27 February 2017
Submission to the Joint Standing Committee on the NDIS - Mental Health Terms of Reference
The provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition
About YFS
YFS is a not-for-profit organisation that delivers a range of services to the people of Logan and surrounds. For more than 30 years we have worked with vulnerable people to build independence and participation.
Programs relevant to this enquiry include:
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Personal Helpers and Mentors services (PHaMs): an Australian Government initiative which aims to increase recovery opportunities for people whose lives are severely affected by their experience of mental illness.
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Social Links, funded by the Queensland Government under the Queensland Community Care stream. Social Links provides community access and capacity building group programs for people with a disability including people with a primary diagnosis of a psycho-social disability.
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Community Connections, funded by Disability Services Queensland via packages for individuals. Activities focus on community access and skills development
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NDIS Get Ready, funded by the Queensland Government to help people with a disability in our region to prepare for the rollout of the NDIS
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Housing programs working with people who are homeless or at risk of becoming homeless to find and maintain stable housing. Many clients in these programs have mental health challenges.
Comments on the Terms of Reference
YFS concerns on the terms of reference for the inquiry are as follow:
(a) the eligibility criteria for the NDIS for people with a psychosocial disability.
Under the eligibility assessment:
“To meet the NDIS disability rules you need to have an impairment or condition that is likely to be permanent (lifelong) and that stops you from doing everyday things by yourself.”
YFS’ experience of delivering community and social support and services with people with mental health or/and psychosocial disability is that conditions and symptoms tend to be episodic in nature. We are concerned that the eligibility requirements will exclude many people who are impacted significantly by psycho-social disabilities, many of whom would benefit from both core support and capacity building to “live an ordinary life”.
We advocate for a more sympathetic eligibility definition for people with psychosocial disability to ensure that more people with episodic issues gain the support they need to avoid crises and achieve their potential.
We recommend intervention and inclusion eligibility criteria similar to the NDIS Early Intervention Checklist should and must apply to mental health or/and psychosocial disability.
Programs like PHaMs demonstrate that people with mental health or/and psychosocial disability benefit from support/assistance to stop the impact of their impairment or condition from getting worse, and to facilitate their active participation in economic and community life.
(b) the transition to the NDIS of all current long and short term mental health Commonwealth Government funded services, including the Personal Helpers and Mentors services (PHaMs) and Partners in Recovery (PIR) programs, and in particular
(i.) whether these services will continue to be provided for people deemed ineligible for the NDIS;
YFS understands that people with mental health or/and psychosocial disability deemed ineligible for the NDIS will need to be exited from Personal Helpers and Mentors services (PHaMs) and transitioned to other appropriate mental health – community and social services. This is a challenge due to the lack of appropriate mental options to replace the capacity and capability of Personal Helpers and Mentors services (PHaMs) program.
Personal Helpers and Mentors (PHaMs) services provide holistic support including providing links with other services such as housing support, employment and education, drug and alcohol rehabilitation, independent living skills courses, clinical services and other mental health and allied health services, while ensuring services accessed by participants are coordinated, integrated and complementary to other services in the community.
While most of the services provided by PHaMs can be easily mapped to NDIS-funded supports, given the similarity in need between people with psycho-social disability and the broader population of people with a disability, unfortunately eligibility is not so straightforward. Many current PHaMs clients are unlikely to be able to demonstrate eligibility for NDIS funding packages, either because their illness is episodic or they are unable to engage in the assessment and planning process without significant support.
Under our new PHaMs contractual arrangements, YFS is endeavouring to transition out of the service clients who will not meet NDIS eligibility requirements. This is proving difficult because:
a) there are few options for them b) it inhibits our ability to refer in to PHaMs people with mental health issues who present at YFS with homelessness as their priority issue but who are not significantly acute to justify referral. In the past, YFS accepted many people with lower-level mental illness into PHaMs to deal with crises such as homelessness. The lack of this option for many is putting significant additional pressure on the homelessness services in our area.
c. the transition to the NDIS of all current long and short term mental health state and territory government funded services, and in particular;
i. whether these services will continue to be provided for people deemed ineligible for the NDIS; YFS strongly recommends that Personal Helpers and Mentors services (PHaMs) and similar community based responses be extended to people with mental health or/and psychosocial disability who are deemed ineligible for the NDIS. This is because of unavailability of service provision and programs for day to day life
activities, support and assistance, which is currently delivered by Personal Helpers and Mentors services (PHaMs) program.
YFS also welcomes people with psycho-social disability into our Queensland Community Care-funded Social Links community access program. These are largely stable people with chronic mental health problems that limit their ability to engage in mainstream community. Social Links provides group activities and learning, while providing case management work to monitor clients’ wellbeing and provide additional support if required. This program is also under review in light of the NDIS, and we are advocating strongly for its continuation as a safety net for people who otherwise are at high risk of ending up in emergency departments, homeless shelters or corrective services care.
d. the scope and level of funding for mental health services under the Information, Linkages and Capacity building framework; Current funding for the Information, Linkages and Capacity building framework under the NDIS is minimal, and most is directed to Local Area Coordinators dealing with the huge influx of people needing NDIS plans. Their ability to proactively undertake developmental work or service the needs of ineligible people of any kind is very constrained. This is expected to continue well after full rollout, with massive workloads to undertake planning and review functions.
e. the planning process for people with a psychosocial disability, and the role of primary health networks in that process; It is clear that people with psycho-social disabilities will need very significant support to access the NDIS – to document and prove eligibility, to prepare for planning, to participate in planning and to implement their plans. This support must be made available urgently.
The Primary Health Network currently delivers (ATAPS) Access to Allied Psychological Services; Aboriginal
and Torres Strait Islander social and emotional well-being, which is a clinical based support and assistance for people with a psychosocial disability.
Clinical based supports are highly focused on intervention i.e. counselling, treatment and rehabilitation; rather thanday to day practical activities and service provision of support and assistance in community engagement and other service provider interactions that Personal Helpers and Mentors services (PHaMs) program delivers to compliment other services.
Currently, Primary Health Network delivers Partners in Recovery (PIR), which is care coordination practice, however, Partners in Recovery (PIR) is also grappling with transitioning to the NDIS.
The role of Primary Health Network for people with a psychosocial disability is currently unclear and undefined.
f. whether spending on services for people with a psychosocial disability is in line with projections; No position.
g. the role and extent of outreach services to identify potential NDIS participants with a psychosocial disability; and No position.
h. the provision, and continuation of services for NDIS participants in receipt of forensic disability services; No position.
i. any related matter.
Solution Focused Proposal
YFS is keen to pilot a service model offering continuity of care and coordination of life and community support and assistance for clients not deemed eligible for NDIS, which include but are not limited to:
Case management on client’s goal and plan GP or/and other health services appointment and engagement Employment services provider appointment and engagement Housing requirements appointment and engagement Other provider service provision requirement appointment and engagement Intervention and community inclusion engagement including community connection Learning – education and training outcomes continuity of care and coordination of life and community support and assistance provisions Earning – employment outcomes continuity of care and coordination of life and community support and assistance provisions.