DOCUMENT 2 FOIOFFICIAL23/24-1328 SGP Knowledge Article Template For Internal Use Only
The contents of this document are OFFICIAL. Guide – Psychosocial disability
This article provides guidance for a planner delegate, internal review delegate, national reassessment delegate, local area coordinator, early childhood partner, technical advisors, liaison officers (HLO/JLO) or complex support needs (CSN) planner to understand: • what is psychosocial disability? • how to recognise psychosocial disability • the social model of health • diversity and social inclusion • the recovery approach • trauma informed support • recovery based language • what is a psychosocial recovery coach? • things for planners to consider • forensic patients • the functional impact of mental health conditions.
You can also refer to the following articles: • Guide – Psychosocial disability – Case examples • Guide – Psychosocial disability – Appendix A – Discharge planning • Guide – Psychosocial disability – Appendix B – Definitions • Guide – Psychosocial disability - Appendix C – Guide for decision makers.
Recent updates October 2023 Current guidance. Before you start You have read and understood:
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FOIOFFICIAL23/24-1328 SGP Knowledge Article Template For Internal Use Only • Our guideline - Reasonable and necessary support (external) • article Guide – Complex Support Needs (CSN) Pathway.
What is psychosocial disability? Psychosocial disability is the term used to describe the experience of people with impairments and participation restrictions related to mental health conditions. The NDIS considers mental health conditions to be a broad term that describes many different disorders, illnesses, and syndromes. While not everyone with a mental health condition will experience psychosocial disability, those that do can experience severe psychological effects and social disadvantage (National Mental Health Consumer and Carers Forum, 2011). This Guide focuses on best practice models of psychosocial support, including promoting individual recovery for the participant and person-centred practice to work towards bridging the gap between medical and social models of recovery. Gaining a better understanding of mental health recovery, recovery language and what recovery oriented means, allows you to: • promote a culture and language of hope and optimism • develop your capabilities to support people with psychosocial disability • encourage participants to recognise and take responsibility for their own recovery and wellbeing to enable them to define their goals, wishes and aspirations.
How to recognise psychosocial disability Psychosocial disability differs from other disability types in that it is episodic and fluctuating in nature. It may be difficult to identify and understand compared to other disability types because: • it cannot always be seen or observed • there is a strong relationship between mental ill-health and psychosocial disability in which each impacts on or can cause the other. Mental illness describes a broad range of conditions with different symptoms, treatments and recovery journeys • the experience and impact is different for every individual.
Social Model of Health The social model of health examines all the factors that contribute to health, such as social, cultural, economic and environmental factors. It differs from the medical model of health that
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FOIOFFICIAL23/24-1328 SGP Knowledge Article Template For Internal Use Only only considers whether a disease or condition is present or not. Psychosocial disability crosses both social and medical recovery models and affects the participant’s ability to participate fully in life (Report: Psychosocial Capability in the NDIA). People with psychosocial disability are more likely than the general population to experience: • poor physical health and suicide • lower levels of employment and education • limited positive and supportive relationships • trauma and discrimination that further reduces access to health care, housing and other mainstream services.
The NDIS supports participants to identify what support they need across all areas of their life and maximise their opportunities for social and economic participation. Diversity and social inclusion A socially inclusive society is one where all people feel valued, their differences are respected, and their basic needs are met so that they can contribute in a meaningful way. Understanding diversity, social inclusion and the social model of health will enable you to: • identify and address the particular socioeconomic barriers faced by the participant with psychosocial disability, and how some of these differ from other disability types • recognise and address attitudinal barriers including stigma and discrimination • identify the reasonable and necessary supports that will support the participant to achieve their goals including employment, education, housing and social supports • support better access to and outcomes from mainstream services for the participant.
Aboriginal and Torres Strait Islander people often perceive their health in the context of the social, emotional and cultural wellbeing of the whole community rather than in terms of their own physical and mental health. They may not accept the language of mental illness and disability. The impact of wellbeing is influenced by their connection to land, culture, spirituality, family and community. Refer to the Guide – Aboriginal and Torres Strait Islander Planning Support to develop strategies and consider how you can support Aboriginal and Torres Strait Islander peoples to achieve the best possible outcomes. The recovery approach
What is recovery?
