Submission to the Senate Community Affairs Legislation Committee:
Inquiry into the Proposed Changes to the National Disability Insurance Scheme (NDIS)
Thank you for the opportunity to provide this submission regarding the proposed changes to the National Disability Insurance Scheme (NDIS).
I am a registered Clinical Psychologist with over two decades of experience working across the Australian mental health sector. Throughout my career, I have worked with people living with disability, chronic illness, substance abuse, trauma, and complex mental health presentations in a variety of clinical settings. More recently, my work has focused on burnout and empathy fatigue, supporting helping professionals whose wellbeing has been significantly impacted by the systems in which they work.
My perspective is informed by both professional expertise and lived experience.
In 2021, I experienced severe burnout that required me to step away from clinical practice for almost two years. While there were many contributing factors, one of the most significant was the cumulative moral distress of working within systems where I repeatedly knew what clients needed but was unable to provide or advocate for those supports because of systemic barriers beyond anyone’s control.
That experience fundamentally changed the way I returned to practice.
Although I had previously worked with third-party systems such as the NDIS, I made the conscious decision to minimise working with other systems. This was not because I lacked compassion or believed people living with disability deserved anything less than excellent care. Rather, I recognised that I could no longer sustainably practise within a system that I had experienced as creating distress not only for participants but also for the professionals attempting to support them.
This submission is therefore offered from a unique perspective. It reflects the observations of a Clinical Psychologist, a former NDIS independent provider, someone with lived experience of burnout, and someone who now specialises in supporting other caring professionals experiencing burnout and moral injury.
I want to make it clear that I support accountability, transparency and responsible stewardship of public funds. Every publicly funded scheme should be subject to appropriate oversight and continuous improvement.
My concern is not that reform is occurring.
My concern is that the current reforms appear to give considerable attention to financial accountability while giving insufficient consideration to the human costs that are transferred to participants, families, carers, providers, and ultimately, the broader health system.
The Human Impact of Policy Decisions
Over the past three years, I have continued to support one NDIS participant living with permanent and degenerative health conditions. While this represents only one person’s experience, the issues I have observed reflect concerns I hear repeatedly from participants, families and colleagues working within the disability sector. What I have witnessed is not simply the impact of disability. It is the psychological impact of navigating the NDIS itself.
I have witnessed ongoing fear whenever policy changes are announced because participants cannot predict whether the supports they rely upon will continue. I have witnessed anxiety generated by uncertainty and prolonged decision-making processes. I have witnessed the emotional exhaustion of repeatedly requiring people with permanent and degenerative conditions to prove disabilities that will not improve. I have witnessed guilt for requesting supports that are clinically appropriate and intended to enable participation in everyday life. I have witnessed increasing shame as public discourse has focused on fraud, misuse and expenditure, creating a perception amongst many participants that they are viewed as a burden rather than citizens entitled to equitable support. Most concerningly, I have witnessed despair and hopelessness that stem not from disability itself, but from repeated interactions with a system established to improve quality of life.
Recently, this participant’s psychology funding was removed without notice. In my professional opinion, this decision significantly increased psychological risk. The impact extended far beyond the participant.
Like many clinicians, I immediately found myself undertaking unpaid work to ensure continuity of care, reduce immediate risk, assist the participant in understanding the decision, identify alternative supports and prevent them from feeling abandoned during a period of considerable distress. I undertook this work because my professional and personal ethics required it. No funding was available for this work. There was no recognition that responsibility had simply been transferred elsewhere. I suspect this experience is being quietly repeated across Australia by countless clinicians, allied health professionals, support coordinators, carers and family members.
The Hidden Costs of Reform
One of my greatest concerns is that current discussions surrounding NDIS reform appear to focus predominantly on expenditure within the Scheme itself. However, reducing expenditure within one part of the system does not necessarily reduce the overall cost of care. Often, it simply transfers those costs elsewhere.
When funded supports are removed, psychological need does not disappear. Responsibility is instead shifted to family members, unpaid carers, general practitioners, emergency departments, community organisations and individual clinicians who frequently absorb significant amounts of unpaid labour because ethical practice
requires them to minimise foreseeable harm. These costs remain largely invisible because they are rarely measured. The financial savings from reducing supports may therefore be offset by increased demand elsewhere in Australia’s health and social care systems.
