NDIA Accountability Project

This project is in DRAFT

Protecting the Supports that Ensure Rights, Agency and Safeguarding for LGBTQ people with intellectual disability (Participant experience)

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Submission 281

Protecting the Supports that Ensure Rights, Agency and Safeguarding for LGBTQ people with intellectual disability

Submission to:

Senate Community Affairs Legislation Committee Inquiry into the National Disability Insurance Scheme

Amendment (Securing the NDIS for Future Generations) Bill 2026

Submission from:

  • Inclusion Melbourne

  • Thorne Harbour Health Correspondence:

  • Nathan Despott, Inclusion Melbourne

  • Head of Policy, Research and Advocacy / Accessible Pride Co-Manager •

  • Matthew Parsons, Thorne Harbour Health

  • Manager, Accessible Pride Program •

  1. About this submission Inclusion Melbourne and Thorne Harbour Health welcome the opportunity to contribute to the Senate Community Affairs Legislation Committee inquiry into the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026.

Inclusion Melbourne is Australia’s longest-serving, continuously operating organisation supporting people with intellectual and cognitive disability and people experiencing social isolation. The organisation is a Registered Training Organisation, a systemic advocacy body, an NDIS Registered Provider, and an Aged Care Volunteer Visitor Scheme (ACVVS) provider. It supports people with intellectual and cognitive disability to live, work, connect and participate in community life as full citizens. Inclusion Melbourne has led national projects relating to: natural supports; inclusion in mainstream sport; political and electoral inclusion; oral health; Circles of Support and Microboards; and LGBTQ inclusion.

Thorne Harbour Health is a community-controlled health organisation governed by our members and accountable to the communities it serves spanning Victoria and South Australia. These communities consist of unique people with diverse backgrounds and experiences who identify as lesbian, gay, bisexual, people with innate variations of

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sex characteristics, trans and gender diverse, non-binary, intersex, queer, other sexualities, gender bodily diverse people, and all people living with HIV. Our services include: Policy and Advocacy for LGBTIQ+ equality, NDIS Registered support delivery to LGBTIQA+ participants, AOD services, Family Violence Services, Health Promotion campaigns, Pronto! providing rapid HIV/STI testing, Equinox – providing a general GP Practice for trans and gender diverse patients, The Positive Living Centre – supporting people living with HIV, LGBTIQ+ specific mental health and counselling programs, rural programs, Aboriginal and Torres Strait Islander Rainbow Mob programs, and social supports for older LGBTQ people.

Alongside the Australian Research Center in Sex, Health and Society at La

Trobe University (ARCSHS), we are also two consortium partners of the ILC funded Accessible Pride project consortium, with our work focusing on the rights, safety, wellbeing and inclusion of LGBTQ people with intellectual disability.

We support the long-term sustainability, integrity, and quality of the NDIS. We also recognise that there are real problems in the Scheme, including inequitable planning outcomes, inconsistent evidence requirements, poor quality supports, weak market stewardship, thin markets, over-servicing in some areas, under-servicing in others, and insufficient protection from poor or exploitative practice.

Our concern is that key parts of the Bill respond to some of these problems through broad funding controls and standardised assessment architecture before the quality, market, accessibility and safeguarding settings are strong enough to protect people who already have the least power in the system.

Please note the following terms that we use frequently in this submission:

  • Community-of-choice: This means communities a person chooses, values or feels they belong to, rather than communities chosen for them by family or services, or due to perceived obligation or assumptions about background. Communities of choice may include cultural, faith, disability, LGBTQ, local, peer, hobby, advocacy or other communities. For people with intellectual disability, support may be needed to explore options, express preferences, make decisions and build real connection – Including with communities that reflect more than one part of who they are.

  • Identity-related supports: This means supports that help a person understand, express and live in ways that reflect who they are. This may include support to access information, make decisions, communicate preferences, explore identity safely, build relationships, connect with peers or communities of choice, and access affirming services. For LGBTQ people with intellectual disability, identity-related supports are needed because sexuality, gender, relationships and community connection are often not made accessible, discussed openly, or treated as ordinary parts of life.

  • Intersectional peer connection: This means connection with people who share or understand more than one important part of a person’s experience, identity or community. For LGBTQ people with intellectual disability, this may include meeting peers who understand disability, sexuality, gender, culture, communication needs, trauma, advocacy or service systems. These connections can reduce isolation, build confidence, support identity development and help people feel recognised as whole people, not only through one part of who they are.

