Impact of mental health challenges on families, carers and kin (Family or carer experience)

Submission 585

MHCA Submission to the Inquiry into the National

Disability Insurance Scheme Amendment (Securing the

NDIS for Future Generations) Bill 2026

June 2026

Submitted by: Katrina Armstrong

Position/Role: Chief Executive Officer

Contact Details: Email: info@mentalhealthcarersaustralia.org.au

Submission 585

Acknowledgement of Country

Mental Health Carers Australia (MHCA) acknowledges the Traditional Custodians of the lands on which we work, live and play. We acknowledge that lands were never ceded, and the First Nations peoples experience of historical and ongoing trauma of dispossession and racism. We pay respects to their spiritual ancestors, elders, and emerging leaders across time. We acknowledge with gratitude their sharing of these lands, their strong connection to Country, community and culture, and their strength and the enduring resilience of their living cultures and ways of knowing, being, and doing. We believe we have a precious opportunity to learn about holistic and community-centred approaches to mental and emotional wellbeing from Aboriginal and Torres Strait Islander people.

About Mental Health Carers Australia

MHCA is the nationally funded mental health family, carer and kin peak body, focused solely on the needs of mental health families, carers and kin. We are led by, and represent, the voices of people with lived experience of supporting someone with mental health challenges MHCA has a number of member organisations across the states and territories, including mental health carer peak bodies, which provide expert jurisdictional advice to inform our policy positions, submissions and advocacy. Our aim is to work constructively with governments to improve policies and programs that directly and indirectly affect mental health families, carers and kin.

About mental health families, carers and kin

Mental health family, carers and kin are everyday Australians providing significant emotional, practical and financial support to their family member or friend living with mental health challenges. This care is grounded in relationships, whether it be as parent, partner, sibling, grandparent or close friend, and is given to protect connection, safety and dignity when systems and services are fragmented or difficult to access. While this support is rarely recognised or resourced, its impacts on carers’ own lives are profound and well documented. Many experience emotional strain, declining mental health, financial and employment insecurity, and a gradual erosion of their own social networks and sense of belonging. Over time, the caring role can also alter the primary relationship itself, as shared identities and everyday connection give way to vigilance and responsibility.

In 2015, a report by the University of Queensland, commissioned by Mind Australia, estimated that the total annual replacement cost of informal mental health care was $14.3 billion. After adjusting for a $1.1 billion offset from Centrelink payments, the net cost was $13.2 billion.1 This figure represents what it would have cost governments at the time to replace the support provided by families and informal carers with formal mental health services such as the then

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Submission 585

existing Partners in Recovery (PiR) and Personal Helpers and Mentors (PHaMS) programs or disability support workers.

MHCA estimates, that due to inflation and the discontinuation of PHaMS following the introduction of the NDIS, this figure would now exceed $20 billion — likely by a significant margin. For context, the total expenditure on mental health by the Australian and state/territory governments in 2022–23 was estimated at $13.2 billion.2

Note on language

MHCA recognises that individuals who support someone with mental health challenges identify in diverse ways based on their personal experiences and relationships. Some prefer the term “carer”, while others identify as a family member, specifying their role (e.g., mother, father, partner, son, daughter etc). Others may identify as a friend, support person, or care partner, emphasising the reciprocal nature of care. To maintain clarity and inclusivity in MHCA submissions, we strive to use concise and broadly inclusive language. For this submission, MHCA will use the terms family, carers and kin interchangeably. On occasion, the term “carer” is used as an umbrella term encompassing family, carers and kin for brevity. Executive summary Mental Health Carers Australia welcomes the opportunity to provide this submission to the

Senate Community Affairs Legislation Committee’s inquiry into the National Disability

Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 (the Bill).3

MHCA supports the long-term sustainability of the National Disability Insurance Scheme. We recognise the need for clearer boundaries between the NDIS and broader service systems. We know the Scheme has increasingly absorbed unmet need caused by fragmented psychosocial support systems, underinvestment in community infrastructure and the erosion of practical low-threshold supports outside formal disability systems.

MHCA was encouraged by the Minister’s initial framing of the reforms. In particular, we welcomed the emphasis on functional capacity over diagnosis and the stated intention to improve consistency and equity within the NDIS. The detail of the Bill does not appear to match that stated intent.

The Bill does not simply move the Scheme toward fairer functional assessment. It narrows core access, planning and funding tests. It removes recognition of real-world factors that affect support need. It creates powers to reduce funding across groups of supports. It tightens reassessment pathways. It creates plan suspension and revocation powers for participants who are not contactable.