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FOIOFFICIAL23/24-1328 SGP Knowledge Article Template For Internal Use Only The term ‘recovery’ is used widely throughout the mental health sector and has different meanings for different people. People who experience psychosocial disability may describe themselves as being on a ‘recovery journey’. In the NDIS, recovery is achieving an optimal state of personal, social and emotional wellbeing, as defined by each individual, whilst living with or recovering from a mental health condition. Clinical recovery and personal recovery are quite different: • Clinical recovery is based on the medical model of health and is the treatment of impairments and the minimisation of symptoms of mental health conditions. • Personal recovery is based on the social model of health and is living a meaningful life and being able to contribute to a community within the limitations caused by a mental health condition.
When people talk about their mental health recovery, they are actively seeking to have a sense of purpose and meaning in their life, despite the symptoms, impairments and disability their condition may bring. An understanding of the recovery approach allows you to communicate in an appropriate, strengths-based manner and use recovery based language throughout the participant’s experience with the NDIS. Recovery is an individual and unique process. It is defined by the person and driven by their needs and choices. Recovery involves: • having hope • being motivated • feeling optimistic about the future • having the skills and strategies to manage the challenges the participant may experience.
Trauma informed support When engaging with the participant it is important: • to be aware they may have experienced trauma • to understand how trauma can impact on their capacity and willingness to participate in planning meetings, particularly discussing their goals and thinking about their progress.
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FOIOFFICIAL23/24-1328 SGP Knowledge Article Template For Internal Use Only Trauma may not be immediately obvious and can be hidden under the surface and triggered by seemingly normal situations. It is important to remember that many participants with a psychosocial disability have had an experience with trauma. You will need to tailor your communication accordingly. The impact of trauma is different for every individual. It can be experienced as: • a high state of alert emotion • a sense of numbness and avoidance • headaches and fatigue • anxiety and depression • nightmares • sleeping and eating issues • misuse of alcohol or drugs.
It is important to listen to the participant’s experiences and respond to each situation accordingly to recognise where specific discussions or experiences may trigger a trauma response. Recovery based language It is important to use language that conveys hope and optimism to the participant and to support and promote a culture that fosters recovery. For example, use the term ‘person with a mental health condition’ rather than ‘mentally ill person’. The following resources will help you to understand and use recovery language: • Recovery orientated language guide (external) produced by the Mental Health Coordinating Council (MHCC) • Reimagine website (external).
Over 90% of our communication is non-verbal, comprising body language, non-verbal cues such as nods and smiles and tone of voice. When communicating with the participant you should focus on: • your non-verbal communication as well as the language you use • the participant’s age, hearing, cognitive or language needs • being authentic, transparent and sincere.
Note: Suicidal or self-harm related thoughts or statements must be taken seriously and are considered to be a participant critical incident. You should use the Participant Critical Incident
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FOIOFFICIAL23/24-1328 SGP Knowledge Article Template For Internal Use Only Framework to determine the necessary and appropriate actions to undertake if you become aware that the participant is threatening or attempting self-harm. What is a psychosocial recovery coach? A psychosocial recovery coach (recovery coach) is a qualified mental health worker and through their own experiences and training, understands mental health and its impacts. They can support the participant to build confidence and motivation, foster hope and build capacity to achieve their goals and use their supports to live a full and contributing life. A recovery coach will also support the participant to understand how the NDIS operates within a broader ecosystem of supports including mainstream and community supports. With support from a recovery coach, it is anticipated that over time, the participant will be able to build their capacity in areas of their life which will then mean they require less support overall to achieve their goals. This could see a decrease in other reasonable and necessary supports in their plan.
Recovery coach types There are two types of recovery coaches. The participant can decide which type of recovery coach they feel will be the best fit for them. Both types of recovery coach have qualifications, training and experience working in the field of mental health. You should understand and discuss with the participant which type of recovery coach might best suit their individual needs. This may depend on a number of factors: • the participant’s stage in their recovery journey • whether they feel more comfortable with a recovery coach who has lived experience of psychosocial disability • other personal preferences that may influence their decision.
