Northern Territory Mental Health Coalition
Submission to the
Joint Standing Committee on the NDIS
The provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition
February 2017
Contact Details: Executive Officer, Vanessa Harris
Office Location: 5/18 Bauhinia Street
Nightcliff Community Centre
Nightcliff NT 0810
Postal Address: PO BOX 1128
Nightcliff NT 0814
Website: www.ntmhc.org.au
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The Northern Territory Mental Health Coalition
About Us
The Northern Territory Mental Health Coalition (the Coalition) is the peak body for the community managed mental health services in the Northern Territory (NT). As a peak body the Coalition ensures a strong voice for member organisations and a reference point for governments on all issues relating to the provision of mental health services in the Northern Territory. The Coalition has a network of 200 individuals, organisations and stakeholders including a membership of 35 organisations across the Northern Territory.
The Coalition provides advice and policy input into mental health service provision and associated challenges to all levels of government, and contributes to national mental health networks and associated peak bodies. As a member of Mental Health Australia and a founding board member of Community Mental Health Australia, the Coalition contributes a perspective on the provision of effective and accessible mental health services in the Northern Territory.
The Coalition
promotes and facilitates the dissemination and discussion of contemporary
information, government policy positions and initiatives to member organisations,
ensures, where possible within available resources, the provision of sector
development services and support to member organisation, and
actively networks with local and national organisations to promote awareness of the role of the Coalition and its members on issues related to the provision of quality mental health services across the Northern Territory.
The Coalition wishes to thank the Joint Standing Committee for conducting this inquiry and for providing our member organisations with the opportunity to make this submission.
The Coalition continues to support implementation of the National Disability Insurance Scheme (NDIS) and is confident the scheme can enhance choice and control for people accessing mental health services, and lead to improved health and wellbeing for people in the Northern Territory.
This submission focuses on the perceived impacts on the mental health, social and emotional wellbeing of the Northern Territory community arising from current and planned changes to the provision of services under the NDIS – with particularly reference to services for people with psychosocial disabilities related to a mental health condition.
This submission includes recommendations to ensure the rollout of the NDIS does not negatively impact upon this consumer group.
This submission contains contributions gathered through surveys and face to face interviews with member organisations and individuals.
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This submission to the committee supports the submission made by Community Mental Health Australia Submission of which the Northern Territory Mental Health Coalition is a founding member.
Executive Summary
What we know
The Coalition and its member organisations are particularly concerned about how people in the Northern Territory living with psychosocial disabilities will receive assistance under NDIS. To access mental health supports under the NDIS, a person is required to have a psychiatric condition with significant and permanent functional impairment.i This requirement appears to contradict the treatment and intake approaches of member organisations for people with
episodic mental illness/psychosocial disability, which emphasise early intervention,
rehabilitation and recovery.
The Coalition asserts that people with psychosocial disability in the Northern Territory will be disadvantaged by the removal of funding for several existing programs that have more flexible eligibility criteria, specifically; Partners In Recovery (PIR), Personal Helpers and Mentors (PHaMS) and Day to Day Living (D2DL). This is due to multiple factors largely unique to the Northern Territory, including:
a. A significant proportion of the population live in rural, remote and very remote locations.
b. There is a high Indigenous population living rural, remote and very remote areas who do not speak English as a first language.
c. There is a significant lack of choice in service providers for people living in very remote areas.
Recommendations
The NT Mental Health Coalition and its members are calling upon the Joint Standing Committee and the NDIS to consider a range of recommendations, and to ensure the NDIS remains accessible and effective in meeting the needs of people living with psychosocial disability in the Northern Territory.
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Ensure clients have access to interpreters and carers at the NDIA assessment stage.
This is to be an opt-out service and delivered in line with guidelines from Aboriginal Interpreter Service and Interpreting and Translating Service NT.
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Northern Territory Department of Health to commence department-wide utilisation
of the EHealth / Telehealth systems to streamline planning and assessment for clients living with psychosocial disability.
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The NDIS to consider the cost of delivering services to consumers living in regional, remote and very remote areas of the Northern Territory.
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A further review of the financial sustainability of service delivery within the NDIA’s current pricing model.
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Some organisations are concerned that the current NDIS pricing model will result in ‘providers of last resort’ where no other provider is able to effectively meet the needs of a person with psychosocial disability. The NDIS needs to provide detailed information to clients, carers and services around what provider-of-last resort options may look like in the NT.
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NDIS to be cognisant of organisational capacity and readiness to provide real choice
to clients. It is likely the NDIS will pose significant strain on smaller, niche services, resulting in organisation closures, decreasing choice for clients and subverting the aims of the NDIS.
