Office of the Public Advocate
South Australia
Confidential until approved for publication
Submission to the Social Development Committee in relation to the provision of services for people with mental illness under the transition to the National Disability Insurance Scheme (NDIS).
November 2018
Contact Person about this submission:
Ms Anne Gale
Public Advocate for South Australia
PO Box 213
Prospect SA 5082
Phone: 08 8342 8200
Fax: 08 8342 8250
Email: anne.gale@sa.gov.au
Introduction
The Office of the Public Advocate, South Australia (OPA) appreciates the opportunity to provide a submission to the Social Development Committee in relation to the provision of services for people with mental illness under the transition to the National Disability Insurance Scheme (NDIS).
Role of the Public Advocate
The Public Advocate is an independent statutory officer appointed by the Governor to fulfil statutory responsibilities assigned under the s21 of the Guardianship and Administration Act 1993 (GAA). The Public Advocate also has responsibilities under the Advance Care Directives Act 2013 and Consent to Medical Treatment and Palliative Care Act 1995 as well as the Mental Health Act 2009 and Powers of Attorney and Agency Act 1984.
The Public Advocate is supported by OPA, to promote the rights and interests of people who may need assistance with decision making.
OPA promotes rights through delivering our services. Services includes giving advice, finding alternatives to guardianship, advocacy, investigations, resolution of certain disputes and acting as guardian of last resort. These are delivered by a team of professional and administrative staff.
The general functions of the Public Advocate are set out in s21 (1) of the GAA:
a) to keep under review, within the public and private sector, all programmes designed to meet the needs of mentally incapacitated persons; b) to identify any areas of unmet needs, or inappropriately met needs, of mentally incapacitated persons and to recommend to the Minister the development of programmes for meeting those needs or the improvement of existing programmes; c) to speak for and promote the rights of any class of mentally incapacitated persons or of mentally incapacitated persons generally; d) to speak for and negotiate on behalf of any mentally incapacitated person in the resolution of any problem faced by that person arising out of his or her mental incapacity; e) to give support to and promote the interests of carers of mentally incapacitated persons; f) to give advice on the powers that may be exercised under the Act in relation to mentally incapacitated persons, on the operation of the Act generally and on appropriate alternatives to taking action under the Act; g) to monitor the administration of the Act and, if he or she thinks fit, make recommendations to the Minister for legislative change;
The Public Advocate may be appointed as the guardian (or joint guardian) of a person with mental incapacity but only if the South Australian Civil and Administrative Tribunal (SACAT) considers that no other order would be appropriate.
Please see submission to the Social Development Committee in relation to the provision of services for people with mental illness under the transition to the National Disability Insurance Scheme (NDIS).
It is important to note that whilst the Office of the Public Advocate (OPA) has approximately 250 clients with a primary diagnosis of mental illness, the percentage of these clients to transition to the NDIS remains low. Transition of psychosocial clients commenced in July 2018 and it is acknowledged that over the next 6 -12 months, the transition will increase and it is envisaged that after this time, the OPA will have a stronger sense of the issues facing clients with mental illness and the NDIS transition.
- The gap between the Federal Government’s predicted and realised percentages of mental health clients receiving NDIS support;
As stated, the majority of OPA psychosocial clients are yet to transition to the NDIS. To date, 22 clients have had a planning meeting and 6 have received a subsequent plan. It appears that the transition is taking longer for some clients than initially anticipated and for some clients this is causing unnecessary angst and confusion. The majority of clients have been aware of the NDIS transition for many months and having a level of uncertainty has in some cases caused clients to worry about potential reduction in support hours and/or being deemed ineligible for the scheme. Specific realised percentages of mental health clients becoming participants is yet to be established given the timing issues outlined above.
- 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 OPA recognises the value of peer workers and receiving support from carers and consumers with lived experience. A common theme for mental health consumers is feeling that they are not heard and feelings of disempowerment when navigating health systems. Despite only a low number of OPA clients and carers receiving support through the Personal Helpers and Mentors program (PhaMs) as well as the Mental Health Respite Centre, for the people that do receive this support, it can be invaluable. The OPA is yet to determine the impact that a reduction in funding to both programs will have given the transition for OPA psychosocial clients to the NDIS is in its infancy. Qualitative data to date indicates that the impact may be significant. More information about the impact will be determined as the scheme progresses and potential gaps in services, particularly in relation to peer support are evidenced.
