General issues around the implementation and performance of the NDIS

Submission 26

Joint Standing Committee on the National Disability Insurance Scheme — the provision of services under the NDIS for people with psychosocial disabilities related to a mental heaith condition

Submission from the South Australian Government

April 2017

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AUSTRALIA of South Australia

General issues around the implementation and performance of the NDIS

Submission 26

Introduction

The successful transition of services, including psychosocial services, to the National! Disability Insurance Scheme (NDIS) is a key priority of the South Australian (SA) Government. The SA Government therefore welcomes the opportunity to provide a submission to the Joint Standing Committee’s Inquiry into the provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition.

This submission addresses key Terms of Reference of the Committee, including:

e the eligibility criteria for the NDIS for people with a psychosocial disability;

e the transition to the NDIS of all current long and short term mental health Commonwealth Government funded services, including the Personal Helpers and Mentors Services (PHaMs) and Partners in Recovery (PIR) programs, and in particular;

o whether these services will continue to be provided for people deemed ineligible for NDIS;

e the transition to the NDIS of all current long and short term mentai health state and territory government funded services, and in particular;

o whether these services will continue to be provided for people deemed ineligible for NDIS;

e the scope and level of funding for mental health services under the Information, Linkages and Capacity building framework;

e the provision and continuation of services for NDIS participants in receipt of forensic disability services; and

e other related matters

Background and Context

The introduction of the NDIS will change the way services are funded and delivered to South Australians with a disability including people with psychosocial disability, allowing participants greater choice of where and from whom they receive services.

The first stage of the NDIS in SA began on 1 July 2013 for children aged 14 years and under. From 1 February 2016, children aged between 0 to 14 years of age will continue to enter the NDIS. Then 15 to 17 year olds will enter from 1 January 2017 and from 1 July 2017; aduits aged 18 to 64 years of age will begin to enter the NDIS based on a staged approach across geographical regions.

The SA and Commonwealth Governments signed a Bilatera! Agreement for the Transition to an NDIS on 15 December 2015. It is expected that around 26,000 South Australians will access the NDIS by July 2018 including around 17,000 people from the existing SA specialist disability system. The Agreement provides for an additional 6,500 people who are not currently receiving disability support services to enter from July 2018 onwards.

The Productivity Commission in 2011 cited that of the 489,000 people with serious mental illness in Australia, only 57,000 (since revised to 64,000) would qualify for an individualised package of support because they have a serious and persistent mental illness with complex interagency needs.

Public mental health service clients receiving state funded psychosocial support will transition to the NDIS from 1 July 2018. People who receive services through Disability SA and have a mental illness, mental health clients in DCS! funded programs, Commonwealth funded clients as well as new clients will transition to the NDIS from 1 July 2017.

General issues around the implementation and performance of the NDIS

Submission 26

SA’s mental health services including services for people with psychosocial rehabilitation and disability support needs have been delivered through the Health sector rather than the Disability sector. While the SA Government has had experience in implementing the NDIS as a trial site for children, it has no direct experience in implementing the NDIS for adults with a psychosocial disability resulting from a mental health condition.

The mental health sector is currently also undergoing significant mental health reform. Ata national level, there are major changes in the funding and structure of services across Australia as a result of the National Mental Health Commission’s Review of Mental Health Programs and Services, and the development of the Fifth National Mental Health and Suicide Prevention Plans. At a state level, the SA Mental Health Commission is developing the state’s first Mental Health Strategic Plan and changes are being made to the state’s Menta! Health Act which will improve the rights of people with mental illness and enhance the capacity of mental health services to provide treatment and care.

Terms of Reference

1. The eligibility criteria for the NDIS for people with a psychosocial disability

Broadly, a person meets the requirement for NDIS support if they are under 65 years, an Australian citizen and has a permanent impairment that significantly impacts on their daily lives under the National Disability Insurance Scheme Act 2013.

The interstate NDIS trial sites for adults during 2013-16 highlighted that people with disability arising from mental illness had difficulty being deemed eligible for the NDIS as there were concerns raised that a person with a mental health diagnosis was not considered to be permanently impaired and there was no accepted way for assessing the functional impairment of a person with a psychiatric condition.

It is important that the eligibility criteria does not lead to less NDIS participants with psychosocial disability in South Australia than originally assumed in Productivity Commission estimates (i.e. 13.9% of NDIS participants; approximately 4,500). This would be unacceptable to the SA Government.

As at 30 June 2016, the NDIS trial sites reported the proportion of people with primary psychosocial disability is in line with Productivity Commission (PC) estimates (13.9%) e.g. in Barwon, 14.2% of participants had a primary psychosocial disability. Whilst in October 2016, Western Australia had reported 1 in 8 people receiving government mental health services were deemed eligible for an individualised support package under the NDIS, however the WA percentage against the PC estimates was not reported.

