Ms Robyn Schutte
Secretary, Social Development Committee
South Australian Parliament
PO Box 572, Adelaide SA 5001
robyn.schutte@parliament.sa.gov.au
Friday, 5 July 2019
Dear Ms Schutte,
Thank you for the opportunity to submit supplementary information supporting our November 2018 submission to the Senate Committee Inquiry into Mental Health Services and NDIS transition.
Neami National would specifically like to submit additional information after the announcement by SA Health in May 2019 of a 25% reduction to non-government funded mental health services from the 1st July 2019.
Until this point, a ‘letter of comfort’ had been received and ongoing messaging from SA Health that services from 1st July 2019 to 30th June 2020 would continue without reduction. This late change has a significant impact for staff retention, continuity of service for consumers and operational planning for mental health services and transition for eligible mental health clients to the NDIS.
Specifically, in relation to the points set out for the inquiry:
- The gap between the Federal Government’s predicted & realised percentages of mental health clients receiving NDIS support;
In addition to the November 2018 data provided by Central Adelaide and Hills Partners in Recovery (CAH PIR) consortium in our original submission, please find transition data from the consortium as at contract end June 30th 2019.
CAH PIR have supported 188 clients to test their eligibility for NDIS. Of this number, 73 have been found eligible for NDIS, 48 have been considered ineligible and 37 are pending decision. The remaining 30 consumers are now inactive with the program and therefore the NDIS decision is unknown.
For those found ineligible the primary reason was that permanent disability could not be established (44). In four cases we have been unable to determine the reason for eligibility not met. Of those found eligible (73), 32 are still waiting for their plans to finalised.
- The ongoing requirements for block funded mental health services provided by the State Government after the NDIS transition;
Neami National delivers the following services in metropolitan Adelaide and Country South Australia affected by the transition reduction targets:
- Individualised Psychosocial Rehabilitation Support Service (IPRSS)
- Housing Accommodation and Support Program (HASP)
- Day and Group Program.
Across these programs, despite diligent support to assist consumers with their NDIS applications:
- Only 16 % of the individuals have an NDIS plan in metro Adelaide (i.e. they have been through the full NDIS application process and received a plan)
- Only 10% of consumers in Country SA have an NDIS plan
- Few of these plans in metro and country SA are yet activated with a full set of services in place
- 15 % are not willing to apply in metropolitan Adelaide and 32% in country SA, this is despite all efforts, resourcing and support to assist and motivate individuals to do so
- 13 % of individuals have been deemed in-eligible
- The significant majority consumers are at various stages of the NDIS process from having submitted their application, through to awaiting a planning meeting
- The Neami consumer experience is that from point of application through to activation of a plan continues to take anywhere up to 6-10 months.
Neami still has significant numbers of people who are new to service, have recently become unwell and who as a result have yet to apply for eligibility to the NDIS. There are significant numbers of consumers who are:
- not willing to apply
- or have received plans that require review or have exited the program without an NDIS plan (will potentially re-appear in the mental health system).
Of concern is the higher rates of people living in Country SA declining to apply when mental health services are already scarce, despite Neami support workers encouraging and offering the support for these individuals to apply.
There is an ongoing wait list for all services and there is continued need and demand for the programs. Each time an individual is exited from these programs, there is another newly unwell person to take their place.
Consumers with high and complex needs, low capacity and high anxiety require intensive support throughout the transition. A change in support team, service provider and type of services received requires careful planning and management. Without this considered and nuanced time-consuming collaboration between the community mental health team, Neami and the new service provider, the risk is an individual returns to hospital or acute inpatient settings where many of our consumers have spent months or years of their lives.
Additionally, consumers with co-morbidities particularly with drug and alcohol issues are facing discrimination with access to the NDIS despite significant mental health issues as their abiding diagnosis and these clients are remaining the purview of a State system that is being reduced.
The reduction commencing in 2019/20 financial year is premature and creates significant risks to consumer service delivery and quality transition from State psychosocial services to the NDIS, resulting in a greater number of people living with significant mental illness needing hospitalisation due to the increased likelihood of acute relapse.
