NDIS Bill

Date: 16/05/2024

Dear Legislative Affairs Committee

RE: NDIS Bill

I am writing to you as a Mental Health Clinician who works with people with psychosocial disability who are currently on the NDIS.

I request that the current proposed reforms do not pass into law. It would be easier to support the NDIS Bill if the rules and vision for the NDIS had been available. I am aware that these are unable to be finalised until the Bill is passed, but having more information would make it easier to support the legislation changes, easier to comment on the legislation and also respectful towards people with disabilities.

I am concerned that the proposed reforms will place unnecessary stress and burden on people with psychosocial disability. This includes:

• Being assessed by an unknown person
• Being assessed by someone who may not have suitable qualifications or experience eg may not understand hallucinations or delusions or dissociation. If they do not understand these concepts then they will have great difficulty in accurately assessing their needs.
• Having an unknown person assess their needs when their whole NDIS budget depends on this assessment going well. Meeting an unknown person is very stressful. Many of the people that I work with find that the planning meetings are very stressful and some choose not to attend those meetings due to that. The needs assessment will be much worse than that in terms of stress.
• Being allocated an early intervention pathway which appears to have less choice and control and less options for the person overall. It is very difficult to know exactly what is proposed as it is not made clear in the legislation.
• When working with people with disabilities there are often multiple diagnoses and factors leading to that diagnosis. For example someone can have Schizophrenia, Intellectual disability, Autism and Physical health challenges. The NDIS requests that the primary disability is registered under the NDIS and that funding is for this and not the other ones. A needs assessment needs to take into account the whole person and not just one disability. To ask people to obtain medical letters for outlining that they have had all the treatment required for each of these to be sonsidered separately is not only time consuming and expensive but it is often also impossible to separate the different symptoms between disorders. Eg if someone is extremely fatigued is this due to the schizophrenia, autism or the physical disability? Many of these factors intertwine to reduce capacity.
• It is not clear what ‘classes’ are but I would hope that it would not result in different rules for people based on their disability group.
• It is not clear what the rationale is for a separate pathway for adults. It sets up a two tier system which often will result in someone feeling that they should be on the other pathway or worried what will happen at the end of their time on the pathway. It is possible to have one pathway and to

Recommendations

• Allied Health professionals that are known to the person with a disability completes a designated assessment and document the persons needs. This person needs to have suitable qualifications.
• Streamline the assessment process so that it is clear the information that is required. This will save money.
• Occupational Therapists need to have input into the development of functional capacity assessments needs assessment and also program design. We are a key profession in assessment and also have key knowledge that could benefit the government.
• Instead of separate pathways, keep to one pathway for all people with disabilities.

NDIS supports I think that more clarity could be provided to make sure that the items that you want funded are the ones funded. But the current legislation looks like it will be limiting supports in the future which may mean that people miss out on disability supports. Some flexibility is needed to make sure that not funding assistive technology is not resulting in paying even more funds than you would have eg paying for support workers to do the job rather than a piece of assistive technology, which the person can not afford to buy themselves. I am particularly disappointed that the legislation does not seem to meet the needs of people in congregate care/psychiatric hostels/residential supports. People who live in these homes often have most of their pay going to the service which results in high levels of poverty and an inability to afford travel, new clothes, ear plugs to reduce sounds, equipment such as CPAP machines or othortics or multiple other needs. If people in these homes think that they will only be getting 3 years of support from the NDIS then it is unlikely that they will be confident enough to move out. This group of people needs to be a priority from a human rights perspective. There are some types of clinical evidence that are based on recent neuroscience and other research findings that will take time to develop enough solid research to meet the threshold to be an NDIS support.I would recommend that emerging research also be considered and that lived experience voice also be considered. This would include sensory interventions including sensory modulation (which has an evidence base in hospital environments but not as established in the community) and also theories of predictive processing which may result in further applications for people with disabilities.

Carolynfitzgibbon1@gmail.com M: 0437280359 PO Box 6292 Trellismentalhealth.com F: 07 3036 6701 Fairfield Gardens

TRfLLISMENTAL HEALTH

Appeal processes and advocacy are important safeguards for people with disabilities and need to be included in the legislation. People with disabilities can have times when they don’t have the capacity to review and consider the complexities and implications of a needs assessment and further down the track may identify a difficulty. The NDIS needs to be responsive to this need. It is similar to the need to be able to take time to respond to NDIS requests for information. I have worked with people who have been unable to open their mail or emails when paranoid or anxious and they would miss out on the NDIS requests for information during this time.

I am also concerned about the budgeting of a large budget and making it stretch for the entire year. Some people may find this difficult , particularly if it was not enough allocated to meet their needs in the first place, and it is not clear who will be supporting people with disabilities in this task and also who will be responsible if the budget runs out.

Recommendations

• Consider the workforce prior to rolling out block funding models.
• Consider assistive technology carefully as it may cost the NDIS more money to refuse an item than it would be to fund it.
• Consider the evidence threshold required for interventions carefully .
• Do not take a punitive approach to people with disabilities. Allow room for errors and provide support to increase capacity.

Workforce

Some of the proposed changes seem to rely on block funding models without considering the impact on the workforce. The disadvantage with using these models include:

• Small businesses and sole traders are unable to apply. These small businesses are often very well suited to people with disabilities, and to people with caring responsibilities.
• Block funding models reduce choice and control of selecting providers.
• Block funding providers tend to employ people with inexperience, as they are cheaper. People with disabilities often have complex needs and benefit from those with experience. I have heard of multiple occasions when people have not had their needs met.

Recommendations

• Do not create block funding only options in the NDIS. I understand that block funding may be required in some remote communities but even in this instance I think that the community needs to be consulted prior to implementing this. And it may instead be an opportunity to set up small businesses and employ local people rather than a national company.
• Do not allow large corporate organisations to have more input than people with disabilities or allied health organisations. For example I think it would be completely inappropriate to require tabling in Parliament of significant stakeholders organisations views alongside legislative instruments.

I am not against changes to the NDIS and creating efficiencies for long term economic sustainability. But the current legislation needs to be stopped and revised once there are further details available in the rules and decisions made as to what needs to be in legislation, what needs to be in rules and what is best and most economical for people with disabilities.

You are welcome to contact me on Ph 0437 280 359 or carolynfitzgibbon1@gmail.com if you have any questions.

Carolynfitzgibbon1@gmail.com M: 0437280359 PO Box 6292 Trellismentalhealth.com F: 07 3036 6701 Fairfield Gardens

Mental Health Occupational Therapist

AHPRA: OCC0001746065

carolynfitzgibbon1@gmail.com M: 0437280359 PO Box 6292 tr ellism entalh ealth.c om F: 07 3036 6701 Fairfi eld Garden s