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Submission 281

Contents

  1. About this submission ........................................................................................................................... 1
  2. About Accessible Pride .......................................................................................................................... 4

  3. Summary of our position ……………………………………………………………………………………………………….. 5 Our recommendations ………………………………………………………………………………………………………….. 6

  4. Assessing the Bill................................................................................................................................... 7

Concern 1: Support determinations create a broad funding reduction mechanism ……………………………… 8

Concern 2: The proposed reforms undervalue the critical role of social, civic and community participation supports in safety, rights and inclusion for many participants …………………………………………………………. 9

Concern 3: The Bill relies on a narrow safety concept ………………………………………………………………….. 10

Concern 4: Quality problems require quality mechanisms ……………………………………………………………. 10

Concern 5: Recognising thin markets ………………………………………………………………………………………. 11

Concern 6: Functional capacity assessments ……………………………………………………………………………. 12

Concern 7: Support needs assessments, including I-CAN, need safeguards ……………………………………. 13

  1. An intersectional lens for LGBTQ people with intellectual disability …………………………………………… 14
  2. Conclusion .......................................................................................................................................... 14

Appendix: Government and sector inputs to this submission…………………………………………………………………… 16

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Submission 281

  1. About Accessible Pride Accessible Pride is an ILC-funded (2024-27) consortium project delivered by Thorne Harbour Health, Inclusion Melbourne and the Australian Research Centre in Sex, Health and Society (ARCSHS) at La Trobe University. The project works to improve the lives of LGBTQ people with intellectual and cognitive disability by developing resources, training, tools and practice guidance that support access to information, education, community, services and support that affirm who people are. The project brings together LGBTQ community health expertise, intellectual disability practice expertise, lived experience leadership and research capability.

Our project extends recent Australian research that found:

  • 92% of LGBTQ people with intellectual disability reported high or very high psychological distress.
  • 59% reported verbal abuse, 20% physical abuse and 36% sexual harassment.
  • 62% said LGBTIQ community and services were not accessible because of intellectual disability.
  • 90% reported suicidal ideation and 1 in 2 had attempted suicide.
  • LGBTQ people with intellectual disability had around twice the rate of homelessness compared with LGBTQ peers.

Hill, A. O., Amos, N., Bourne, A., Parsons, M., Bigby, C., Carman, M., & Lyons, A. (2022). Violence, abuse, neglect and exploitation of LGBTQA+ people with disability: A secondary analysis of data from two national surveys. ARCSHS, La Trobe University.

The project uses a Participatory Action Research approach. This means our project is evidence-based and evidence-building and that LGBTQ people with intellectual and cognitive disability are not only consulted after decisions are made, but help shape the work, test ideas, guide what is created and contribute to how findings are understood. Project activity has included learning needs analysis, co-design, resource development, training design, research and evidence translation. Outputs include Easy Language resources, sector guides, supported decision-making guidance, event inclusion tools, training and eLearning for disability and LGBTQ organisations.

A core insight from the project is that poor outcomes for LGBTQ people with intellectual disability are not only caused by individual knowledge gaps or personal vulnerability. They are often shaped by access, support, systems, communication and gatekeeping.

Accessible Pride has organised this work around six recurring problems that were identified during the problematisation phase of the project. These are:

  1. LGBTQ people with disability often not having support to learn about even the basic aspects of their LGBTQ identity;

  2. LGBTQ people with intellectual disability not being supported to live safe, proud and well lives;

  3. Disability services not adequately supporting them in accordance with their rights, genuine needs and identity-based goals;

  4. LGBTQ communities and services needing to connect better;

  5. Laws, rules and systems relating to LGBTQ people and people with disability not interacting to produce positive or sufficient effects for LGBTQ people with intellectual disability; and

  6. LGBTQ and disability experts not working together enough – and not working with LGBTQ people with intellectual disability together – to improve practice and outcomes.

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These problems help explain why ordinary health promotion, service access and rights-based frameworks often fail to reach LGBTQ people with intellectual disability.

The project’s research and practice work has also highlighted the importance of identity as more than a demographic category.

For LGBTQ people with intellectual disability, equitable support for identity development is contingent upon one’s access to cognitively accessible information, close relationships, privacy, opportunity, supported decision-making, community access and how others interpret or restrict a person’s choices. Emerging work on LGBTQ suppression practices has identified that harm may occur not only through overt discrimination, but through ordinary service processes: poor intake, risk-averse support planning, weak supported decision-making, behaviour support that fails to adequately consider identity and unmet needs, omission of accessible sexuality and gender information, restriction of relationships, and limited access to LGBTQ community. These practices may be framed as duty of care, safeguarding or service boundaries, and therefore may not be recognised as harm.