The two types of recovery coach are:
- Lived Experience Recovery Coach – with lived experience competencies.
- Psychosocial Recovery Coach – with learnt experience competencies. A lived experience recovery coach, in addition to their formal qualifications has lived through their own experiences with mental health and recovery. They will draw on their personal understanding of mental illness and its impacts when working with the participant. They are able to disclose their lived experience in a purposeful manner to build rapport and a trusting relationship with the participant. This allows them to better understand how the
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FOIOFFICIAL23/24-1328 SGP Knowledge Article Template For Internal Use Only participant may be feeling and they can use that understanding to support the participant on their own recovery journey.
How a recovery coach will work with the participant The participant may not have had this type of support before. They may ask you about the type of support a recovery coach will provide and what benefits they may get from this additional support. It is important that you understand and discuss the role with the participant so they understand how a recovery coach will support them to pursue their goals and live a full and contributing life. Discuss the below points with the participant and explain how the recovery coach will support them in their recovery, engagement with the NDIS and other supports. A recovery coach will support the participant to build their capacity and positive relationships in the community, which in turn will reduce the intensity of supports required in the future. A recovery coach will work with the participant to: • develop a recovery-enabling relationship with them, their families and carers. This relationship will be built on trust and a shared understanding of the participant’s goals and needs so they can work through the ups and downs of a recovery journey together. • develop and maintain an individual recovery plan. The Recovery Plan will support the participant and optimise available resources (including their NDIS funding and clinical mental health services). • provide recovery coaching. A recovery coach will engage with the participant and support them to take more control of their lives. Supporting the participant to better manage the complex challenges of day to day living and articulate and own what a contributing life means for them and their families, and carers. • coordinate services and support them to access a range of different resources and services in a way that helps them work towards their goals identified in their Recovery Plan. • complete progress reports to demonstrate that supports are meeting participant expectations and needs. The recovery coach will provide progress reports to the participant and NDIS at agreed times. Progress reports will outline how NDIS funds and other resources are being effectively utilised to progress goals identified in the participant’s Recovery Plan.
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FOIOFFICIAL23/24-1328 SGP Knowledge Article Template For Internal Use Only • engage with the NDIS by developing their knowledge and skills in navigating the NDIS, self-advocacy and fund management so they become an active participant.
Things for planners to consider
Planning for episodic conditions The symptoms of psychosocial disability may be episodic and vary in intensity and need for support. To allow the participant to manage these needs, you should: • ensure Core support categories are flexible so supports can be increased or decreased as necessary • explain plan flexibility to the participant and their informal supports so they understand how to use their plan funding flexibly • explain that if they are hospitalised, some of their NDIS funded supports (for example Core supports) may not be available to them while they are an inpatient. The supports can start as soon as they are out of hospital.
Supports to consider Funded supports should be considered in the context of: • A focus on capacity building and individual skill development. Many people with a psychosocial disability have had little or no access to skill-based assessments and supports that build their individual capacity. • Identifying support needs based on the whole of person. The participant may experience social isolation and may not have informal support networks to help them engage with mainstream, community or funded supports. The participant will likely need support to implement their plan. • The impact both regular and irregular supports may have on maintaining the participant’s wellness. Funded supports for domestic assistance, and/or assistance with self-care and community access, could all be integral to supporting the participant to maintain their overall wellness, even if they are only used episodically.
