Clinical judgement essential for adequate treatment of psychosocial disability (Provider advocacy)

Submission 385

Submission 385

The Australian Association of Psychologists Inc. (AAPi) submits that the NDIS Amendment (Securing the NDIS for Future Generations) Bill 2026, together with its associated policy architecture, risks shifting the Scheme away from its foundational commitment to individualised, rights-based support and toward a model driven by standardisation, fiscal containment, and administrative convenience. The proposed reforms raise serious concerns regarding increased ministerial power, higher treatment thresholds before disability supports are available, greater reliance on peer-reviewed evidence as a funding gateway, reduced capacity for responsive reassessment, expanded automation, and more standardised planning processes that may fail to account for the complexity of disability and psychosocial functioning.

AAPi’s central position is that disability support decisions must remain individualised and grounded in the clinical evaluation of the professionals working with the participant, who have assessed their presentation over time, and are qualified to judge whether a treatment is clinically indicated, whether further treatment options that are available would be harmful, or whether additional intervention is likely to be beneficial. Evidence hierarchies can inform policy, but they cannot substitute for clinician judgement in determining what is reasonable, necessary, safe, and effective for a particular person. The diversity of disability presentations, the episodic and contextual nature of psychosocial disability, and the interaction between impairment, environment, trauma, family systems, culture, service access, and comorbidity mean that abstract research findings are often an incomplete guide to individual need. Adequate treatment must be determined by clinical judgement, not research evidence alone AAPi strongly opposes any approach under which the question of whether a person has received “adequate treatment” is determined primarily by reference to research evidence. That question must instead rely on the clinical evaluation of the professionals working directly with the participant. Those professionals are best positioned to determine whether prior treatment has been adequate in light of the participant’s history, response pattern, goals, co-occurring conditions, psychosocial circumstances, service access barriers, and risks associated with further intervention. In many cases, further treatment may be clinically inappropriate, retraumatising, inaccessible, or harmful, and in others, targeted intervention may still be warranted. A rigid requirement tied to generalised research evidence cannot safely resolve those questions.

This is especially important because research evidence in disability and psychosocial care is often heterogeneous, uneven across diagnostic groups, methodologically limited, and poorly suited to capturing participant-specific responses. The NDIS Quality and Safeguards Commission itself describes evidence-informed practice as requiring the integration of contemporary research with the rights and perspectives of people with disability, professional expertise, and the practice context, rather than relying on research alone. Over-reliance on peer-reviewed evidence as a gatekeeping device would therefore represent a serious departure from contemporary evidence-informed practice. It would also risk overruling current clinical practice on the basis of outdated

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Submission 385

or inappropriate evidence that fails to take into account the individual factors that are critical to determining whether support is needed and what support will

work (National Disability Insurance Scheme Quality and Safeguards Commission,

2023).

This position is supported by the broader literature and policy guidance. The NDIS Commission’s Evidence-Informed Practice Guide states that good practice requires integrating the best available contemporary research with the expertise of professionals, the rights and perspectives of people with disability, and the realities of the implementation context. Likewise, recent literature on psychosocial disability within the NDIS highlights that individual recovery trajectories are complex, qualitative, and highly context dependent, and that standardised capacity-building frameworks may fail to capture those realities. These sources support a model in which research informs practice, but clinician judgement remains central when making individual decisions about treatment adequacy and support need (Hayes et al., 2016; National Disability Insurance Scheme Quality and Safeguards Commission, 2023). Plans should be assessed and decided by clinicians AAPi’s position is that participant plans should be assessed and decided by appropriately qualified clinicians. Where planning decisions are made by workers without sufficient clinical qualification and training, there is a substantial risk that complexity will be missed, risk factors will be underestimated, functional decline will go unrecognised, and supports will be matched to administrative categories rather than genuine need. That model does not merely create poor participant experiences, it creates poor plans. Poor plans often underfund the supports, therapy, technology, and environmental adjustments that would stabilise or improve functioning, and they can thereby contribute to worsening disability, greater family strain, crisis escalation, disengagement from community participation, and higher downstream costs.