For this submission, the relevance is direct. Community connection, peer support, accessible information, supported decision-making and identity-affirming services are not optional extras. For many LGBTQ people with intellectual and cognitive disability, they are the conditions that make safety, self-determination, rights, identity and ordinary community life possible.

  1. Summary of our position We do not argue that all current spending on social, civic and community participation, capacity building, or community access is high quality or should be preserved unchanged. We have seen examples of passive, repetitive, poorly designed or poorly reviewed supports. We also acknowledge that people with stronger informal advocacy, more confidence, greater privilege, fewer social and/or demographic barriers, better professional networks, and better-written evidence for NDIS Plan meetings have sometimes received more funding than people with similar or greater support needs.

However, a blunt funding reset does not distinguish poor-value or highly subjective support from critical support that is functioning as a person’s only pathway to the realisation of rights in areas such as peer connection, communication, community, identity, self-advocacy and core human relationships. The Bill’s proposed support determination mechanism is therefore not just a budget tool. It creates a way for Government to reduce funding for specified groups of supports across plans, including where those supports may otherwise have been assessed as reasonable and necessary for an individual participant.

Government material (eg. https://www.health.gov.au/our-work/ndis-legislation-changes/amendments/ndis amendment-securing-the-ndis-for-future-generations-bill-2026/about-the-changes-to-the-ndis) indicates this reset will include a 50 per cent reduction in budget allocations for social, civic and community participation supports and a 10 per cent reduction in capacity building daily activity budget allocations, while noting this will not necessarily translate into the same reduction in actual spending for every participant because some participants do not use all allocated funding.

The policy rationale appears to distinguish supports aimed at civic, social and community participation and capacity building from “critical supports” such as personal care, eating, drinking, toilet support, medication support, home modifications, mobility equipment, transport, consumables and Specialist Disability Accommodation. We believe this distinction is too narrow when applied to people with intellectual disability and

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Submission 281

other cognitive disability, particularly those with intersectional identities and related additional and unique needs, like LGBTQ people with intellectual disability.

For many people with intellectual disability, social, civic and community participation support is not optional, recreational or secondary. It is often what enables a person to leave home, build confidence, learn rights, connect with peers, access self-advocacy, develop ordinary adult identity, reduce isolation and have contact with people outside family or paid support systems.

For LGBTQ people with intellectual disability, these supports are even more critical. These supports may be one of the only practical pathways to accessing LGBTQ community, affirming health care, identity exploration, peer connection, sex and relationships education, trusted supporters, and protection from identity suppression, gatekeeping or coercion. As referenced in section 2 of this submission, research shows that LGBTQ people with intellectual disability suffer higher rates of minority stress, abuse, violence, and discrimination which drive alarmingly high levels of extremely poor health and well-being outcomes. This research also shows that a person having connection to the LGBTIQA+ community is the most effective protective factor against these drivers leading to these poor outcomes. Access to safe and LGBTIQA+ affirming supports is also a critical protective factor. However, LGBTQ people with intellectual disability have an experience of the NDIS provider marketplace that is indeed that of a ‘thin market’ due to the low proportion of providers with sufficient skill and expertise to provide evidence-based intersectional support.

Our central contention is that sustainability, particularly for intersectionally marginalised groups like LGBTQ NDIS participants, should be pursued by improving planning quality, support quality, assessment validity, provider accountability, market stewardship and safeguarding - not by creating broad powers to reduce whole categories of support that may be central to safety, autonomy, identity, community connection and citizenship.

Our recommendations

  • Amend or remove the proposed support determination power unless stronger safeguards are added, including clearer limits on the classes of supports that can be reduced, transparent impact analysis, appropriate scrutiny, and a stronger test than simply having regard to “participant safety”.

  • Require the Bill and its implementation to distinguish between low-value or poorly evidenced social, civic and community participation supports and those that are critical to a participant’s identity development, community connection, safety, rights, communication, decision-making, or safeguarding. This distinction should not be left to broad category-level assumptions.

  • Broaden the safety test so any support determination must consider identity-based exclusion, loss of community connection, health, wellbeing, social isolation, communication support needs, decision-making support, informal support stress, and risk of abuse, neglect, exploitation, violence or coercion.

  • Require an impact statement before any support determination is made, including impacts on people with intellectual and/or cognitive disability, LGBTIQA+ identities, complex communication needs, psychosocial disability, First Nations people, culturally and linguistically diverse communities, people in rural/regional areas, and people in other thin or inaccessible markets.

