Nial health condition
Submission to the Joint Standing Committee on the NDIS: The Provision of Services under the NDIS for people with psychosocial disabilities related to mental health conditions
Joint submission by the Hume
and Loddon Mallee Murray
Partners in Recovery Consortia
February 2017
BOS
Jal UME: PARTNERS IN partners in RECOVERY _ ‘ecovery
LODDON MALLEE MURRAY REGION
Contents
Partners in Recovery (PIR)…………………………………………………………………………………………3
PIR and the National Disability Insurance Scheme (NDIS) ……………………………………………..3
Who benefits?…………………………………………………………………………………………………………..3
Hume and Loddon Mallee Murray PIR………………………………………………………………………….4
Response to the Terms of Reference…………………………………………………………………………..4
Our Concerns……………………………………………………………………………………………………………5
How the problems can be addressed …………………………………………………………………………..7
Endorsing organisations …………………………………………………………………………………………….8
Submission to the Joint Standing Committee on the NDIS 2
Partners in Recovery (PIR) PIR is an initiative of the Australian Government Department of Health that aims to better support people with severe and persistent mental illness with complex needs and their carers and families, by getting multiple sectors, services and supports they may come into contact with (and could benefit from) to work in a more collaborative, coordinated, and integrated way.
Through system collaboration, PIR promotes collective ownership and encourages innovative solutions to ensure effective and timely access to the services and supports required by people with severe and persistent mental illness with complex needs to sustain optimal health and wellbeing.
The mainstay of the PIR workforce is the Support Facilitator, who works to support individuals to build a recovery plan, and to identify and coordinate holistic services and supports to deliver against this plan. The program is oriented around a partnership model, with consortium-based governance structures in line with this approach.
PIR and the National Disability Insurance Scheme (NDIS) The PIR program is transitioning into the NDIS. Prior to NDIS commencement in a region Partners in Recovery will:
continue to provide services to PIR participants help PIR participants and their families to understand the NDIS assist with preparation of NDIS applications (pending age and residency requirements).
Once NDIS commences in a region area Partners in Recovery will:
provide support through the assessment and planning processes provide services to eligible NDIS participants (Support Coordination and Individual
Capacity Building NDIS items)
provide continuity of support for PIR participants found not eligible for the NDIS until alternative arrangements have been implemented
Sector collaboration and governance, necessary for maintaining and improving networks and referral pathways, continues to be a key focus of Partners in Recovery. The PIR program will cease in June 2019.
Who benefits? The Australian Government Department of Health estimates that there are around 60,000 Australians currently living with severe, persistent and debilitating mental illness who have complex needs and face significant obstacles participating in society and social or vocational activities. This cohort of people often fall through system gaps and require intensive support to meet the complexity of their needs. They are the target for support from the PIR program. There is significant but not complete crossover between this group and the 64,000 people that the NDIS consider likely to be eligible for NDIS support due to psychosocial disability by 2020.
Submission to the Joint Standing Committee on the NDIS 3
Hume and Loddon Mallee Murray PIR
The Hume and Loddon Mallee Murray PIR programs are led by Murray PHN in partnership with consortia in both regions. Both partnership groups reach across sectors to strengthen the links between the diverse services and supports participants may benefit from.
The Hume PIR Consortium is a partnership of eleven multi-sectoral organisations and a consumer and carer member. The program operates across North East Victoria and Southern New South Wales with Support Facilitators based at organisations in Albury, Wodonga, Finley and Wangaratta (see Hume PIR Catchment Area). It operates with a maximum participant number of 136 at any one time.
The Loddon Mallee Murray PIR Consortium is a partnership of nine organisations, which secures consumer and carer input through its partnership arrangements. The program
operates across Central Victoria and Southern New South Wales with Support Facilitators
based at organisations in Bendigo, Echuca, Kerang, Swan Hill and Deniliquin (see Loddon Mallee Murray Catchment Area). It operates with a maximum participant number of 135 at any one time.
Notably, there is no PIR program in Goulburn Valley, the region between the two PIR programs.
Response to the Terms of Reference This submission will focus on the following elements of the inquiry Terms of Reference: 1b) 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 whether these services will continue to be provided for people deemed ineligible for the NDIS. 1g) The role and extent of outreach services to identify potential NDIS participants with a psychosocial disability.
