Submission

This submission outlines my experiences of trying to access support and services from the NDIA.

I am a 56 year old woman living with a major depressive disorder with concomitant anxiety, anorexia and bulimia, complex PTSD, and a borderline personality disorder.

On 8 June 2018 I became a participant on the NDIS, however dental services were not included in my plan. Dental treatment to correct issues resulting from my long standing and severe anorexia and bulimia nervosa is integral to my goals to engage in the community and employment, and an important part of improving my mental and emotional wellbeing. Therefore, I requested a review of my plan to include the required dental treatment. This review denied my request for dental treatment to be included in my plan as the NDIA did not consider the dental treatment as reasonable and necessary, or value for money. The NDIA deemed that the dental treatment could be accessed through the public system, despite specialist psychiatric and occupational therapy reports supporting my need to access private dental services due to my complex PTSD, a NDIA accepted disability.

I appealed this decision through the Administrative Appeals Tribunal. However, before the matter went to hearing, the NDIA settled the matter granting me funding for a personal trainer and permission for me to obtain a quote for the required dental treatment.

This decision was communicated to me by the NDIA in a way that did not make it clear that the approval was not for dental treatment, but for a dental quote only. My initial understanding was that funding was granted for both a personal trainer and dental treatment.

This miscommunication caused me considerable psychological distress, exacerbating my reliance on self-harm and binge eating/vomiting to cope with the distressing feelings.

As the decision did not grant funding for dental treatment, I again began a process of appealing the decision through the Administrative Appeal Tribunal in 2020.

This appeal has been an arduous process over more than 2 years, which has created considerable distress for me. The process to prepare for the hearing was incredibly onerous. Throughout the process of this appeal I have had to facilitate on my own, while the NDIA had a barrister, lawyer, and NDIA case manager. Although I was eventually able to secure the support of a disability advocate from the Rights, Information and Advocacy Centre, this was not legal advocacy. Overall, I have felt this legalistic and adversarial experience was dehumanising and the power imbalance of being questioned by multiple lawyers was retraumatising. The whole process was not trauma-informed, resulting in heightened anxiety and increased reliance on self-harm to cope.

Throughout the process I felt my eligibility to the scheme was being questioned, and that I needed to prove all my illnesses to the tribunal. My private sexual trauma and abuse material was brought into question, and the seriousness of my conditions were subject to scrutiny by unknown professionals. My right to privacy was breached as private psychiatric reports were requested to be provided to the tribunal. Moreover, having to sit through discussions of my history was triggering and upsetting, and I needed to leave the room during these times. These experiences made me feel invalidated and not listened to. The resultant anxiety and distress led to increased reliance on self- harm to cope.

Furthermore, stating that the requested dental treatment is not ‘value for money’ is an insult to a person with a disability. To be told that I am not “value for money”, is disheartening and it gives me the message that “you are not worthy enough”.

I found online hearings over Zoom difficult as I never got to see the lawyers who were in the zoom hearing, as their faces were always hidden. When the hearings were in person in Melbourne, this necessitated me outlaying for the expense of travelling from my home in regional Victoria to Melbourne, and overnight accommodation in Melbourne.

Ultimately the protracted legal process cost far in excess of the requested dental work, and I was left feeling broken and with no support.

Changes to the capability and the culture of the NDIA I would like to see –

• Staff to better understand the distinction between physical and psychiatric illnesses. There are no diagnostic tests in psychiatry (no blood tests, scans, etc) which can be used to “prove” psychiatric illness.
• Participants have access to legal representation to reduce the power imbalance when undergoing review processes.
• NDIA staff be trauma informed.
• NDIS processes be changed to reflect a trauma-informed approach.
• NDIA staff ensure participants receive information in a timely manner.
• Outcomes of reviews be explained in a manner that ensures participants are clear on the outcome.

I would like to thank the Joint Standing Committee for this opportunity to share my experience and express how it has felt through the whole Appeals Tribunal Process.

Letter of Support –

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   15th of December, 2022.

                      To Whom It May Concern:

 Dear Sir/Madam,

      I am                  treating Psychiatrist.             was initially referred to me in
 November of 2004.

      I understand that                     is preparing a submission to the standing committee into
  NDIS, and has asked me to contribute some comments of my experience of dealing with
 NDIS/NDIA on her behalf.

                   suffers from a borderline personality disorder (or complex trauma), major
  depressive disorder with concomitant generalised anxiety, post-traumatic stress disorder,
 and an eating disorder (bulimia nervosa and anorexia nervosa).

        had applied to receive NDIS benefits four years ago (2018). There have been
 numerous issues/problems with the process and the outcome for              .