  • Recognise that thin markets are not only geographic. The Bill and its implementation should identify and respond to thin or inaccessible markets for people who require civic and community participation supports which are cognitively accessible, communication-supported, peer-led, trauma-informed, and culturally safe and affirming for protect identity attributes such as LGBTIQ+, Aboriginal & Torres Strait Islander, and/or Culturally and Linguistically Diverse NDIS participants.

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Submission 281

NDIA planning      Introduces support needs          The validity, accessibility and safety of implementation

and assessment   assessments and new framework     will determine whether the system recognises:

implementation    planning over time, with I-CAN       •  The complex nature of identity development of

version 6 used as the basis for the people with intellectual disability

new support needs assessment.     •  The compounding nature of intersectional

experiences (eg. That a person with two minority identities will experience more barriers, complexity or disadvantage than simply the sum total of barriers that they would experience were they to only have one of those minority identities)

  • Critical support needs which are intersectional identity related, hidden, relational, and/or developmental.

    Quality and Practice standards, registration These are the mechanisms most directly responsible

    market settings reforms, pricing reforms, for identifying poor-quality, poor-value or exploitative

commissioning, provider oversight supports. If such mechanisms are not strengthened, and market stewardship sit partly indiscriminate funding reductions may substitute for outside this Bill. the harder work of improving quality and market design.

Concern 1: Support determinations create a broad funding reduction mechanism

What is in the Bill:

The Bill proposes a new support determination mechanism. Proposed section 34A would allow the Minister, by legislative instrument, to determine a percentage lower than 100 per cent by which a funding component amount for a specified group of supports is reduced while the determination is in force. The Bill also provides that the Minister must have regard to the safety of participants when making the determination.

Our position on this:

This is a significant change because the determination is not made plan-by-plan. The Explanatory Memorandum describes support determinations as legislative instruments that can reduce funding for specified groups of supports in old framework plans by operation of law. It also explains that changes to funding as a result of support determinations are not subject to merits review because they are broad legislative-like decisions rather than decisions about the circumstances of a particular person.

This should be treated as a major policy choice. It means a support can remain reasonable and necessary in the participant’s plan, while the funding available for that support is reduced by a general instrument. That is different from improving planning quality. It risks replacing individualised approaches with broad budget control.

We recommend that this mechanism either not proceed in its current form or be amended so that any support determination is subject to stronger scrutiny in its safeguard considerations for people with intellectual disability (and especially for groups experiencing ‘thin markets’ due to needs specific to their diverse or intersectional attributes), transparent impact analysis, parliamentary scrutiny, a public rationale for any determination, and accessible review pathways for individual participants who are adversely affected.

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Concern 2: The proposed reforms undervalue the critical role of social, civic and community participation supports in safety, rights and inclusion for many participants

What is in government material relating to the Bill:

The Department of Health, Disability and Ageing states that budgets for social, civic and community participation supports will be reset from October 2026, with budget allocations reduced by 50 per cent, and capacity building daily activity budget allocations reduced by 10 per cent. It also states that changes will occur progressively as participants’ plans are reassessed or renewed over a 12-month period, and that actual spending reductions may differ where participants were not using all of their allocated budgets.

The Office of Impact Analysis (OIA, PMC) summary (https://oia.pmc.gov.au/published-impact-analyses-and reports/national-disability-insurance-scheme-reforms) describes the Government’s preferred reform package as involving changes to Scheme eligibility requirements and changes to the volume of supports funded by the NDIS. It also notes that the Impact Analysis was assessed as “Adequate” and would have benefited from further quantification of costs and benefits and a more detailed implementation and evaluation plan.

Our position on this:

In our view, this reinforces the need for caution before reducing support categories that may function as important safeguards against isolation, exclusion and poor practice for NDIS participants with intellectual disability and intersectional identity related needs.

We agree that the Scheme should apply a degree of scrutiny to supports that are either:

  • poor-quality,

  • passive or connected to segregated activities (with the exception of self-advocacy groups, peer advocacy groups, or intersectional identity-related peer groups), or

  • not connected to activities with identity-affirming, capacity building, or agency developing features. However, we assert that many supports in other categories (that is, supports outside the social, civic and community participation category) would fall foul of such scrutiny, while many supports in the category in question would not.