The literature is consistent with this concern. Person-centred and individualised care planning is widely recognised as critical to aligning supports with actual needs, goals, context, and outcomes. Evidence on psychosocial disability further indicates that support systems are less effective when they fail to account for fluctuating needs, social disadvantage, and the lived realities of recovery. A planning model that sidelines clinician expertise in favour of standardised or minimally skilled assessment risks false economies. Funds may be withheld at the point of planning, but the consequence may be higher use of crisis, hospital, carer, and replacement supports later (Claes et al., 2010; Hayes et al., 2016; National Disability Insurance Scheme Quality and Safeguards Commission, 2025; Young et al., 2025). Funding the right thing at the right time reduces long-term costs AAPi submits that funding the right support at the right time is not contrary to sustainability, it is one of the preconditions for sustainability. When clinically indicated, therapy, environmental supports, and assistive technology are provided early and responsively, participant functioning can be maintained or improved, avoidable decline can be prevented, and longer-term dependence on more intensive and expensive supports can be reduced. Conversely, when supports are delayed until impairment

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Submission 385

worsens, the Scheme may incur greater costs through crisis responses, preventable deterioration, hospital use, breakdown of informal care, and more intensive long-term packages (Australian Institute of Health and Welfare, 2025; Hayes et al., 2016; World Health Organization & United Nations Children’s Fund, 2022).

Available literature supports this position. The Australian Institute of Health and Welfare reports that timely, comprehensive, appropriate and effective prevention and early intervention services support better health and wellbeing and can reduce future care and support costs. Literature prepared for the NDIS on psychosocial disability similarly concludes that effective early intervention can improve outcomes and reduce future service need and long-term scheme costs. The World Health Organization also notes that assistive technology can maintain or improve functioning and that early provision can reduce secondary complications and broader health system burden. Taken together, this body of evidence supports a planning and funding model that prioritises timely, clinically indicated supports rather than delayed, standardised, or narrowly cost-driven decision-making (Australian Institute of Health and Welfare, 2025; Hayes et al., 2016; World Health Organization & United Nations Children’s Fund, 2022).

Definition of Functional Capacity

AAPi has concerns regarding the proposed revision of the definition of “functional capacity” in the legislative changes, particularly the narrowing of the concept to exclude environmental and personal context.

The current proposal appears to conceptualise functional capacity in a way that isolates individual impairment from the broader lived context in which a person operates. This approach is inconsistent with the social model of disability, which is well established both within Australia and internationally, and which recognises that disability arises from the interaction between an individual’s impairment and the social, environmental, and attitudinal barriers they face.

In practice, functional capacity cannot be meaningfully understood without consideration of:

• environmental factors (e.g. housing stability, access to supports, community participation opportunities)

• personal context (e.g. trauma history, family dynamics, cultural context, socioeconomic circumstances)

• systemic barriers (e.g. service availability, discrimination, accessibility) These factors are not peripheral. They are integral to determining how a person functions in everyday life. Excluding them from the definition risks reducing functional capacity to a narrow, impairment-based construct that does not reflect real-world experience.

This represents a shift away from the principles that underpin the NDIS, which was designed to reflect contemporary understandings of disability and to move beyond

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Submission 385

purely medicalised models. It also risks placing Australia out of step with international approaches, including those informed by the United Nations Convention on the Rights of Persons with Disabilities, which emphasises the importance of environmental and social factors in shaping disability outcomes.

AAPi is concerned that this narrower definition will have significant practical consequences for participants.

Firstly, it is likely to increase evidentiary barriers. Participants may be required to demonstrate functional impairment in a way that is artificially disconnected from the contexts in which those impairments are most evident. For example, individuals who are able to function in limited or highly supported environments may not meet a narrowly defined threshold, despite experiencing substantial functional limitations in less structured or less resourced settings. This risks excluding individuals whose needs are genuine but context-dependent.

Secondly, the proposed definition introduces interpretive ambiguity. Without clear recognition of contextual factors, assessments of functional capacity may become more subjective and inconsistent, with different assessors applying varying interpretations of what constitutes impairment and its impact. This undermines fairness and transparency within the Scheme.

Thirdly, there is a risk that participants will be required to meet a higher threshold to demonstrate eligibility or ongoing need. By narrowing the scope of what is considered relevant, the definition may effectively raise the bar for access, particularly for individuals with complex, fluctuating, or psychosocial disabilities, where context is critical to understanding functional impact.

For the psychology workforce, this is of particular concern. Psychological assessment relies heavily on understanding individuals in context, including the interaction between cognitive, emotional, behavioural, and environmental factors. A definition that excludes these elements does not align with evidence-based practice and limits the ability of clinicians to provide accurate and meaningful assessments.

AAPi therefore recommends that the definition of functional capacity be revised to explicitly incorporate environmental and personal context, consistent with:

• the social model of disability
• the principles underpinning the NDIS
• contemporary clinical and disability practice A definition that reflects the interaction between individuals and their environments will better support equitable access, improve consistency in decision-making, and ensure that the Scheme remains aligned with its foundational objective of supporting meaningful participation and inclusion.

