People with Disability Australia Incorporated
Postal Address: PO Box 666
Strawberry Hills NSW 2012
Street Address: Level 10, 1 Lawson Square
Redfern NSW 2016
Phone: 02 9370 3100 Toll Free: 1800 422 015 Fax: 02 9318 1372
ABN 98 879 981 198 TTY: 02 9318 2138
Toll Free TTY: 1800 422 016 Email: pwd@pwd.org.au
March 6, 2017 TIS: 13 14 50 NRS: 1800 555 677
NGO in Special Consultative Status with the Economic and Social Council of the United Nations
Joint Standing Committee on the National Disability Insurance Scheme (NDIS)
PO BOX 6100
Parliament House
Canberra ACT 2600
Email: ndis.sen@aph.gove.au
Dear Committee,
Inquiry into the Provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition
People with Disability Australia (PWDA) thank the Committee for the opportunity to provide input to this inquiry.
PWDA is a leading disability rights, advocacy and representative organisation of and for all people with disability. We are a NSW and national, cross-disability peak representative organisation and member of Disabled Peoples Organisations Australia (DPO Australia). We represent the interests of people with all kinds of disability. We are a non-profit, non government organisation. PWDA’s primary membership is made up of people with disability and organisations primarily constituted by people with disability. We have a vision of a socially just, accessible and inclusive community, in which the human rights, belonging, contribution, potential and diversity of all people with disability are recognised, respected and celebrated with pride.
We note that the Productivity Commission is currently undertaking a review of NDIS costs, including looking at jurisdictional capacity and whether there has been any impact on mainstream services. We urge the Committee to be informed by the findings of this review in terms of the capacity of the NDIS to respond to those people who are deemed eligible for support under the NDIS, but also for those who require psychosocial support services who will not be NDIS-eligible.
Our vision is of a socially just, accessible and inclusive community, in which the human rights, citizenship, contribution and potential of people with disability are respected and celebrated.
PWDA share the concerns raised by Mental Health Australia in their submission to this inquiry. We note that they, and others (including PWDA) have on numerous occasions raised these issues directly with the Government and the NDIA, including during the recent consultations on the Draft Fifth National Mental Health Plan. Given the considerable input around policy and practice it is extremely concerning that it remains unclear how the NDIS and mental health services will interact at both a policy and operational level to ensure the rights of people with disability are upheld and the principles of choice and control realised.
In PWDA’ submission to the consultation on the Draft Fifth National Mental Health Plan1, we recommend that the Department of Health work with the NDIA to facilitate a mechanism through which feedback and concerns regarding the interaction of the NDIS and mental health services can be raised. This should be part of the national reform and system performance measures, but this mechanism must have a remit to cover both the NDIS and mental health service systems, ensuring that feedback from consumers directly influences improvements in both areas of reform.
In addition, monitoring and reporting processes should recognise the interdependence of these systems and measure the contribution of each reform against commitments made. As the NDIS is rolled out, lessons learnt from participants themselves will be invaluable.
NDIS eligibility and access for people with psychosocial disability
Under the NDIS, individuals with psychosocial disability are required to provide current
evidence of their psychiatric condition, and that this condition be a ‘permanent
impairment’. This eligibility criteria is particularly challenging in a practical sense, and raises concern that many people in need for individualised support will miss out.
People with psychosocial disability as a result of mental illness are not a homogenous group. An individual’s experience of mental illness is personal, and as such the impact of their disability over the long term is difficult to predict, may change over time, and fluctuate depending on factors that are impossible to foresee. A person may have a ‘permanent impairment’ in so far as they may have diagnosed bipolar or schizophrenia, but their support needs may differ depending on other social support in place, living situation, medication they are taking etc. These other factors will fluctuate significantly over their
lifetime, from having limited impact on their everyday life, to presenting significant
challenges with very high support needs.
The current policy framework, and the criteria of ‘permanent disability’ are contrary to the recovery focus of mental health services and practice, as well as the social model of disability embedded in the CRPD and the National Disability Strategy. This rhetoric does not
1 PWDA submission to the Draft Fifth National Mental Health Plan can be accessed here http://www.pwd.org.au/pwda-
publications/submissions.html
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promote a positive, recovery-orientated model to the provision of psychosocial support, but rather focuses on the ongoing ‘impairment’ as proof of a person’s permanent psychosocial disability and need for support.
There remains a lack of clarity around the referral and assessment processes for the NDIS and how the Scheme will interact with mental health services providers at an operational level. Until clear assessment criteria are developed, including an assessment tool for services, inconsistencies will remain around eligibility. In addition, there is an immediate need for capacity building and training for mental health providers and other mainstream services (such as GPs, hospitals, PHN’s), in terms of their respective roles in relation to the NDIS, and how people can be referred and assessed for eligibility.
