More certainty required in the NDIS for people with a psychosocial disability.
The National Consumer Peak Alliance (the Alliance) is concerned about how people with psychosocial disabilities will be impacted by the proposed reforms to the NDIS. These concerns stem from the recommendations outlined in the final report of the Independent Review into the NDIS “Working together to deliver the NDIS”; in addition to the recently tabled National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024 (the Bill).
We are concerned about how people with psychosocial disability will be considered under an ‘early intervention’ pathway.
The recently tabled National Disability Insurance Scheme Amendment (Getting the NDIS Back on dependent on the development of the NDIS Rules. These Rules, once drafted, will provide additional detail on the processes outlined in the legislation, including around early intervention pathways. As it is likely that the findings of the final report will be considered in developing these Rules, the Alliance has several concerns about the approach to early intervention outlined in the final report.
The Alliance notes Recommendation 7 of the Independent Review into the NDIS “Working together to deliver the NDIS” (final report): “to introduce a new approach to NDIS supports for psychosocial disability, focused on personal recovery, and develop mental health reforms to better support people with severe mental illness”.
Under the proposed changes in Recommendation 7, most people accessing the NDIS for psychosocial disability will have their supports geared towards ‘recovery’ goals and have their NDIS access transitioned to the Section 25 early intervention pathway (see: ‘Fact Sheet 7: For people with psychosocial disability and their families.’)
There is also scope under Recommendation 7 for participants who will likely require lifetime supports under the NDIS to access the scheme under Section 24 ‘disability met’ plan pathway. While the report acknowledges the Section 24 pathway is still an option for participants, it does not detail the process of bypassing Section 25, whether there is a cap on the numbers of consumers who are able to do this, or how the NDIA will make this decision.
The Supporting Analysis document for the final report also recommends early intervention supports should be re-assessed every two years, or ‘at a frequency determined by the Needs Assessor’ (p. 311) with no minimum or maximum ‘frequency’ set for reassessment at this time. There is also not enough information as to how this process differs from the previously proposed Independent Assessments.
There is a risk that participants and prospective participants with psychosocial disability, regardless of the severity and permanence of their disability, could face repeat assessments, the need to repeatedly prove their disability and the need to go through the NDIS application process twice (once for each pathway) solely due to their disability being psychosocial in nature.
Final Report Recommendations
The final report recommends early intervention supports for people with psychosocial disability should be provided for up to three years under the Section 25 pathway, which includes the following features:
- If after three years participants are determined to not need ongoing support, they will be assisted by a Navigator to connect with ‘foundational supports’, which under the new recommendations will be mostly state-based.
- For participants found to need ongoing support, they will need to re-apply for NDIS access through Section 24 with support from a Navigator through a ‘streamlined pathway’.
- Navigators will assist both people who need ongoing NDIS supports as well as those who are determined to no longer need NDIS supports through foundational supports.
The NDIA should not hold a default assumption about how best to fund and support NDIS participants with psychosocial disability. Instead, an impartial and individualised case-by-case review of each current and future participant should be conducted to ensure that participants are funded and supported based on their individual needs and functional impact. Any legislation drafted that impacts people with psychosocial disability should include specific protections so that they remain empowered within and across the services and systems they engage with.
Co-design and co-development of the proposed reforms with consumers is essential for all future development of the NDIS
The Government has expressed a desire for a broader range of support options through state-based options, rather than relying only on NDIS funded supports, that are oriented around minimising the functional impact of a person’s disability. However, consumers need assurances that the flexibility allowed in the legislation is balanced against their need for security in ensuring they won’t lose access to their funded supports.
The benefits and importance of collaboration in the reform of the NDIS was identified in the final report of the Independent Review of the NDIS “Working together to deliver the NDIS”[1]. Despite this, the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024 was tabled on 27 March 2024 with minimal consultation and collaboration with NDIS participant and advocates. Participants were not given advance notice that a bill was to be introduced and the community engagement sessions that were run after the bill was introduced had minimal opportunities for participant collaboration. The Alliance is disappointed that development of the Bill itself was not conducted through co-development or co-design principles. Lack of adequate consultation and engagement risks this legislation inadvertently causing harm to the diverse range of consumers it supports.