   First of all,                     is one of my most unwell and chronically disabled patients, and
  requires regular consultations with a psychiatrist, GP, dietician, support workers and a
 mental health nurse.        has been accepted for the Disability Support Pension
  following a rigorous assessment process by the Government, which in my view
 demonstrates her level of disability.       had been placed on the Magellan
  list/program in Victoria as a survivor of severe domestic violence.

  Despite all this,            first application to the NDIS was rejected due to lack of evidence
  of disability. This was despite a number of letters/reports from myself and her general
  practitioner detailing the evidence of          psychosocial disability. It seems that the
 NDIS is specifically designed to exclude medical evidence of illness/disability.

When was eventually accepted into the NDIS, despite a good overall level of funding available, the NDIS refused to pay for certain benefits such as psychotherapy, gym membership/swim membership and exercise physiology, dental treatment and so on. It seems that the funding was allocated into a number of different “pools” of money and despite overall funding being adeqate, the allocation to incorrect “pools” made it impossible for to access the benefits she needed. There was never any explanation at the commencement of NDIS funding as to what these “pools” of funding were and how they could be used appropriately.

When asked for a review to re-allocate her funding, the process took many months. I spoke to the head of NDIS quality team during this process to enquire how long it was likely to take to be told that there were no staututory timeframes for a review, and it could take as long as it takes (possibly many months). I understand that this has now been amended and that there are now acceptable timeframes for a review to take place.

        was not satisfied with the outcome of the review, and appealed the

NDIS/NDIA refusal to fund certain services/treatments in the AAT. This required legal representation, and had a great deal of difficult to secure any funding for legal services.

Eventually, was granted funding for some services (such as gym membership/exercise physiology, etc), and was directed to get a quote for dental treatments by the tribunal. If there was no way that the NDIA/NDIS would ever fund dental treatment, why was directed to obtain a quote for dental services in the first place?

Despite some services being approved, struggled to get her NDIS coordinator to organise and arrange payments for these services (they kept refusing, saying that such services could not be funded by NDIS despite a tribunal decision to grant funding for these ervices).

Eventually, she had to return for further AAT hearings to resolve her ongoing dispute regarding funding for dental treatment.

Each hearing (and I believe there were 4 in total) took many months to arrange, and there seemed to be no continuinty of evidence. Each time the ribunal made reuests for the same information regarding to be provided.

In one of my reports in September of 2021 I wrote: “Please note that this is now the 3rd or 4th AAT hearing regarding essentially the same issues for .”

On the 28th of January 2020 the AAT made a determination that should attend for the purpose of:

i) Making recommendations as to the dental health supports that the applicant requires, and Assessing whether those dental health supports are related to the applicant’s ongoing functional impairment and would enable the applicant to undertake the activities of daily living. i i) A functional assessment in relation to functional capacity in daily living skills, as well as any limitations in relation to her attending publicly available dental services by (Occupational Therapist)

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This is now over 18 months ago. All of the above information has already been provided to NDIS/NDIA and their lawyers in a number of different reports from myself, and her GP, and dietician, and mental health nurse and dentist and occupational therapists over the past 3 years (my first report regarding this was dated January 2018). Therefore, Iam uncertain as to why this matter is under review again, and why this could not have been handled in an efficient and timely manner as this matter has now dragged on for over 3 years causing considerable distress to and duplication and waste of resources.”

Although the NDIS was supposed to be a “no fault” insurance scheme, their lawyers requested to attend for an independent medical examination by an NDIA appointed psychiatrist. The implication was that all the information provided by myself and her general practitioner and dentist over the years was biased and invalid, and not to be trusted. When refused to attend such an examination, the NDIA requested access to full medical/psychiatric history. felt that this was a gross invasion of her privacy.

Eventually, we agreed on only the last 5 years of medical records being made available to the NDIA. A copy of my notes was then perused by a forensic psychiatrist , who (based only on my own records) disputed my assessment of illnesses and treatments required.

My understanding is that the NDIS is a “no fault” insurance scheme, therefore, | believe that did not have to “prove” why she suffers from certain disabilities/handicaps.

It took the best part of 4 years to achieve closure for , and the process has been quite traumatic and anxiety-provoking for her. In the end, the funds which were wasted in the legal dispute would have paid for requested treatments many times over.

Yours sincerely,

Consultant Psychiatrist.