Submission to the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026

Impacts on People with Psychosocial Disability

I am a sole trader Occupational Therapist registered with the Occupational Therapy Board of Australia through the Australian Health Practitioner Regulation Agency (AHPRA). I have extensive experience working with people living with psychosychological disability arising from severe and persistent mental illness. In my role, I support participants to improve functional capacity, develop independence, engage in their communities, maintain housing, participate in employment and education, build social connections, and reduce reliance on acute health and crisis services.

While I acknowledge the importance of ensuring the sustainability of the NDIS, I am deeply concerned that a number of the proposed changes may have significant unintended consequences for people with disabilities, particularly psychosocial disability, a cohort that is already among the most vulnerable and marginalised members of our community.

Impacts on People with Psychosocial Disability

I am concerned that the proposed changes in the legislation may result in reduced access to supports for people living with psychosocial disability and may lead to some individuals becoming ineligible for supports altogether.

People with psychosocial disability frequently experience fluctuating levels of functioning, periods of deterioration, and barriers to self-advocacy. People living with severe and persistent mental illness experience some of the highest levels of disadvantage within Australian society, with many relying upon formal supports due to limited family and social networks (Productivity Commission, 2020; National Mental Health Commission, 2023). Many of the participants with whom I work have limited family support, fragmented social networks, histories of trauma, homelessness, institutionalisation, and repeated interactions with crisis-driven systems. Their ability to maintain housing, manage daily living activities, engage in treatment, participate in the community, and avoid hospitalisation is often directly linked to the availability of NDIS-funded supports.

The evidence underpinning psychosocial rehabilitation demonstrates that sustained support focused on community participation, skill development, social inclusion, housing stability and recovery contributes to improved outcomes and reduced reliance on crisis services (Farkas et al., 2005; World Health Organization, 2022). Conversely, disruptions to support systems are associated with increased rates of relapse, hospitalisation, homelessness and involvement with emergency and justice systems.

I am concerned that the proposed changes will result in participants losing access to supports that enable them to remain safe, well, and connected to their communities. For many individuals, support needs do not disappear simply because eligibility criteria become narrower. Rather, needs become unmet.

Public Narratives About Disability and Their Impact

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) recognises the inherent dignity and worth of all persons with disabilities and requires States Parties to combat stereotypes, prejudices and harmful practices relating to persons with disabilities (Article 8).

I am deeply concerned that recent public discourse surrounding NDIS reform has contributed to increased stigma towards people with disability. Research consistently demonstrates that stigma and discrimination negatively impact mental health outcomes, community participation, help-seeking behaviour and recovery for people living with mental illness (Corrigan et al., 2014; Thornicroft et al., 2022).

The language used by some government representatives, media outlets, and commentators has often been dehumanising, stigmatising, and discriminatory. Public narratives have increasingly framed participants as a financial burden, a cost to be controlled, or contributors to unsustainable expenditure rather than as citizens entitled to support, dignity, participation, and human rights.

Participants with whom I work have reported significant distress arising from these discussions. Many describe feeling as though they must justify their disability, their support needs, and even their right to receive assistance. They frequently express fears that supports critical to their survival, safety, and quality of life may be removed.

A recurring theme among participants with psychosocial disability is the perception that there is a hierarchy of disability, where psychosocial disability is viewed as less legitimate, less visible, or less deserving than other forms of disability. Many individuals report feeling invalidated by public discourse and by policy discussions that appear to question the legitimacy of psychosocial disability itself.

Concerns Regarding the Proposed Definition of Functional Capacity

I have observed these narratives negatively impact participants’ mental health, wellbeing, confidence, and engagement in recovery. For some individuals, the uncertainty and stigma associated with proposed reforms has exacerbated anxiety, depression, hopelessness, and suicidal ideation. Participants who had previously made significant progress in their recovery have described feeling discouraged and demoralised by messages suggesting that their support needs are excessive or unjustified.

I am concerned that a system established to support participation, inclusion, and recovery has increasingly become a source of fear and uncertainty for some of the very people it was designed to assist.