Collaborative approaches to policy can be a useful tool in rebuilding and improving relationships between governments and priority populations. Collaboration should occur throughout the design and development process; and requires early engagement with the identified stakeholders for it to be maximally effective.
We understand that the Government has committed to co-development and co-design of the NDIS Rules that will accompany the Bill. It is essential that this commitment is adhered to, and that co- design and co-development be conducted with the diverse range of consumers and participants that the legislation supports.
The Government must have close consultation with people who have lived experience of disability, including those with psychosocial disabilities. Consultation with the disability community should
focused on the proposed early intervention pathways, changes to the review and assessment process
and to build assurances that the proposed early intervention supports will not impact a person’s ability to access long-term, permanent or additional package support.
Appropriate and considered co-design and co-development with consumers and participants will in- turn ensure that questions community members have about the proposed changes to the NDIS are adequately addressed.
Some questions the Alliance members have heard from our members are:
- Will providers of Service Navigation be independent from other NDIS service providers?
- Will there be a cap or limitation on how many participants can access the NDIS via section 25 (early intervention) pathway?
- How will frequency of people’s reviews be determined, will participants have input into this decision, and how will the decision be communicated with participants?
- How will the findings from the Disability Royal Commission be incorporated to ensure human rights are adequately considered where these issues were overlooked in the review recommendations?
The Alliance acknowledges the importance of ‘recovery’ in many systems; however, we hold grave concerns about the interpretation and implementation of ‘recovery’ within the context of the NDIS.
The Alliance endorses the concept of personalised approach to recovery which will differ from person to person. Personalised recovery may not include a reduction of symptoms or an increase in functional capacity. Applying a more general recovery lens to psychosocial disability suggests that people will recover from their disability, an approach which can be harmful to participants. Any individual recovery may not reduce a participant’s need for funded supports through the Scheme.
Recovery may be used to create a separate pathway for people with psychosocial disabilities, thereby being used to disadvantage people living with psychosocial disability both within, and outside, the NDIS. The current NDIS legislation upholds the right to ‘reasonable and necessary support to live an ordinary life’ for all people living with permanent and substantial disability – we believe it’s important this right is upheld for all NDIS participants, including those with psychosocial disabilities.
We share the Forum’s concerns about the possible system reforms
Section 10(b) and 10(c) of the Bill rely on the drafting of the rules, which have not yet been designed and no information released to the community. This lack of clarity is concerning given the discussions around the transition of foundational supports from federal to state budgets there is a significant risk that the development of foundational supports will not keep pace with the NDIS reforms.
The Alliance agrees with the National Mental Health and Consumer Carer forum who express concerns that a separate ‘foundational support system’ for psychosocial disability on top of already multiple existing systems of mental health, Alcohol and Other Drugs (AoD), suicide prevention, disability, NDIS, and health, is to be avoided.
In some jurisdictions, there is much trust yet to be rebuilt to ensure faith in the quality and adequate provision of early intervention supports. The creation of the NDIS led to significant gaps in services for people with psychosocial disability, many of whom had trouble accessing the scheme, with many of their previous supports being folded into the NDIS or ceased to be funded by state governments expecting those to be covered by the NDIS.
We support design that centres and supports people with disability
We welcome the Federal Government’s recent announcement of a significant investment to design and consult on key recommendations from NDIS Review including the creation of Foundational Supports by means of the development of a ‘Foundational Supports Strategy’ and that this will change the landscape of the disability ecosystem in Australia. The Review proposed that Foundational Supports comprise of both ‘general’ supports for all people with disability, and ‘targeted’ supports including people with persistent mental illness. Given this we believe there needs to be a stream of close consultation that is supported in design by experts in these areas, with a specific focus on lived experience expertise.
We call for greater certainty on national policy
Effective stewardship is an essential component of systems planning and monitoring. This is particularly important at the nation level. The ability of the consumer community to commit to any proposed changes to the current funding landscape will be contingent on greater clarity about the future scope and powers of the National Mental Health Commission. In the absence of greater independence from government and powers to compel information, or an equivalent independent agency to do so, any assurances made about foundational supports and other funding changes remain uncertain across states and territories. These are recommendations from the Productivity Commission’s report that still remain unactioned.
The Alliance would welcome a discussion with the Minister to examine ways this work can be collaboratively undertaken with mental health consumer peaks.
–~ CONSUMER ALLIANCE
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