The Consortia consider that they are in good positions to make a joint partnership submission to inform the inquiry drawing on their collective wisdom as to the needs of the PIR client group, and through their deep understanding of the PIR program.
The reasoning for focusing on item 1b is that this speaks directly to the role of the PIR program, an area of expertise for the Consortia, and addresses their Terms of Reference which include a remit to identify and advocate on issues relating to transition to NDIS in order to make the transition as positive as possible for PIR participants, to include NDIS eligible and non-eligible participants.
The reasoning for focusing on item 1g is to harness and report the partnership’s experience of whether, and to what extent PIR clients may need support to successfully access services.
Submission to the Joint Standing Committee on the NDIS 4
Our Concerns
1b) 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 whether these services will continue to be provided for people deemed ineligible for the NDIS.
It is estimated that between 10-35% of PIR participants will not be eligible for support under the NDIS. In June 2015, PIR in the Hunter (an NDIS trial site), reported that 35% of PIR participants had initially been found to be NDIS ineligible1; a figure which is understood to have reduced but not disappeared following appeals to the NDIA (anecdotally to 10-20%).
This figure can only be taken as a possible indication of the size of this cohort of people as the sample size in Hunter was low and we understand that NDIS trial sites may not accurately reflect the NDIS in full scheme. Nonetheless, this does suggest that a significant cohort of people currently receiving PIR support will not be eligible for the NDIS, and hence will lose service support when PIR ceases at June 2019. In the Hume and Loddon Mallee Murray PIR regions, so this percentage would equate to between 28 and 98 PIR participants at any one time, or between 40 and 130 people in a year period.
Whilst PHN’s are implementing a stepped care approach to the provision of clinical mental health services, including for people with severe mental illness, it should be noted that PHN’s are prohibited from commissioning Psychosocial Support services as part of this approach. It must also be noted that Murray PHN, which covers the vast majority of the Hume and Loddon Mallee Murray PIR regions, does not currently expect to receive increased funding to cover any additional expenses that commissioning such services would require.
This represents a gap in services that this cohort will experience should additional support not be provided post June 2019, with the associated risk that people with severe and persistent mental illness and complex needs will fall through system gaps once again.
The Concern: There will be PIR clients who will not be eligible for the NDIS, for whom support will cease on 30 June 2019.
The Hume and Loddon Mallee Murray PIR consortia consider that the profiles of this PIR eligible, NDIS ineligible group include:
people who are unable to evidence the persistence of mental illness to the extent that the NDIS requires, but still require psychosocial support to manage day to day tasks and recover people with episodic needs for whom disability is not permanent or likely to be permanent, but experience significant periods of temporary decline and benefit from substantial support during periods of high need, including psychosocial support people unwilling to engage with the NDIS system who would otherwise be eligible (for example, people who do not consider themselves ‘disabled’ or people who have had bad experiences of support systems in the past, including some Aboriginal/
Torres Strait Islander people)
people who are not able to engage with the NDIS due to their illness and /or circumstances, (for example people in chaotic circumstances who do not have easy access to evidence of disability or consistent contact details or who are not aware of
1 Hunter PIR (2015): Hunter PIR and the NDIS: Building a Stronger Partnership
Submission to the Joint Standing Committee on the NDIS 5
the NDIS, or who are not internet connected) and do not have the required support or advocacy to do so.
Given the extreme vulnerability of these groups, and our knowledge that with the right support, many people can regain a sense of wellbeing and recover, this risk is, in the view of the Hume and Loddon Mallee Murray PIR consortia, unacceptable.
1g) The role and extent of outreach services to identify potential NDIS participants with a psychosocial disability.
The Hume PIR and Loddon Mallee Murray PIR consortia recognise that PIR clients can be slow to engage and hard to reach, and further understand that Assertive Outreach is not a feature of key NDIS structures in their current form.
We believe that key successes of Hume and Loddon Mallee Murray PIR have been an investment in building partnerships with organisations to facilitate identification of potential PIR participants, developing an understanding of stigma and isolation and the impacts of this on the client group, and the persistent investment in rapport building with clients to support engagement. In addition to the hugely positive impacts of this approach that have been identified at a local level, the Assertive Outreach feature of the PIR program has been recognised as a key facilitator of PIR’s success at a national level2.
In this context, it is important to recognise that in areas where there are no PIR programs (such as the Goulburn Valley region), despite the presence of some services that are working hard to provide the needed support, there is likely to be a particular shortage of support to assist people with severe mental illness and complex needs to the services that they require.