- The effects on South Australians with mental health issues who are deemed ineligible to receive NDIS funding;
Neami National operates the Street to Home service, which provides a housing first approach to assisting rough sleepers in the CBD into housing and support.
Over the past 12 months we have seen an increase in rough sleeping, as noted in Adelaide Zero Project Data, from 143 individuals in 2018 to 227 in 2019. Data demonstrates that 72 percent of these individuals are experiencing mental illness and our Street to Home team have seen an increase of people living with a disability and/or mental illness rough sleeping who have been impacted by the transition from block funded mental health (or disability) services to NDIS
One example was a young man sleeping rough in North Adelaide who experienced a range of issues associated with disability and mental illness. As recipient of Disability SA clients from a very young age due to being assessed as having mental and cognitive capacity of a 10-year-old, this young man did not have the mental capacity to make decisions on his own behalf. Without a service able to assertively support this young man to make an application or navigate the NDIS system to build and execute a plan he became homeless.
As a result of his homelessness, he was difficult to locate and engage with and so he was closed prior to being supported to access NDIS. This young man continues to be at high risk of exploitation, deterioration in health and was also exhibiting challenging behaviours with other community members. In spite of the best efforts of homelessness service providers his future housing placements come with great risk without the necessary supports in place needed to enable a successful transition to independent living and out of rough sleeping.
For this population group, more broadly, the lack of connection to services and supports to enable testing of eligibility and access to necessary evidence and documentation to support applications, will continue to have devastating impacts for the some of the most vulnerable people in our community.
The reduction of mental health services in 2019/20 is premature while the system continues to be under significant stress, resulting in people in high risk categories falling through the gaps when this could be avoided.
- The sufficiency of services provided to people with mental illness who are accepted into the NDIS;
As previously stated in our original submission, for those people who have received NDIS plans, the high proportion of core supports within plans continues not to be suitable or reflective of current evidenced based recovery-oriented capacity building service delivery approaches. Well known to be best practice in mental health psychosocial service delivery. Due to the nature of many symptoms associated with mental illness, much of the service delivery under block funded programs involve assertive engagement and follow-up which is not translated to an NDIS environment.
- Any other relevant matters.
Current SA Health non-government services have service agreements in place for a period of three months, ceasing 30th September 2019. There is no certainty of service agreements beyond this date. This is challenging in terms of workforce retention, ensuring continuity of supports for individuals, assuring families and individuals that they will not miss out on necessary services, and in future planning both operationally and financially.
This method of contracting is also not in line with SA Government DPC Guidelines, DPC Circular 044 applies to all ongoing and one-off funding.
This outlines a number of principles:
- Robust Planning and Design - ‘Public authorities and the NFP sector work together when planning and developing funding strategies to ensure outcomes are based on evidence of community need.’
- Collaboration and Partnership - ‘Where appropriate, public authorities offer longer term contracts (three years plus three years plus three years) to enable strong, ongoing relationships’
- Community Development Principles - ‘Where possible, and particularly in relation to health and community services, funding should reflect a community development approach which builds resilience in the community and the capacity to respond to change.’
Reductions to mental health services available to South Australian citizens in 2019/20 is premature given the following:
- Five Year Strategic Mental Health Plan – has not yet been released or implemented in SA.
- Victorian Royal Commission – has just commence and will deliver findings of their failed mental health services transition to NDIS in Nov 2020.
- Interstate Transition Learnings - contrary to Victoria, NSW and Queensland have increased investment in mental health services.
- NDIA are still in the process of implementing their Psychosocial Application and Planning Pathway.
Neami National continues to encourage and assist people who experience psychosocial disability to access the NDIS scheme and deliver NDIS services in South Australia through our subsidiary company Me Well. We are committed to working collaboratively with SA Health and other non-government partners to assist people to receive appropriate and quality services both via mental health or the NDIS system.
Please don’t hesitate to contact me on Ph: 0434 332 718 should you seek any further clarification or information.
Warmest Regards,
Kim Holmes State Manager SA Neami National