SUBMISSION
to the Parliamentary Joint Standing Committee on the provision of services under the NDIS for people
with psychosocial disabilities related to a mental health condition
Table of Contents
2.0 Eligibility and access………………………………………………………………………………………………..3
3.0 Continuity of support ……………………………………………………………………………………………….4
4.0 Transition of block funded services to NDIS ……………………………………………………………..5
5.0 The success of Partners in Recovery ………………………………………………………………………..6
6.0 Summary………………………………………………………………………………………………………………….7
7.0 Recommendations……………………………………………………………………………………………………7
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1.0 Overview
The Partners in Recovery (PIR) Sunshine Coast and Gympie welcome the invitation to provide a written submission for the Inquiry into Mental Health in the National Disability Insurance Scheme (NDIS).
Sunshine Coast and Gympie PIR Consortia is led by the Central Queensland, Wide Bay, Sunshine
Coast PHN (PHN) and consists of members from the Sunshine Coast Hospital and Health Service,
Community Focus, Suncare Community Services, STEPS Group Australia, Mental Illness Fellowship
Queensland (MIFQ), North Coast Aboriginal Corporation for Community Health (NCACCH) and Graceville Centre – Lutheran Community Care. PIR Sunshine Coast and Gympie is also governed by a Consumer Reference Group and a Carer Reference Group with a representative from each of these groups, a member of the consortium.
The region recognises that the NDIS is a once in a lifetime opportunity to reshape the current system, with the intention of enhancing a person’s choice and control. The individual funding, ensures that the person can determine what level of care they need and who will deliver this care however, it would appear that those who will be ineligible for the scheme currently accessing PHAMS and PIR will be left without support due to the transfer of current Government funding to the NDIS.
The purpose of this submission is to demonstrate the need for both PHaMS and PIR to continue for this cohort that do not have a psychosocial disability but have mental illness and needs that can be supported in recovery and increased independence. The Mental Health Terms of Reference for the submission are addressed throughout the paper and issues such as eligibility, unintended consequences and continuity of care will be explored and discussed.
1.1 Information Sources
The submission includes feedback from Sunshine Coast and Gympie PIR Consortia members including both the Carer and Consumer Reference Groups. Responses were captured via surveys and focus groups which is the foundation of the submission. Local community service organisations were also consulted with as well as the Hospital and Health service.
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2.0 Eligibility and access
The eligibility of the NDIS is causing significant angst among community members and service providers, particularly as the unintended consequence of the scheme will inadvertently reduce services and supports currently available for those cohorts that will be out of scope.
The Sunshine Coast and Gympie PIR has provided support to over 550 people over the lifespan of the program and continues to receive, on average ten new referrals per week. New referrals that are accepted are based on people assessed as having a permanent psychosocial disability with complex interagency needs. This figure does not account for the number of enquiries received or the number of referrals who are determined not eligible at the point of intake, which would account on average for around 60% of enquiries. Through our central intake function we ensure that people are directed to the most appropriate service or community support that is aligned to meet their needs. Approximately 25% of those inquiries are connected directly to PHaMS or PHaMS employment services.
A review of current PIR clients was conducted to determine the percentage of those who are likely to be NDIS eligible, based on the access requirements. According to this review 30% of clients were determined likely to be ineligible to access an Individually Funded Package (IFP).
Consortia partners deliver client mental health services aside from PIR, such as Personal Helpers and Mentors program (PHaMs) and other individual supports. As part of the survey, consortia partners were asked to estimate the percentage of clients outside of PIR, that receive mental health support, they deem likely to be ineligible for the NDIS. It was estimated that at least half of these clients will not be eligible for an IFP.
A main referral source not only for PIR clients, but also those that are deemed ineligible at the point of intake, is the PhaMs program, particularly those who require less intensive support. This cohort is likely to be the same cohort ineligible for the NDIS and with the expected cessation of programs such as PIR and PhaMs, over a quarter of current PIR clients and an estimated half of current PhaMs clients, will be left with very limited support options.
