Submission 84 — Katoomba Neighbourhood Centre, Inc. — The provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition | External submission

The provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition

Submission by Katoomba Neighbourhood Centre Inc. to the Joint Standing

Committee on the NDIS – Mental Health Terms of Reference.

Katoomba Neighbourhood Centre Inc

6-10 Station Street (PO Box 197)

Katoomba NSW 2783

P: (02) 4782 1117

Katoomba Neighbourhood Centre, Inc. (KNC) welcomes the Joint Committee inquiry into the provision of services under the National Disability Insurance Scheme (NDIS) for people with psychosocial disabilities related to a mental health condition.

We have addressed the following points in this submission:

1.a. the eligibility criteria for the NDIS for people with a psychosocial disability.

1.e. The planning process for people with a psychosocial disability.

1.g. the role and extent of outreach services to identify potential NDIS participants with a psychosocial disability.

1.a. The eligibility criteria for the NDIS for people with a psychosocial disability: Regarding eligibility, the National Disability Insurance Scheme Act 2013 states that:

Disability requirements: (1) A person meets the disability requirements if:

(a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or to one or more impairments attributable to a psychiatric condition; and (b) ) the impairment or impairments are, or are likely to be, permanent; and (c) the impairment or impairments result in substantially reduced functional capacity to undertake, or psychosocial functioning in undertaking, one or more of the following activities:

i. communication; ii. social interaction; iii. learning; iv. mobility;

v. self-care; vi. self-management; and (d) the impairment or impairments affect the person’s capacity for social and economic participation; and (e) the person is likely to require support under the National Disability Insurance Scheme for the person’s lifetime

(2) For the purposes of subsection (1), an impairment or impairments that vary in intensity may be permanent, and the person is likely to require support under the National Disability Insurance Scheme for the person’s lifetime, despite the variation.

KNC is concerned that some people with severe mental health issues may not meet the eligibility criteria if the requirement of ‘permanency’ [24 (1) (b)] is too rigid. Many mental health conditions can be well managed with the right supports and this includes conditions that may not be considered permanent, such as post-traumatic stress disorder (PTSD), however without access to appropriate supports they become life-long mental health issues. The focus on and language of recovery in treating Mental Health issues can also mean prospective NDIS participants may consider their condition not to be permanent, whether their issues will be lifelong or not.

Also of concern to KNC are cases where people are being rejected on the basis of their diagnosis. There is a general conception that there is a list used by contact centre staff and people are being told they do not meet the eligibility requirements based on this list. This would seem to be in contradiction to the Act.

Recommendations:

That impairments due to psychiatric conditions are considered to be permanent in relation to access to the scheme.
That the NDIA considers how it handles access requests for people with mental health issues and takes into account the confusion around multiple diagnoses and discussions of permanency.
The process of calling a contact centre and requesting an Access Request Form, and being asked questions about illness and impairments may be inappropriate for this cohort.

1.e. The planning process for people with a psychosocial disability, and the role of primary health networks in that process:

The nature of the impairments experienced by people with mental health issues can often mean that they find it hard to engage in the planning process and are not as able as others to articulate how their disability affects their everyday lives. There is a real risk that people who do not have a good understanding of their impairments due to their psychosocial disability and/or cognitive impairments will be unable to give an accurate indication of their current lives, goals and needs.

Client Story (1)

C.H., a man in his late 40’s, attended his planning meeting with Local Area Coordinators and his Mother who is in her 80’s. CH’s extreme social anxiety and his cognitive impairment meant that he did not speak during the planning meeting. His Mother at the time had a limited understanding of the NDIS and as a result CH’s NDIS plan and goals do not reflect the impairments he experiences due to his illness or include supports that will help Craig broaden his life and experiences, and lead a more satisfying life.

A greater understanding of how psychosocial disability affects other areas of health is needed by planners within the NDIA and advocates and support persons accompanying participants to planning meetings. People experiencing Mental Health issues are at greater risk of experiencing poor physical health. For example many people on anti-psychotic medications are at risk of unwanted weight gain. Where co morbidities such as obesity or diabetes are present Planners need to understand the benefits of including support areas of “health and wellbeing”. This would allow participants to access interventions such as dieticians and exercise physiologists. Other examples would include the negative physical impacts of being unable to be consistent with self-care and daily routines. Support in this area should be included in all plans for people with a psychosocial disability as the episodic nature is unpredictable and supports may need to be put in place quickly during a critical episode without having to complete a lengthy review.

Recommendations:

Expand the role of PHN’s and Mental Health Access teams, and other partners outside the Health system eg Community providers to ensure participants have advocacy and a voice during their planning meetings.
Within the planning process include Coordination of Supports to ensure plans can be used where the PWD with mental health issue does not have the capability of organising supports for themselves. Due to the often episodic nature of psychosocial disability Coordination of Supports should be included even when the person presents well.
That NDIA planners creating plans for people with psychosocial disability have specific knowledge of the needs of people experiencing mental health issues, and the types of supports to include in an individual’s plan.

1.g. The role and extent of outreach services to identify potential NDIS participants with a psychosocial disability: KNC is unaware of any process to flag with the NDIA potential participants who seem to have ‘slipped through the cracks’. Many community organisations working in their local communities, KNC included, are aware of people who seem to be eligible but who have taken no steps to become part of the NDIS. This particular cohort may well be the least likely to seek out participation in the NDIS for various reasons. It might be a distrust of ‘services’ and ‘government’ due to past negative interactions; or not recognising that they are unwell; or simply not having the resources and functional ability to use the current system of calling the contact centre and waiting for long periods on hold. Many do not have access to a phone.

Client Story(2).

MH, a 32 year old woman living independently in the community recently came to the attention of KNC. Police were called to do a welfare check after another community member raised concerns for her wellbeing. The police then left the property after they determined that she posed no risk to herself or others. They did note however that MH seemed to be living in extreme squalor. Although MH did not want to discuss her situation further with the police she agreed to interact with KNC as a trusted organisation within our Community.

KNC found MH’s living conditions to be a danger to herself and anyone visiting the premises and were able to organise her temporary relocation to a safe environment. MH has multiple disabilities including physical disabilities; psychosocial disabilities and a psychiatric diagnosis. She was however unknown to any local services.

Once the premises have been returned to a safe and habitable condition, it is hoped that MH can return home and continue to live independently. This is strongly dependent upon her acceptance onto the scheme being expedited so that she returns with the necessary supports in place.

Organisations working closely with their local populations need to have a mechanism for communicating with the NDIA and the NDIA needs to have a priority list for expediting people onto the scheme. Any such system needs to recognise the trust relationship that these organisations have with community members, and allow for initial contact, questions and meetings to be managed within the community organisation if such measures are flagged as necessary.

Recommendations:

That the NDIA create a mechanism for community providers to bring to their notice eligible people who have not yet accessed the scheme.
That this process includes a structure for organisations to remain a part of the journey for as long as is needed for the participant to gain trust in the process.
That resources be made available to non-mental health specific services and community organisations (eg. Neighbourhood centres; family support services; Drug & Alcohol Support Services) to identify and support people with MH issues in accessing NDIS; identify individual needs and planning appropriately.