27 February 2017
Joint Standing Committee on the National Disability Insurance Scheme
PO Box 6100
Parliament House
Canberra ACT 2600
Dear Committee Secretariat,
Thank you for the opportunity for the Brisbane South Partners In Recovery (BS PIR) consortium to provide a submission to the ‘Joint Standing Committee into the provision of services under the National Disability Insurance Scheme (NDIS) for people with psychosocial disabilities related to a mental health condition’. We are pleased to contribute tangible solutions for the continuation of access to services and we support the imperative for providing better health outcomes for people living with severe and persistent mental illness, alongside their families and carers.
The BSPHN region represents almost 25% of Queensland’s population and is estimated to increase by 19% to approximately 1.2 million people by 2021. In 2013, approximately 25,000 residents (2% of the region’s population) identified as Aboriginal and Torres Strait Islander peoples, accounting for 13% of Queensland’s total Aboriginal and Torres Strait Islander population. Our community is also one of the most culturally and linguistically diverse (CALD) in Queensland, incorporating 43% of the total CALD population in Queensland. In addition, more than 600 refugees were settled in the region in the 2014-15 financial year.
Brisbane South PHN (BSPHN) is the lead agency for Partners In Recovery (PIR) in the Brisbane South region. We partner with 10 non-government mental health focused organisations who have the specialties to meet the varying needs of the population residing in Brisbane South. These PIR partner organisations coordinate services in the community with a recovery focus, and an understanding and empathetic approach that enables lives to be changed. This includes a person-centred approach which builds on the strengths of PIR participants without focusing on the diagnosis. Since the BSPHN PIR program’s inception in 2013, BS PIR has received 2,596 referrals, which has led to the development of 1,882 action plans with participants.
While the BS PIR consortium is supportive of the NDIS scheme, we have specific concerns around the provision of services under the NDIS for people with psychosocial disabilities related to a mental health:
The episodic nature of mental health excludes, by our estimate within our region, at least half of our participants, leaving limited services outside of the NDIS Reduction or loss of recovery orientated mental health services for those excluded by NDIS A high proportion of people living with severe and persistent mental illness are likely to be ineligible for NDIS, creating significant gaps in the service and support system for people with mental illness if current program such as PIR and PHaMS are not continued Stigma attached to a diagnosis within priority populations within our region such as Aboriginal and Torres Strait Islander people and people from non-English speaking backgrounds Lack of culturally appropriate tools and supports (provision of interpreters under the planning process) in place for Aboriginal and Torres Strait Islander people and people from Culturally and Linguistically diverse backgrounds The low knowledge level and understanding of NDIS within our region’s community based services, GP’s and primary health providers.
To support the successful rollout of NDIS as it relates to Mental Health, the BS PIR consortium is proposing the implementation of five key recommendations:
The development of assessment tools specific to Mental Health; including the development of culturally accessible resources and assessment tools for Aboriginal and Torres Strait Islander and Culturally and Linguistically Diverse
Communities
The engagement of Specialist NDIA Mental Health Assessors who understand the complexity of people living with severe and persistent mental illness The continuation of programs such as PIR and PHaMS in responding to the significant service and support gaps for people living with a mental illness NDIS engagement within forensic facilities to enable assessments prior to release from services; continuation of NDIS supports while in secure settings PHNs to be given a clear directive on their role in support of NDIS rollout within the region.
Further details on these recommendations are provided below:
- Our Region Brisbane South PHN (BSPHN) supports primary health clinicians and a community of more than 1 million people, across a region of more than 3,800 square kilometres spanning urban, regional and rural populations. BSPHN’s region includes almost 25% of Queensland’s population and is estimated to increase by 19% to approximately 1.2 million people by 2021.
In 2013, approximately 25,000 residents (2% of the region’s population) identified as Aboriginal and Torres Strait Islander peoples, accounting for 13% of Queensland’s total Aboriginal and Torres Strait Islander population.
Our community is also one of the most culturally and linguistically diverse (CALD) in Queensland, incorporating 43% of the total CALD population in Queensland. In addition, more than 600 refugees were settled in the region in the 2014-15 financial year.
- Mental Health and the NDIS 2.1 The episodic nature of mental health can be in conflict with the eligibility criteria of NDIS requiring lifetime supports. The current criteria is designed for people with a physical disability and is not the right fit for mental health
Mental illness accounts for 13% of the total burden of disease in Australia and is the largest single cause of disability, comprising 24% of non-fatal disease. Around 600,000 Australians experience severe mental illness and some 60,000 have enduring disability symptoms (AIHW, 2014).
Our consortium believes the episodic nature of mental health is in conflict with the eligibility criteria of NDIS requiring evidencing of lifetime supports and necessitates people identifying as having a permanent disability. This in turn may negatively impact on a person’s wellness and recovery as well as compound stigma associated with mental health.