Capacity building supports These may include:
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FOIOFFICIAL23/24-1328 SGP Knowledge Article Template For Internal Use Only • improved daily living skills. For example, assistance with decision making, daily planning and budgeting • improved relationships. For example, individual social skills development • increased social and community participation. For example, life transition planning including mentoring, peer support and individual skill development • improved living arrangements. For example, assistance with applying for accommodation and tenancy obligations
Capacity building – Recovery coach Support by a recovery coach who will work with the participant to: • build capacity and resilience • manage the complex behaviours involved with psychosocial disability issues • improve social and economic participation • identify, plan, design and coordinate supports • plan and maintain engagement through periods of increased support needs
Capacity building – Support coordinator Support by a support coordinator to • connect with informal, mainstream and/or funded supports • maintain support relationships • resolve service delivery issues and points of crisis (LAC or support coordination depending on the participant’s individual circumstances). Note: some participants may already have a support coordinator and may choose to continue working with their support coordinator rather than changing to a recovery coach.
Core supports Support to assist the participant to manage activities of daily living: • personal care • community access • attending appointments • shopping, household and health management.
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FOIOFFICIAL23/24-1328 SGP Knowledge Article Template For Internal Use Only For a breakdown of supports generally funded by the NDIS, and supports generally funded by other parties, refer to the article Guide to psychosocial disability - Appendix C. Note: The NDIS does not fund supports for clinical treatment related to mental health conditions. Forensic patients In cases where the participant is in hospital or detained in a secure mental health facility there may be further planning considerations you need to take into account. Participants who are in a secure mental health facility may be forensic patients. Forensic patients are people who: • have been found unfit to be tried for an offence (whether or not a special hearing has been held) and ordered to be detained in a correctional centre, mental health facility or other place • have gone through a criminal trial or a special hearing and are ‘not guilty on the grounds of mental illness’ (Mental Health Coordinating Council).
Please refer to articles Guide to psychosocial disability – Appendix A for information related to participants involved with the criminal justice system. For example, incarcerated and pending release. Functional impact of mental health conditions Funded supports must address the impact of the participant’s functional impairments. Supports associated with treating the symptoms of the mental health condition is considered clinical treatment and remains the responsibility of other mainstream service systems. For example, if a participant experiences symptoms of panic or paranoia when using public transport and accesses Cognitive Behavioural Therapy to address this, the provision of this support would be the responsibility of the health system. The NDIS could fund capacity building supports (Increased Social and Community Participation support category) to support the participant to build capacity to use public transport with the aim of independent travel. This may include support with trip planning, understanding transport systems and developing strategies to manage when trips don’t go to plan. For further examples of symptoms and related functional support needs, please refer to pages 7-8 in NDIA’s Completing the access process for the NDIS: Tips for Communicating about Psychosocial Disability (external) for individuals with psychosocial disability. Next steps
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FOIOFFICIAL23/24-1328 SGP Knowledge Article Template For Internal Use Only
- For guidance on how to add psychosocial recovery coach funding to a participant’s plan, refer to article Add psychosocial recovery coach funding.
- For guidance on how to add support coordination funding to a participant’s plan, refer to article Add support coordination funding. Article topics and case names – internal use only
Topics This article relates to the following topics: • Add: t_complaintsandcriticalincidents • Add: t_complexsupportneeds • Add: t_implementation • Add: t_planchanges • Add: t_planmanagement • Add: t_psychosocialdisability • Add: t_reasonableandnecessary • Add: t_reviewingdecisions • Add: t_safeguarding
Case names You can use this guidance for the: • Add: dc_case_checkin • Add: dc_case_evidenceextension • Add: dc_case_functionalcapacityassessment • Add: dc_case_hospitaldischarge • Add: dc_case_internalreview • Add: dc_case_participantbudgetupdate • Add: dc_case_participantcriticalincident • Add: dc_case_participantriskassessment • Add: dc_case_planapproval • Add: dc_case_planchange • Add: dc_case_planimplementation
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1.0 CS0074 |Class 1 approval APPROVED | 2022-11-18 1.1 MGC723 |Updated to make sure content is DRAFT 2023-08-23 transferred from PG — Psychosocial Disability. Minor updates to change any NDIS Business System language to PACE language. 1.2 REB563 | Updates to formatting in alignment with DRAFT 2023-09-13 new Knowledge Article template. Links and article references updated. 2.0 JS0082 |Class 1 Approval APPROVED | 2023-09-21 V2.0 2023-09-21 Guide — Psychosocial disability Page 12 of 12
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