NDIA Accountability Project

Psychologists' Contribution to the National Disability Insurance Scheme

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Australian Psychological Society

Level 11, 257 Collins Street

30 June 2023 Melbourne VIC 3000 PO Box 38

Flinders Lane VIC 8009 T: (03) 8662 3300

Committee Secretary

Joint Standing Committee on the National Disability Insurance Scheme PO Box 6100

Parliament House

Canberra ACT 2600

Submitted online: https://www.aph.gov.au/Parliamentary_Business/Committees/OnlineSubmission

Dear Committee Secretary

Australian Psychological Society Submission to the NDIS General Issues Inquiry

The Australian Psychological Society (APS) welcomes the opportunity to provide a submission to the Joint Standing Committee on the National Disability Insurance Scheme’s General Issues Inquiry. As the peak body for psychology in Australia, we are dedicated to advancing the scientific discipline and ethical practice of psychology in the communities we serve and to promote good psychological health and wellbeing for the benefit of all Australians.

Our submission is informed by results from our recent survey of almost 800 APS members - the majority of whom work with NDIS participants - about their experience of providing NDIS services. One key finding is that psychologists as a whole remain strongly committed to the aims and values of the NDIS. Members commented on the “life-changing” impacts and effective outcomes that they have witnessed in participants as a result of the interventions and supports provided through the NDIS. Psychologists noted that when it is working effectively, the NDIS has been able to provide participants with the ability to access consistent, holistic, evidence-based and targeted supports - including psychological supports - where this was not possible in the past.

Nonetheless, almost three-quarters of members responding to the survey felt that the NDIA and NDIS planners did not understand the role and scope of psychologists. Importantly, psychologists reported that this lack of understanding directly resulted in policy and planning decisions which are not aligned with participants’ level of need for psychological support, to the detriment of participants themselves.

The APS has previously commented on these challenges and will continue do so in future submissions. In this submission, however, we have chosen to highlight five areas where psychologists make a significant contribution to the NDIS. Recognising and strengthening the contribution of psychologists is critical as part of our shared and ongoing commitment to the NDIS in the second decade of its operation.

1. Psychologists have a wide-ranging, responsive and participant-led contribution to the NDIS

As our survey results showed, the ways in which psychologists work within the NDIS are as varied as the Participants within the Scheme. Some of the most common NDIS-related services provided by psychologists include:

  • Providing individual and group-based therapeutic supports to promote capacity and independence;
  • Conducting assessments (including cognitive, neurodevelopmental and psychosocial) and providing reports to planners, NDIA and other health and disability practitioners;
  • Specialist Behavioural Intervention Support;
  • Early Childhood Interventions;

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  • Parent support/training and family systems supports, for parents and families of a child with disability;
  • Participating in multidisciplinary/team care arrangements for NDIS participants;
  • Coordinating and facilitating supports for participants with other professionals or agencies, or with the participant’s planner, support coordinator, local area coordinators (LACs) or the NDIA;
  • Supporting their clients in understanding and applying for the NDIS;
  • Providing supervision to psychologists and other NDIS providers;
  • Design and delivery of NDIS or disability-related training and professional development activities; and
  • Conducting research and development of the evidence base in relation to disability and NDIS supports.

Members reported through their survey that a sizeable proportion of their NDIS-related time is ensuring that the psychological services they provide are integrated with participants’ overall supports, goals and needs. Our survey results also showed psychologists provide NDIS-related services from a variety of settings, ranging from solo or small practices, to leading large multidisciplinary NDIS-focused practices, or working within public and community health organisations. One theme from our survey results was that psychologists are dedicated to working flexibly and persistently in order to help participants achieve their goals through the provision of meaningful, consistent support.

2. Psychologists work to promote the functional capacity and independence of NDIS participants

Psychologists are experts on mental health in the broadest sense. According to the World Health Organization:

“Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in. Mental health is a basic human right. And it is crucial to personal, community and socio-economic development.”1

There is close alignment between this definition of mental health and the objectives and values of the NDIS. This means that in addition to addressing psychological disorders and problems, psychologists work to promote participants’ ability to live a meaningful and fulfilling life with both independence and connection. Therapeutic supports and interventions provided by psychologists through the NDIS are therefore always in the service of ultimately promoting a participant’s functional capacity, and through this, achieving their goals and hopes.