In addition, a recent Mental Health Council of Australia study found nearly 29% of respondents reported a negative experience with a health provider in the last year (Australia, Mental Health Council of, 2011), emphasising the need for health providers who are specially trained to support those with a mental illness.
Recommendation: There is a need for specialist NDIS Mental Health Assessors within the NDIA who understand the complexity of people living with severe and persistent mental illness along with processes that allow for flexibility in assessment and planning timeframes. Planners need to be skilled in collecting information from a range of other supports not just the individual.
Recommendation: Where the current NDIS Assessment tools are heavily reliant on a diagnosed condition, our region suggests cognitive based assessments on application and at review periods, would better identify supports required to develop capacity for people living with mental illness.
Recommendation: In reflection of the diverse population within our region it is essential for all NDIS resources and application processes be culturally accessible for our Aboriginal and Torres Strait Islander peoples and Culturally and Linguistically Diverse communities. We recommend culturally appropriate assessments be explored, such as the Mater Assessment Tool. As well, application processes need to be reviewed to ensure equitable access.
2.2 A high proportion of people living with severe and persistent mental illness is likely to be ineligible for NDIS, creating significant gaps in the service and support system for people with mental illness if current program such as PIR and PHaMS are not continued
A recent assessment activity on the likelihood of eligibility conducted by BS PIR Support Facilitators suggested only 47% of current clients were likely to be eligible for NDIS. There are concerns a significant proportion of people accessing PIR will not be eligible for NDIS packages and there remains a question over which services will remain in place to support people living with severe and persistent mental illness.
Additionally, the BS PIR Consortium has specific concerns about the support mechanisms in place for people who are not eligible for NDIS if those block funded programs that have specialist knowledge and the skills required to support people with mental illness are not continued.
Recommendation: There is a need for programs such as PIR to continue otherwise it will create even bigger gaps and barriers in the community. This may have an unintended consequence of increasing burden on other services ill equipped to respond to the needs of this cohort and increased presentation to Emergency Department or Acute Care settings.
PIR was established by the Department of Health (DoH) in response to recognition that people living with severe and persistent mental illness were falling through the gaps of existing services and supports. Nationally, it was intended that the PIR initiative would support 20,000 people by 30 June 2016. This service target was exceeded. As at 15 March, 2016, there were more than 20,000 PIR Active clients and a further 10,000 clients exited from the program (DoH, 2016). For the Brisbane South region, DoH service targets were exceeded six months prior, in December 2016, which demonstrates the need for programs such as PIR to continue.
BS PIR’s participation in the HRMI Economic Evaluation Report further highlighted a positive impact both in terms of addressing unmet need and delivering a positive economic benefit, with a projected net benefit ratio of 1.38 over a five year period. (HRMI, 2016)
An evaluation of PIR Program participants, procured from Griffith University, reported positive changes in 20 of 23 nominated areas of need and identified areas of empowerment, transformation and enhanced social connections as domains of positive change (Griffith, 2016).
2.3 Knowledge level of NDIS of Community Based Services, GPs and Primary Health Providers within our Region
With the current rollout of NDIS across the country, the main focus of NDIA is understandably on operationalising the program. With PIR the only program within BSPHN with a specific brief to support NDIS planning and participation, it is recommended for each PHN to be provided with specific direction on their scope of support.
PHNs have established mechanisms in place and the relationships with providers to support NDIS transition. In gaining feedback from the PIR Consortium who are preparing transition of participants to NDIS there is concern about the level of knowledge of GPs and primary health care providers about the processes and implication of NDIS for their clients.
Recommendation: While NDIA processes and plans continue to develop to meet the needs of people accessing the program across the country, there is a need for a clear line of communication to providers who already have the infrastructure in place. For PHNs to provide the necessary support, the BS PIR Consortium suggests consistent and reliable processes be determined and implemented by PHNs.
2.4 NDIS engagement within forensic facilities to enable assessments prior to release from services; continuation of NDIS supports while in secure settings
Under current NDIS Guidelines, access to NDIS packages are restricted while patients reside in either forensic or secure settings. When a patient is within the forensic or secure setting, support for them ceases. For people living with severe and persistent mental illness, continuity of care and support is vital.
Recommendation: We recommend NDIS supports continue while in these facilities as support is potentially most needed at a heightened time of vulnerability. For people likely to be NDIS eligible, assessment should occur in conjunction with discharge planning.
Recommendation: Currently in the NDIS Price Guide there is no scope for stakeholder meetings between NDIS services and secure/forensic mental health facilities to coordinate services on discharge. It is our recommendation that service integration within these settings be added to the Price Guide and protocols be established between NDIS Local Area Coordinators (LAC’s) and mental health services within forensic and secure settings.
Thank you again for considering our submission. We looking forward to working with the Federal Government to ensure the successful implementation of the NDIS, particularly in relation to those most vulnerable in our communities.
Yours sincerely