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
27 February 2017
About HealthWest Partnership
HealthWest brings together 50 health care providers, community organisations and local councils in a voluntary partnership. The partnership is committed to supporting an integrated approach to strengthening our local communities’ health and wellbeing. HealthWest is one of 28 Primary Care Partnerships across Victoria funded through the Department of Health and Human Services. HealthWest covers five local government areas in Melbourne’s western metropolitan region.
HealthWest works to effect system-level improvements in partnership with our members and other stakeholders. The western metropolitan region of Melbourne is a vibrant area, rich in culture and home to many people from refugee and asylum seeker backgrounds. Since 2013 HealthWest has been working with members to improve service integration for people from refugee backgrounds experiencing or at risk of mental illness.
In November 2016 HealthWest supported the Refugee and Asylum Seeker Mental Health
Working Group of western Melbourne to convene a forum to identify the changes, challenges and opportunities arising for refugees with the rollout of the National Disability Insurance Scheme (NDIS). The following submission outlines key opportunities identified at the forum to co-create a system which is more accessible and better meets the needs of people from refugee and refugee-like backgrounds.
This submission directly relates to people from refugee and refugee-like backgrounds.
Refugees (and people from Refugee-like backgrounds) are currently underrepresented in the mental health system, yet a significant proportion have experienced high levels of trauma before entering Australia and are in need of mental health supports upon arrival and as they transition into their new life within Australia. A recent study found 89% experienced traumatic events prior to migrating, 35% of males and 45% of females were at moderate or high risk of psychological distress, compared to 7% of males and 11% of females in the wider population.1 With high rates of ongoing depression, anxiety and PTSD some of these people will be eligible for NDIS.
1 Jenkinson R, Silbert M, De maio J, Edwards B. (2016) Settlement experiences of recently arrived humanitarian migrants. Melbourne, Australian Institute of Family Studies.
Response to the terms of reference for the inquiry
Eligibility
a. the eligibility criteria for the NDIS for people with a psychosocial disability Language barriers, cross-cultural factors and the nature of torture and trauma related mental illness present unique challenges for determining the permanency of a person’s impairment/s. Refugees may require additional support in determining eligibility to ensure they receive equitable access to NDIS. Consideration needs to be given as to what barriers refugees might experience in determining eligibility and how the NDIS can assist in addressing these barriers either through additional supports or amendment of eligibility requirements.
Supports for people ineligible for NDIS
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
People who do not have permanent residency in Australia will not be eligible for the NDIS, including Asylum Seekers, people on Temporary Protection Visas (TPVs) and people on Safe Haven Enterprise Visas (SHEVs). This group will be eligible for the remaining state funded mental health system in Victoria, however, there is still some uncertainty about what programs and services will remain. There is concern about whether the remaining system will have capacity to meet the needs of this group. A range of community services must remain for people ineligible for NDIS, with the skills and capacity to support these service users.
Engaging people with complex needs
i. any related matter Access to language services Access to adequate language services is essential to ensure equitable access to the NDIS. Consideration needs to be given to the availability of language services, including the availability of funding and promotion to NDIS participants and workers. The workforce will require training in when and how to use language services. Standards, policies and procedures are also needed to support best practice. Refer to the Centre for Culture, Ethnicity & Health for more information about best practice: http://www.ceh.org.au/knowledge hub/?_sft_category=language-services
Flexibility in supports The flexibility of the NDIS model has particular relevance in the context of torture and trauma related mental health difficulties. NDIS acknowledges that mental health difficulties can be characterised by variations in intensity, and accounts for these changes by providing a flexible
budget to increase and decrease supports as necessary. There is concern as to how flexible and responsive individual plans will be if they are only reviewed annually.
Workforce capabilities: Working cross-culturally and supporting trauma-informed recovery A workforce which is trained to work cross-culturally and provide trauma-informed recovery will better support people in achieving their recovery goals. The workforce needs to have an understanding of and be responsive to the diversity of refugee experiences and cultural backgrounds. Workforce pricing structures and professional development infrastructure needs to support and prioritise training in these areas. Refer to this publication by Foundation House for information about trauma-informed recovery and working cross-culturally with refugees: http://www.foundationhouse.org.au/integrated-trauma-recovery-service-model/ .
Workforce diversity NDIS may offer the opportunity to build and deploy more specialised and diverse workforces which can better support refugees. Workforce diversity increases the effectiveness of organisations to support consumers from diverse backgrounds and promotes social inclusion. Evidence shows that workforce diversity results in increased access and capacity for organisations to identify community needs and provide information and services that respond to these needs in accessible and appropriate ways.2
Data monitoring Best practice data collection infrastructure and practices are needed to ensure NDIS data accurately reflects the number of refugees accessing supports. Opportunities exist with future commissioning and funding arrangements to implement better standards for data collection, to ensure NDIS can effectively monitor access to supports. Refer to this publication by the Victorian Refugee Health Network for information about Identifying people from refugee backgrounds: http://refugeehealthnetwork.org.au/identifying-people-from-refugee-backgrounds/.
Community Participation
Consumers, families and communities are valuable partners in developing and improving systems. Effective consumer participation enables systems and organisations to develop policies, programs and practices which better reflect the diverse needs of communities. Vulnerable and disadvantaged people are likely to face more barriers to participation, which will lead to further disadvantage. Participation of people from refugee backgrounds is essential in the rollout and ongoing implementation of NDIS. Mechanisms are needed to encourage NDIS providers to include refugees in community participation activities, and to measure the impact of their participation on the system.
2 Williams, Shanita D, et al. (2014) “Using Social Determinants of Health to Link Health Workforce Diversity, Care Quality and Access, and Health Disparities to Achieve Health Equity in Nursing.” Public Health Reports, Vol. 129:2.
Contact
HealthWest would be pleased to attend the Committee in person to speak to the issues outlined in this document. We would do this in partnership with one or more of our partners from the Refugee and Asylum Seeker Mental Health Working Group of western Melbourne, who can speak directly about their experience of working with people from refugee and asylum seeker backgrounds accessing supports for mental health.
W: healthwest.org.au A: Level 1, 37 Albert St