NDIA Accountability Project

Submission 117 — Flourish Australia — The provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition

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Parliamentary Inquiry into the provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition

March 2017

Introduction

Flourish Australia welcomes this opportunity to submit a response to the Joint Standing Committee on the NDIS regarding the provision of services under the NDIS for people with psychosocial disability related to a mental health condition.

Flourish Australia, previously known as RichmondPRA, is one of Australia’s largest and most experienced not-for-profit community based, mental health organizations. For over 60 years, we have worked in local communities to support people on their mental health recovery journey. We provide a range of psychosocial support programs across our metropolitan and regional locations in NSW and South East Queensland - including individual support in the home and the community, group programs and activities, supported employment opportunities and assistance to find and maintain work. Our aim is to build participation pathways and support people with a mental health issue to achieve their goals and live hopeful and meaningful lives. For 2015/16, we supported 4,723 people in this way.

Our organisational culture fosters leadership in recovery-oriented, strengths-based and person led support. The value we place on lived experience is evidenced by 50% of our staff identifying as having a lived experience of a mental health issue, and through our peer workforce strategy. Currently 37% of our frontline staff are mental health peer workers, drawing on their own lived experience of a mental health issue and recovery journey to support others to achieve their goals.

We have significant experience providing services under the NDIS, having been part of the Hunter trial site since 2013. At the end of 2016, we were supporting over 350 people under the Scheme, 160 of whom commenced receiving services from Flourish Australia following the advent of full Scheme rollout in July 2016. Many of these ‘newer’ people are based in the Hunter where there is heightened awareness of, and demand for, the NDIS. Those numbers include people transitioning from other Commonwealth programs including Australian Disability Enterprise (ADE) services, Partners in Recovery and Support for Day to Day Living in the Community programs.

Flourish Australia strongly supports the NDIS and the opportunity it provides for greater certainty, choice and control, and economic and social participation for people with disability who require life-long support. We are also strongly supportive of the inclusion of psychosocial disability within the Scheme’s remit, and have seen firsthand the benefits of the Scheme for the people we support and their families.

However, we are also mindful that, as with any reform of such a substantial scale, there can be

unintended consequences, implementation  issues and uncertainty,  especially during the

transition phase. We are particularly mindful of the impact of this on the people we support. These are the focus of our submission.

In preparing our submission, we have drawn on our direct experience of the Scheme in the Hunter and elsewhere, and have consulted the people we support who are NDIS participants and our frontline staff to ensure their views are reflected.

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Terms of Reference

a) The eligibility criteria for the NDIS for people with a psychosocial disability From our experience of supporting participants to transition to the NDIS, we have encountered an inconsistent and imprecise application of the eligibility criteria for people with a psychosocial disability. While the overarching principle of identical eligibility criteria regardless of disability type is supported, the inconsistent application of these criteria to people with psychosocial disability is having detrimental impacts on the people we support.

We have seen people with psychosocial disability (see NMHCCF 2011) being denied eligibility for the scheme based on the type of their mental health diagnosis rather than the functional impact caused by it. This appears contrary to advice from the NDIA and also outlined in the National Disability Insurance Scheme Act 2013 (Cth) (the Act). Section 24 of the Act outlines the disability requirements that lead to an eligibility assessment. This section highlights the key Disability Requirements for Scheme participation as being:

  • Disability attributable to one of more of physical, social, intellectual, cognitive, neurological, sensory, physical or psychiatric impairments, and

  • Permanency, and

  • Substantially reduced functional capacity to undertake activities listed under 6 key domains – communication, social interaction, learning, mobility, self-care and self management, and

  • The impairment impact the person’s capacity for social and economic participation, and

  • The person is likely to require support under the NDIS for their lifetime. In addition, 24(2) allows for the episodic nature of many mental health issues, by recognising that whilst an acute illness may be episodic, impairments can be and could be considered “permanent”.