As stated above, there is already a level of concern regarding the eligibility criteria to access the NDIS and the effect that this will have for those that are considered out of scope. The Sunshine Coast and Gympie area does not transition to the NDIS until January 2019, therefore it is predicted that it will become increasingly difficult to access the scheme, nearing final rollout. This could see a significant increase in previously reported figures of those deemed likely to be ineligible.
3.0 Continuity of support
Continuity of support for people experiencing a level of mental distress is vital for their long term recovery. With the funding from current operating services being transitioned to the NDIS, it is unclear how people outside of the NDIS scheme will receive support, despite the fact that they are receiving services at present. The lack of clarity around what continuity of support will look like during this reform, could potentially jeopardise the steps already taken towards recovery.
The Government have guaranteed continuity of support for people who do not meet NDIS access requirements, however these long term arrangements are still a work in progress. It is evident that there is little faith in this being upheld with one service provider stating, “I think it is pretty much impossible to deliver on that promise”.
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The Queensland Bi-lateral agreement clearly articulates that no one will be “worse off” the Governments response however, when the detail of these long term arrangements is questioned, to date has been that the Information, Linkages and Capacity Building (ILC) component of the NDIS will provide this support.
As stated above, the ILC component has been branded as the answer to ensuring continuity of support for those who will be ineligible for an IFP. However, the level of funding that has been allocated for the ILC component does not match the need of the community and what is currently being provided in the community. Aside from the shortfall of allocated money, the ILC framework outlines that majority of the funding will go towards the Local Area Coordinator (LAC) positions. These positions have several functions with the main being to support those with an IFP locate supports. As outlined in the framework, only a quarter of the LAC role will be to assist those, in the short term, ineligible for an NDIS plan to connect into mainstream services and community activities. This raises a number of concerns; the lack of time the LAC will have to perform this function and how this function is intended to operate, given the cut to block funded services such as PIR and PHaMs. One service provider reported, “It appears that the good work that is already being done in the community is being ignored”.
Another concern presented is the multi-disciplinary skills and experience LACs will need when it comes to working in a mental health context with one stakeholder reporting
“There are plenty of people with backgrounds in disability and a limited mental health workforce. The combination of having both is scarce. We can’t expect LACs to be able to coordinate supports when it takes time and trust to engage. I just don’t see how there’s enough resource in ILC to make any real difference.”
4.0 Transition of block funded services to NDIS
The ILC component does not appear adequate in meeting the needs of the community and with the transition of block funded services to the NDIS, the impact is set to be detrimental with a significant flow on effect. Not only will it be insufficient in meeting the needs of the individuals out of scope but for their significant others as well.
The assessment of needs tool, used as part of the PIR eligibility process, demonstrates that the top three client needs are; daytime activities, company and employment/volunteering. These top three needs have remained consistent over the course of the program and these needs are frequently met by services such as PHaMs who work with individuals over time to identify barriers, build skills and confidence to engage in a variety of social contexts. Accordingly, PIR worked alongside PhaMS to coordinate other supports and remove barriers. PIR in its assertive outreach has identified people who have been ‘hidden’ by nature of their social withdrawal.
People’s needs will only escalate if they are unable to access the continuum of psychosocial care that is currently available. Population health data demonstrates that a person who is experiencing a level of mental distress, often has other associated needs for example; alcohol and other drug, housing, financial and particularly physical health. One Carer reported “Further isolation, lack of continuity and support will result in higher incidence of relapse”. A Service Provider also reported, “It’ll leave a gap between well population and high intensity population. The community will lose the support to prevent people from escalating or re-admission”.
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If these supports are not refunded, it places greater strain on informal supports including carers with one Carer reporting, “Carers will be forced to carry the burden as often the responsibility falls back on them when there are no formal supports. This will increase the risk of family breakdown”.
The Acute Care Team intake line with the clinical mental health service identifies the moderate level of mental illness as one of the biggest cohorts seeking assistance. With the criteria of access to state mental health services targeted to high and severe intensity, the ‘missing middle’ is a growing concern with the PHN mental health clinical services not in a position to support psychosocial activities.