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Submission 585

These changes need to be read together. Their combined impact is likely to be greater than the effect of any single amendment. For people with psychosocial disability, the Bill risks creating a system where support needs are assessed more narrowly, plans are less responsive and unpaid families are expected to absorb more risk. Foundationally, the comments below, informed by our member organisations and lived expertise despite the short consultation timeframe, are grounded in a clear caution: family, carer and kin support must not be treated as an unlimited reserve of unpaid labour. An effective and sustainable NDIS does not replace relationships. It protects them.

MHCA notes that the NDIS has always operated within an individualised model. This sits uneasily with contemporary understandings of relational wellbeing. An individualised approach is particularly difficult to reconcile in Australia’s growing multicultural society, and in a country where First Nations peoples have always held deep understandings of social and emotional wellbeing grounded in family, kin, Country, culture and community.

The current National Disability Insurance Scheme Act 2013 (Cth) (the Act)4 does not fully reflect this relational reality. It does, however, contain some bare minimum recognition that families, carers and significant people matter. It recognises that relationships between people with disability and their families and carers should be respected ((NDIS Act 2013, s 4(12), s 4(12A)). The Bill now risks stripping away even that limited recognition in the parts of the Act that will most directly shape assessment and funding decisions.

The reforms are proceeding before there is a clearly articulated and operational foundational support system capable of responding to psychosocial disability outside the NDIS. A great deal of attention has been given to what supports may become harder to access through the Scheme. Far less clarity exists about what services will replace them, when they will be available, and whether they will be available at the level people actually need.

This is not a small implementation issue. It is central to whether the Bill can operate safely. Without increased and sustained investment in psychosocial foundational supports, community infrastructure and practical low-threshold assistance, the reforms risk shifting unmet need onto families, carers, homelessness services, emergency departments, acute mental health services and other overstretched parts of the community sector.

MHCA recommends that the Bill not proceed in its current form. At a minimum, the amendments below are required before passage.

Summary of recommendations

1. Amend proposed s 9B so functional capacity assessments identify the supports currently sustaining a person’s functioning, including family, carer and kin support, environmental stability, psychosocial supports and assistive supports

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Submission 585

2. Require the support needs assessment process, including I-CAN testing and piloting, to include structured family, carer and kin input unless there is a clearly documented reason this would be inappropriate

3. Retain s 32K(3A) and note 2 to s 32L(6), or replace them with stronger provisions requiring support needs assessments and budget methods to take account of environmental factors, interacting impairments, relational context and the sustainability of informal support

4. Amend the proposed change to s 34(1)(aa) so supports can be funded where the eligible impairment is a substantial or material source of the support need, including where there is a multi-step causal chain between impairment and support need

5. Amend proposed ss 34(1G), 34(1H), 34(1J) and 34(1K) so informal support is only relied on where it is reasonable, safe, sustainable, freely provided and consistent with the participant’s rights, will, preferences and relationships

6. Amend proposed s 34(1K) so decision-makers must consider the impact of reliance on informal support across the whole relational unit, including the participant, family members, carers and kin

7. Remove or substantially narrow proposed s 34A. Any support determination power should require public consultation, Parliamentary disallowance, a published psychosocial disability impact assessment and a family and carer impact assessment

8. Require a real-world audit before any reset of Social, Civic and Community Participation or Capacity Building Daily Activity budgets for people with psychosocial disability. This should assess whether funding is being used for discretionary activity or for structured support such as supported community access, therapeutic routine and skills development

9. Prescribe NDIS Rules under proposed s 25A(5) that expressly recognise the complexity of psychosocial disability, including that fluctuating and episodic conditions may still involve enduring functional impairment and disability-related support need.

10. Ensure the NDIS Rules clarify when it is inappropriate to determine that treatment options are available for psychosocial disability, including where treatment efficacy is contested, treatment is not practically accessible, or treatment may reduce symptoms without resolving functional impairment.

11. Clarify how proposed s 25A and any related NDIS Rules will operate alongside s 25 early intervention requirements and the psychosocial early intervention pathway recommended through NDIS reform processes.

12. Allow family members and carers to request an unscheduled reassessment where they provide substantial informal support, even if they are not a plan nominee, subject to appropriate safeguards and the participant’s rights

13. Amend the plan renewal provisions so unused funding can roll over for at least the next quarterly funding period where a participant has been hospitalised or in significant psychosocial crisis and has been unable to use supports

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14. Clearly articulate, fund and operationalise foundational psychosocial supports that are relational by design, before tightening NDIS eligibility or reducing access to NDIS-funded psychosocial supports

15. Functional capacity and support needs assessment must not treat supported functioning as independence

What the Bill proposes

Schedule 1, Part 1, item 4 inserts proposed s 9B into the NDIS Act. Proposed s 9B defines functional capacity as (a) a person’s ability to undertake an activity without assistance from other people, assistive technology or modifications, and (b) in a context that excludes, as far as possible, the impact of the person’s environmental and personal circumstances.