We have been told in some instances that issues like depression (and other mood disorders), borderline personality disorders and post-traumatic stress disorders are not ‘disabilities’ for the purposes of the Scheme. Reliance on diagnosis is problematic and moves the scheme away from focusing on disability support to a more medical/health related service.

On other occasions, the focus on the ‘primary’ disability to the exclusion of other disabilities fails to capture the very complex needs of people with co-morbid factors and can lead to a package not reflective of their needs. This mixed message around the importance of diagnosis versus the importance of functional impact in assessing eligibility underlies an inconsistent approach to the disability requirements and impacts confidence and certainty in the Scheme.

On the permanency element of the disability requirements we have also seen an inconsistent application of the requirements as outlined in the Act. On at least two occasions, eligibility has been questioned or declined due to a condition not being ‘fully treated and stabilised’, this reinforces our concerns about moving the Scheme into a medical/health focus rather than reasonable and necessary supports for functional impairment/disability. Additionally, we have

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not been able to find a reference to this phrase in NDIA guiding documentation. In many instances, there might be countless available treatment options that make testing all available options almost impossible. Furthermore, the delay in getting appropriate NDIA funded supports ‘wrapped around’ people with psychosocial disability, particularly following the withdrawal of other programs, might exacerbate issues experienced by people and significantly contribute to their ongoing symptoms.

The focus during the access and planning phase on ‘thinking about your worst day’ in order to establish functional impact is at odds with the recovery model of psychosocial support. This can have the effect of re-traumatising people living with mental health issues and detracting from the goals and strengths focus once people have transitioned to the Scheme.

Our experience is that understanding of mental health issues/psychosocial disability by key people administering the Scheme can be extremely variable. A practical example of this is the 1800 info line. Some staff can be quite knowledgeable and provide useful, practical advice. Others have a very limited understanding of mental health issues and are discouraging of applying for the scheme, to the extent that on several occasions Flourish Australia staff have received the advice that mental health is a concern solely of the health system NOT the NDIS.

The COAG Disability Reform Council Quarterly Report (October 2016) highlights that the approval rate (eligibility rate) for people with psychosocial disability was one of the lowest at 69.4%. This compares to approval rates of 95.9% for intellectual disability, 97% for autism and 98.6% for cerebral palsy (Table 2.8, p 45). This lower rate is consistent with the low percentage of people with psychosocial disability with approved plans as a proportion of all participants coming onto the Scheme during the first quarter for 2016/17 (5.8%) consistent with the NDIA’s focus on transitioning people with other eligible disabilities in State and Territory funded programs.

This could also mean that people with a mental health issue do not understand the Scheme or are wrongly applying for it; or it could be that NDIA staff (or their agents) managing access requests do not sufficiently understand how the Scheme applies to people with psychosocial disability. The case study below illustrates that the application of the Scheme to mental health issues seems to still be a ‘work in progress’.

Case study A woman living with a psychosocial disability arising from their mental health issue had her NDIS Access Request declined.

The advice provided by the NDIA when they declined the application was that NDIA assessors relied on her mental health diagnoses rather than the functional impairments arising from the mental health issue. They referred to the need for a person to have received all possible treatments before being eligible.

This advice does not appear to recognise the functional impairments experienced by the person exist even when their illness may fluctuate, and can have a significant and continuing impact on their life. Staff explained to the Assessor that her functional impairment was such that she required supported employment in an ADE and support facilitation through Partners in Recovery, to maintain her independence and wellbeing.

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The case study, above, further demonstrates the point made above about the focus being on functional impairment and not having to exhaust all treatment options prior to becoming eligible. However, such an approach has been identified, it would seem to have been influenced by

Disability Support Pension Impairment assessments. Such an approach  is,  in our view,

inconsistent with the Scheme’s objectives.

The Productivity Commission estimated that 13.8% of Scheme participants would be people with psychosocial disability, and the trial sites achieved higher rates of participation by this cohort than has occurred in the first quarter of full rollout commencing. It is imperative that further investigation and corrective actions are undertaken to increase the numbers of people with psychosocial support coming onto the Scheme. Guidance and training for NDIA staff (including LACs) in the areas of mental health and the application of the Scheme and its access criteria to people with lived experience should be an urgent priority as part of any corrective action plan, as should a public education and awareness campaign as outlined above.

