NDIA Accountability Project

Issues with NDIS Access and Support Worker Training for Mental Health Clients

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Bendigo Health Community Care Units

6th December, 2022

To whom it may concern,

We are writing to you to regarding the inquiry into the Capability and Culture of the National Disability Insurance Agency (NDIA).

We are staff (nurses, occupational therapists, social workers, mental health clinician, and medical staff) from the Bendigo Health Community Care Units (CCU). Our service provides residential psychosocial rehabilitation to people suffering from mental illness that has impacted their daily functioning. We aim ensure that residents have the skills and/or services they need to live independent lives when they leave our unit. This often involves completing assessments and NDIS access requests, supporting residents with planning meetings, helping them to find support coordinators and ensuring support workers are in place when needed.

We would like to bring to your attention the issues we have discovered in working with the NDIA as well as those employed to work under the NDIS.

1. NDIS access and planning

  • Due to the nature of mental illness it can be difficult for some people to seek help. There has been a number of instances where vulnerable and unwell people have finally decided to follow through with an access request, only for them to be rejected despite expertise evidence provided. This often has wider impacts on the individual’s mental health and may lead to them isolating more and declining to apply again.

  • At CCU we ensure that we support our residents with any planning meeting as due to the nature of some mental illnesses individuals may struggling with insight into their own needs and capabilities, or to advocate for themselves. This could lead to insufficient plans if the participants are not able to have someone with experience to support them.

  • When supporting participants with planning meetings we ensure that we advocate for or clients’ needs backed up by our own expertise from working in mental health. However, at times this experience and expertise is not considered by the NDIA planners. We have had experiences where planners have appeared to come into planning meetings with their own agenda and are not willing to hear other points of view.

2. Support agencies and workers

  • We often recommend that clients receive 1:1 support to support them to achieve their goals regarding everyday function and community engagement. However, when it comes time for the worker to engage they will not work with in the goals specified in the NDIS plan, or other plans that have been made. Workers will often do tasks for a client’s rather than with them or encouraging them to do for themselves, which is counterproductive to their recovery or NDIS goals.

    • Examples: client getting their worker to clean their unit for them rather than working together, worker then not having the understanding, confidence, training, or motivation, to overcome this.

  • Support workers appear more focused on “not being fired” rather than ensuring clients are enabled to do their own tasks. When CCU staff have tried to work with support organisations to have workers to work within recovery framework and not just do things for clients, these organisations have pushed back and complained to management - citing that it is the participant’s Choice and Control.

  • Some workers appear not to do any planning with their participants on what they will do and this can end up with poor rapport and wasted support hours. On several occasions workers have attended CCU, sat in the unit with a client and watched movies rather than do any daily tasks or community activities and then would often leave early due to client boredom.

    • Example: a worker attending CCU to see a client then proceeding to eat the clients food and drink, then sit and watch TV, this made the client uncomfortable but without the confidence to speak up.

  • There is currently no training to be a NDIS support worker which means these workers are not prepared to work with mental health clients. This often leads to poor outcomes as they do not understand that the clients often need support to build motivation. Or alternatively not enough information is handed over to worker to know how to work effectively with clients.

  • Support workers are often not aware of relevant risk factors regarding participants which can put both themselves and the participants in danger.

    • Example: a young female worker sent to work with a participant who is a registered sex offender without any prior information given. The worker

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would often be alone with the participant including secluded bush walks. Until CCU intervened and requested a new worker.

  • There has been many instances of last minute changes or cancellation for participants that, can lead to a feeling of rejection or of disillusionment for the individual. Often they may have a new worker each time which brings up issues of both rapport and planning, as the worker does not know the person, their needs or goals.

Support coordination

  • We have had experiences of inappropriate behaviour from support coordinators and professional boundaries crossed. There appeared to be some with minimal taining or qualifications or understanding of mental health needs.

    • Example: A support co-ordinator was letting her patient stay with her and charging her rent. The patient was placed in a vulnerable position with a predatory male also on the property. This was a definite conflict of interest and crossing of boundaries. It was the Support co-ordinators’ own start up, there seemed to be no rules or oversight. The only people who were concerned was CCU staff. The individual ended up leaving after a few weeks and returned to CCU. We had a lot of trouble getting the pts’ possessions back from the support co-ordinator

  • There had been a push recently for mental health participant to have recovery coaches instead of support coordinators, however we have found that there is miscommunication of job description. Where recovery coaches to not believe that they have to coordinate the care for their client rather just be a mental health worker/counsellor, this has left client with little to no support with what was asked in the planning meetings

    • Example: a recovery coaches completing of 7 visits over 10 weeks leading up to discharge from CCU however nil planning made for post discharge, making no support companies or services were engaged.

These issues outlined above cause great concern for us at CCU as we can see how participants who do not have someone or a service such as ourselves to advocate for them, they may not be in a position to be properly supported by the NDIS or at worse,taken advantage of when (they) are in a vulnerable state. We would also recommend and encourage that NDIA planners are required to take on the expertise and recommendations. As well as to ensure that participants always have an advocate present during their initial planning meeting.

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We would highly encourage that there be mandatory training or qualifications for support workers to engage in work with participants who have mental health disorders.

Mental Health clients are some of the most vulnerable members of our society. It is imperative that the NDIA ensures that these participants are able to be supported in their recovery by the NDIS and that there are safe guards in place to ensure that they are treated with the respect that they deserve.

We hope that this Parliamentary enquiry will enable to NDIA to address the many issues that are faced by not just the mental health participants but all NDIS participants and will allow for better care for all.

Yours Sincerely Bendigo Health CCU Staff