This definition will shape access and planning decisions. It will affect how people meet the disability requirements and early intervention requirements. It will sit behind future Rules that prescribe methods, criteria, classifications and thresholds for assessing functional capacity.

The Bill will operate alongside support needs assessment and budget-setting processes. Departmental materials indicate that the support needs assessment process will use I-CAN version 6,5 a personal and environmental circumstances questionnaire and targeted assessments.

MHCA’s concerns

MHCA supports greater consistency in decision-making. We agree that diagnosis alone should not determine access to disability supports. Functional impact matters.

The concern is that proposed s 9B risks separating a person from the supports that make functioning possible. A person may appear to manage because family, carers, psychosocial supports, routines, housing stability and trusted relationships are supporting and sustaining daily function.

This is particularly relevant for people with psychosocial disability. Member organisation Arafmi Queensland has advised MHCA that carers described living “constantly on edge” and “holding it all together”. They described the stabilising role of support workers, routines, housing stability, medication support and coordinated care. Members have likewise noted that family, carers and supporters often hold deep relational insight into a person’s functioning and support needs. We are not asking the NDIS to fund everything in a person’s life. Instead, we would like to ensure that any assessment is honest about what is holding the person up. If the assessment records capacity without recording the support behind that capacity, the resulting plan will be inaccurate.

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Submission 585

We have heard that families often feel forced to present the worst version of the person they support in order to prove need. This is distressing and stigmatising. It works against recovery oriented practice. A new functional capacity framework should not deepen that problem. It should allow families and carers to describe support needs in a way that does override the participant’s voice. Rather, this it should recognise that supported decision-making and relational evidence are often essential to accurate assessment.

MHCA is aware that piloting and testing of the support needs assessment are underway for different groups. We are disappointed that families, carers and kin have not been properly invited to be part of this testing process. This is particularly concerning for people with significant functional capacity impairment. In many cases, a family member or carer will be the person best placed to convey accurate information about day-to-day functioning, risk, escalation, support intensity, service gaps and the sustainability of informal support.

Recommendation

1. Amend proposed s 9B so functional capacity assessments identify the supports currently sustaining a person’s functioning, including family, carer and kin support, environmental stability, psychosocial supports and assistive supports

2. Require the support needs assessment process, including I-CAN testing and piloting, to include structured family, carer and kin input unless there is a clearly documented reason this would be inappropriate

3. The Bill removes bare minimum whole-of-person recognition from assessment and budget-setting

What the Bill proposes

Schedule 1, Part 3, item 28 repeals s 32K(3A) of the NDIS Act. That provision currently requires the Minister, when making Rules about the method for working out total funding amounts in new framework plans, to be satisfied that those Rules adequately take account of the variety of factors that may affect a participant’s need for NDIS supports.

The note to s 32K(3A) refers to environmental factors and to situations where a participant’s support need arising from an eligible impairment is impacted by another impairment that does not meet the disability or early intervention requirements.

Schedule 1, Part 3, item 30 repeals note 2 to s 32L(6). That note currently recognises that a participant’s disability support needs arising from an eligible impairment may be affected by environmental factors or by another impairment that is not itself an access impairment.

MHCA’s concerns

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Submission 585

MHCA recognises that while the existing provisions are not a complete relational safeguard, they provide a bare minimum recognition that support need cannot be understood in isolation from a person’s real life.

Their removal narrows the legal architecture at exactly the point where new planning processes will rely more heavily on assessment reports and budget methods. This is not only an implementation issue. It is a legislative issue. The Bill removes the statutory instruction that the Rules must account for the variety of factors that affect support need.

The Explanatory Memorandum indicates that this repeal is intended to ensure supports are funded only where needed directly as a result of eligible impairments.6 MHCA does not oppose appropriate boundaries. However, for the reasons mentioned above, drafting to repeal these provisions risk pushing the Scheme away from accurate assessment and toward artificial categorisation.

Recommendation

3. Retain s 32K(3A) and note 2 to s 32L(6), or replace them with stronger provisions requiring support needs assessments and budget methods to take account of environmental factors, interacting impairments, relational context and the sustainability of informal support

4. The “arising directly from” test risks excluding legitimate psychosocial support needs

What the Bill proposes

Schedule 1, Part 3, item 31 amends s 34(1)(aa) by requiring a reasonable and necessary support to address needs “arising directly from” an impairment or impairments for which the participant meets the disability requirements or early intervention requirements.

