Australian
Alcohol
& Other
Drugs Council
Submission to Senate
Standing Committee on the
National Disability Insurance
Scheme (NDIS)
NDIS General Issues Inquiry
Submitted on 9 July 2023
9 July 2023
Senator Libby Coker
Chair, Joint Standing Committee on the National Disability Insurance Scheme
PO Box 6100
Parliament House
Canberra ACT 2600
ndis.joint@aph.gov.au
Dear Ms Coker
Thank for you for the opportunity to contribute to the NDIS General Issues inquiry.
The focus of our submission is on the intersection of alcohol and other drug (AOD) use, disability and the criminal justice system. As such, AADC calls for easier pathways into the NDIS and for greater flexibility of support provided where the NDIS is accessed by people with complex needs. We believe that easier access to the NDIS and greater flexibility of support will enable people with concurrent AOD issues and disability to be diverted away from the criminal justice system as well as support better outcomes for people currently within, and transitioning from, custodial settings.
About us
AADC is the national peak body representing Australia’s alcohol and other drugs (AOD) sector. We work to advance health and public welfare through the lowest possible levels of AOD related harm by promoting effective, efficient and evidence-informed prevention, treatment and harm reduction policies, programs and research at the national level. AADC’s founding members comprise each state and territory peak body for the AOD sector, other national peak bodies relating to the AOD sector, and professional bodies for those working in the AOD sector.
The current membership of AADC is:
| Alcohol, Tobacco and Other Drug Association ACT (ATODA) | Alcohol, Tobacco and Other Drugs Council Tasmania (ATDC) | Association of Alcohol and Other Drug Agencies NT (AADANT) |
| Australasian Therapeutic Communities Association (ATCA) | Australian Injecting and Illicit Drug Users League (AIVL) | Drug and Alcohol Nurses of Australasia (DANA) |
| Family Drug Support (FDS) | National Indigenous Drug and Alcohol Committee (NIDAC) | Network of Alcohol and Other Drug Agencies (NADA) |
| Queensland Network of Alcohol and Other Drug Agencies (QNADA) | South Australian Network of Drug and Alcohol Services (SANDAS) | The Australasian Professional Society on Alcohol and other Drugs (APSAD) |
| Victorian Alcohol and Drug Association Inc (VAADA) | Western Australian Network of Alcohol and other Drug Agencies (WANADA) | Drug Policy Modelling Program* |
| *AADC associate member |
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Improving Responses to Complexity
Data on the intersection between AOD use and disability in the general community is scant. However among the limited available research, there is some association between hearing and vision loss and increased likelihood of AOD use. Similar limited data was found in relation to people on the autism spectrum and likelihood of AOD use increased where autism co-occurred with depression.[1]
While data about the intersection between AOD use and disability in the general community is limited, there is a large volume of evidence about this intersection for people within custodial settings and the criminal justice system. In short, both people with disability and people who use AOD are over-represented in custodial settings, and there is a significant co-occurrence of these issues in these populations.
In the context of youth justice systems in Australia, a Victorian parliamentary inquiry found that 24% of young people sentenced or on remand presented with issues concerning their intellectual function and 11% were registered with a disability service. Alongside this, 30% presented with mental health issues, 18% had a history of self-harm or suicidal ideation and 66% had a history of AOD use.[2] In relation to Fetal Alcohol Spectrum Disorder (FASD) specifically, research finds that up to a third of young people detained within the Banksia Hill facility in Western Australia had a FASD diagnosis, yet this was likely to be an underestimate due to the lack of comprehensive assessment. FASD prevalence was estimated to be closer to 50% and up to 89% of young people detained had some type of neurodevelopmental impairment.[3]
Within adult custodial settings, estimates suggest that up to 10% of people have an intellectual disability, a rate five times higher than in the general community.[4] In the context of other impairments, such as hearing loss, Aboriginal and Torres Strait Islander people in custody are particularly impacted, with an estimated 80-95% living with hearing impairment.[5] As in youth justice systems, people who use AOD are over-represented (up to 70% have used drugs in the 12 months prior to incarceration[6]) and there is a similar intersection between people with disability in custodial settings and illicit drug use. Research suggests that illicit drug use among people with intellectual disability prior to and after incarceration is common.[7]
AADC is concerned that, at present, the NDIS does not have sufficient capacity or flexibility to provide adequate support to populations with multiple, complex needs. The intersection between AOD use and disability also often comes with intersection with other issues such as mental health, child protection system involvement, direct experiences of trauma and exposure to intergenerational trauma, low socio-economic status and housing instability – all of which add to complexity. Systemic failures to provide adequate supports to people with multiple complex needs increase the risk of this population being criminalised and incarcerated, with opportunities for diversion away from the criminal justice system missed and supports inadequate to prevent recidivism after people return to the community. In the case of FASD, the National Disability Insurance Agency acknowledges that
[1] Reif, S., & Mitra, M. (2022). The complexities of substance use disorder and people with disabilities: Current perspectives. Disability and Health Journal, 101285.