Psychologists often work with NDIS participants in relation to managing significant life transitions, adapting psychologically to changes in functional capacity in other areas of their life (e.g., for participants with a degenerative condition), understanding the impact of their developmental experiences (including developmental trauma and relationship difficulties), and addressing the effects of stigma, discrimination and systemic barriers within a social model of disability.

Psychologists promote the mental health and social and emotional wellbeing of NDIS participants through the application of evidence-based practice (which is a combination of the application of the best available research evidence, the psychologist’s clinical expertise, and an approach which is guided by the participant’s values, culture and preferences). Psychologists do this in collaboration with other NDIS supports and providers, drawing on other strengths as outlined below.

3. Psychologists work effectively with complexity by applying their skills in case formulation

Psychologists are highly trained in working with a person within the complexity of their personal, social, environmental and institutional systems, while not losing sight of their values, preferences and strengths. This professional competency is essential for supporting NDIS participants to realise their goals in a coordinated, person-centred and goal-directed way.

Psychologists have particular expertise in case formulation or case conceptualisation, which is a structured way of drawing on psychological theory and evidence to make sense of a person and their needs in a way that is coherent, contextually-sensitive and personally meaningful to the participant and other people involved in their support.2–5 Psychologist typically operate within a biopsychosocial framework in developing their formulation or conceptualisation, which recognises the ever-changing and interconnected contribution of biological/genetic, psychological and social/environmental factors relevant to a person’s problems, strengths and goals.

Psychologists develop their formulation or conceptualisation collaboratively with participants by drawing together disparate strands of information from multiple sources. This information might include the participant’s description of their experiences and history, psychological assessments, reports from other health and disability

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practitioners, and information from other people (such as family members, teachers and support workers). By doing so, psychologists can provide a way for the whole system to better understand the person at the centre.

This ability to integrate complexity and to make sense of it for the participant and others to understand is particularly beneficial where there is a combination of disabilities and other presenting issues (e.g., the presence of a neurodevelopmental condition, physical disability, mental health problems and adverse childhood experiences). Rather than focus on discrete problem areas or diagnoses, psychologists work with participants to understand the relationship between these issues and to develop an integrated approach to psychological and other supports which help participants to make progress towards their goals.

Psychologists are also uniquely positioned to understand and work with complex family systems, including where multiple members of a family are NDIS participants. Within a biopsychosocial formulation, psychologists can work with the system as a whole and work to achieve both the overall and individual needs and goals.

Psychologists are mindful of the challenges of working with complexity. By receiving regular supervision, engaging in peer consultation and participating in continuing professional development – which are essential components of ethical and professional standards for psychologists’ practice – psychologists working in the NDIS have multiple opportunities to reflect on their practice, continually learn about working in complex systems, and maintain a sense of openness, curiosity and humility about their work. By providing supervision to other NDIS providers (which includes non-psychologists), psychologists can help other professionals to develop their capacity for work within complex systems, and to deepen their understanding of the psychological aspects of a client’s experiences, support needs and goals.

4. Psychologists help clients to form the capacity and relationships needed to engage with the NDIS

For many NDIS participants, navigating the ‘system’ and managing the multiple administrative touchpoints which surround their supports can be both a significant challenge and an empowering new opportunity.6 While choice and control are critical pillars of the NDIS, the ability and need to exercise these (especially for the first time) can be a psychologically significant situation for which support is often sought by participants. This is reflected in the experience of one NDIS participant quoted in the Summer Foundation’s 2022 survey of people with disability:

“The NDIS helped pay for my psychology for my disabilities for 3 years which is essential for me being able to engage with NDIS at all, and being able to access essential services and be able to have continuity of awareness and communicate. It’s my communication aid.”7

With their understanding of participants’ needs within the context and complex system of the NDIS, psychologists have a significant role in helping them develop the capacity, skills and confidence needed to engage meaningfully with the Scheme. This includes providing therapeutic support in relation to interpersonal relationships (e.g. assertiveness and communication skills, and understanding the impact of previous trauma on NDIS interactions), decision-making (including understanding and expressing the participant’s own values, strengths and goals), and developing adaptive psychological approaches and responses to engaging with the Scheme (e.g. problem-solving and managing the sometimes intense emotions related to NDIS interactions). This can take the form of support for decision making which generalises beyond NDIS interactions into other areas of the participant’s life.