7. The NDIS to immediately implement evidence-based training for NDIA
Planners/Assessors in relation to psychosocial disability, cultural awareness and cross cultural communication. NDIS to ensure planning and assessment processes are culturally accessible and evidence-based.
Northern Territory Context
Health services in the Northern Territory are provided in the context of unique geographic and demographic factors. The Northern Territory Department of Health has described some of the challenges these factors present to the delivery of services; includingii:
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The NT Department of Health covers 1.35 million square kilometers, much of which is sparsely populated and has a high portion of Aboriginal people.
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The NT population is ageing and experiences high levels of chronic disease and co- morbidities, especially in the Aboriginal population.
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Over 43% of the NT population reside in remote or very remote areas. There are over 600 communities and remote outstations in the NT, all with varying numbers of people
and families with limited access to services.
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Social and economic disadvantage has particular links to remoteness and the lack of services.
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In 2015 – 16, NT hospitals received 3,282 admissions with mental health diagnosis. 4
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Coalition members report that the lack of a uniform electronic patient information system across the Northern Territory health system contributes to a ‘clunky’ coordination of care.
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While Indigenous people constitute 30% of the NT’s population, Indigenous people represent 43% of all consumers assisted by community-based (non-inpatient) mental health services and 52% of admissions to mental health inpatient facilities.iii
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The NT recorded the highest imprisonment rate in Australia, at 958.1 prisoners per 100,000 adult population in the March Quarter 2016. This is 4.7 times the national rate of 204.7 prisoners per 100,000 adult population. iv
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During the March Quarter 2016, the Northern Territory Aboriginal and Torres Strait Islander imprisonment rate was 3,025.2 per 100,000 adult Aboriginal and Torres Strait Islander population. This is 29.4% higher than the national Aboriginal and Torres Strait Islander imprisonment rate of 2,337.6 prisoners per 100,000 adult Aboriginal and Torres Strait Islander population. v
Members Perspectives
Uncertainty and a lack of detailed information around the rollout of the NDIS were common themes to emerge from surveys and interviews with the Coalition’s members.
Coalition member organisations that work within a recovery and rehabilitation model contend that the Federal Government must continue to fund a flexible, low-barrier-to-entry service, such as PIR, D2DL and PHaMS. These services are effective in supporting people who need ongoing community-based care and coordination support. The flexibility of these programs has ensured that consumers and their carers have a wrap-around service that is suitable for their families and communities.
Coalition members are also adamant that NDIS ensures that all services under the NDIS for people with psychosocial disabilities align with the principles of the current policy and practice frameworks:
a. A National framework for recovery-oriented mental health services: guide for practitioners and providersvi
b. Fourth national mental health plan: an agenda for collaborative government action in mental health 2009-2014vii
c. Working Together: Aboriginal and Torres Strait Islander Mental Health and
Wellbeing Principles and Practiceviii
d. United Nations Declaration on the Rights of Indigenous Peoplesix e. Principles of Aboriginal Community Control Health Organisationsx 5
f. Primary Mental Health Care modelxi Many Coalition members have raised concerns about the financial sustainability of service delivery within NDIA’s current pricing model. This is of particular relevance for organisations that deliver services in regional, remote and very remote areas, where service costs are significantly higher.
Members report that NDIS is posing significant strain on small to medium services that do not have resources to redevelop organisational systems and structures to operate sustainably within a market-based service economy. There is a concern that this will result in organisation closures and lead to a market of larger, one-size-fits-all service organisations, reducing quality of services and limiting choice for consumers - especially those living in very remote communities.
The Bilateral Agreement between the Commonwealth and Northern Territory for the transition to an NDIS recognises the risk of service failure in remote communities, where there are thin or non-existent markets, including limited supply and very low demand for services. The agreement also states that the NDIA is responsible for ensuring provider of last resort services are in place for all participants in the NT, where other services are not operational. xii Member organisations report a lack of detailed information around what ‘provider of last resort’ options might look like in practice, causing angst throughout the sector.
The Coalition and its members are working with the Northern Territory Primary Health Network (NT PHN) to ensure equity and continuity of services and programs continue for consumers. However, PHNs across Australia have been directed by the Federal Government not to commission psychosocial services, while several programs transferred to the NT PHN involve psychosocial services. The inability of PHN’s to fund psychosocial services will thus produce a gap in meeting the support needs of NT communities.