MHCA’s concerns

MHCA understands the intent to clarify the boundary of NDIS responsibility. Clear boundaries matter. However, the word “directly” raises legal concern because it is likely to narrow the causal link between an eligible impairment and a funded support.

The proposed wording may require participants to prove that each support need arises directly from an eligible impairment, rather than being substantially connected to that impairment within the person’s broader life circumstances. This is difficult to reconcile with the objects of the Act,7 which go some way to give effect to Australia’s obligations under the Convention on the Rights of Persons with Disabilities8 and sit more comfortably with a social model of disability9 than a narrow impairment-only approach.

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Submission 585

For psychosocial disability, support needs may arise through a multi-step causal chain. A psychosocial impairment may affect social capacity, executive functioning, emotional regulation, trust, motivation, safety and the ability to engage with services. These impacts may then affect housing, community participation, appointments, routine, relationships and crisis risk. Members have warned that narrower reasonable and necessary rules may disadvantage people with multiple disabilities or overlapping support needs. When a support is refused because it does not fit neatly within an eligible impairment category, families are often left to fill the gap.

Likewise, this gap does not affect everyone equally. People with access to legal advice and detailed reports may be better able to establish the required connection. Families and consumers without that support, including those in regional and remote areas, are more likely to miss out. MHCA anticipates that the amendment may lead to further disputes about causation, particularly following the line of case law leading up to CEO of the NDIA v Eastham [2026] FCA 147. Families and carers already take on a significant degree of administrative burden leading up to and during the course of NDIS access. This will be a burden made more complex when interacting with legal systems.

Recommendation

4. Amend the proposed change to s 34(1)(aa) so supports can be funded where the eligible impairment is a substantial or material source of the support need, including where there is a multi-step causal chain between impairment and support need

5. Parental responsibility and informal support provisions must not shift responsibility onto families

What the Bill proposes

Schedule 1, Part 6, item 73 inserts new provisions into s 34 that affect how the CEO applies s 34(1)(e). That existing provision requires the CEO to take account of what it is reasonable to expect families, carers, informal networks and the community to provide.

Proposed s 34(1G) requires the CEO, in relation to a child participant, to take into account the presumption that parents are responsible for providing substantial care and support. Proposed s 34(1H) provides that substantial care and support includes supervision, personal care, transport, emotional support, behavioural support and other daily living assistance that is reasonably expected of a parent of a child of a similar age.

Proposed s 34(1J) provides that the CEO must not be satisfied of s 34(1)(e) if the primary or substantial purpose of the support is to reduce burdens on parental time below what is reasonably expected of a parent, improve household efficiency, or give effect to a parent’s preference for supports to be provided by someone other than a parent.

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Submission 585

Proposed s 34(1K) applies more broadly. It requires the CEO to consider whether relying on family, carers, informal networks or the community would expose the participant or another person to material risk of harm, abuse or neglect that cannot be mitigated through informal or lower-cost supports. It requires the CEO to consider the desirability of maintaining informal supports and community networks instead of replacing them with funded supports, unless replacement is necessary due to risk or unsustainability.

MHCA’s concerns These provisions are among the most concerning in the Bill for families, carers and kin supporting someone with a psychosocial disability.

The parental responsibility provisions do not adequately distinguish ordinary parenting from disability-related care. Supervision, emotional support, behavioural support and transport may be ordinary parenting in some circumstances. They may also become intensive disability related supports when the frequency, intensity, duration or risk is far beyond what would usually be expected for a child of a similar age. The Bill does not provide enough clarity about how this distinction will be made. Without clearer safeguards, the test is likely to be applied inconsistently and may create further confusion for participants, families and decision-makers.

In a similar way, the informal support provision starts from a position of maintaining informal support unless risk or unsustainability is established. Families and carers should not have to reach breaking point before funded support is considered reasonable and necessary. A relational model would ask whether the support arrangement is safe, sustainable and appropriate for the whole caring network or relational unit.

We have heard that many families and carers are already operating at or beyond capacity, even with NDIS supports in place. Carers described balancing employment, financial pressure, their own health needs and the emotional toll of long-term caring. Members have likewise told us that, when working well, NDIS supports make caring more sustainable by providing structure, respite, shared responsibility and stability.