As reported in the latest COAG report, the Scheme is already experiencing a number of cost pressures arising from various factors including higher than expected numbers of children entering the Scheme, increasing package costs, and a mismatch between benchmark package costs and actual package costs. The report also identifies that these pressures require a management response to ensure sustainability. It would be very disappointing if the slower take up of the Scheme by people with psychosocial disabilities were to inadvertently become a ‘management response’, as part of the approach to contain costs. People with psychosocial disabilities should not be further disadvantaged simply because they were a late inclusion into the Scheme, and the Scheme has not sufficiently evolved to appropriately take their needs into account.

We are very concerned that potential NDIS participants are required to provide evidence of a diagnosis. This in itself presents a barrier to accessing the NDIS, as it is expensive, and at times distressing, to see a psychiatrist/ specialist for diagnostic purposes. There is no funding available for people to have the required assessments completed. Furthermore, there is conflicting advice regarding the relative importance of diagnosis versus functional impact/impairment. We have seen people with psychosocial disability being denied eligibility for the Scheme based on their mental health diagnosis rather than the functional impact/impairment, which is in contradiction to other advice provided by the NDIA.

We are also concerned that the involvement of medical practitioners and a reliance on diagnosis as the starting point for assessment of eligibility is a fundamental and inappropriate shift in the operation of the scheme.

It is also important to note that many people with a psychosocial disability, who would benefit from the scheme, are not connected with (and, some, have had very poor experiences with) the service system. The need to include a letter of support from a GP or other health professional as part of the application process can be a significant barrier to access. It has also highlighted a lack of understanding among some GPs, psychiatrists and health professionals about the Scheme and the notion of permanent/life-long impairment. Some GPs do not always think holistically about a person’s life beyond their immediate health needs or their need for medication, and may not be well placed to comment on or provide evidence to support the need for assistance in other

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areas. Greater education of GPs and other health professionals and the development of useful tools are needed as this lack of understanding can severely impact a person’s chances of gaining access to the Scheme. This education process would most effectively be undertaken at a national, systemic level with the NDIA, other relevant Commonwealth agencies and with a psychosocial disability playing a lead role.

We are also aware that the approval process does not factor in that people experiencing symptoms of mental illness (e.g. hearing voices) who have a psychosocial disability may find it difficult to communicate their support needs in a clear and concise way. For example:

  • They may not have the ability to organise their thoughts and communicate clearly;
  • They may not have the confidence to fully communicate their support needs; or
  • They may wish to appear more competent than they are, to paint the best possible picture, and to ‘hide’ their symptoms. We have seen several people denied access to the Scheme due to their inadequate description of their support needs.

Focus Groups

Several focus groups were held in two different locations, including Western Sydney and Newcastle, to gather first-hand accounts from current NDIS participants supported by Flourish Australia. Overall, people reported feeling very anxious and overwhelmed by the process of applying for the NDIS. They felt that it was essential to have the support of a service provider throughout the process, as the lack of information and general feeling of confusion made it extremely difficult to navigate the process independently. People generally felt that there was a lack of information available in regards to how the Scheme “works” for someone living with a mental health issue. Many people reported that they were led to believe they wouldn’t be eligible for the Scheme, which resulted in a great deal of anxiety and a sense of reluctance to submit an Access Request.

People reported that they found the paperwork very overwhelming. We received feedback from some people that when they applied by themselves they were declined. It was only with the support and advocacy of Flourish Australia that their application was successful. In general, people have found it quite difficult to get a doctor to complete the paperwork in a sufficient and timely manner.

Recommendations:

  1. The NDIA, in consultation with relevant experts including those with lived experience of a mental health issue who experience a psychosocial disability, should develop clearer, more detailed guidance on the application of eligibility criteria for people with psychosocial disability, to reduce inconsistent advice and decision making by LACs and planners.