The issue of NDIS eligibility for people with disability arising from severe mental illness has been raised across jurisdictions and been recognised at a national level. In 2014, the NDIA Mental Health Sector Reference Group was established to provide expert advice on how psychosocial disability could be better integrated into the NDIS with one of its tasks to develop clearer eligibility criteria and definitions in order to improve access to the NDIS for peopie with psychosocial disability. Reference Group membership includes representation from the NDIA, relevant Commonwealth and some State Governments, peak bodies and consumer and carer representatives. SA is not represented on this group.

Related to issues of eligibility, the mental health sector has raised questions about how the strong recovery focus in contemporary mental health practice fits with the NDIS requirement that psychosocial disability is considered to be a permanent disability. While the NDIA is working in partnership with the sector on best practice approaches within the context of Scheme parameters, it is important that outcomes for NDIS participants with psychosocial disability are monitored with reference to the recovery paradigm.

As recent as March 2017, the NDIA’s Mental Health Team and National Access Team (NAT) reported on the NDIS eligibility for accessing psychosocial support services. This information included descriptions of the access criteria for psychosocial disability and the decision-making process of the NAT, with reference to people with primary psychiatric conditions. Additionally, the NDIA’s Mental Health Team is currently reviewing program guidelines for SA Health funded psychosocial services and will provide advice regarding alignment with NDIS access criteria and reasonable and necessary supports funded through the Scheme.

The focus by the NDIS in reviewing the eligibility criteria for accessing psychosocial support services is welcomed by SA and should be noted by the Inquiry as a positive step in assisting mental health clients to receive NDIS funded services.

2. The transition to the NDIS of all current long and short term mental health Commonwealth Government funded services, including the Personal Helpers and Mentors Services (PHaMs) and Partners in Recovery (PIR) programs, and in particular;

• whether these services will continue to be provided for people deemed ineligible for the NDIS

Commonwealth funding is currently provided directly by the Commonwealth to non-government organisations (NGOs) in South Australia to deliver for the following four mental health programs: Partners in Recovery (PIR), Personal Helpers and Mentors (PHaMs) and Support for Day-to- Day Living in the Community (D2DL). It is understood that the Commonwealth funding currently allocated to these four programs is expected to be transferred to the NDIS funding stream. Additionally, the Mental Health Respite: Carer Support (MHR:CS) program provides support to the carers and families of people living with mental illness and this funding will also transfer to the NDIS.

The concern in transferring all Commonwealth mental health program funding (or a large component thereof) to the NDIS is that many existing mental health clients who are receiving Commonwealth funded programs will not meet the NDIS eligibility criteria and may not receive the necessary services that support them to live successfully in the community. This impact of this decision may result in poorer mental health outcomes for people with severe mental illness, increased reliance on SA’s crisis and acute hospital services as well as an increased risk of homelessness and involvement in the justice system. In addition, no new mental health clients will have access to Commonwealth funded psychosocial support programs unless they have a significant and enduring psychosocial disability and are eligible for the NDIS.

During 2016-17, there are currently over 4000 South Australians benefitting from these Commonwealth psychosocial programs. Varying advice has been received as to the number of PHaMs, PIR and D2DL participants who may be eligible for an individualised support package

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under the NDIS ranging from 10 percent to 70 percent for PHaMs and D2DL and up to 90 percent for PIR. The exact percentages are not yet known.

The loss of access to Commonwealth funded carer respite and support programs will also impact carers and families. Under the NDIS, a carer will not be able to receive a service to support their needs and will only be able to access respite services if those services are included as part of the individualised NDIS package of the person with the psychosocial disability.

The issue of South Australian citizens not being eligible for Commonwealth funded mental health services have been raised with the relevant Commonwealth Ministers. In the correspondence, the SA Government sought clarification on how the Commonwealth will provide ongoing support to mental health consumers who are not eligible for the NDIS in keeping with the ‘continuity of support’ provisions detailed in Schedule D of the Bilateral Agreement. Additionally, this matter has been raised by the SA Minister for Disabilities in a paper on Mental Health and the NDIS at the Disability Reform Council meeting held on 3 March 2017.

The SA Government is concerned of the potential loss of these essential Commonwealth funded mental health programs and the impact on existing clients of these services as well as for new clients not eligible to access the NDIS. Commonwealth funding should be maintained during the implementation of NDIS to ensure SA citizens who are ineligible for NDIS funding continue to receive care through existing Commonwealth funded mental health services.

3. The transition to the NDIS of all current long and short term mental health state and territory government funded services, and in particular

• whether these services will continue to be provided for people deemed ineligible for the NDIS

The SA Government is committed to ensuring that people with mental illness and associated psychosocial disability who are ineligible for NDIS are appropriately supported with services to live quality lives in the community.

In 2011, the initial modelling by the Productivity Commission estimated that there would be approximately 57,000 NDIS participants with significant and enduring primary psychosocial disability (since revised to 64,000).