Recommendation

5. Amend proposed ss 34(1G), 34(1H), 34(1J) and 34(1K) so informal support is only relied on where it is reasonable, sustainable, freely provided and consistent with the participant’s relational unit

6. Amend proposed s 34(1K) so decision-makers must consider the impact of reliance on informal support across the whole relational unit, including the participant, family members, carers and kin

7. Support determinations create a broad power to reduce funding below assessed need

What the Bill proposes

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Submission 585

Schedule 1, Part 4, item 34 inserts proposed s 34A. This would allow the Minister to determine a percentage by which a funding component amount for a specified group of supports is reduced in old framework plans.

The provision expressly allows this to occur even where the result is that funding for a reasonable and necessary support is less than the total cost of that support.

MHCA’s concerns

MHCA considers that this Ministerial power risks undermining the practical effect of the NDIS Act’s objects, including the object of enabling people with disability to exercise choice and control in the pursuit of their goals and in the planning and delivery of their supports (NDIS Act 2013, s 3(1)(e)). It would allow broad funding reductions across groups of supports without a recent assessment of the participant’s actual support needs. A person’s disability may not have changed. Their family’s capacity may not have changed. Local services may not have improved. Yet the reduction could still apply.

The impact analysis attached to the Explanatory Memorandum models reductions to Social, Civic and Community Participation and Capacity Building Daily Activity supports, with the preferred option to reduce community participation by 50% and capacity building daily activity budgets by 10% in a phased approach over 12 months from 1 October 2026. The impact analysis recognises likely increases in informal caring responsibilities and acknowledges that women are more likely to be affected because they make up the majority of primary carers. Yet, we are mindful that the full impact on carers is not properly assessed.

For people with psychosocial disability, Social, Civic and Community Participation is not simply discretionary social activity. In many cases it is supported community access, skills development, therapeutic routine and isolation prevention. It can be the support that allows a person to maintain routine, connect with safe people and remain in the community. For MHCA, we are equally concerned that in most cases, this funding provides a respite outcome for families and carers.

NDIA data from Q2 2025/26 suggests the funding most exposed to these reductions sits overwhelmingly with people not in Supported Independent Living (SIL).10 Of the psychosocial spend to 31 December 2025, about $1.855 billion of Social, Civic and Community Participation (Core (Community)) and about $294.4 million of Capacity Building Daily Activities went to participants not in SIL. This may suggest a large share of the impact would fall on people living in the community, including potentially those living with family and carers, although the NDIA still does not publish the kind of family/carer data that would let us test that properly. Indiscriminate reductions risk increasing isolation, crisis risk, emergency department presentations, hospital admissions and pressure on families. When funded support is removed, the need does not disappear. It lands on carers.

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Submission 585

Members have echoed concerns that reductions in support may require carers to provide more direct daily support, pay privately for services, reduce work hours, leave employment or absorb additional housing and crisis-management responsibilities. Tandem Victoria for example, has raised concern that reductions to Social, Civic and Community Participation and Capacity Building Daily Activity supports may limit opportunities for people with psychosocial disability to build skills in the long-term and connect with their community.

Recommendation

7. Remove or substantially narrow proposed s 34A. Any support determination power should require public consultation, Parliamentary disallowance, a published psychosocial disability impact assessment and a family and carer impact assessment

8. Require a real-world audit before any reset of Social, Civic and Community Participation or Capacity Building Daily Activity budgets for people with psychosocial disability. This should assess whether funding is being used for discretionary activity or for structured support such as supported community access, therapeutic routine and skills development

9. Permanence, treatment and the missing psychosocial early intervention pathway

What the Bill proposes

Schedule 1, Part 8 amends the disability requirements and early intervention requirements by introducing a tighter approach to permanence and treatment.

The Bill provides that an impairment is not permanent, or likely to be permanent, unless the person has undertaken all appropriate treatment, any other treatment is unlikely to materially improve, reverse or alleviate the impact of the impairment, and the impairment is likely to persist for the person’s lifetime.

The Bill introduces a new concept of “appropriate treatment” in proposed s 25A. Proposed s 25A(5) provides that NDIS Rules may make different provision for different classes of participants and different impairments or classes of impairments. The Explanatory Memorandum states that this rule-making power is intended to capture circumstances where it may be inappropriate to determine that treatment options are available for some impairments, including types of treatment options for people with psychosocial disability. In the absence of those Rules, it remains unclear how “appropriate treatment” will be interpreted for psychosocial disability. It is not clear what treatment means, who will decide whether treatment is appropriate, how specialist clinical opinion will be weighed, and how the test will apply where treatment may reduce symptoms without resolving functional impairment.

MHCA’s concerns

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Submission 585

MHCA supports access to treatment, early intervention and recovery-oriented practice. Nonetheless, we are wary that the proposed provisions may shift the focus of eligibility away from enduring functional impairment and support need, and toward contested judgments about treatment history, treatment availability and future improvement.