[2] Legal and Social Issues Committee. (2018). Inquiry into youth justice centres in Victoria: Final Report. Melbourne: Parliament of Victoria.
[3] Bower, C., Watkins, R. E., Mutch, R. C., Marriott, R., Freeman, J., Kippin, N. R., … & Giglia, R. (2018). Fetal alcohol spectrum disorder and youth justice: a prevalence study among young people sentenced to detention in Western Australia. BMJ open, 8(2).
[4] Queensland Advocacy Incorporated (2015). dis-Abled Justice: Reforms to justice for persons with disability in Queensland. Brisbane: QAI.
[5] Deafness Forum Australia. (2022). Closing the Gap: Addressing the hearing health of Aboriginal and Torres Strait Islander peoples in criminal justice settings. Deafness Forum Australia.
[6] Australian Institute of Health and Welfare 2020. Health and ageing of Australia’s prisoners 2018. Cat. no. PHE 269. Canberra: AIHW.
[7] Young, J. T., Van Dooren, K., & Claudio, F. (2016). Transition from prison for people with intellectual disability: a qualitative study of service professionals. Trends and Issues in Crime and Criminal Justice [electronic resource], (528), 1-12.
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access to adequate support for people with FASD “remains a significant challenge” and that the current approach “lacks a comprehensive multidisciplinary approach that reflects the needs of the individual, bringing clinical and non-clinical providers together (such as health, education, child protection, employment, housing and justice) to determine the most appropriate supports”.[8] Within custodial settings, although an application may be made to the NDIS, support is not available until release. The Aboriginal Legal Service of Western Australia notes that for many of their clients, a custodial setting may be the best environment to establish NDIS engagement and support the transition back to the community.[9] In addition, AADC is concerned by recent reports that people with psychosocial disabilities will be increasingly diverted away from the NDIS in favour of community-based mental health services.[10] Such an approach would undoubtedly exacerbate the existing challenges for people with multiple complex needs, including in particular FASD, which requires a disability focus. There is a significant opportunity for the NDIS to play a key role in enabling the development of comprehensive health and social service responses for people with FASD and other disabilities – particularly in the context of facilitating more effective prevention and transitions in criminal justice system contexts.
In this context, AADC makes recommendations in two key priority areas to intervene early and prevent people with disability who have co-occuring harm from AOD use from being engaged by the criminal justice system and support better outcomes where people transition from custody to the community:
1. Expanding partnerships and creating broader pathways into the NDIS
In order to ensure people with more complex needs can access an NDIS plan and be provided with support, AADC recommends that the NDIA seek to broaden its entrance pathways and establish ongoing relationships with sectors such as AOD, housing and homelessness, mental health and child protection. Stronger engagement with these sectors in enhancing pathways for people with disabilities with intersecting and complex needs to access NDIS support is critical and would no doubt assist with diverting people with disabilities away from the criminal justice system and incarceration. Where people are incarcerated, strengthened partnerships with justice and justice health agencies would enable NDIS supports to commence prior to release and improve opportunities for community reintegration, achieving better long-term health and social outcomes for individuals with disabilities, their families and communities.
The need for building partnerships with other key sectors is highlighted by the Children’s Commissioner Northern Territory’s submission to the 2019 Commonwealth Parliament inquiry into FASD. The Commissioner noted within the Northern Territory’s residential care sector, the workforce and those involved with the care of children were often unfamiliar with the operation of the NDIS and how to maximise its effectiveness. Further, in the context of FASD, the Commissioner noted that it
[8] National Disability Insurance Agency. (2019:6). National Disability Insurance Agency Submission to the Community Affairs References Committee inquiry into effective approaches to prevention, diagnosis and support for Fetal Alcohol Spectrum Disorder. Canberra: NDIA
[9] Aboriginal Legal Service of WA Inc. (2019). Submission to the Senate Community Affairs Reference Committee Inquiry: Effective approaches to prevention, diagnosis and support for Fetal Alcohol Spectrum Disorder. Perth: ALS.