Equally important are the human costs. Participants experience increased uncertainty, distress and disruption to therapeutic relationships. Families assume greater caring responsibilities. Clinicians face increasing ethical dilemmas as they attempt to balance professional responsibilities with funding constraints. These are genuine costs, even if they do not appear within NDIS budget reporting.
The Impact on the Caring Workforce
Today, my clinical work focuses primarily on burnout and empathy fatigue. From both lived experience and professional practice, I have come to understand that burnout is not simply the result of working long hours. It frequently develops when caring professionals are repeatedly placed in situations where they know what is needed but systemic constraints prevent them from providing appropriate care. This is commonly described as moral distress. When repeated over time, moral distress contributes to burnout, workforce attrition and reduced professional wellbeing, and the flow-on impact to the care of the individuals seeking health care is compromised.
My own experience reflects this reality.
It is also reflected in the experiences shared by many colleagues who have reduced or withdrawn from NDIS work because the emotional burden of navigating the system has become unsustainable. A luxury the participants do not have.
If Australia is committed to building a sustainable disability support system, workforce sustainability must be considered alongside financial sustainability. A scheme cannot function effectively if it unintentionally contributes to the loss of the very professionals required to deliver it.
Accountability Should Apply Across the Entire System
Public discussion surrounding the NDIS has understandably emphasised participant accountability and provider accountability. Fraud should be addressed. Poor quality services should be addressed. Public funds should be protected.
As registered health professionals, psychologists are accountable to AHPRA, the Psychology Board of Australia, professional standards and ethical obligations. That accountability is both necessary and appropriate. However, I believe accountability should also extend to evaluating the unintended consequences of government policy decisions.
Questions that deserve greater consideration include:
How are the psychological impacts of funding reductions being monitored?
What measures exist to evaluate participant wellbeing following significant policy changes?
How is the unpaid labour transferred onto providers, carers and families being recognised?
What monitoring exists regarding workforce burnout, provider attrition and reduced participation in the NDIS workforce?
How are downstream costs to the broader health system being evaluated?
Good governance requires accountability not only for financial expenditure but also for the human consequences of policy decisions.
Without measuring these outcomes, there is a risk that reforms considered financially successful may simultaneously reduce participant wellbeing, increase workforce burnout and shift costs into other parts of the health system.
Recommendations
I respectfully recommend that the Committee consider:
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Evaluating major NDIS reforms against participant wellbeing, continuity of care and quality of life, alongside financial outcomes.
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Introducing routine monitoring of workforce wellbeing, provider retention and moral distress as indicators of Scheme sustainability.
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Increasing transparency regarding the unintended consequences of significant policy decisions.
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Reducing unnecessary reassessment requirements for people living with permanent and degenerative conditions where there is no reasonable expectation of functional improvement.
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Recognising continuity of psychological care as an important protective factor for participants experiencing complex and enduring disability.
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Ensuring participants, carers and frontline clinicians play a meaningful role in the evaluation of future reforms.
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An agency separate from the government to ensure the ethical delivery of this scheme.
Conclusion
The long-term sustainability of the NDIS depends upon more than financial responsibility. It also depends upon sustaining the wellbeing of the people who rely upon the Scheme and those who deliver it. As both a Clinical Psychologist and someone who now specialises in burnout, I am deeply concerned that important human consequences of the current reforms risk remaining invisible because they are difficult to quantify. Yet they are no less real. Participants experience increased fear, uncertainty and psychological distress. Families assume additional caring responsibilities. Providers quietly absorb unpaid labour and increasing moral distress. Some ultimately leave the workforce altogether. These outcomes should not be viewed as inevitable side effects of reform. They should be recognised, measured and actively considered alongside financial outcomes.
I hope that future reforms to the NDIS continue to strengthen accountability while also preserving the dignity, safety and wellbeing of the Australians the Scheme exists to support. A sustainable NDIS must be both financially sustainable and humanly sustainable. Without both, we risk achieving short-term savings at the expense of long term outcomes.
- Take gentle care of you,
Shannon Swales
Psychologist and Midlife Reclaimed Coach
Pronouns: She/her/hers
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I acknowledge Aboriginal and Torres Strait Islander peoples as the first peoples and traditional custodians of the lands where I live and work, the lands of the Jagera and Turrbal people.