- The effects on South Australians with mental health issues who are deemed ineligible to receive NDIS funding;
For many psychosocial clients, the prospect of transitioning to the NDIS is daunting and can be confusing. Clients have highlighted feelings of rejection and fear when deemed ineligible for NDIS funding. For many clients, regular support has kept them well and the thought of losing such support can have a negative impact on a persons’ wellbeing.
Given the low number of OPA clients who have transitioned to the scheme, the impact of ineligibility is yet to be determined. Of specific concern is Exceptional Needs Unit clients where diagnosis may be unclear and reports are outdated. This client group have historically
been ineligible for mental health services however have been in receipt of high level packages due to their complex support needs. Without ongoing funding this client group may be at higher risk of homelessness, involvement with Correctional Services and increased presentations to hospital. The OPA will continue to monitor this client group as well as the impact of ineligibility more broadly.
However, the OPA has been pleased with the number of clients deemed eligible for the NDIS after previously not receiving state funded support. This has been specifically observed for clients living in Supported Residential Facilities.
- The sufficiency of services provided to people with mental illness who are accepted in the NDIS;
It is difficult to gauge the sufficiency of services provided to eligible psychosocial participants given the low number of OPA clients who have transitioned to the scheme. The OPA is particularly interested in the capacity of Support Coordinators (including Specialist Support Coordinators) to work with complex clients with mental illness to implement their plans. Additionally, the OPA will closely monitor the use of restrictive practices by new providers as well as how providers respond to acute and crisis situations.
An area the OPA will closely monitor is the adequacy of services to deal with highly complex needs and the skill levels of services and workers. The pricing regime is a factor here where it may not be economical or sustainable for a service to deliver specialised services.
Another factor is the market readiness to provide such service, particularly in regional and remote areas. Many markets are underdeveloped at this point in time.
As the number of OPA psychosocial clients transitioning to the NDIS increases, more will be known about the capacity of the sector to respond to such issues.
- The effects on South Australian with metal health issues undertaking the application process for the NDIS;
The majority of OPA psychosocial clients have support either from their case manager or provider to assist them with the application process to the NDIS. Where a client does not have this support, in some cases a guardian is required to provide support and in a minority of cases, undertake this process in its entirety. Guardians involved with the application process have on occasions found it difficult to provide the required evidence to substantiate the functional impact of the persons disability. For some clients having current or up to date reports can be difficult to obtain and can be hampered by a persons’ previous experience of assessments and their resultant disengagement with services. Additionally, reports can be written in a rehabilitation setting where a person’s recovery and strengths are highlighted rather than the functional impacts of their disability and therefore do not always fulfil the eligibility requirements for the purposes of NDIS.
For some clients in custodial or forensic settings, demonstrating the functional impact can be even more of a challenge. In these situations clients’ recovery and stability may be as a result of the high level support they receive. Given their mental health has remained stable for many years, the functional impact of their disability can take time to become apparent and may only surface once high level support is reduced, for example in a community setting
In navigating the application process, guardians have found inconsistent skill and knowledge levels between NDIS workers. Whilst many workers have a commitment to client rights and choice, the impacts and episodic nature of mental health is not always fully understood. The OPA welcomes the introduction of a specific client pathway for mental health consumers that is currently under development. The impact of such a model will be more fully understood as OPA psychosocial clients transition to the scheme.
The ever changing landscape of the NDIS can be an additional challenge for guardians and clients accessing the application process. Further clarification regarding the required consent to access the scheme as well as the interface of guardian and nominee roles is required. This lack of clarity has led to unnecessary confusion and delays in access being met.
- Any other relevant matters;
The OPA recognises the importance of the NDIS is providing choice and control to clients living with mental illness. It is important for the NDIS to understand and recognise the episodic nature of mental illness and respond with flexibility in relation to eligibility to the scheme. Similarly, the benefits of clients receiving support from consumers and carers with lived experience has been widely documented and appropriate funding needs to continue to ensure that clients can continue to access such support.
The OPA is committed to ensuring the success of the NDIS and meets regularly with representatives from the NDIS, Mental Health stakeholders as well as interstate jurisdictions to troubleshoot issues as they arise as well as to ensure consistency both internally and externally. The OPA recognises that the transition for psychosocial consumers is in its infancy and the OPA welcomes the opportunity to work with key bodies to ensure clients are able to access a scheme which affords flexibility and is responsive to their needs.