed ineligible for NDIS, but the nature of this initiative is still yet to established and so there is still uncertainty and concern as to whether this will be sufficient for those needing support.
The effects on South Australians with mental health issues who are deemed ineligible to receive NDIS funding;
We as a consortium have concerns about consumers deemed ineligible for NDIS. Our concerns include decline in mental health/wellbeing, increases to hospitalisation and suicidal thinking and behaviour. We anticipate increased social isolation and decline in other community psychosocial measures as a result of our consumers feeling the loss of existing service models. There is quite a bit of confusion and anxiety for people around the process of testing eligibility, transitioning and subsequent continuity of support arrangements. We are concerned about supporting our consumers through this as best we can, for as long as we are able. We are also concerned about the support for consumers with new NDIS applications and reviews after planned program cessation of June 30 2019.
There are a number of vulnerable individuals in specific circumstances that we are concerned may not be eligible for services through the NDIS. These include;
- People experiencing BPD, PTSD (not just veteran PTSD), and DV.
- People who are service resistant and hard to reach (like homelessness).
- Aboriginal and Torres Strait Islander people
- People from a CALD background
- People with a severe cognitive impairment/language impairment.
- Complex presentations.
We have a number of consumers who have chosen not to test their eligibility for sound reasons such as:
- Acutely and sub-acutely unwell at the moment and the focus is on their health.
- People experiencing family and domestic violence
- People who are newly diagnosed as having a mental illness and are hopeful that it will not become a permanent condition.
The sufficiency of services provided to people with mental health illness who are accepted into the NDIS;
At this time sufficiency of service is unclear. It seems that psychosocial support service options as offered through NDIS are quite limited and inadequate at the moment. This may, in part, due to the categories of support defined by the NDIS. Largely it is capacity building support that is needed, however clients seem to be getting more core support options built into their plans. In addition to this, accessing case management type supports through the NDIS seems very difficult even though it is one of the most important services actually needed for those with a psycho-social disability.
There are a lot of providers coming into the market providing core supports at a far lower quality than is required to replicate or improve existing services. Also there will likely be significant industrial issues in the sector due to capacity building not being adequately funded. In addition some of the providers listed as registered to offer supports on the lists used by Local Area Coordinators (LACS) are not up to date.
There is concern about the time limited services offered by NDIS, and constraints on the types of services that are offered. Issues include:
- The focus on brief intervention, short term services by many services often does not meet the needs of this target population. Services need a recognition of the recovery process. People may be travelling well, but it is likely they will relapse and need supports again.
- Lack of services who can undertake assertive outreach.
- Lack of services who can do home visits/outreach. Many of our consumers experience severe social anxiety and/or depression and will not leave their home, or they really struggle to leave the house and keep appointments without support. The lack of services who will do home visits, or communicate via technology such as skype mean that for many consumers they either can’t access the service, or are exited due to cancelled appointments.
- Strict eligibility criteria such as catchment areas and needing to have a diagnosis is a barrier.
- Not enough hours of service delivery available to meet the complexity of need (inadequate funding).
- Many services have difficulty meeting the needs of people with complex problems. Most PIR consumers have co morbid physical health problems and/or AOD misuse. Trauma histories are very common, as are cognitive impairments, ASD, challenging behaviours, domestic and family violence etc. Our clients need services who are able to respond to this complexity
The effects on South Australians with mental health illness undertaking the application process for the NDIS;
The application process for NDIS is proving to contribute to significant amounts of confusion, stress and anxiety for some of our consumers. It is challenging to encourage consumers to test eligibility when they are going through crisis or instability. We are working hard to support consumers with their ongoing and present needs whilst still working towards the testing of eligibility. This can be difficult for mental health workers to negotiate and navigate with consumers in a way that doesn’t compromise important consumer/worker relationships.
There is a significant amount of support time and resources (most of it) has been taken up with this process meaning other significant needs haven’t been able to be attended to. In addition to our programs commitment to testing NDIS eligibility at this time, there is a risk that this work may not lead to a positive outcome in terms of NDIS eligibility. Consumers who have found that they are not eligible have found this news quite difficult to understand/process and they have required a significant amount of support through this.
The process of testing for eligibility, requires a high level of availability and responsiveness by the consumer. Our consumers need systems that are aware of the barriers consumers face and are flexible, persistent and creative in building and maintaining working relationships.
In order to demonstrate eligibility for NDIS, our staff sometimes feel they need to work in a deficit way to prove the need for reasonable and necessary supports. This is in contrast to the strengths based, recovery oriented approaches of community mental health programs such as ours. Our focus on the need to demonstrate functional impairment, whilst obviously necessary to a point, can create some damage to relationships and impacts on wellbeing for our consumers.
Overall we remain optimistic and positive about the services that NDIS may offer our consumers. We do, however, have concerns about the suitability of services available. We hope that existing community health programs that have successfully supported people with mental health issues for many years will be retained (in some way) to compliment NDIS service delivery. The need for flexible, tailored and responsive services should still remain to support consumers of mental health services.
Should you require further information please contact CAH PIR Lead Agency, Regional Manager, Shannon O’Keefe shannon.okeefe@neaminational.org.au