Concerns Regarding the Proposed Definition of Functional Capacity

I am concerned that proposed changes to the assessment of functional capacity represent a significant departure from contemporary disability practice, evidence-based assessment frameworks, and Australia’s international human rights obligations.

The proposed approach appears to assess functional capacity without assistance from other people, without assistive technology, and without consideration of environmental and personal circumstances.

This approach does not align with the principles underpinning the International Classification of Functioning, Disability and Health (ICF), which recognises disability as an interaction between a person’s health condition, environmental factors, personal factors, participation opportunities, and supports. It explicitly recognises that functioning cannot be understood in isolation from the supports, barriers, relationships, technologies and environments within which a person lives (World Health Organization, 2001).

Similarly, the proposed approach appears inconsistent with the principles contained within the United Nations Convention on the Rights of Persons with Disabilities (CRPD), which Australia has atted. The CRPD similarly adopts a social and human rights model of disability. Article 1 of the Convention recognises that disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinder their full and effective participation in society on an equal basis with others.

Australia ratified the CRPD in 2008 and has committed to implementing policies that support participation, inclusion, equality and accessibility. Assessing functioning outside of environmental context risks moving disability assessment away from contemporary evidence-based and rights- based approaches and toward an outdated impairment-focused model.

I am concerned that assessing people outside the context of their actual environments, supports, relationships, and assistive technologies moves disability assessment away from a contemporary social model of disability and toward an outdated biological and deficit-based model.

In practical terms, people do not function in a vacuum. Functioning is always influenced by context. For a person with psychosocial disability, environmental supports, trusted relationships, community connections, routines, and assistive strategies may be the very factors that enable successful functioning.

Removing consideration of these factors risks producing assessments that are both unrealistic and inaccurate. It will significantly underestimate the impact of disability while simultaneously failing to recognise the supports required for people to participate safely and meaningfully in society.

Workforce and Service Delivery Concerns

I am concerned that the proposed changes may negatively impact the disability workforce and reduce participant access to experienced and specialised providers.

The NDIS Review Final Report recognised the importance of maintaining a diverse provider market that includes small providers and sole practitioners capable of delivering specialised and participant-centred services (NDIS Review, 2023). The psychosocial disability sector relies heavily on smaller providers, sole traders, and specialised clinicians who have developed expertise in supporting people with severe and persistent mental illness. Many participants choose smaller providers because of the flexibility, continuity, and personalised approach they offer.

Trust is a critical component of effective engagement for people with psychosocial disability. Many participants have experienced trauma, coercive treatment, stigma, discrimination, and negative interactions within health and social service systems. Building trust often takes considerable time and consistency. Research consistently identifies continuity of care, relational safety and trauma- informed practice as essential components of effective psychosocial support and recovery- oriented service delivery (Slade et al., 2014; Australian Health Ministers’ Advisory Council, 2013).

I am concerned that reforms which reduce participant choice or undermine the viability of small providers may disproportionately affect people with psychosocial disability. Participants may lose access to trusted practitioners with whom they have established therapeutic relationships and instead be forced to navigate larger, less personalised systems that may not adequately meet their needs.

I am also concerned that ongoing uncertainty within the NDIS environment may contribute to workforce attrition. Skilled allied health professionals may leave the disability sector due to concerns regarding business sustainability, administrative burden, and policy instability. This would further reduce service availability for participants who already face lengthy waitlists and workforce shortages.

Economic Implications of the Proposed Changes

I am concerned that there has been insufficient modelling of the broader economic impacts associated with the proposed reforms.

The NDIS is not solely a social expenditure; it is also a significant economic investment. Independent economic analyses have estimated that each dollar invested in the NDIS generates between $2.25 and $2.50 in economic activity through workforce participation, employment generation, increased productivity and reduced reliance on other government systems (NDIA; every Australian Counts; various economic impact analyses). Reports indicate that for every dollar invested in the NDIS, approximately $2.25 to $2.50 is returned to the Australian economy through increased economic participation and associated economic activity.

I am concerned that measures viewed as cost-saving in the short term may ultimately result in higher costs across other areas of government expenditure.