  2. An appropriate provider should be engaged by the NDIA to deliver training and education by people with a psychosocial disability for NDIA planners, LAC staff and others involved in administering the Scheme to enhance their knowledge of psychosocial disability, mental health issues, impacts on daily living, recovery focused support models and strengths based language.

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  1. A comprehensive education program targeting GPs, psychiatrists and other health professionals to improve their knowledge of the NDIS and understanding of their role in it, should be developed and overseen by relevant Commonwealth agencies.

  2. Investigation of the low rates of participation by people identifying as ATSI and CALD should be undertaken, to ensure that the Scheme is accessible to those most in need.

b) The transition to the NDIS of all current long and short term mental health Commonwealth Government funded services, including PHaMS and PIR, and in particular:

i. Whether these services will continue to be provided for people deemed ineligible for the NDIS

The transition of PIR participants to the NDIS has been slow moving and characterized by inconsistent decision-making and substantial changes to implementation as the transition rolls out. Many of the policy changes which have impacted PIR service delivery agencies appear to be caused by a lack of effective communication between the Department of Health (PIR funding body) and the National Disability Insurance Agency. Fundamental elements of the transition, such as access processes, reporting requirements, guidance materials and allocation of Coordination of Supports in plans are continually changing and still not finalised eight months after transition commenced. PIR Organisations are working effectively to progress the program transition in this space, but are fighting declining morale and ongoing uncertainty about key elements of our work.

While the NDIS is built on choice or control, the absence of alternative arrangements almost forces participants with psychosocial disability to apply for the NDIS or risk unavailability of services. This is particularly true of the PHaMS program, where progressive cuts to funding levels have led to a significant reduction in services to existing participants. In this transition period, the withdrawal of services before new NDIS funded services arrive to take their place is creating significant service gaps.

For people who are not deemed eligible or choose not to test their eligibility, PIR services will continue to be provided until the proposed conclusion of the program on 30 June 2019. This presents greater certainty that PIR participants will receive necessary support for at least the next two and a half years. We have been advised that Continuity of Support arrangements for PIR participants and participants in other Commonwealth funded mental health programs will be advised in due course. Our understanding from the Hunter Trial site is that 80-90% of PIR participants are deemed eligible for the Scheme and will receive funded supports through the NDIS, but that the number of eligible Day to Day Living (D2DL) and Personal Helpers and Mentors (PHAMs) participants who are eligible for NDIS is significantly lower, meaning these Continuity of Support arrangements will be vital for a large number of people currently supported through Commonwealth mental health programs. Until these arrangements are advised there will be a significant degree of anxiety and uncertainty experienced by both people living with psychosocial disability and the sector which supports them.

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The ‘in-kind’ arrangements that apply to programs such as Support for Day to Day Living in the Community and PIR to support transition are overly complex and bureaucratic. Different approaches or interpretations are being taken by Commonwealth program staff in different regions, and the transition process does not seem to have been designed around the needs and interests of the people who access services.

Another program area that is being impacted by the rollout of the NDIS and where there are adverse impacts for people with mental health issues is Australian Disability Enterprises (ADEs) program. The issues that we are experiencing in relation to ADEs and supported employees are summarised in the box below.

Australian Disability Enterprises

DSS funding of supported employment has been gradually closing to new participants as the NDIS rolls out across Australia. As of July 2016, ADEs have been prevented from accepting new employees who meet the age and residency requirements for the NDIS – until such time as they been successful in gaining access to the Scheme, and receiving an NDIS plan that allocates funds for employment in an ADE. Anyone who meets the age and residency requirements for the NDIS, and has their Access Request denied by the NDIA, is thereafter ineligible for employment in an ADE.

This funding transition has had a negative impact on the numbers of people participating in supported employment in Flourish Australia’s ADEs. The process of gaining access to the Scheme has been very slow – in some instances there has been a waiting period of over 3 months to receive a response to a person’s Access Request.