[10] Evans, J. (2023, 28 June). “People with psychosocial disability may be diverted from NDIS in future, as government forecasts 27,000 reduction in participant growth”, ABC Online. Accessed 7 July 2023 at https://www.abc.net.au/news/2023-06-28/psychosocial-disability-ndis-future-inclusion/102534200? cldee=LF636ATy8CIRGqefgmoa9OR4jinksQ3ynqKQWNkhIaCXiVZAG4gomiPVY1pgVXlA&recipientid=contact-2bcad0a205c5ec11a7b5002248158412-7ddff3f83c3540dba705775841d7e7bc&esid=9b32e9d7-ee1a-ee11-8f6c-6045bd3df640
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was critical that screening for FASD– even as late as pre-sentencing – was critical for changing the trajectory of young people.[11]
Alongside this, AADC recommends that, at minimum, the NDIA establish partnerships with national, state and territory peak organisations, such as AADC and its members, to identify training opportunities for workforces in key sectors on how the NDIS can be accessed and effectively used to improve outcomes for their client groups. AADC would welcome the opportunity to work with the NDIA on this workforce capacity building. More broadly, the interface between sectors such as AOD and disability could be strengthened through engagement between respective national governance structures with the aim of prioritising and coordinating effort. At present, there is no sector inclusive, national AOD governance structure with a role in coordinating efforts with between levels of the Australian, State and Territory governments and AADC recommends that such a structure be established.
2. Enabling more flexible support options
Alongside creating a stronger interface with sectors providing support for people with complex needs, AADC recommends that the support provided through NDIS plans have more flexibility to address complexity and the specific needs of people from particularly marginalised and disadvantaged backgrounds. At present, foundational needs such as housing and dental care are excluded from resourcing under NDIS plans. This is despite the availability of secure, stable housing and access to dental care being key factors in supporting better health and social outcomes for people with complex needs, particularly in the context of those transitioning out of custodial and other institutional settings and back into the community. The current lack of flexibility also comes in the context of declining affordable private rentals and long waiting lists for public and community housing, resulting in people being held on remand - as they are do not have stable accommodation and thus cannot be released on bail - as well as contributing to challenges of reintegrating to the community once they are released from custody.[12] In the context of dental care, the ongoing exclusion of dental services from Medicare – as well as a range of other issues - has a disproportionately negative impact on the oral health of people in custodial settings, people who use AOD, people with disability and people on lower incomes.[13] [14] As such, AADC calls for greater flexibility in NDIS care planning to enable access to critical supports, such as housing and dental care, by exception where there is market failure or other exceptional circumstances that can be demonstrated. This flexibility in enabling NDIS plans to better respond to complex needs will help improve health and social outcomes, support better transitions from custodial and other institutional settings and contribute to diverting people with disabilities away from the criminal justice system.
Conclusion
AADC believes there is significant opportunity to improve outcomes for people at the intersection of AOD use, disability and a range of other issues causing deprivation and exclusion which impact on
[11] Office of the Children’s Commissioner Norther Territory. (2019). Submission to the Inquiry into the Effective Approaches to Prevention, Diagnosis and Support for Foetal Alcohol Spectrum Disorder (FASD). Darwin: Office of the Children’s Commissioner Norther Territory
[12] Pillarisetty, A. (2023, June 11). “Finding a rental is hard – but for those leaving prison, there is an ‘absolute crisis’”, ABC News Online. Accessed 30 June 2023 at https://www.abc.net.au/news/2023-06-11/rental-housing-accommodation-challenges-after-leaving-prison/102462230?utm_source=newsshowcase&utm_medium=discover&utm_campaign=CCwqFwgwKg4IACoGCAow3vI9MPeaCDCcnswBMJjh4gE&utm_content=bullets
[13] Australian Alcohol and other Drugs Council. (2023). Submission to Senate Select Committee into the Provision of and Access to Dental Services Inquiry into Provision of and Access to Dental Services in Australia. Available at https://aadc.org.au/resources/
[14] Australian Institute of Health and Welfare. (2023). Oral health and dental health care in Australia. Canberra: AIHW.
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health and wellbeing. It is critical that these opportunities be capitalised on to decrease the over-representation of people with multiple and complex needs, including those with disability, in custodial settings. As such, AADC recommends that:
- The NDIA establish partnerships with sectors such as AOD to broaden pathways into the NDIS
- The NDIA work with AOD sector peak organisations to identify training opportunities for workforces in key sectors on how the NDIS can be accessed and effectively used to improve outcomes for their clients with disabilities
- A sector-inclusive, national AOD governance structure be established to enable prioritisation and coordination between like-structures for the NDIS and broader disability sector
- The NDIS incorporate more flexibility into its supports to better cater for people with disabilities and complex needs to enable access to necessary supports, such as housing and dental care, where there is market failure or other exceptional circumstances.
Thank you for the opportunity to make a submission to this inquiry. AADC would welcome the opportunity to present to the Committee and expand on the issues raised in our submission. If you require any further information, please do not hesitate to contact me directly
Yours sincerely
Melanie Walker
CEO, Australian Alcohol and other Drugs Council
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