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MENTAL HEALTH

Carolyn Fitzgibbon Trellis Mental Health

10/07/2024

deep Legislative Affairs Committee

RE: NDIS Bill

I am writing in my capacity as an Occupational Therapist in Private Practice and whose work includes the NDIS. I work with people with psychosocial, neurodevelopmental, neurological and intellectual disabilities. The majority of the people that I work with have multiple disabilities.

I request that the current proposed reforms do not pass into law.

It is considered best practice and contemporary to have trauma informed principles in systems that work with people with disabilities. The concepts of trauma informed care need to be reflected in this legislation. The Blue Knot Foundation Organisatioinal Guidelines for Trauma Informed Practice have been widely used in Australia, including being adapted for use by the Australian Human Rights Commission. These guidelines for working with a trauma informed approach will be used to inform and also critique the current NDIS legislation.

What are ‘trauma informed’ services?

’‘Trauma-informed services are informed about, and sensitive to, trauma-related issues. They do not directly treat trauma, or the range of symptoms associated with its different manifestations. The possibility of trauma in the lives of all clients/patients/consumers is a central organizing principle of trauma-informed care, practice and service-provision. This applies to every service, either or not trauma is recognized or identified in individual instances.’’

Organisational Guidelines for Trauma-Informed Service Delivery. Page 93

Why should the NDIS legislation be written according to Trauma Informed care principles?

Trauma informed services approach each person in a trauma informed way as a type of universal standard to be able to be inclusive for people with trauma histories. In addition to this many people with disabilities have higher rates of trauma. It is estimated that two thirds of people with disability in Australia have experienced violence. (Disability Guidelines for trauma informed practice) . Other types of trauma also have high rates.

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What are the core trauma-informed principles?

Trauma-informed Principle 1

Safety “Relates to emotional as well as physical safety. This means that it requires the physical space to be welcoming as well as functional. “

Organisational Guidelines for Trauma-Informed Service Delivery. Page 25

Is the NDIS legislation currently applying the trauma -informed principle of safety? No. There are multiple parts of this legislation that are not safe including:

• The needs assessment being completed by an unknown person
• The needs assessment being completed by someone who may not have suitable qualifications and experience to do the assessment. (this is not clear in the current legislation)
• The needs assessment determines the budget and does not appear t o be reviewed. This puts enormous pressure on the person to communicate their needs effectively on the day of the assessment.
• The needs assessment needs to be able to be completed safely even if this takes longer and is more expensive than anticipated. Eg over several sessions so that the person is comfortable.
• The needs of people who live in supported residential environments may not be met by the early intervention pathway and this may result in continuing to live in an unsafe environment.
• Capping the NDS budgets according to the class of participant can result in individual factors not being recognized including cultural and language needs, domestic violence and many other factors. This can result in very unsafe living situations.
• The needs assessment needs to be of the whole person, all of their impariments and also to consider their environment. Picking one disability is not safe. Eg someone with cerebral palsy and profound hearing loss should not have to choose one disability to be funded.
• Needing to live with someone with another disability due to a NDIS funding decision is not emotionally safe and may not be physically safe either.

Trauma-informed Principle 2

Trust “Requires service sensitivity to client needs at all levels of contact . This requires being attentive to the ways services consistently convey their reliability to clients. “

Organisational Guidelines for Trauma-Informed Service Delivery. Page 25

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Is the NDIS legislation currently applying the trauma-informed principle of Trust? No. There are multiple parts of t his legislation that are not applying the principle of trust including:

• Many people in the disability community do not trust that their needs will be met in the new legislation.
• The wording of ‘classes’ are not clear but appear to be to create different rules for people based on their disability group rather than individual needs.
• The legislation does not refer to assessing the needs of the whole person which can reduce trust in the NDIS being able to meet their needs.
• The lack of transparency in the process such as non disclosure agreements, unclear wording, rules that will be sorted out later.
• There are people from organisations who have described feeling fearful that if they speak out that this will impact their funding.
• The person with a disability needs to be provided with a copy of their needs assessment.

Trauma-Informed Principle 3 Choice “Means that services should provide choice to clients at all of the levels at which this is possible. This means that the service needs to be receptive to client choice and communicate this to clients - even and especially where there seem to be minimal possibilities for choice.”

Organisational Guidelines for Trauma-Informed Service Delivery. Page 25

Is the NDIS legislation currently applying the trauma-informed principle of Choice? No.

There are multiple parts of this legislation that are not applying the principle of choice including:

• Choice of needs assessor w ho is independent.
• Support budget is not based on goals and choices but is based on a class with a capped limit. Someone may have a goal to move out of home from living with their parents and require an increased support budget in the first year to achieve this, but the budgets appear to be capped by class so this is choice is unlikely to be met.
• Choice of reasonable and necessary supports to meet needs. This choice was available in the previous legislation.
• Choice of place to live as this depends on having enough budget to be able to have the supports to live in some places.
• Choice of who to live with as some people may need to live in a one to three ratio.
• Choice of assistive technology. Some flexibility is needed to make sure that not funding assistive technology

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• 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.
• Choice of providers may be reduced through the increase of blended payments and block funding.
• Choice of obtaining another assessment if the first needs assessment was not accurate or they were not comfortable with it.

Trauma-informed Principle 4

Collaboration “Requires consistently communicating a sense of doing with rather than to or for clients. It also means always considering the ways in which this is conveyed.”

Organisational Guidelines for Trauma-Informed Service Delivery. Page 25

Is the NDIS legislation currently applying the trauma -informed principle of Collaboration? No. There are multiple parts of this legislation that are not applying the principle of collaboration including:

• There has not been a reduction in power imbalances.
• There is not enough information on the rules and legislation to be able to collaborate. For example it is not clear what classes mean or which classes of people may be targeted in the early intervention.
• Minister Bill Shorten has outlawed some supports without stating whether he collaborated with participants, such as stopping sex workers. This reduces trust in the collaborative process.
• The economics of how the legislation will cut costs has not been revealed which reduces the ability to collaborate.

Trauma-informed Principle 5

Empowerment “People with complex trauma will respond better to treatment when they are empowered in ways that are unique to them, and the professionals and institution should not underestimate the person’s ability to be very useful and active in their own treatment. “

Organisational Guidelines for Trauma-Informed Service Delivery. Page 25

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Is the NDIS legislation currently applying the trauma-informed principle of Empowerment?

No.

There are multiple parts of this legislation that are not applying the principle of empowerment including:

• reduction and elimination of some review processes
• Reduction and elimination of complaint processes
• Not specifically setting up services to assist people who are living in supported residential services to empower them to live in more suitable premises.
• Removal of choice and control in many areas of the legislation.
• The early intervention pathway has the potential to reduce empowerment of people due to the short term nature of it.

I do not support the NDIS legislation in its current form even with the recent amendments. I am very concerned for the future of the participants that I work with, for people with psychosocial, neurodevelopmental and neurological disabilities in particular and all NDIS participants more broadly.

I am concerned that there will be less Occupational Therapists working in the NDIS scheme which would be a significant loss due to the skill set being so well matched to increasing functional capacity. The current changes do not express value in our profession and have not included us in key consultation processes such as psychosocial early intervention design and this is very concerning.

Kind regards-

Carolyn Fitzgibbon Mental Health Occupational Therapist AHPRA : OCC0001746065

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References

• Blue Knot Foundation 2020 Organisational Guidelines for Trauma-Informed Service Delivery. Authors: Kezelman C.A. & Stavropoulos P.A.

• Blue Knot Foundation 2020 Supporting people with disability who have experienced complex trauma

Authors: Kezelman C.A. & Dombrowski, J.