It is also important to recognise the complicating factors experienced by people in rural and remote areas in terms of access to support, including the impact of stigma as a barrier to help-seeking, scarcity of services (market failure already being a reality in some rural areas), and travel time considerations.
Whilst it is understood that health organisations will be expected to support people who are potentially eligible for the NDIS to apply to the scheme (including GP’s and state-funded clinical mental health services), it has been the experience of the Hunter NDIS trial site that the gaining of consent and gathering of evidence and supportive documentation for PIR client’s NDIS applications typically takes at least 20 hours of professional time per individual3. The Hume and Loddon Mallee Murray PIR consortia do not believe that health services will realistically be in a position to make this additional investment of time to support hard to reach PIR-type participants to access the NDIS.
The Concern: Some people with severe and persistent mental illness and complex needs will not access the support they need without assistance.
This is a second key gap in services that this cohort will experience should additional support not be provided post June 2019. The associated risks that people with severe and persistent mental illness and complex needs will not access appropriate supports is also, in the views of the Hume and Loddon Mallee Murray PIR consortia, unacceptable.
2 Urbis (2015): Partners in Recovery Annual Report 2014-2015 3 Estimated by the PIR team in the Hunter during the trial site 2014-2016: Hunter PIR report 2016.
Submission to the Joint Standing Committee on the NDIS 6
How the problems can be addressed The Consortia recommend that an additional service is offered to support people with psychosocial disabilities related to a mental health condition after June 2019 to address these two concerns.
The Consortia have reflected on our own experiences of the features of PIR that have been effective, along with our multi-sectoral experience of the needs of the PIR group.
We consider key features of such a service to be:
a focus on service coordination (to explicitly include carers) the capacity to provide direct psychosocial support that includes allowance for travel time. This could be by the worker themselves or through a commissioning approach, perhaps using the NDIS marketplace the use of an assertive outreach approach a workforce that has strong qualifications/ experience a recovery focus that is central flexible funds are available a strategic planning function is embedded to include health, NDIS and local community partners strong referral pathways to health are embedded including general practice, PHN’s and state funded clinical mental health services strong referral pathways to NDIS are embedded flexibility of approach are allowed, including the possibility of accelerated start-up, dependent on local context.
The Consortia have considered the type of provider that may best deliver such a service.
Examples considered included Local Area Coordinators, Primary Health Networks, state
funded clinical mental health services, or other NGO’s. The consortia do not make a recommendation regarding provider-type, but suggest that any organisation considered should be able to deliver all of the key service features listed above.
Submission to the Joint Standing Committee on the NDIS 7
Endorsing organisations
All those listed below have formally endorsed this submission:
Consumer Endorsement: Colin Timms & Loddon Campaspe Southern Mallee Consumer
Participation Group
Carer Endorsement: Jennifer Fogarty
Murray PHN: Matt Jones, Chief Executive Officer
Mind Australia: Philip Dunn, Area Manager, Central & Western Region
Wellways: David Cahill, Regional Manager, Murray Region
Anglicare Victoria: Phil Eddy, Manager, Community Services
One Door Mental Health: Michelle Saffery, Regional Manager, NSW South West Region
Centacare: Sharon Jamnikar, Assistant Program Manager Recovery Support Services,
South West NSW
Golden City Support Services: Anne Fahey, Manager, Mental Health and Dual Disability,
Carer Support & Carer Relations
Southern Mallee Primary Care Partnership: Bronwyn Hogan, Executive Officer
Rural Housing Network: Catherine Jefferies, Client Services Manager
Haven; Home, Safe: Rachel Gellatly, General Manager
Albury Wodonga Aboriginal Health Services: David Noonan, Chief Executive Officer
Gateway Health: Vicki Pitcher, General Manager
Northern District Community Health Services: Greg Little, Chief Executive Officer
Bendigo Community Health Services: Liz March, Executive Director Programs
Murrumbidgee Local Health District: Alison Thorne, District Community MHDA Manager,
Specialist Mental Health/Drug and Alcohol Services
Albury Wodonga Health: Brian Kennedy, Operations Director Adult Mental Health
Bendigo Health: Peter Robertson, Director of Stakeholder Relations, Psychiatric Services
Lead contact: Alistair Bonsey, PIR Manager, Murray PHN
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