We also strongly reject any assumption that social, civic and community participation is generally secondary to critical supports for cohorts such as people with intellectual disability, and especially those who are also LGBTQ, for whom these supports may be the very supports that make safety and a basic quality of life possible. For this group their social, civic and community participation supports are critical in:

  • Reducing isolation and dependence on a single household, service or family gatekeeper.

  • Connecting people to intersectional peer support as well as culturally safe and identity-affirming self-advocacy, and rights information.

  • Creating regular contact with communities of choice and building natural supports outside paid support systems, which mitigates risks of identity suppression, abuse, neglect, exploitation, violence, coercion or poor practice come to light.

  • Supporting ordinary adult identity development and affirmation, friendship, belonging, civic participation, work, learning, volunteering and contribution.

  • Building decision-making confidence and communication opportunities in real environments. For LGBTQ people with intellectual disability, community participation is the most essential route to accessing affirming community, accessible information about sexuality and gender, intersectional peer connection, privacy,

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safe relationships, sexual health information, and protection from identity suppression. A broad reduction in the funding allocation for the category without strong individual safeguards that spotlight marginalised intersectional groups like LGBTQ people with intellectual disability risks cutting the support that allows the person to be seen as a whole adult person with legal rights to support around their protected attributes that empower them to enjoy an equitable quality of life akin to their LGBTQ peers without disability.

Concern 3: The Bill relies on a narrow safety concept

What is in the Bill:

The Bill requires the Minister to have regard to participant safety when making a support determination. The Explanatory Memorandum describes relevant safety considerations as including whether a reduction could place participants at risk of neglect, crisis or loss of essential functioning.

Our position on this:

That is important, but not enough. For people with intellectual disability, safety is not only defined through the lens of physical safety, such as whether someone receives safe personal care. Safety also encompasses psycho-social emotional safety which depends on whether the person has trusted relationships outside their immediate service context, can communicate concerns, understands their rights, has access to advocacy, can spend time in community-of-choice settings, has privacy, and is not dependent on one gatekeeper for information, relationships and decisions.

For LGBTQ people with intellectual disability, safety also includes protection from LGBTQ identity suppression. Suppression does not always look like overt homophobic, biphobic or transphobic hostility. For LGBTQ people with intellectual disability it more often manifests as silence on LGBTQ topics, avoidance of these topics, overprotection, refusal to provide accessible information (gatekeeping), fear-based restrictions, denial of privacy, failure to support intersectional peer or intimate relationships, or treating identity exploration as behaviour or risk rather than as part of personhood and citizenship. Suppression is also most likely to occur within the immediate environment of existing supports at home, in disability-specific environments, and adjacent domains. This makes access to high quality social and community participation focused NDIS funds essential in countering identity suppression risk through the provision of access to LGBTIQA+ affirming communities-of-choice.

We therefore recommend replacing or supplementing the current safety test with a broader statutory safeguard requiring consideration of identity, relationships, community connection, health, wellbeing, social isolation, communication, decision-making, informal support sustainability, rights, and exposure to abuse, neglect, exploitation and violence.

Concern 4: Quality problems require quality mechanisms

What is in the context around the Bill:

Government material makes it clear that some social, civic and community participation and capacity building supports do not consistently improve community participation, inclusion or capacity.

Our position on this:

We agree that this is the case. Our concern is that the proposed response to this issue is too blunt. The NDIS Practice Standards already specify quality standards that registered NDIS providers must meet when delivering supports and services to NDIS participants. They also raise participant awareness of what quality service provision

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should look like. The NDIS Commission is also reviewing the Practice Standards to consider whether obligations are appropriate, focused on the right things and supported by guidance about high-quality, safe and participant centred supports. The Accessible Pride partners have made a detailed submission to the NDIS Commission regarding the review of the Standards to ensure vital improvements are made to protect and meet the unique needs of LGBTQ people with intellectual disability. We welcome the opportunity to share the submission with the Senate Committee upon request.

At the same time, Practice Standards alone are not sufficient. Many community participation and capacity building supports may be delivered by unregistered providers, sole traders or small community-based arrangements. Some of those arrangements may be excellent and trusted, however some may be poor quality, poorly reviewed, culturally unsafe for participants with diverse identities, and even deliberately or inadvertently engaging in LGBTQ identity suppression practices. That means quality reform must include practice standards, provider regulation, market stewardship, pricing reform, participant-led feedback, commissioning where appropriate, and clear expectations about what good community participation and capacity-building support actually looks like for a diversity of lived-experiences of NDIS participants and especially those with legally protected identity attributes.