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Without this broader framing, there is a significant risk that participants will face increased barriers to access, inconsistent assessment outcomes, and reduced alignment between policy intent and lived experience.

Pricing Governance and Market Stability

AAPi has significant concerns regarding the proposed legislative changes that would place pricing decision-making authority solely with the Minister, rather than maintaining or strengthening an independent pricing mechanism.

AAPi recognises the importance of ensuring the long-term sustainability of the NDIS. However, pricing decisions sit at the centre of the Scheme’s integrity and directly influence participant access, provider sustainability, workforce capacity, and ultimately the quality and safety of services delivered. For this reason, the governance of pricing must be structured to ensure decisions are transparent, evidence-based, and consistent over time.

A sustainable and effective NDIS depends on a careful balance between financial stewardship and the maintenance of a stable, responsive service market. Achieving this balance requires pricing that reflects the true costs of delivering services, particularly those that are complex, labour-intensive, and reliant on highly skilled professionals such as psychologists. AAPi has consistently advocated for the use of an independent pricing authority, such as the Independent Hospital and Aged Care Pricing Authority (IHACPA) or an equivalent body, to ensure this balance is achieved in a transparent and methodologically robust manner.

Independent pricing arrangements provide important safeguards. They operate within defined governance frameworks, apply consistent methodologies, and incorporate structured consultation with stakeholders. This allows for pricing decisions that take into account system-wide data, workforce conditions, service complexity, and participant outcomes, rather than being driven by short-term pressures. Critically, independent mechanisms support predictability, enabling providers and the workforce to plan, invest, and deliver services with confidence.

In contrast, vesting pricing authority solely in the Minister introduces significant risks. Ministerial decision-making is inherently influenced by changing policy priorities, fiscal pressures, and electoral cycles. As a result, pricing decisions may become more volatile and less transparent, with adjustments occurring without sufficient consultation or visibility of the methodology underpinning them. This creates uncertainty in the market, undermines accountability, and weakens the stable pricing signals that are essential for workforce development, provider participation, and long term service planning.

AAPi is particularly concerned that concentrating pricing authority in this way increases the likelihood that decisions will prioritise short-term cost containment over long-term system outcomes. This concern is heightened by the broader architecture of the Bill,

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which would permit the Minister to reduce funding below what is assessed as reasonable and necessary in order to contain scheme costs, regardless of a participant’s actual support needs. That is a profound shift away from the NDIS’s foundational logic. If pricing and related funding decisions are used not simply to reflect the efficient cost of delivering appropriate supports, but to deliberately fund less than a person requires, the Scheme risks moving from an individualised support model to one driven by fiscal rationing. While fiscal responsibility is an important element of scheme governance, it cannot justify a framework that denies participants the full level of support deemed necessary for safety, functioning, participation, and recovery. Such an approach would create clear risks of underfunding complex supports, worsening unmet need, shifting costs elsewhere in the system, and increasing pressure on families and informal carers to fill gaps that the Scheme has chosen not to meet.

For psychology and other allied health services, these risks are especially pronounced. Cost levers of this kind create a real risk that highly skilled supports will be inadequately funded, not because they are unnecessary, but because they are more expensive than lower-cost service options. AAPi is aware of psychology supports already being declined in participant plans on the basis that another allied health profession could provide a superficially similar service more cheaply, despite that alternative not being what is clinically necessary for that individual. This is deeply concerning. It reflects a funding logic in which price is allowed to displace clinical appropriateness and participant need. Psychological services are highly skilled, require significant training and supervision, and are fundamentally labour-intensive. They are not readily substitutable without compromising quality, safety, and effectiveness. The same concern applies across allied health where different professions may contribute in complementary ways but are not interchangeable. If pricing and funding settings encourage lower-cost services to be funded instead of the high-quality services a participant actually needs, the result may be short-term savings on paper but poorer outcomes, unmet need, avoidable deterioration, and greater downstream costs to the Scheme. This is therefore a very real risk both to participants and to the long-term sustainability of the NDIS overall.

More broadly, diminished pricing certainty undermines confidence in the Scheme as a whole. A functioning NDIS market depends on providers being able to operate within an environment that is stable, predictable, and reflective of the real costs of delivering care. Where this confidence is eroded, there is a tangible risk of reduced provider engagement, decreased service availability, and poorer participant outcomes. AAPi therefore reiterates its strong position that pricing within the NDIS should remain the responsibility of an independent statutory authority. This approach is more likely to ensure that pricing decisions are transparent, consistent, and informed by evidence, while allowing for an appropriate balance between Scheme sustainability, market viability, and participant wellbeing.

