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: Grand Pacific Health, Mr Ron de Jongh CEO
Joint Standing Committee on the National Disability Insurance Scheme
PO Box 6100
Parliament House
Canberra
ACT 2600
Grand Pacific Health
Grand Pacific Health (GPH) provide a wide range of high quality health and mental health services and supports that assist people to manage their physical and mental health to communities across South Eastern NSW and the ACT. Our focus is to assist people to stay as healthy as possible and enjoy contributing lives. The main programs that GPH delivers are Psychological Services (previously ATAPS and MHSRRA), Aboriginal Health and Health Promotion.
Since 2013 GPH has also the lead agency for two Partners in Recovery (PIR) initiatives in Illawarra-Shoalhaven and Southern NSW. Southern NSW began rollout of NDIS in 2016–17 and Illawarra-Shoalhaven will commence rollout in 2017–18. PIR works to connect people with serious and enduring mental health issues to the supports necessary for them to meet their needs and offers care coordination activity to ensure that all supports and services are working from a recovery focussed plan of care. The remit of PIR was to work with the most vulnerable and disconnected consumers including the homeless, those with comorbidities and histories of traumatic contact with mainstream mental health services.
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 NDIS the planning process for people with a psychosocial disability the role and extent of outreach services to identify potential NDIS participants
Eligibility Criteria
When the NDIS commenced in Southern NSW in 2016–17 the remit of Southern PIR services became to assist program participants to access the NDIS including supporting the gathering of evidence for the Access Request Form and linking people into individual capacity building services that could be included in the NDIS plan should they be deemed eligible.
Our experience has been that the eligibility criteria is poorly understood as regards psychosocial disability and that assessors are making vastly different decisions on eligibility when Access Request Forms are lodged.
A lack of rigour in the implementation of the eligibility process is of concern as to the equity of access and the ability of consumers to muster the required resources to prove eligibility or appeal decisions. We are also working with NSW based mental health services who are experiencing similar difficulties in accessing the Scheme.
It has been our experience that without the dedicated resources of experienced support staff and the ability to buy in expertise such as psychiatric and occupational therapy resources, this client group would not successfully transition into the Scheme. 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.
Continuity of Supports for people deemed ineligible
People deemed ineligible for the NDIS are not able to be exited from PIR due to new exit rules brought in by the Department of Health. Until PIR terminates as a program in 2019 they will be eligible to continue to receive PIR supports. It is unclear however, where exit pathways may exist for these consumers and whether those affected by episodic functional impacts will have access to appropriate mental health services. This is particularly concerning to GPH in respect of the roles of PHNs in determining the stepped care model for each region.
It will be easy for PHNs to overlook the service needs of this cohort who require a range of clinical and non-clinical supports. Further they are difficult to locate in the community as they are frequently disconnected from psychosocial support services such as housing and employment as well as absent from many primary care environments. As a result we fear that the only option for service will again be the state mental health services who have consistently failed to meet the needs of this cohort. It is also not yet clear that the ILC role will adequately meet any such emergent gap in services. A ‘PIR like’ service will continue to be needed to support a group of people who experience severe episodic impacts to assist with the impacts of ill health and linkage to appropriate mental health treatment Primary Health Networks 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
GPH PIR services will typically take many weeks to develop an action plan to address the person’s goals. These are often paced over time so as to address the most pressing need initially and bring in less critical services and supports over a period of time. The NDIA planning process is significantly shorter as on most occasions, goals are developed during one meeting and without a plan to pace the timing and intensity of service delivery over a period of months. The capacity for goals to be determined appropriately, in one meeting, is questionable. People with enduring and complex mental illness often have cognitive impairments and fluctuating capacity, capability and motivation to participate in care planning and support activities. In these cases the need for care coordination is critical in order to ensure that the plan is in-step with both the immediate needs and the goal focussed strategies included in the plan. Again the allocation of coordination of support hours has been highly variable so far and has almost always been inadequate to meet the needs of the cohort and resulted in a loss of service provision.
The NDIS recognise the prior work of pre-existing support services, reducing duplication in the planning process. The NDIA staff require specialist skills in working with people with a psychosocial disability to enable effective support planning.
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 typically 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 remain largely unproven. Future funding for a PIR-like service must incorporate the additional costs of providing a service in complex and challenging settings including where two people are required to undertake a home visit.