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The Productivity Commission’s original inquiry into disability care and support highlighted that investment in disability supports generates substantial economic and social returns through increased workforce participation of both people with disability and their families. When participants receive appropriate supports, they are more likely to maintain housing, engage in employment and education, and participate in community life.

When participants lose access to supports, they are more likely to experience crises requiring hospitalisation, emergency services, homelessness responses, justice system involvement, welfare dependence, and other high-cost interventions. Cost-shifting between systems should not be mistaken for genuine savings.

The NDIS also supports economic participation beyond individual participants. It enables family members and carers to maintain employment and contribute to the workforce. It supports the employment of hundreds of thousands of workers across allied health, disability support, administration, transport, community services, and related industries. Participants themselves contribute to local economies through engagement in community activities, businesses, recreation, education, and employment.

I am concerned that insufficient consideration has been given to the broader economic consequences of reducing supports and restricting access. Any assessment of sustainability should consider both expenditure and the substantial social and economic returns generated through disability support investment.

Recommendations

In light of the concerns outlined above, I respectfully recommend that the Committee consider the following amendments and safeguards to the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026.

Recommendation 1: Retain a Human Rights-Based Definition of Disability and Functional Capacity

The Bill should be amended to ensure that assessments of disability and functional capacity remain consistent with the International Classification of Functioning, Disability and Health (ICF) and Australia’s obligations under the United Nations Convention on the Rights of Persons with Disabilities (CRPD).

Functional capacity assessments should explicitly consider:

• The interaction between impairments, environmental factors and personal circumstances.
• The role of informal supports, formal supports and assistive technologies.
• Barriers and facilitators to participation in everyday life.
• Fluctuating and episodic conditions, including psychosocial disability.

The legislation should avoid adopting a narrow impairment-based approach that assesses individuals outside the context in which they live and function.

Recommendation 2: Guarantee Continuity of Support for Existing Participants

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The Bill should include safeguards to ensure that existing participants do not lose access to essential supports without comprehensive evidence demonstrating that equivalent and accessible alternative supports are available.

No participant should be exited from the NDIS or experience substantial reductions in supports unless:

• A comprehensive transition plan is developed.
• Appropriate alternative supports are identified and available.
• The participant has successfully engaged with those supports.
• Independent review rights have been exhausted.

Recommendation 3: Establish a “No Wrong Door” Guarantee

The Australian Government should establish a legislated “no wrong door” principle to ensure that people with disability who are found ineligible for the NDIS are not left without support.

Where a person is determined ineligible for NDIS supports, legislation should require active referral pathways and funded service responses rather than simply redirecting individuals to systems that may not have the capacity or resources to support them.

Recommendation 4: Conduct Independent Modelling of Impacts on Psychosocial Disability

Before implementing significant eligibility and assessment changes, the Government should commission independent modelling examining:

• The number of people with psychosocial disability likely to lose access to supports.
• The impact on housing and homelessness services.
• The impact on emergency departments and public mental health services.
• The impact on the justice and forensic mental health systems.
• The economic consequences for carers and families.
• Long-term whole-of-government costs and cost-shifting effects.

The findings should be publicly released prior to implementation.

Recommendation 5: Require a Comprehensive Service Gap Analysis

The Government should undertake a national service gap analysis to identify what supports currently exist for people who may become ineligible for the NDIS.

No eligibility reforms should proceed until governments can demonstrate that appropriate psychosocial supports exist outside the Scheme and that these supports are adequately funded, accessible and available across metropolitan, regional and rural Australia.

Recommendation 6: Protect Participant Choice and Control

The Bill should preserve the foundational NDIS principles of participant choice and control.

Participants should continue to have meaningful choice regarding:

• Their support providers.

• Their allied health professionals.

• Their support coordination arrangements.

• The way supports are delivered.

Particular consideration should be given to the importance of trusted therapeutic relationships for people living with psychosocial disability due to high incidence of history of interpersonal trauma.

Recommendation 7: Protect Workforce Sustainability

The Government should undertake formal workforce impact assessments before implementing reforms that may affect provider viability.

Specific consideration should be given to:

• The role of sole traders and small providers.