Access to quality services and choice and control for participants
The NDIA estimate that by 2019-2020, approximately 14% (approximately 64,000) of NDIS participants will be people with severe and ongoing psychosocial disability. However, the Australian Government estimates that ‘around one third of the 690,000 Australians with severe mental illness have chronic, persisting illness and that most have a need for some form of social support, ranging from low intensity or group-based activities delivered through mainstream social services to extensive and individualised disability support’2.
There is well-founded concern that the NDIS projected numbers fall well short of the
number of people who will actually be eligible, and questions remain around how the NDIS will ensure that everyone who is eligible receives the funding and support they need, whilst ensuring that those people found not eligible for NDIS support, continue to access quality essential services and support.
In 2015, the Council of Australian Governments (COAG) agreed to the Principles to determine the responsibilities of the NDIS and other service systems and supporting Applied
Principles. These Principles outline agreed responsibilities between the NDIS and
mainstream services, including mental health. As stated in the 2nd Implementation Plan for the National Disability Strategy Driving Action 2015-20183, these Principles ‘include a commitment to a seamless interaction of people with disability with the NDIS and other service systems, as well as coordinated approaches between systems. This recognises that there is a need for service systems to work together at the local level to coordinate supports for participants, as they often require supports from multiple systems or transition from one to another’.
PWDA are particularly concerned about reports that community mental health support
2 Australian Government response to Contributing Lives, Thriving Communities – Review of Mental Health Programmes and Services, November 2015 p. 25 http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-review-response
3 The 2nd Implementation Plan for the NDS can be accessed here https://www.dss.gov.au/disability-and-carers/programs-
services/government-international/national-disability-strategy-second-implementation-plan
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services (such as Personal Helpers and Mentors Program (PHaMs), Mental Health Carers Respite Scheme, Day to Day Living Program) are being wound back as the transition to the NDIS occurs, and that people who are not eligible to the NDIS will no longer have access to these services. There will continue to be considerable need for quality community based
mental health services for people not eligible for the NDIS, and it is critical that the
Government clarify these interactions as a matter of urgency. The lose of early intervention services, and low-level services such as these will ultimately result in increased costs across the mainstream services sector, as people seeking support are instead forced to rely on crisis services and hospital emergency departments. People with mental health concerns who are unable to access support may, as a consequence, have impacts across other areas of their lives, including housing stability and employment.
People with psychosocial disability, as with other individuals eligible for the NDIS, may to different degrees require support in the pre-planning and planning processes of the NDIS. The first plan process currently underway involves the direct transition of disability support services from the current funding arrangements to provision under NDIS. However, a practice framework is not in place to guide this process for psychosocial services. Without independent advocacy support during this process, people with psychosocial disability are likely to end up with plans that do not meet their needs.
For example, PWDA is providing individual advocacy support to a number of people with disability who live in Assisted Boarding Houses in NSW. Community support for people living in these boarding houses has, in the past, been provided through the Partners in Recovery (PIR) program, funded to different agencies by the Department of Health. On transition to the NDIS, PIR has been nominated as coordinator of supports for these clients, regardless of whether or not they have identified the need for mental health support in their plans or whether PIR are the most suitable agency to provide this coordination role.
As outlined in PWDA’s submission to the consultation on the Fifth National Mental Health Plan4, there needs to be particular attention paid, as noted in the Applied Principles, to how
investments in psychosocial early intervention can support people with early onset
psychosis and improve whole-of-life outcomes for individuals, consistent with the insurance principles of the NDIS. This is a critical consideration in the establishment of responsibilities between the mental health sector and the NDIS to ensure that people who may benefit from early intervention are identified as early as possible and referred appropriately.
Quality and Safeguards
4 PWDA’s submission to the Draft Fifth National Mental Health Plan, can be found here http://www.pwd.org.au/pwda publications/submissions.html
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The NDIA recently released the Quality and Safeguard Framework5, and we acknowledge that the Practice Standards and Code of Conduct will reflect the National Standards for Mental Health Services. As the Framework has just been released there is a need for a further clarification around how the Provider Practice Standards and Certification scheme will be operationalized across the NDIS for services providing psychosocial support, and how the verification, monitoring and review of these standards will be integrated across the NDIS and mental health sector. We urge the Committee to seek further information in this regard from the NDIA and the Department of Health.