The Coalition members are concerned that the National Disability Insurance Agency (NDIA) is moving away from face-to-face assessment and is excluding carers and interpreters for clients applying for the NDIS. This has a significant impact on people living with psychosocial disability. In some cases, NDIA Planners are reported to have inadequate understanding of psychosocial disability and to have underestimated or overlooked key areas of support required by the clients.
In the Northern Territory, member organisations and carers report that clients are having difficulties in effectively articulating their ongoing needs during the assessment process. NDIA assessors have reportedly had difficulty in understand people with psychosocial disability, particularly in the areas of;
a. Understanding episodic or chronic psychosocial disability b. Understanding of services/programs before the NDIS commenced c. Understanding of carers roles and the value-add that carers provide 6
The NDIS has highlighted that the scheme is for people living with a psychiatric condition, who have significant and permanent functional impairmentxiii. Those at greatest risk of being ineligible for a NDIS package are people living with the most common psychosocial disabilities including post-traumatic stress disorder, anxiety, depression and intergenerational trauma.
Under the National Disability Insurance Agency (NDIA) clients are required to provide evidence of a diagnosis of their psychosocial disability from a professional clinician ie; Psychologist. This type of specialist service is not readily available in most remote areas, with significant waiting periods existing for most consumers within the public health system.
Indigenous people are significantly over-represented both in the Northern Territory (NT) prison system, and in accessing community mental health services. Coalition members are concerned by this correlation and by existing restrictions on access to non-inpatient mental health services for prisoners in the NT.
Conclusion
The Northern Territory Mental Health Coalition members work to support the mental health and social and emotional wellbeing of the Northern Territory’s communities. As such, our sector is a key partner in improving access to the NDIS for people living with psychosocial disability.
NDIS should consider the likelihood of market failure in the Northern Territory if current pricing models are not revised. It is also imperative that detailed and accurate information around provider of last resort options are made available to clients, carers and service providers. Simultaneously, NDIS needs to ensure that planning and assessment processes are culturally and linguistically responsive and respectful.
Greater investment in flexible, community-based mental health services is required in the Northern Territory. These services have proven their capacity to meet the needs of people living with psychosocial disability, particularly people from diverse cultural and linguistic backgrounds, including Indigenous peoples living in remote and very remote communities.
The NDIS needs to respond to the unique cultural, geographic and demographic contexts of the Northern Territory to ensure equity of support for people living with psychosocial disability in the Northern Territory. Failure to do so is likely to result in significant social and economic costs.
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References
i Mainstream interface: Mental health services - Supports the NDIS will fund in relation to mental health services. National Disability Insurance Scheme https://www.ndis.gov.au/html/sites/default/files/documents/supports_ndis_fund_mental _health2_0.pdf
ii Northern Territory Department of Health Annual Report 2015-16
http://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/723/3/DoH_Annual%20
Report_2015-16.pdf
iii Northern Territory Mental Health Service Strategic Plan 2015 – 2021 http://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/988/1/Mental%20Healt h%20Service%20Strategic%20Plan%202015%20-%202021.pdf
iv Northern Territory Department of Corrections Annual Report 2015-16
https://correctionalservices.nt.gov.au/__data/assets/pdf_file/0007/379771/Corrections
Annual-Report-2015-16.pdf
v Northern Territory Department of Corrections Annual Report 2015-16
https://correctionalservices.nt.gov.au/__data/assets/pdf_file/0007/379771/Corrections
Annual-Report-2015-16.pdf
viii Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing
Principles and Practice Editors: Nola Purdie, Pat Dudgeon and Roz Walker
http://nceta.flinders.edu.au/files/2113/5891/4630/working_together_full_book.pdf
ix United Nations (2008). United Nations Declaration on the Rights of Indigenous Peoples. United Nations. Articles 3 and 4. http://www.un.org/esa/socdev/unpfii/documents/DRIPS_en.pdf
x National Aboriginal Community Controlled Health Organisation (2016) NACCHO
Submission to Inquiry into Human Services: Identifying Sectors for Reform, Sub227 into
Human Services: Identifying Sectors for Reform. Productivity Commission, Melbourne.
p. 3. http://www.pc.gov.au/__data/assets/pdf_file/0007/204964/sub227-human- services-identifying-reform.pdf
xii Bilateral Agreement between the Commonwealth and Northern Territory for the transition to an NDIS. Page 1 of 2, Schedule K. Arrangements for provider of last resort services, during transition.
xiii Mainstream interface: Mental health services - Supports the NDIS will fund in relation to mental health services. National Disability Insurance Scheme National Disability
Insurance Scheme (NDIS)
https://www.ndis.gov.au/html/sites/default/files/documents/supports_ndis_fund_mental _health2_0.pdf
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