This is difficult to reconcile with the Minister’s emphasis on functional capacity rather than diagnosis. In practice, decisions about permanence and treatment will still depend on medical interpretation and prognostic judgment. For psychosocial disability, this may create a higher and more uncertain access threshold.

The existence of a treatment pathway does not mean a person’s functional impairment has resolved. A partial treatment response does not mean a person no longer needs disability support. Many people maintain periods of stability because there is support around them. Apparent improvement may reflect support-maintained functioning rather than reduced disability-related need.

Further clarification is needed about how “appropriate treatment” will be understood in the psychosocial disability context. Psychosocial disability sits at the interface between clinical treatment, psychosocial support, housing, community connection and relational support. It is not clear whether the Bill’s treatment test is intended to capture clinical treatment only, or whether it could be interpreted more broadly.

In this context, MHCA emphasises that medications and other clinically accepted treatments can have disabling effects of their own. A treatment may be appropriate in a clinical sense while still affecting a person’s energy, cognition, motivation, physical health or capacity to participate in daily life. This is particularly important for psychosocial disability, where the effects of treatment can become part of the person’s functional impairment. For example, medication may assist with symptoms while also contributing to fatigue, cognitive slowing, weight gain or other physical health impacts that affect daily functioning.11

Treatment efficacy in mental health is often partial or contested.12 Treatment pathways can also carry stigma that compounds the disabling impact of psychosocial disability. A person with psychosis, for example, may experience functional impairment not only through symptoms such as hearing voices, but through the social stigma attached to those experiences. That stigma can affect work, housing, relationships, community participation and a person’s sense of citizenship. These impacts are often less visible than some physical impairments, which makes accurate assessment even more important.

Treatment should therefore not be treated as a simple pathway from functional impairment to improvement. The Bill needs to recognise that a person may have undertaken treatment, or remain engaged in treatment, and still experience enduring functional impairment that requires support.

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Submission 585

The exclusion of financial and geographical circumstances is equally alarming. Treatment is not meaningfully available simply because it exists somewhere in Australia. Consumers, families and carers face long waitlists, high gap fees, travel barriers, workforce shortages, cultural safety concerns and trauma related to past experiences of restrictive or coercive mental health care.

The Bill creates further uncertainty in relation to early intervention for psychosocial disability. Current s 25 of the Act recognises early intervention where supports are likely to reduce future support needs, prevent deterioration in functional capacity, or strengthen the sustainability of informal supports, including by building family and carer capacity. The NDIS Review recommended stronger early intervention approaches for psychosocial disability.13 Work on that pathway appears stalled. It is therefore unclear how the Bill’s tighter permanence and treatment provisions will operate alongside an early intervention approach that has not yet been properly built.

Recommendation

9. Prescribe NDIS Rules under proposed s 25A(5) that expressly recognise the complexity of psychosocial disability, including that fluctuating and episodic conditions may still involve enduring functional impairment and disability-related support need.

10. Ensure the NDIS Rules clarify when it is inappropriate to determine that treatment options are available for psychosocial disability, including where treatment efficacy is contested, treatment is not practically accessible, or treatment may reduce symptoms without resolving functional impairment.

11. Clarify how proposed s 25A and any related NDIS Rules will operate alongside s 25 early intervention requirements and the psychosocial early intervention pathway recommended through NDIS reform processes.

12. Reassessment pathways must recognise changes in family and carer capacity

What the Bill proposes

Schedule 1, Part 2, item 21 inserts proposed s 48A. This provision sets the conditions for participant-requested plan reassessments.

It requires a significant change to ongoing support needs arising from an eligible impairment. The change must result from an alteration in functional capacity or an alteration in personal or environmental circumstances. Where the change relates to personal or environmental circumstances, it must be unanticipated, significant and ongoing, and relate to living arrangements, education arrangements, work arrangements or the participant’s network for informal support.

Schedule 1, Part 2 limits who can request a reassessment. A support coordinator or plan manager would no longer be able to request reassessment on behalf of a participant.

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Submission 585

MHCA’s concerns

MHCA supports measures that prevent providers from requesting reassessments without a participant’s knowledge or in ways that create conflicts of interest. Proposed s 48A is still too narrow.

It does not expressly include hospital discharge, loss of clinical support, withdrawal of community mental health services, family violence, carer illness, carer burnout, service failure or major changes in risk. It requires some changes to be unanticipated. That may exclude predictable life transitions that still create real changes in support need.

