Impacts of reduced therapy hours on participants with disability (Participant experience) | External submission

Submission 461

Submission to the Senate Inquiry into the NDIS

I am a registered clinical psychologist working with children, adolescents, and families with disability-related support needs. I am writing to express significant concerns about the impacts of recent and proposed changes to NDIS therapy funding, reassessment processes, and expectations that families absorb greater responsibility for support provision. My submission draws on de-identified examples from clinical practice and the lived experiences of participants and their families.

Why Disability Should Not Be Funded Through Mental Health Pathways

It is essential to distinguish between mental health treatment and disability-related therapeutic support. Funding disability through mental health mechanisms—such as Mental Health Care Plans—creates clinical, ethical, and systemic problems:

Mental health frameworks are designed for diagnosable mental illnesses, not lifelong neurodevelopmental or physical disabilities. Using these pathways misrepresents the nature of a participant’s needs and leads to inappropriate expectations about “recovery” or symptom remission.
Disability-related therapy targets functional capacity, participation, and long-term skill development, not the treatment of mental illness. These supports are ongoing, multidisciplinary, and preventative. They do not fit within the short-term, episodic model of Medicare-funded mental health care.
Using mental health funding to address disability reinforces stigma, implying that disability is a psychological problem rather than a legitimate functional impairment requiring specialised supports.
Mental health plans are capped and time-limited, meaning participants with lifelong disabilities would inevitably experience gaps in care, regression in functioning, and increased carer burden.
Clinicians are placed in ethically compromising positions, pressured to frame disability-related needs as mental illness to secure minimal funding. This distorts clinical documentation and undermines diagnostic integrity.
Families are left without appropriate support, as mental health pathways cannot provide the frequency, intensity, or multidisciplinary coordination required for disability-related intervention.

For these reasons, disability supports must be funded through disability-specific mechanisms such as the NDIS. Mental health pathways cannot—and were never designed to—meet the long-term, functional, and developmental needs of people with disability.

Impacts of Therapy Reductions Over the past 12–18 months, many participants have experienced substantial reductions in funded therapy hours. These reductions have had clear and measurable consequences:

Increased emotional dysregulation, behavioural escalation, and school refusal when therapy frequency is reduced below clinical need.
Loss of previously consolidated functional gains, particularly in communication, adaptive behaviour, and social participation.
Increased reliance on crisis services, school-based support, and informal carers when therapeutic scaffolding is removed.

Submission 461

Families report heightened stress, burnout, and reduced capacity to maintain routines, safety, and participation.
Therapy is not a “nice to have” for these participants; it is a stabilising intervention that prevents deterioration and supports safe engagement in daily life.

Treatment Can Improve Functioning While Disability Remains A recurring misunderstanding is the assumption that improved functioning means reduced disability. In practice:

Participants often make gains in emotional regulation, communication, or daily living skills through therapy, yet still require ongoing support to maintain these gains.
Improvements do not eliminate the underlying neurodevelopmental disability, sensory vulnerabilities, or executive functioning impairments.
When therapy is withdrawn prematurely, participants frequently regress, demonstrating that the disability remains and requires sustained intervention.
One adolescent, for example, showed significant improvement in school attendance and social engagement after a year of therapy. When funding was reduced, anxiety escalated, sleep deteriorated, and she withdrew from learning. The disability had not changed, only the support.

Difficulty Accessing Mainstream Supports Families are consistently told to “use mainstream supports first,” yet these supports are often inaccessible or unsuitable:

Public mental health services have waitlists of 6–18 months and strict exclusion criteria.
School systems are under-resourced and unable to provide the level of individualised support required for students with complex needs.
Community programs frequently lack disability-informed staff or are unable to accommodate sensory, behavioural, or communication needs.
Many families report being “bounced” between systems, with each service advising that another service is responsible.
The result is that NDIS participants fall through gaps that mainstream systems are not equipped to fill.

Concerns About Reassessments Families and clinicians are increasingly anxious about reassessment processes:

Reassessments often require extensive documentation, multiple assessments, and significant clinician time, which is not always funded.
Participants with lifelong, non-progressive disabilities are repeatedly required to “prove” their disability, causing distress and retraumatisation.
Families fear that honest reporting of progress will lead to loss of essential support, creating a perverse incentive to minimise achievements.
Reassessment should not become a barrier to accessing necessary, ongoing disability supports.

Workforce Implications Therapy reductions and administrative burdens are contributing to workforce strain:

Clinicians spend increasing amounts of unpaid time preparing reports, justifications, and appeals.

Submission 461