Faced with the bureaucracy and complexity of the NDIS (including adverse experiences of being labelled as ‘difficult’ by other providers), psychologists can help participants stay engaged and focused on their goals and needs, while providing a supportive space for them to reflect on the positive and negative psychological impacts of their NDIS journey. By having a thorough biopsychosocial conceptualisation of participants needs and goals, psychologists are able to maintain a sense of flexibility and understanding in their work with participants. At the same time, psychologists’ application of evidence-based supports helps participants to develop the functional and interpersonal capacity needed not only to maximise their NDIS engagement but to realise their broader goals and hopes.

Another participant in the Summer Foundation study sums up the way in which NDIS-funded psychology services can amplify and catalyse a participant’s attainment of their goals: “I now have a brilliant psychologist who genuinely listens and together we create goals and ways for me to be able to accomplish things I need to in my life.”7

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5. Psychologists support NDIS participants from early childhood and throughout the lifespan

This person-centred, system-informed and evidence-based approach to psychologists’ work in the NDIS is well-illustrated in the Early Childhood context. Referrals often ask psychologists how best to promote children’s thinking, learning, behaviour, relationships and participation. As noted above, psychologists are in a unique position to provide support not only to children but to parents and the child’s whole system.

Psychologists use tailored assessment approaches to inform children’s goals and interventions, to review progress and to diagnose where appropriate. Psychologists are specialists in learning and development, social-emotional skills, behavioural guidance and mental health, and the relationship between them. By building capacity in a child’s whole system through early intervention, psychologists work to reduce the amount of supports that they are likely to need in the future. This results in benefits not only for the child and their family, but the sustainability of the Scheme as a whole.

Psychologists have expertise in working from a developmental approach, which looks to the future and anticipates the emerging needs of children as they grow up and engage with others (including with NDIS supports) in new and different ways. The contribution of psychologists continues through the lifespan, growing and changing together with their clients and their family and organisational systems.

Looking to the future of the NDIS

Ultimately, psychologists are optimistic about what the NDIS can do to support Australians with a disability. The problems and difficulties psychologists experience with the NDIS are primarily due to operational and administrative issues. These are problems with achievable solutions which can be realised through collaborative endeavours such as mutual education, realistic levels of funding and co-designed regulatory reform. We remain hopeful that the full contribution of psychologists is recognised and valued through this period of review and reform.

Thank you again for the opportunity to provide a submission to the Committee’s NDIS General Issues Inquiry. If any further information is required from the APS, I would be happy to be contacted through our National Office on redacted or by email at:

Yours sincerely

Dr Zena Burgess, FAPS FAICD Chief Executive Officer

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References

  1. World Health Organization. (2022, June 17). Mental health. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response
  2. British Psychological Society. (2011). Good Practice Guidelines on the use of psychological formulation. https://doi.org/10.53841/bpsrep.2011.rep100
  3. Wright, A. J. (2022). Deliberate Context-Driven Conceptualization in Psychological Assessment. Journal of Personality Assessment, 104(5), 700–709. https://doi.org/10.1080/00223891.2021.1942024
  4. Beardmore, L., & Elford, H. (2016). Psychological formulation in a community learning disability team. Learning Disability Practice, 19(10), 28–33. https://doi.org/10.7748/ldp.2016.e1799
  5. Russell, R. B., Theodore, K., & Lloyd, J. (2022). “You’re changing the pattern”: Cognitive analytic team formulation with learning disabilities care staff. Advances in Mental Health and Intellectual Disabilities, 16(1), 53–66. https://doi.org/10.1108/AMHID-05-2021-0024
  6. Warr, D., Olney, S., Karanikolas, A., Katsikis, G., & Peters, D. (2017). Choice, control and the NDIS: Service users’ perspectives on having choice and control in the new National Disability Insurance Scheme. University of Melbourne. https://socialequity.unimelb.edu.au/__data/assets/pdf_file/0008/2598497/Choice-Control-and-the-NDIS.pdf
  7. Winkler, D., Brown, M., D’Cruz, K., Oliver, S., & Mulherin, P. (2022). Getting the NDIS back on track: A survey of people with disability. Summer Foundation. https://apo.org.au/sites/default/files/resource-files/2022-11/apo-nid320536.pdf

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