A flow-on effect of this is that our referral partners (e.g. Cumberland Hospital, Community Mental Health Services) are becoming increasingly reluctant to refer people to ADEs as they are anxious that the person will not be eligible for the NDIS, and therefore they will ultimately be ineligible for supported employment. Furthermore, 8 months after the introduction of the Scheme, we are yet to see funding for supported employment in an NDIS plan for someone who was not in supported employment prior to becoming an NDIS participant.

The combined effect of the above is that the number of supported employees (and attached funding) has declined significantly since July 2016 commencement of the Scheme (illustrated in the graph below). This impacts significantly on the viability of this service offering which continues to have many of the same ongoing operating costs despite declining numbers. (See graph on next page)

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ADE FUNDING TREND PRE-POST NDIS

2015-16 - DSS Funding     2016-17 DSS Funding     2016-17 DSS and NDIS participants

320 300 280

260PARTICIPANTS 240

220TOTAL                200                                             Septem  Octobe Novem  Decem          Februar                                          July    August                                    January         March    April   May    June                                                     ber        r      ber     ber               y

2015-16 - DSS Funding             280     292     292     293     290     290     295     302     275     278     275     269

2016-17 DSS Funding              258     252     249     238     234     227     222     219

2016-17 DSS and NDIS participants   258     252     249     238     236     231     236     241

MONTH

The Commonwealth’s own statistics estimate that 600,000 people in Australia have a severe mental disorder (DoHA 2013). Another 4-6% (about 1 million people) are estimated to have a moderate disorder, while a further 9-12% (about 2 million people) have a mild disorder (DoHA 2013). Obviously the NDIS is only targeting those who are a subset of the severe category, being the people most severely affected. But people classified in the severe, moderate and even mild categories will have need for and benefit from psychosocial support, even if they do not qualify for the NDIS.

The Commonwealth’s draft Fifth National Mental Health Plan, which sets out seven priority areas and supporting actions, recognises that significant reform is required to address the shortfalls of the current complex system, of which the NDIS is only one element.

The Commonwealth has made a commitment to ensuring ‘continuity of support’ for those currently receiving a service but not eligible for the NDIS. The NDIA website states that ‘Governments have committed to ensuring people with disability who are currently receiving services are not disadvantaged in the transition to the NDIS’. This means that if you are currently receiving a disability service, but do not become a participant in the NDIS, you can continue to have access to your current support consistent with your current arrangements’.

But the detail of what this will mean or look like is not yet available. In the absence of this clarity, we know of some providers who are no longer accepting people into their programs if they do not have an NDIS plan. And as highlighted above, we are seeing situations where those who are not eligible for the NDIS are no longer able to continue accessing services (in this case, ADEs) which they have been receiving up until now. Staff need to be able to provide clear information, explanations and assurances to participants who are very anxious. We are compounding their anxiety by being unable to answer their questions in relation to continuity of support.

Recommendations:

  1. The Commonwealth Government should commit to continued provision of a range of services for those people with a psychosocial disability who do not qualify for the NDIS but who would benefit from psychosocial support and other services. This commitment should occur in the context of finalising the fifth National Mental Health Plan, establishing clear priorities, responsibilities and timeframes and ensuring that people with lived experience have a strong voice throughout the planning process.

    1. Relevant Commonwealth Departments should urgently finalise transition

arrangements and provide clear guidance and advice in this regard, recognising the detrimental impact of ongoing uncertainty for people with a psychosocial disability.

  1. The Commonwealth Government should finalise and release Continuity of Support arrangements as a matter of urgency so that people who are not eligible or are unsure about applying for the Scheme have information and clarity about their options for the future.

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c) The transition to the NDIS of all current long and short term mental health state and territory funded services, and in particular:

i. Whether these services will continue to be provided for people deemed ineligible for the NDIS

As we currently understand the agreements, long and short term mental health state funded service sin NSW will not transition into the NDIS as they are focused on integrated clinical, non clinical and rehabilitation supports.