Greater clarity is still required in relation to the eligibility criteria for psychosocial disability under the NDIS, to enable accurate assessment of the proportion of current clients of both Commonwealth and State-funded psychosocial support services likely to access the NDIS. The SA Government anticipates the review of the eligibility criteria from the NDIA Mental Health Sector Reference Group will provide this clarification and support mental health patients with access to NDIS funded services.

Processes for the collaborative planning, monitoring and review of the mental health system, which includes the NDIS, should be implemented between the Commonwealth, NDIA and the State Government to ensure that the specific needs of people with severe and persistent mental illness and/or associated psychosocial disability are met and people do not fall through the gap.

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General issues around the implementation and performance of the NDIS

Submission 26

4. The scope and level of funding for mental health services under the Information, Linkages and Capacity building framework

The NDIS has two components: the individual funding packages and Information, Linkages and Capacity building (ILC). ILC is the NDIS component primarily for people who do not meet the criteria for an individualised support package. !n July 2015, ali governments including the SA Government agreed to the ILC Policy Framework which sets out the activity streams and funding principies. The 5 activity streams are:

• Information, Jinkages and referrals;
• Capacity building for mainstream services;
• Community awareness and capacity building;
• Individual capacity building; and
• Local area coordination.

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The goals of ILC supports are to build the capacity of people with disability through the provision of information, connection to mainstream and community services and skills development as well as building the capacity of mainstream and community services to ensure greater inclusion of people with disability.

The ILC Commissioning Framework will be implemented in SA at full scheme from 1 July 2018. At this time, there is still uncertainty about the scope of ILC supports, how they will be determined and how they will be implemented for South Australians with mental illness and psychosocial disability, their families and carers. Of particular concern, is whether the level of funding for [LC support has the capacity to achieve the intended outcomes.

To date, only limited funding has been allocated nationally to ILC supports which the ILC Commissioning Framework (October 2016) outlines ‘will be built up slowly over the next few years’ to approximately $132 million nationally when the NDIS has been fully rolled out in 2019 — 2020. It is expected that SA will receive a proportionate amount of approximately $9 million in funding which will be allocated to South Australians with disability including for people with psychosocial disability.

Given the significant role that ILC supports are expected to have, the SA Government is still uncertain how ILC will contribute to supplementing services to those people deemed not eligible for an individualised funding package and is concerned that ILC is funded at an appropriate level to meet its significant remit. At this stage, no information has been provided as to how ILC will be funded in the longer term and whether state and territory governments will be expected to make a funding contribution.

5. The provision and continuation of services for NDIS participants in receipt of forensic disability services

Forensic consumers are people who have been found not guilty of an offence by reason of mental impairment or being unfit to stand trial. The forensic mental health system in SA comprises a number of service elements which includes James Nash House inpatient facility, The Ashton House step down residential rehabilitation unit and the community team.

General issues around the implementation and performance of the NDIS

Submission 26

People in the forensic mental health system are some of the most vulnerable members of our community and are even more likely to experience overt stigma and discrimination than others with mental health diagnoses. This is largely due to public perception that they present an inherent danger - thus limiting their opportunity to live and participate in the community or access services available to other citizens.

Further, peopie with co-morbid mental health diagnoses and/or Intellectual Disability or Acquired Brain Injury make up a significant proportion of those under the care of the forensic mental health system — either in residential care facilities or in the community. This group is frequently among the most complex in terms of their care, support and rehabilitation needs.

At the NDIS and Psychosocial Disability Forum in South Australia in March 2017, the NDIA confirmed that forensic clients living in the community will have access to the NDIS the same as any other population group. Key issues will be to proactively support engagement through early referral, coordination and continuity of services and the availability of skilled psychosocial disability support providers to work with this complex population group.

Consideration should be given to developing a specific approach for forensic consumers with complex needs which supports their assertive engagement and transition to the NDIS in order to maximise their clinical and psychosocial disability outcomes.

6. Any other related matter

« Mental health advocates have raised concerns about whether appropriate supports are in place for people with psychosocial disability, including those with particularly complex needs and/or who are isolated, to engage with NDIS access and planning processes. Policy, operational and provider engagement work is being undertaken to promote access to the Scheme by people with complex needs and significant barriers to service access. NDIS access and engagement needs to be monitored over time to ensure that particularly vulnerable Australians with psychosocial disability are not falling through the gap.

• The mental health sector has highlighted a lack of clarify and applicability in relation to NDIS supports for psychosocial disability, as well as pricing levels in plans for these services. In response, the NDIA is implementing a range of initiatives in partnership with the sector through the Psychosocial Support Design Project, and market assessment and development strategies.

• Itis critical that approaches to engaging and supporting Aboriginal and Torres Strait Islander (ATS!) people with psychosocial disability under the NDIS are aligned with the NDIA’s Aboriginal and Torres Strait Islander Engagement Strategy.