Families and carers can experience sudden changes that make an existing support arrangement unsafe or unworkable. A carer may become unwell, age, experience financial hardship, take on other caring roles, lose housing stability, return to work or no longer be able to provide the same level of support. If the participant cannot request reassessment themselves and the family member or carer is not a plan nominee, the pathway risks exacerbating existing unmet need and trapping people and families in plans that no longer reflect their lives.

Recommendation

12. Allow family members and carers to request an unscheduled reassessment where they provide substantial informal support, even if they are not a plan nominee, subject to appropriate safeguards and the participant’s rights

13. Plan renewals and funding periods must account for hospitalisation and crisis

What the Bill proposes

Schedule 1, Part 5 inserts proposed s 50A. It replaces plan continuations with statutory plan renewals. Old framework plans will have legislated end dates. On that date, a plan may renew by operation of law.

The renewed plan will generally replicate the previous plan’s content and funding amounts, subject to ministerial determinations and other adjustments. Unspent funds from the previous plan will not necessarily carry over in a way that reflects why funds were unused.

MHCA’s concerns

We know that the episodic nature of psychosocial disability lends itself to highly variable plan use. Nonetheless, lower use in a particular period does not always mean lower need. It may mean the person was in hospital, in crisis, unable to engage with services, affected by relapse or unable to find suitable supports.

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Submission 585

If unspent funds are lost at renewal, or if funding periods are applied rigidly, families may lose the flexibility required to respond during recovery. The period after hospitalisation or crisis can involve heightened support needs. It is often when a person needs trusted support to rebuild routine, reconnect with services and return to community life. Without flexibility, MHCA is concerned that families and carers become the default buffer.

Recommendation

13. Amend the plan renewal provisions so unused funding can roll over for at least the next quarterly funding period where a participant has been hospitalised or in significant psychosocial crisis and has been unable to use supports

14. Foundational supports must be in place before NDIS supports are narrowed

What the Bill proposes

The Bill tightens NDIS access, planning, reassessment and funding settings. It sits within a broader reform agenda that assumes stronger foundational supports outside the NDIS.

MHCA’s concerns

We are mindful that current NDIS sustainability efforts, including this Bill, would narrow NDIS access and supports before there is a clear, funded and operational system of psychosocial foundational supports outside the Scheme.

This is particularly concerning given the existing access barriers for people with psychosocial disability. Access rates for people with psychosocial disability have fallen from 51% in Quarter 2 of 2022–23 to 32% in Quarter 3 of 2025–26.14 Over the same period, access rates across all disability types have remained far higher, at 86% in Quarter 3 of 2025–26.15

These figures point to access processes that do not adequately account for psychosocial disability, including the need for psychosocial-specific skills, knowledge and experience among those assessing access requests. The existing difficulty in access is further reflected in the number of people with psychosocial disability who are NDIS participants remaining far below the Productivity Commission’s original projections for this cohort when population growth is taken into account.

The problem is not solved by assuming that people who cannot access the NDIS will be supported somewhere else. The unmet need analysis estimated that more than 500,000 people with psychosocial disability are currently left without adequate support outside the NDIS.16 In practice, many of these people are likely to be supported by families, carers and kin, often without recognition or adequate support for their own wellbeing. This is the system context into which the Bill is being introduced.

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Submission 585

The NDIS should not be the only pathway to psychosocial support. However, it is unsafe to tighten access before the alternatives exist. Without foundational supports that are funded and strong enough to respond to complex psychosocial disability, unmet need will not reduce. It will be shifted onto families and carers, hospitals, homelessness services and crisis systems.

We acknowledge that much of this work will sit within the next National Mental Health and Suicide Prevention Agreement. However, MHCA is concerned that Agreement negotiations are progressing in a tight fiscal environment, with short engagement timeframes and without clear outcomes for families, carers and kin. This is not consistent with the direction recommended by the Productivity Commission’s 2025 review of the Agreement, which emphasised the need for clearer accountability and stronger system stewardship in conjunction with the lived experience peak bodies.17

Foundational supports cannot be treated as a vague future promise. They must be relational by design and capable of supporting the whole person, including the family, carer and kin relationships that often sustain safety, stability and participation. MHCA is ready to work with government to articulate what that should look like in practice.

Recommendation

14. Clearly articulate, fund and operationalise foundational psychosocial supports that are relational by design, before tightening NDIS eligibility or reducing access to NDIS-funded psychosocial supports

Conclusion

MHCA supports a sustainable NDIS. However, sustainability cannot be achieved by making families, carers and kin carry more of the work, risk and responsibility that funded supports currently help to share.