Recommendation:

  1. Relevant Governments should continue to fund state based mental health programs and pursue reforms to ensure an integrated, sustainable system that provides the right care and community based support at the right time.

d) The scope and level of funding for mental health services under the Information, Linkages and Capacity Building framework.

Currently, only $132 million is allocated to ILC funding, with the lion’s share of the original funding now paying for LACs. This means that only 0.6% of the total NDIS budget is available for achieving the ILC’s important goals: that is, building the capacity of mainstream services to be inclusive of people with disability; and making sure that people with disability and their families have the skills, resources and confidence to participate in the community.

The recent ‘national readiness’ grants program, as part of the first round of ILC funding, allocated $13 million for activities that ‘increase mainstream services’ knowledge and skills to meet the needs of people with disability’ or that ‘help community activities and programs understand the needs of people with disability and have the skills and knowledge they need to be more inclusive’.

Arguably, the level of funding - and its short-term nature - is not sufficient for grant recipients to effectively improve access to mainstream services or community activities. A case in point is the mental health system. Given that providing appropriate and timely services to people with mental health issues should be its core business, it is questionable whether a one-off project, funded via a small grant, will be able to achieve the desired outcome - and at a national level.

Recommendations:

  1. The level of funding remaining for the ILC program, and the short-term nature of the grants to be provided, should be revisited, given the important and ambitious aims of the program.

  2. State, Territory and Commonwealth Governments need to provide assurances to people with mental health issues and their families that they will continue to be able to access appropriate specialized community based mental health supports where they are not eligible for the NDIS, to assist them to maintain their independence and wellbeing.

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e) The planning process for people with psychosocial disability and the role of primary health networks in that process;

In general, people who participated in our focus groups reported feeling confusion and anxiety ahead of their planning meeting. They felt that there was a lack of communication and information regarding the process – they were unsure what questions would be asked and were worried that if they performed badly there would be negative consequences such as losing their Disability Support Pension (DSP).

Once at the planning meeting, most people reported a positive experience – for example ‘Bob’. ‘Bob’ felt extremely anxious about attending his planning meeting with the LAC. Due to this anxiety, he was having a cigarette outside the office where the meeting was to take place, and was contemplating leaving rather than attending the meeting. However, the LAC came out of the building and spoke to him reassuringly and made him feel comfortable about taking part in the planning meeting. Bob consequently did take part, and is happy with the experience and the subsequent package he received.

However, increasingly we are finding that people are being contacted by the NDIA, or by an LAC, and that planning meetings are occurring over the phone. This is an inappropriate method for conducting such important meetings, particularly for people who live with a mental health issue. Many people will not answer calls when they do not recognise the number due to the anxiety they experience. For those that do answer the call, they are often taken by surprise by it and are not prepared, comfortable or confident. Coupled with the fact that they may not have a support person present, this can lead to an inaccurate representation of their support needs, and a subsequent inadequate plan.

During focus groups, there was an extremely negative view of phone interviews, with people advising that they found the experience overwhelming, leading to an inability to think ‘on-the spot’.

We would also argue that talking face-to-face to a person to ascertain their needs is a more respectful approach and more likely to enable an accurate assessment, reducing the need for follow-up meetings, review of decisions etc.

In our view the role of PHNs should be education of GPs and other health professionals to understand the NDIS, its processes and the importance of their contribution to achieving a good result for people applying to access the Scheme. Providing GPs with information, knowledge and resources to encourage a more holistic approach and greater understanding of the need to assess functional impact, would improve the experience of potential participants.

The primary role of PHNs is, at a system level, to identify unmet need and service gaps in relation to the mental health system, and undertaking planning and commissioning to address these. This is required in respect of the population who is eligible for the NDIS (particularly where the market is under developed and unable to meet demand) but also for the population not eligible for the NDIS and which is at risk of falling through the cracks.