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Submission 385

Increased reliance on informal supports creates significant safeguarding and developmental risks The legislation’s stronger presumption that families and other informal networks will absorb care and support responsibilities creates serious risks for participants and their families. AAPi is particularly concerned that where formal supports are reduced or abandoned, women and children with disability may be exposed to greater dependence on relationships that are not always safe, stable, or capable of meeting complex support needs. For people with disability, informal support arrangements can also increase vulnerability to coercive control, neglect, exploitation, and barriers to disclosure where the person providing care is also the person exercising power over daily living, communication, finances, movement, or access to services. Policy settings should not assume that informal care is neutral, benign, or available without cost. In many cases, it redistributes risk from the Scheme onto women, children, and already stressed households (Australian Institute of Health and Welfare, 2026; Australian Institute of Health and Welfare, 2025; People with Disability Australia & Domestic Violence NSW, 2021).

This concern is supported by the literature on domestic and family violence. National Australian data indicate that people with disability experience substantially higher rates of violence, abuse, and intimate partner violence than people without disability, with women with disability facing particularly elevated risk. The Australian Institute of Health and Welfare reports that women with disability are significantly more likely to experience intimate partner violence, emotional abuse, stalking, and sexual violence, and that people with disability may also experience abuse through threats of abandonment, withdrawal of care, interference with medication or equipment, and control by carers. Research concerning children and young people with disability likewise shows that they face heightened risk of domestic and family violence, may be harmed by a range of perpetrators across family and service settings, and can fall through gaps between disability, child protection, and family violence systems. In this context, forcing greater reliance on informal supports without robust safeguards is not merely unrealistic, it may increase exposure to harm (Australian Institute of Health and

Welfare, 2026; Australian Bureau of Statistics, 2021; Australia’s National Research

Organisation for Women’s Safety, 2022; People with Disability Australia & Domestic Violence NSW, 2021).

These risks are reinforced by current Queensland and national policy developments on coercive control. In Queensland, coercive control has been a criminal offence since 26 May 2025, and the legislative framework expressly recognises that abusive patterns can occur not only in intimate partner relationships, but also in family and informal unpaid care relationships. This is highly relevant to the present Bill. If disability policy settings increase participant dependence on unpaid carers or family members without adequate formal safeguards, oversight, and accessible pathways to disclosure and review, they may inadvertently increase exposure to precisely the forms of controlling and harmful conduct that domestic and family violence reforms are now attempting to recognise and prevent. At the national level, the National Principles to Address Coercive Control also emphasise that coercive control is a pervasive and traumatic pattern of abuse requiring coordinated responses across prevention, early intervention,

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service systems, and legal settings. NDIS policy should be aligned with that safeguarding direction, not move participants further into high-dependence arrangements without protection (Attorney-General’s Department, 2023; Queensland Government, 2025).

AAPi also emphasises that families cannot simply be presumed able to meet the developmental needs of children with disability unless capable environments have first been built around them. The evidence on capable environments and family stress indicates that good developmental outcomes depend on social, physical, and organisational conditions that support safety, regulation, learning, meaningful participation, and responsive caregiving. Where those conditions are absent, families may be overwhelmed, children may have fewer opportunities to develop adaptive skills, and patterns of distress, dysregulation, or maladaptive coping can become further entrenched. For children with disability in particular, under-supporting the family environment risks embedding disability through preventable developmental disadvantage, escalating behaviour support needs, and avoidable strain on carers. A sustainable Scheme must therefore invest not only in the child, but in the conditions that make healthy child development and family support possible (Cheng & Lai, 2023; McGill et al., 2020).

Recommendations

1. Adequate treatment should be determined on the basis of clinical evaluation by qualified professionals working with the participant, not by a rigid or exclusive reliance on peer-reviewed research evidence.

2. The legislation and subordinate rules should expressly preserve the role of professional clinical judgement, participant history, lived experience, contextual factors, and risk of harm in decisions about eligibility, treatment adequacy, reassessment, and funding.

3. Research evidence should inform policy and practice, but it must not operate as a gatekeeping mechanism that overrides contemporary clinical judgement or participant-specific evidence.

4. Participant plans should be assessed and decided by appropriately qualified clinicians with relevant disability expertise.