A better quality test would ask whether a support supports a person’s identity development and rights, strengthens vital community-of-choice connection, reduces isolation, increases self-determination, builds communication and decision-making, respects privacy and dignity of risk, and gives the participant a stronger life beyond the service system. We do not have clarity about how these considerations might be incorporated into the reset.

Concern 5: Recognising thin markets

What is in the context around the Bill:

Government material calls attention to the unique needs of those experiencing ‘thin markets’ in rural and regional locations.

Our position on this:

We support attention to the ongoing cross-sector discourse regarding thin markets in the NDIS Provider marketplace, typified by rural and regional experiences and people with unique, high intensity support needs. However, thin markets should not only be understood through these lenses. There are also thin markets for people who need LGBTQ affirming disability support and culturally safe supports in tandem with cognitively accessible services, communication support, trauma-informed practice, supported decision-making, self-advocacy, peer support, or workers skilled in helping people build connections with their communities-of-choice.

For LGBTQ people with intellectual disability, the market can be thin in two directions at once. Our project’s investigation has found that:

  • Disability support services, many of which dominate the lives of this cohort, are often not confident or competent in supporting sexuality, gender identity, relationships or LGBTQ community access.

  • LGBTIQA+ ‘Community Controlled’ and LGBTIQA+ specialist services can be reluctant to support LGBTQ people with intellectual disability and are not cognitively accessible or set up to include people with intellectual disability. They rarely have Easy Language information, do not understand the practice of Supported Decision Making, and have not cultivated disability practice partnerships.

  • Most LGBTQ people with intellectual disability in our organisational and project networks are not yet connected to LGBTIQA+ communities, organisations, or events.

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Where a person has access to identity-affirming community connection, intersectional peer support or culturally safe self-advocacy supports, that support should be treated as crucial protective infrastructure. Removing or reducing it may not simply reduce an activity. It may remove the person’s bridge to their identity, rights, voice, confidence, and safeguarding from identity-based suppression, violence, abuse, neglect and exploitation.

Concern 6: Functional capacity assessments

What is in the Bill:

The Bill introduces and clarifies the concept of functional capacity. The Explanatory Memorandum states that activities include mobility, communication, social interaction, learning, self-care and self-management. It also states that the next step is linking the definition of functional capacity to assessment outputs and that new eligibility criteria applying functional capacity assessments are expected to commence in 2028.

Government material says access to the NDIS will be based on a standardised, evidence-based assessment of functional capacity, with a Technical Advisory Group to advise on thresholds and assessments. It also says people already accessing the NDIS will be reassessed progressively over three years from that date.

Our position on this:

We support consistency and evidence-informed assessment. However, our experience is that functional capacity assessments can produce an incomplete or misleading picture when they treat capability as though it sits only within the individual, rather than also being shaped by support, opportunity, environment, relationships, communication access and prior experiences of exclusion and low expectations. This is particularly relevant where community connection and capacity-building supports are involved, especially in relation to identity development, citizenship and identity-specific community connection. A person’s current confidence, initiative, communication, decision-making, self-advocacy or community participation may reflect both impairment-related support needs and the opportunities, expectations and supports they have or have not had. If this context is not considered, an assessment may accurately record current limitations but fail to identify the supports needed to build capability, reduce isolation and expand the person’s life.

This is not an argument against functional assessment. It is an argument for assessment that can distinguish between enduring impairment-related support needs, skills that have not yet been developed, and capability that may emerge when the person has accessible, intersectional information; trusted support; peer connection; quality Supported Decision Making; and opportunities for normative connection to communities of choice.

This is particularly relevant for LGBTQ people with intellectual disability. A person may not appear to have clear support needs relating to sexuality, gender, relationships or LGBTQ community if they have never had LGBTQ affirming accessible information, privacy, intersectional peer connection, or LGBTIQA+ culturally safe support opportunities to explore those parts of themselves and their life. Without specific measures that are sensitive to this area of need, an assessment that only records what is currently visible may miss the support needed to make identity, relationships and community connection possible and prevent the intense suffering caused by long-term suppression of sexual or gender identity.

Functional capacity assessment should therefore be sensitive to identity development and examine not only what a person currently does, but what has shaped their current functioning, what opportunities they have or have not had, what supports have made capability possible, and what risks arise if those supports are withdrawn. Without this, functional capacity assessment may unintentionally treat the effects of exclusion or low opportunity as evidence that support is not needed, or provide little guidance as to which supports are in fact required, which is expanded in concern 7, below.