The greatest tragedy of people not being severe enough in need to access services is the perverse incentive to become more unwell. This is the most significant risk this submission seeks to make to the joint standing committee and the greatest fear.
5.0 The success of Partners in Recovery
The success of PIR is evident through the client outcomes, the networks established, the connections and linkages all whilst implementing a recovery based model. There are numerous “success stories” which are attributed to the PIR framework.
As previously stated, the PIR central intake line receives numerous calls from not only service providers but community members including family and friends as well. For this region, a waitlist/vacancy register is maintained by the Lead Agency, of the main services that are often recommended if the person does not appear to have a psychosocial disability at the point of Intake. In order to access this level of community service knowledge, the Intake and Referral Facilitator is required to maintain effective working relationships with key stakeholders that offer a variety of services and have a strong presence in the community. The Intake and Referral Facilitator also has a well-established relationship with the local hospital and health service and routinely in-reaches to the psychiatric ward. Not only does the Intake and Referral Facilitator identify potential PIR participants but builds the capacity of staff and patients by sharing information for supports outside of PIR. One staff member commented, “We don’t get much of an opportunity to network with community services so we are often unaware of what’s out there, it’s really helpful to have PIR come to us”.
Given the cohort that PIR targets, including those likely to be out of scope for NDIS, a level of assertive engagement is required. It is evident that the NDIS may not allow for this being that it is an insurance model. Support Facilitators are highly trained to work with the PIR target group and implement various strategies to create a safe environment which results in active engagement from the client. PIR is flexible in its approach and has the ability to go at the pace most comfortable to the client. This is absolutely essential as it not only allows for the episodic nature of mental illness but it instantly distils a level of trust between PIR and the person. One service provider commented, “Building rapport took a number of months, once this developed, PIR was able to coordinate communication with all key services providers”.
Support Facilitators also work very closely with services and supports that they link their clients in with and act as a mentor for working with this cohort. Support Facilitators know their clients and are aware of best practices for positive engagement. One service provider reported “We had long term consumers who were falling over because of the inadequacy of supports available and no continuity
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of care. We have now been able to link these consumers to a support facilitator, to organise their supports, and that has been of real benefit to them, and we see lots of big changes”.
PIR has been able to build effective referral pathways through various strategies, one example being the fortnightly ward visits to the local hospital. This referral pathway ensures continuity of care for those discharging from hospital. A service provider commented on the benefit of this referral pathway, “PIR has provided a neutral space where the mental health services can work together for a common goal, so despite the other dynamics, the common purpose is the really complex client that’s severally disadvantaged”.
6.0 Summary
The need for these programs is evident through the number of clients that have accessed the PIR program and the continual referrals and inquires that are received. The PHaMs program, consistently has a waitlist for their service, indicating that the demand is higher than what is currently funded, therefore raising great concern for the demand if programs such as these ceased.
It is clear that the NDIS cannot be the only system, particularly for those that are out of scope and are currently being supported by block funded services. The government needs to consider what the consequences will be as outlined in this paper if programs that currently exist in community do not continue in some form.
7.0 Recommendations
Recommendation 1: Continue grants based funding for PHAMS and PIR to support the cohort of people with moderate to high levels of mental illness who do not have a psychosocial disability but are at significant risk.
Recommendation 2: Co-design with all stakeholders to ensure that those who are outside of NDIS scope, continue to receive the support that they require.
Recommendation 3: That the NDIA Assessors are appropriately trained to understand functional impairment in the context of psychosocial disability. The current assessment tool may not capture the accurate level of functional impairment. A person with a psychosocial disability will more often than not, have the capacity to undertake a task, but is unable to due to the nature of their disability. A deeper level of questioning and exploration will be required for this cohort.
Recommendation 4: That the PIR Central Intake function be considered as a potential opportunity to operate the Digital Mental Health Gateway.
Recommendation 5: That the PIR eligibility criteria is broadened to moderate and complex needs.
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