Restrictive practices
Restrictive practices, including seclusion, solitary confinement, and physical, mechanical or chemical restraint are routinely used in aged care and disability services, mental health services and other places where people with psychosocial disability receive support (such as nursing homes and hospitals). These practices violate the rights of people with disability to be free from torture or cruel, inhuman or degrading treatment or punishment.6
The NDIS Quality and Safeguards Framework includes a preventative component on reducing restrictive practices, and the introduction of consistent quality requirements for behaviour support practitioners and relevant providers, as well as national reporting. Under the Framework, the Senior Practitioner will have an educative role in the reduction of restrictive practices.
Efforts to reduce and eliminate the use of restrictive practices must not be restricted to services providing psychosocial support under the NDIS. Efforts in the mental health sector and other mainstream services where restrictive practices occur must be aligned with the NDIS Quality and Safeguards Framework, including the role of a National Senior Practitioner. The market model of the NDIS will see fewer people with disability utilising formal disability services, therefore policy and legislation around the use of restrictive practices must be broad enough to cover the range of unregistered and mainstream services support and accommodation services that people with disability may access.
It is essential that efforts made towards the reduction and elimination of restrictive practices be explicit around particular practices that are prohibited or that require external oversight and approval, monitoring and review processes. A clear and consistent pathway to criminal proceeding is required where service providers breach requirements, whether they be NDIS or mainstream support providers.
The appropriateness of the NDIS for people on the margins
5 NDIS Quality and Safeguards Framework
https://www.dss.gov.au/sites/default/files/documents/02_2017/ndis_quality_and_safeguarding_framework_final.pdf 6 Rights Denied: Towards a National Policy Agenda about Abuse, Neglect and Exploitation of Persons with Cognitive Impairment, People with Disability Australia 2010. Can be accessed http://www.pwd.org.au/pwda-publications/reports.html
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People with psychosocial disability are often on the margins of society, lacking social connections and any formal or informal disability support services. These people have very
complex support needs, arising from multiple forms of social disadvantage and
discrimination. This may include more than one form of disability (for example, cognitive and psychosocial disability), violence, homelessness, a history of substance abuse, poverty, ill-health etc. Routine systemic failures have driven these people to the fringe of society, and consequently they often find themselves in and out of the criminal justice system and where their psychosocial disability is recognised, in receipt of forensic services.
The NDIS has no provision for outreach to people who are marginalised in this way. Access to the NDIS is predominately online and requires a permanent address. In addition, the services that these people come into contact with, such as crisis accommodation, mental health services, police and emergency departments, may not have the requisite knowledge to identify that an individual may be eligible for assistance under the NDIS, or the referral pathways for this to occur. The NDIA does not have internal staffing capacity to provide the outreach that is needed. The assumption that these people will self-refer to the NDIS is just not feasible.
The NDIS principles of choice and control and the specific focus on disability support services are irrelevant to people who are marginalised, or within the criminal justice system. Disability supports make up only one aspect of a complex set of needs, which requires a holistic response across many services sectors. People with psychosocial disability on the margins of society would most likely not have decision making supports in place for them to make informed decisions about their disability support needs7. In addition, the planning process for the NDIS requires detailed service needs over a set time period, predicting in advance what those needs may be. For people with complex psychosocial disability, who are marginalised and living in crisis, this prediction of need is impossible.
As state funding for disability is transferred to the Commonwealth, there is a real risk that people with complex psychosocial disability will fall through the gaps. Under the market model, providers will be able to refuse services to people that they consider too difficult, or that they feel that they do not have the skills and capacity to support. Eligibility to the NDIS does not guarantee a provision of services in this new environment, and due to the siloed nature of the scheme does not provide the holistic response that is needed, particularly for those people exiting forensic services and re-integrating into the community. It is essential therefore that provision of specialist services under the mental health services system be maintained, including for people who may be NDIS eligible. How the NDIS would interact with the criminal justice system should a person have a plan, but find themselves back in the
7 The Community Restorative Centre Paper published in January 2017, ‘Access to the NDIS for people with cognitive disability and\complex needs who are in contact with the criminal justice system’ provides a comprehensive overview of this issue for people with cognitive disability, and we urge the Committee to refer to the papers key challenges and concerns, as they are relevant to this inquiry
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criminal justice system, is another complexity around which there is no operational
guidance.
This issue is highly complex and requires extensive consultation and planning. We strongly urge the Committee to recommend that COAG and the NDIA make this a priority area of work. The NDIS may not be the appropriate mechanism through which support provision for people with psychosocial disability in receipt of forensic services, or living on the margins of society should occur.
We welcome the opportunity to elaborate further on any issues raised in this letter.
Yours sincerely,
Kate Finch
Manager: Systemic Advocacy
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