• Workforce retention in regional and rural communities.

• The availability of mental health-informed allied health professionals.

• The impact of administrative and compliance burdens on service delivery.

A sustainable NDIS requires a sustainable workforce.

Recommendation 8: Introduce Independent Clinical Oversight

Where decisions involve reducing, refusing or removing supports for participants with psychosocial disability, an independent multidisciplinary panel with expertise in mental health, occupational therapy, psychosocial rehabilitation and lived experience should be involved in review processes.

This would help ensure decisions are clinically informed and reflect contemporary evidence regarding recovery, functioning and participation.

Recommendation 9: Undertake Formal Human Rights Compatibility Review

The Committee should seek independent legal advice regarding the compatibility of the proposed changes with Australia’s obligations under the CRPD.

Particular consideration should be given to:

• Article 3 (General Principles).

• Article 5 (Equality and Non-Discrimination).

• Article 19 (Living Independently and Being Included in the Community).

• Article 26 (Habilitation and Rehabilitation).

• Article 28 (Adequate Standard of Living and Social Protection).

Any provisions found to undermine these obligations should be amended accordingly.

Recommendation 10: Commit to Co-Design and Meaningful Consultation

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Any future changes affecting eligibility, assessments or participant supports should be developed through genuine co-design with people with disability, disability representative organisations, clinicians and service providers.

People with psychosocial disability must be meaningfully involved in decisions that affect their lives, consistent with the principle of “Nothing About Us Without Us” that underpins the Disability Rights Movement and the CRPD.

Recommendation 11: Undertake Comprehensive Whole-of-Government Economic and Fiscal Modelling Prior to Implementation

Before implementing any significant changes to NDIS eligibility, functional capacity assessment, funding access, or participant supports, the Australian Government should commission and publicly release independent whole-of-government economic and fiscal modelling.

This modelling should assess not only the direct impact on NDIS expenditure, but also the anticipated impacts across all areas of government spending and economic activity, including:

• Public mental health services.
• Emergency departments and hospital admissions.
• Primary healthcare services.
• Housing and homelessness services.
• Justice, policing and forensic mental health systems.
• Social security and income support payments.
• Carer support systems.
• Child protection and family support services.
• State and Territory disability and community support services.

The modelling should also examine broader economic impacts, including:

• Workforce participation of people with disability.
• Workforce participation of family members and carers.
• Employment within the disability, health and community services sectors.
• The viability of small businesses and sole traders operating within the NDIS market.
• Consumer spending generated through participant engagement in community, social and economic activities.
• Lost productivity associated with increased illness, hospitalisation, homelessness, and social exclusion.

Conclusion

I respectfully urge the Committee to carefully consider the impacts of the proposed reforms on people living with disability, particularly psychosocial disability.

Submission to the National Disability Insurance Scheme Amendment Bill 2026

I am concerned that the proposed changes may increase exclusion, reduce access to essential supports, exacerbate mental health difficulties, and place additional pressure on already overwhelmed health, housing, welfare, and justice systems. I am further concerned that the proposed definition of functional capacity does not reflect contemporary disability frameworks, evidence-based practice, or Australia’s obligations under the Convention on the Rights of Persons with Disabilities.

People with psychosocial disability are among the most vulnerable members of our community. Effective disability support enables them to participate in society, maintain housing, build relationships, pursue employment, engage in recovery, and live meaningful lives. Any reforms intended to secure the future sustainability of the NDIS must ensure that they do not do so at the expense of the people the Scheme was established to support.

Thank you for the opportunity to provide this submission.

Yours sincerely,

Sincerely,

Francesca Coniglio

Productivity Commission.

(2020). Mental Health Inquiry Report.

Slade, M., Amering, M., & Oades, L. (2014). Recovery: An international perspective. Epidemiology and Psychiatric Sciences, 17(2), 128–137.

Thornicroft, G., Mehta, N., Clement, S., et al. (2022). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet Psychiatry.

United Nations. (2006). Convention on the Rights of Persons with Disabilities.

World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF).

World Health Organization. (2022). World Mental Health Report: Transforming Mental Health for All.

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