The Bill is being introduced in a system where people with psychosocial disability already face significant barriers to NDIS access, and where families and carers are already holding together care that should be shared across disability, mental health, housing and community systems. Foundational psychosocial supports outside the NDIS are not yet clear, funded or operational. In this context, the proposed changes risk leaving families with narrower assessments, less responsive plans and fewer practical supports to keep caring arrangements safe and sustainable.

The impact will not sit with the NDIS alone. Where funded supports are reduced or access is tightened, families and carers are likely to absorb the unmet need through more unpaid care, more crisis response, more system navigation and greater pressure on their own health, employment and relationships. This is not genuine system sustainability. It is cost shifting onto the people who are already doing too much.

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Submission 585

MHCA recommends that the Bill not proceed in its current form. At a minimum, it must be amended to protect family, carer and kin relationships, preserve accurate assessment of psychosocial disability, and ensure foundational supports are in place before NDIS supports are narrowed. Families, carers and kin should be recognised as part of a person’s life, not treated as the fallback service system when funded supports are reduced.

MHCA would welcome the opportunity to appear at a public hearing to discuss these issues further and provide evidence on the likely impacts of the Bill on mental health families, carers and kin.

1 Diminic S, Hielscher E, Lee Y, Harris M, Schess J, Kealton J, & Whiteford H, (2017) The economic value of informal mental health caring in Australia: technical report,

The_economic_value_of_informal_mental_health_caring_in_Australia_summary_report.pdf

2 Australian Institute of Health and Welfare: https://www.aihw.gov.au/mental-health/topic areas/summary 3 National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 (Cth), https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/Bills_Search_Results/Result?bId=r74 87.

4 National Disability Insurance Scheme Act 2013 (Cth), https://www.legislation.gov.au/C2013A00020/latest/text.

5 Department of Health, Disability and Ageing, Public consultation on new framework planning: Discussion paper (Canberra: Commonwealth of Australia, 2026), 5–6.

6 National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 (Cth), Revised Explanatory Memorandum, 25–26, https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/Bills_Search_Results/Result?bId=r74 87.

7 National Disability Insurance Scheme Act 2013 (Cth), s 3, https://www.legislation.gov.au/C2013A00020/latest/text.

8 United Nations, Convention on the Rights of Persons with Disabilities, arts 1 and 3, https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-persons-disabilities.

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Submission 585

9 See, Committee on the Rights of Persons with Disabilities, General Comment No. 6 (2018) on equality and non-discrimination, [3], https://digitallibrary.un.org/record/1626976/files/CRPD_C_GC_6-EN.pdf.

10 National Disability Insurance Agency, Quarterly Report to Disability Ministers: 31 December 2025 – Appendices (Canberra: NDIA, 2026), tables D.4–D.8, https://www.ndis.gov.au/media/8282/download?attachment=.

11 See, Halstead S et al., “Holistic prevention and management of physical health side-effects of psychotropic medication: second report of the Lancet Psychiatry Physical Health Commission,” The Lancet Psychiatry (2025), https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(25)00162 2/abstract.

12 See, Crutzen S et al., “A Naturalistic Cohort Study of People in Long-term Care for a Psychotic Disorder:

the Association Between Antipsychotic Side Effects, Dose, and Societal Functioning,” Schizophrenia

Bulletin (2025), https://pubmed.ncbi.nlm.nih.gov/40801808/.

13 Independent Review into the National Disability Insurance Scheme, Working together to deliver the NDIS: Final Report (Canberra: Commonwealth of Australia, 2023), 315, https://www.ndisreview.gov.au/sites/default/files/resource/download/working-together-ndis-review final-report.pdf.

14 National Disability Insurance Agency, Supplement to Quarterly Report 2022–23 Q2 – Appendix E Supplement 2022–23 Q2 (2023), worksheet “Table E5”.

15 National Disability Insurance Agency, Supplement to Quarterly Report 2022–23 Q2 – Appendix E Supplement 2022–23 Q2 (2023), worksheet “Table E5”.

16 Department of Health, Disability and Ageing, Analysis of unmet need for psychosocial supports outside

of the National Disability Insurance Scheme: Final Report (Canberra: Commonwealth of Australia, August

2024), https://www.health.gov.au/sites/default/files/2024-08/analysis-of-unmet-need-for-psychosocial supports-outside-of-the-national-disability-insurance-scheme-final-report.pdf.

17 Productivity Commission, Review of the National Mental Health and Suicide Prevention Agreement:

Interim Report Overview (Canberra: Australian Government, June 2025), 24,

https://assets.pc.gov.au/2025-06/mental-health-review-interim-overview.pdf.

Published May 2026 Page 18 of 18