5. The Scheme should avoid over-reliance on unskilled or minimally skilled assessors in planning processes, because this creates a material risk of inappropriate plans, participant decline, and higher long-term costs to the Commonwealth.

6. The NDIS should fund clinically indicated therapy, supports, assistive technology, and environmental adjustments at the point they are needed, recognising that timely intervention can improve functioning and reduce downstream costs over time.

7. Reassessment pathways should remain accessible where treating professionals identify deterioration, changing risk, or emerging support needs.

8. The legislation and rules should not presume that informal supports can safely replace formal disability supports, particularly where this would increase dependence, carer burden, or exposure to violence, abuse, neglect, or coercive control.

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9. Planning processes for women and children with disability should include explicit safeguarding consideration where informal supports are relied upon.

10. For children, the Scheme should fund supports that help build capable family environments, including timely therapy, parent support, coordination, environmental adjustments, and other clinically indicated measures that enable families to meet developmental needs safely and effectively.

11. Pricing decisions within the NDIS should be made by an independent statutory authority using transparent methodology and structured consultation, rather than solely at Ministerial discretion.

12. The legislation and pricing framework should not permit lower-cost services to be funded as substitutes for supports that are clinically necessary for an individual participant, nor allow funding to be reduced below what is reasonable and necessary simply to contain scheme costs.

In summary, AAPi submits that the Bill should not entrench a system in which individual disability support decisions are displaced by generalised evidence hierarchies, standardised processes, or assessments undertaken without adequate clinical expertise. If the objective is genuinely to secure the NDIS for future generations, then the Scheme must fund the right supports at the right time, on the basis of skilled clinical assessment and participant-specific evidence. That approach is more consistent with contemporary evidence-informed practice, more likely to protect participants from decline, and more likely to produce sustainable value for the Commonwealth over time.

Thank you for the opportunity to provide this submission.

Sincerely,

Amanda Curran

Chief Psychologist

Australian Association of Psychologists Inc.

www.aapi.org.au

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References

1. Attorney-General’s Department. (2023). National Principles to Address Coercive Control in Family and Domestic Violence. Australian Government.

2. Australian Institute of Health and Welfare. (2025). Australia’s Disability Strategy 2021–2031 Outcomes Framework: 3rd annual report – Prevention and early intervention. AIHW.

3. Australian Bureau of Statistics. (2021). Women with disability at increased risk of violence. ABS.

4. Australian Institute of Health and Welfare. (2026). People with disability. Family, domestic and sexual violence data page. AIHW.

5. Australia’s National Research Organisation for Women’s Safety. (2022). Connecting the dots: Understanding the domestic and family violence experiences of children and young people with disability within and across sectors: Final report. ANROWS.

6. Cheng, A. W. Y., & Lai, C. Y. Y. (2023). Parental stress in families of children with special educational needs: A systematic review. Frontiers in Psychiatry, 14, 1198302.

7. Claes, C., Van Hove, G., Vandevelde, S., van Loon, J., & Schalock, R. L. (2010). Person-centered planning: Analysis of research and effectiveness. Intellectual and Developmental Disabilities, 48(6), 432–453.

8. Hayes, L., Brophy, L., Harvey, C., Herrman, H., Killackey, E., & Tellez, J. J. (2016). Effective, evidence-based psychosocial interventions suitable for early intervention in the National Disability Insurance Scheme (NDIS): Promoting psychosocial functioning and recovery. Centre for Mental Health, Melbourne

School of Population and Global Health, The University of Melbourne / Mind

Australia.

9. McGill, P., Bradshaw, J., Smyth, G., Hurman, M., & Roy, A. (2020). Capable environments. Tizard Learning Disability Review, 25(3), 109–116.

10. National Disability Insurance Scheme Quality and Safeguards Commission.

(2023). Evidence-Informed Practice Guide. NDIS Quality and Safeguards

Commission.

11. National Disability Insurance Scheme Quality and Safeguards Commission.

(2025). Evidence Review – Person-Centred Practice. NDIS Quality and

Safeguards Commission.

12. People with Disability Australia & Domestic Violence NSW. (2021). Women with Disability and Domestic and Family Violence: A Guide for Policy and Practice.

13. Queensland Government. (2025). Coercive control laws. Queensland Government.

14. World Health Organization & United Nations Children’s Fund. (2022). Global report on assistive technology. WHO and UNICEF.

15. Young, G., Mathews, M., Meredith, L., Sibbald, S. L., & Ryan, D. (2025). Person- centred plans from the perspective of persons-supported in a community care setting: A qualitative study. Journal of Applied Research in Intellectual Disabilities.

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