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Concern 7: Support needs assessments, including I-CAN, need safeguards

What is in the context around the Bill:

The NDIA has announced that the new way of planning will include a support needs assessment, described as a guided conversation with a trained assessor to understand a participant’s disability support needs. The NDIA has also stated that it is partnering with the University of Melbourne and the Centre for Disability Studies to develop the assessment, and that I-CAN version 6, developed by the Centre for Disability Studies, will be used as the basis for the new support needs assessment.

The NDIA describes I-CAN as a validated, strengths-based tool developed over more than 20 years in the Australian context and tested through multiple research studies across a range of disability groups.

Our position on this:

We do not submit that I-CAN has no value or that standardised support needs assessment is inherently inappropriate. Our concern is what any support needs assessment is capable of recognising. In our experience, some higher-level support needs for people with intellectual disability, including support to build self determination, full citizenship and identity development, are not always captured by assessments focused on current functioning. These needs are often found in the relationship between what a person can do, what they have been taught, what they have been allowed to try, what environments they can access, what expectations others hold for them, and what support has been available to help them build confidence and capability over time.

This goes to the logic of planning. Some support needs are obvious because a person cannot complete a task without assistance. Others are less visible because they relate to the conditions that allow capability to develop in the first place. This includes support to build an internal sense of identity, understand options, make decisions, communicate preferences, build relationships, access community, recover from exclusion, access intersectional peer supports and communities of choice, and participate equitably in ordinary adult life.

If an assessment gives too much weight to a narrow view of current functioning, without considering support history and opportunity, it may understate the support required to build new capability. A person may have current limitations in identity development, decision-making, community-of-choice access, friendships or intimate relationships because they have not had enough accessible information, trusted support or safe opportunities to practise these parts of life. Conversely, a person may appear not to need particular supports because they are suppressed, compliant, quiet, socially isolated or conditioned to expect inadequate support. Both patterns can lead to support needs being missed or understated.

For LGBTQ people with intellectual disability, this risk is acute. Support needs connected to identity development, sexuality, gender identity, relationships, privacy, consent and LGBTIQA+ community belonging may not be visible unless the assessment recognises that these areas are often suppressed, avoided or never made accessible. The issue is not only whether a person can disclose an LGBTQ identity. It is whether they have had the information, privacy, trusted support and community connection needed to build understanding and expression of this part of life safely.

Furthermore, assessment should not force or rely on initial disclosure. It should create safe ways to identify support needs connected to sexuality, gender identity, relationships, privacy, consent, intersectional peer connection, identity-affirming health care and community access, without requiring a person to disclose in front of family, nominees, staff or others who may be unsafe or dismissive.

All support needs assessments must consider the developmental and relational conditions of capability. They should first examine where current functioning may reflect lack of opportunity or environmental barriers, before assuming it reflects static impairment. They must also consider where support could build capacity rather than

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simply maintain routines that assume and reinforce low functioning. These considerations are essential if the new planning system is to avoid replicating and reinforcing the very issues that the NDIS was designed to overcome.

  1. An intersectional lens for LGBTQ people with intellectual disability Our work with LGBTQ people with intellectual disability points to recurring practice and system failures, including:

  • failure to centre the lived experience expertise of LGBTQ people with intellectual disability themselves in policy development, service design and delivery, and the development of cross-sector practice

  • lack of accessible information about identity, including information to support identity development, leading to wide-spread identity suppression practices

  • overprotection and infantilisation resulting in gatekeeping of LGBTQ topics

  • risk-avoidant disability practice inadvertently creating identity suppressing environments

  • inaccessible and disconnected LGBTQ community settings

  • weak recognition of identity-related support needs creating passive, identity suppressing environments

  • poor cross-sector coordination between LGBTIQA+ organisations, disability support sector organisations, disability advocacy, allied health providers, and other adjacent and allied professionals and experts.

These issues are examples of how standard disability systems commonly fail when a person’s support needs sit at the intersection of intellectual disability, communication access needs, sexuality, gender, relationships, privacy and community-of-choice connection.

These patterns are directly relevant to the Bill because broad funding levers and standardised assessment systems may already often fail to identify risks, support needs, and opportunities for innovative, intersectional supports that could help people overcome a range of critical barriers, and this is likely to be made worse by the Bill. If an assessment only asks what a person can do, without understanding who they are, what they have never been taught, what they have never been allowed to say, or never been safely supported to explore, it will inevitably understate their support needs and perpetuate identity suppression.

