The Provision of services under the NDIS for people with a psychosocial disability related to a mental health condition
Joint Standing Committee on the NDIS – Mental Health Terms of Reference
Submission: The experience of Hunter Partners in Recovery and the NDIS
Joint Standing Committee on the National Disability Insurance Scheme
PO Box 6100
Parliament House
Canberra ACT 2600
Hunter Primary Care
Hunter Primary Care delivers a wide range of quality cost efficient health services to the Hunter community. Our focus is to provide an effective primary health care system that meets the needs of the community and keeps people well and out of hospital. The main programs that Hunter Primary Care delivers are GP Access After Hours, mental health programs, Care Coordination, Aged Care Emergency, Aboriginal Health programs and Rural Primary Health Services. This represents a comprehensive suite of programs that have been developed over time to address gaps in primary health care and to improve health outcomes for the community.
Hunter Primary Care is the lead agency for Hunter Partners in Recovery (PIR). Hunter PIR, in its first three years of operation, encompassed the Hunter NDIS Trial Site affording the program a unique insight into the NDIS design for people with a psychosocial disability, the future gaps that will emerge at the cessation of PIR funding and the issues arising with implementation of the Scheme.
In response to the Terms of Reference, this submission is responding, in particular to:
- the eligibility criteria for the NDIS for people with a psychosocial disability
- the transition to the NDIS for people who are clients of PIR
- continuity of support for people deemed ineligible for the Scheme
- the planning process for people with a psychosocial disability
- the role and extent of outreach services to identify potential NDIS participants
NDIS Eligibility Criteria
Hunter PIR has successfully supported over 200 people to access the NDIS via the Access Request process. This work involved extensive and ‘hands on’ liaison with mental health clinicians and General Practitioners to ensure sufficient evidence of psychosocial disability and its functional impacts were provided. It is our strong view that without PIR, or similar assistance, the client group would not successfully transition into the Scheme.
PIR also provided significant detail on the needs and goals of the person, however, the NDIA often required further ‘clinical assessments’, devaluing the knowledge and experience of the PIR program staff. Further costs have been incurred when PIR has been required to purchase Occupational Therapy assessments at the request of the NDIA. This experience indicates a potential inequity of access to the NDIS for people with a psychosocial disability and the onus of proof relying on the individual or a support service.
Over 95% of people we assist to access the NDIA are successful and deemed eligible for the Scheme. This figure, however, masks the significant proportion of people we have not successfully supported to access the NDIS due to interruptions in engagement and contact often related to fluctuations in health, the mobility of the client group, moving out of the area and high rates of incarceration. Future funding will need to be provided to assist people access the Scheme with particular expertise to engage those most at risk of falling through the gaps. It is anticipated that many people will not access the Scheme during the current life of PIR and will need to be followed up, with repeated attempts to engage. The additional costs to evidence gathering for NDIS access could be reduced with a greater acceptance of non-clinical evidence, particularly on functional impacts. Funding limitations within PIR need to address this ongoing evidential requirement.
People deemed ineligible and continuity of supports
The small number of people deemed ineligible for the NDIS in the Hunter PIR client group have typically had a mood disorder which has been deemed ‘treatable’ by the NDIA. The functional impact of the disorder may be significant and access to appropriate mental health services not sufficiently tailored to meet their needs e.g. limited affordable treatment options. A ‘PIR like’ service will continue to be needed to support a group of people who experience severe episodic mental illness to assist with the impacts of ill health and linkage to appropriate mental health treatment Primary Health Networks need to play a key role in ensuring mental health treatment options meet the full range of mental health disorders and delivery options
The planning process for people with a psychosocial disability
Hunter PIR will typically take many weeks to develop an action plan outlining the person’s goals due to the complexity of needs affecting the clients we support. The NDIA process is significantly shorter, on most occasions, goals are developed during one meeting. The intent of the person centred goal orientation of the NDIA is not in question; instead, it is the capacity for these goals to be determined appropriately, in one meeting, with an NDIA staff person who they have just met. And often the planning situation is occurring over the phone further limiting the capacity for person centred goal setting. The NDIS design could to a greater degree recognise the prior work of pre-existing support services, reducing duplication. The NDIA staff require specialist skills on psychosocial disability to enable recovery oriented goal setting.
The role and extent of outreach services to identify potential NDIS participants
Assertive outreach approaches are essential to enable service delivery to the most hard to reach people with a psychosocial disability, often also affected by homelessness and drug issues. The value of assertive outreach provided by specialist teams is often underestimated and the cost benefit (for example
a reduction in contact with police, ambulance and emergency departments) is an area, unfortunately, largely unproven.
A key concern expressed by partners of Hunter PIR is the adequacy of funding to deliver high quality services for people with complex needs under the NDIS. Our experience, to date, suggests this issue will most often arise when a two person outreach visit is necessary to manage risk. On many occasions, the risk may not be attributed to the person, rather their living situation. Many people reside in dense and/or problematic social housing settings. The cost of providing a service in these circumstances on an ongoing basis and managing risks appropriately are not recognised by the NDIS, causing a cost gap to emerge.
The incidence of poor quality housing options, drug misuse and criminality are outside the scope of the NDIS but have profound impacts on the ability of services to be delivered and the person to benefit and build capacity, ultimately reducing the efficacy of the NDIS.
In addition, sub-acute mental health crises and other risk associated behaviours such as hoarding and squalor may not be addressed by acute mental health services or psychological services. This highlights the value of PIR or like service, with a flexible, mobile, assertive outreach approach and highly skilled staff. Future funding for a PIR-like service must incorporate the additional costs of providing a service in these complex and challenging settings. The cost impacts of not funding a mental health service that meets this need are likely to be far greater.
Sally Regan (BSW, MASW)