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Recommendation:

  1. PHNs should be encourage to take an active role in the education of GPs, psychiatrists and other health professionals in relation to the NDIS.

    f) Whether spending on services for people with psychosocial disability is in line with

projections

We know from the most recent COAG Quarterly Report that the proportion of people with psychosocial disability who joined the Scheme in the first quarter of 2016/17, as a proportion of all people joining the Scheme in that period, was low at 5.8%. This suggests that spending on people with psychosocial disability under the Scheme is most likely lower than projected.

Recommendation:

  1. There is a need for bipartisan political support for the NDIS to ensure the Scheme is fully funded in the long term.

g) The role and extent of outreach services to identify potential NDIS participants with a psychosocial disability;

Under the initial PIR contract (2013-2016), a core function of PIR was to actively seek out and assist people living with severe and persistent mental health issues who are socially and/ or geographically isolated. The capacity of PIR to undertake this vital work was severely limited under the most recent PIR contract, where the introduction of Maximum Client Loads and other measures to limit further expansion of the program have capped our numbers.

Once full transition to Scheme occurs and PIR block funding disappears, the availability of appropriately skilled workers with sufficient time to undertake this important engagement work will be virtually non-existent. This is a particular issue in regional areas where the large geographical coverage and low threshold populations will make it particularly difficult to access people in remote towns, particularly where those people may not have been known to the disability or mental health sector previously.

Locating these people, building connections with them and assisting them to understand and access the Scheme will take time. There is a need for the development of an outreach strategy, in collaboration with specialist community based services and people with lived experience, to ensure that those who are most vulnerable and marginalised are not excluded from the Scheme.

The way in which the Department of Health has designed the transition of PIR to the NDIS has had the unintended consequence of encouraging PIR organisations to seek to continue to provide “support facilitation or co-ordination” to people post-NDIS transition when, in many instances, that support is not required.

Data from the NDIA indicates that people who identify with Aboriginal and Torres Strait Islander heritage or from Culturally and Linguistically Diverse communities are not accessing the Scheme

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at a rate that is reflective of the needs in these communities. Special attention needs to be paid to ensure that culturally appropriate and safe outreach strategies, processes and other elements of the Scheme are developed in consultation with relevant communities.

Recommendations:

  1. The Maximum Client Loads caps in PIR should be removed to facilitate PIR services to provide ongoing engagement and identification of hard to reach people, to facilitate their access to the NDIS, and provide short-term co-ordination of support for people transition to the NDIS from PIR.

  2. This arrangement could be funded within the current funding envelope for PIR by renegotiating the levels of in-kind support for people currently in the NDIS.

Conclusion

The above information highlights that there are many issues being experienced by people with psychosocial disability - and their service providers - when it comes to accessing the NDIS which are not optimal. Many of these relate to the pace with which the Scheme is being rolled out, the administrative processes governing the reforms, and the lack of understanding of those administering the Scheme when it comes to the important distinction between a mental health issue and a psychosocial disability or continuing impairment.

It is imperative that ‘lessons learnt’ are acted upon, problems resolved and improvements made as the Scheme continues to roll out. In this regard, the Senate Inquiry is a very welcome opportunity to focus on the experience of people with a psychosocial disability and identify how the Scheme can better cater to their particular needs and circumstances.

It is also an opportunity to highlight that it is vitally important that services, support and system reform continue in respect of the needs of people who are not eligible for the Scheme given its primary focus on a “severe and persistent” mental health issue that gives rise to a psychosocial disability.

It is important to acknowledge that while most people we have spoken to have experienced uncertainty, confusion and anxiety throughout the process of gaining access to the Scheme and during the planning process – the majority of people who were successful in gaining access to the Scheme reported that once they had a Plan, they experienced a greater level of support, independence, hope and control than they previously had. Most importantly, participants report that the support they now receive under the NDIS is enabling them to work toward achieving their goals.

Reference: National Mental Health Consumer and Carer Forum (NMHCCF), 2011, Unravelling psychosocial disability. viewed 10/3/17 at http://nmhccf.org.au/publication/unravelling-psychosocial disability-position-statement

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