The assessment and planning system should not wait for a person to confidently disclose a fixed LGBTQ identity before recognising related support needs. Many people first need accessible LGBTQ-affirming information about sexuality and/or gender identity, private conversation with trusted supporters, Supported Decision-Making approaches, intersectional peer connection and safe community-of-choice access before they can understand or articulate their own identity, relationship or safety needs.

Directly related to this is the fact that community participation funding should not be treated as optional. It is not less important than personal care support needs, nor is it simply support for ‘recreation’. For LGBTQ NDIS participants, whether they be confident self-realised LGBTQ people or suppressed, it is one of the primary funded pathways that enables access to fundamentally important LGBTIQ identity-affirming rights education, sex and relationships information, LGBTQ peer connection, intersectional self-advocacy, LGBTIQA+ Culturally Safer health services, and trusted adults they can relate to and build uniquely meaningful connection with outside family or disability service systems that are often not LGBTQ affirming.

  1. Conclusion The NDIS needs reform, but reform such as the proposed indiscriminate en masse reduction to social, civic and community participation supports must not narrow the Scheme’s purpose to seemingly only catering to bodily care and basic daily living maintenance. For people with intellectual disability, an equitable quality of life is not achieved

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through direct residential, vocational or personal care alone. It is supported through a wholistic approach to assessing physical as well as psycho-social-emotional wellbeing needs and matching these with appropriate capacity-building and Supported Decision Making approaches to relationships, communication, choice, risk, learning, belonging, contribution, identity, privacy, advocacy, community and ordinary adult citizenship.

For LGBTQ people with intellectual disability, these conditions are even less likely to be accurately assessed, intentionally planned, and appropriately provided in identity-affirming ways. Without this enormously consequential approach to their supports, LGBTQ people with intellectual disability are sentenced to lives in which they are isolated, unseen, overprotected, misread, suppressed or disconnected from potential communities-of-choice and LGBTIQ Culturally Safe services that could help them live safely and well. Current NDIS system failings are key drivers in this cohort’s extreme and alarmingly poor health and well-being outcomes (outlined again below), and if not accounted for with amendments, the Bill in its current form will inevitably worsen these shocking statistics.

  • 92% of LGBTQ people with intellectual disability reported high or very high psychological distress.

  • 90% reported suicidal ideation and 1 in 2 had attempted suicide.

  • 59% reported verbal abuse, 20% physical abuse and 36% sexual harassment.

  • 62% said LGBTIQ community and services were not accessible because of intellectual disability.

  • LGBTQ people w intellectual disability had around twice the rate of homelessness compared with LGBTQ peers. We again assert that the Bill should be amended to ensure robust safeguarding measures are introduced. NDIS participants with intellectual disability, particularly those with intersectional identities, rely on current civic, social and community participation as an indispensable protective factor against these poor health and well-being outcomes so must have robust protection and safeguarding measures in order to not experience a reduction in this life-saving necessary category of funded support. We propose that sustainability be pursued through:

  • better assessment that is sensitive to identity and historically constructed deficit,

  • better holistically affirming support planning,

  • better quality regulation attuned to safeguarding marginalised groups with identity attributes legally recognised as protected, and

  • better market stewardship. These approaches will be far more effective than creating a blunt mechanism that indiscriminately reduces access to the crucial supports that make possible equitable access to identity development and affirmation, safety, self determination, wellbeing, and uplifting connections to communities-of-choice and intersectional peers.

We welcome further engagement from the Senate Community Affairs Legislation Committee.

Nathan Despott(he/they) Matthew Parsons (they/them)

Head of Policy, Research and Advocacy Project Manager, Accessible Pride

Helen Williams (she/her) Peter Locke (he/him)

CEO Director of Services (HIV, Clinical & Community Support)

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Appendix: Government and sector inputs to this submission

  • APH inquiry:

https://www.aph.gov.au/Parliamentary Business/Committees/Senate/Community Affairs/NDISFutureGenBill

  • APH Bill page:

https://www.aph.gov.au/Parliamentary Business/Bills Legislation/Bills Search Results/Result?bId=r7487

Primary evidence inputs:

  • Hill, A. O., Amos, N., Bourne, A., Parsons, M., Bigby, C., Carman, M., & Lyons, A. (2022). Violence, abuse, neglect and exploitation of LGBTQA+ people with disability: A secondary analysis of data from two national surveys. ARCSHS, La Trobe University.

  • Smith, E. M., Zirnsak, T.-M., Bartlett, K., Power, J., & Bigby, C. (2024). “Because it’s who I am”: Self- determination of LGBTQ adults with intellectual disability. Disability & Society, 39(1), 1-20.

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