Office of the Public Guardian submission to the Joint Standing Committee on the NDIS Inquiry into the provision of services under NDIS for people with psychosocial disabilities related to a mental health condition
- Equal access – no one disadvantaged Unclear eligibility
The unclear eligibility requirements for participation in the NDIS and an acceptable definition of a mental health condition remain key concerns about the impact of the transition to NDIS. Feedback from the Barkly trial site highlighted the restrictiveness of the eligibility criteria, as many people currently accessing mental health services were not found to be eligible according to the NDIS guidelines.
The requirement that an impairment be, or likely be permanent, and recovery unlikely, risks excluding a substantial number of people with mental health conditions whose access to support services is episodic, or fluctuates over the long term. Mental health conditions are subject to change, including long periods where symptoms are non-existent, and in many
cases recovery is possible with access to support services. ‘Undefined applicants’ are
required to volunteer themselves for NDIS consideration, however, individuals with
psychosocial disabilities often do not readily reach out to support to take preventative steps.
It is imperative that, at minimum, the transition to NDIS maintains the status quo of the accessibility and flexibility of existing mental health services. Those who currently have access to services must continue to have access to support services in the same or similar manner.
Different needs for people with mental health and intellectual disability
A service system that works well for people with intellectual disability does not necessarily work for people with mental health conditions. Experience at trial sites has demonstrated a lack of capacity of the NDIS staff and necessary tools to accurately identify mental health conditions. In the Northern Territory, access to culturally-appropriate support for Aboriginal and Torres Strait Islander people with mental health issues is another key concern. A review of the Barkly trial site for instance highlighted that low levels of cultural competence amongst NDIS staff, the bureaucratic nature of the NDIS process, and the lack of information provided in an accessible way to Indigenous clients (including providing for individuals with literacy issues), resulted in resistance amongst Aboriginal and Torres Strait Islander people to engage. Additionally, remoteness provided a barrier to accessing information and resources about the NDIS scheme. These findings demonstrate that without improvements in the approach to
engagement with all clients with mental illness, and particularly indigenous clients with
mental health issues, there is a considerable risk that they will be left behind.
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Improved access The current mental health services system in the Northern Territory is a mixture of private,
community and public services, funded by both the Commonwealth and Territory
governments. While the service system is small compared to other jurisdictions, and
imperfect, it is meeting clients’ needs for flexible, place-based support across the recovery time span.
Access in remote communities
Feedback from the Barkly trial indicated that while there was a degree of confidence that the NDIS scheme could work well in an urban environment, significant doubts remain that it is an appropriate model for remote communities. Psychosocial programs such as Partners in
Recovery, Access to Allied Psychological Services and Mental Health Services in Rural and
Remote Areas have the organisational flexibility to tailor services to the cultural context of the Northern Territory and each client’s individual needs. There are indications that remote service providers may have difficulty managing a client-payment system, and struggle to meet staff capacity requirements in order to be an eligible service provider.
Outreach services
In the Northern Territory, outreach services that work to connect with people in the early stages of their illness are a key element of the mental health services support network. Outreach programs provide critical support for people to take steps toward recovery before psychosocial disability becomes worse (a proactive, preventative approach). It is not clear how these services will continue under the NDIS scheme. Services that provide intervention support at a first episode, and work with the individual toward recovery help to prevent further episodes and consequent worsening of the mental health issue. The importance of
early intervention, before the opportunity to build a contributing life is undermined by
recurrent episodes, was a key finding of the Mental Health Commission’s 2014 Report of the
National Review of Mental Health Programmes and Services: Contributing Lives, Thriving
Communities (http://www.mentalhealthcommission.gov.au).
Primary Health Care
Many people in the Northern Territory access psychosocial support through the primary health network. Some of these clients are not engaged in identified programs, so under the current approach, do not qualify for NDIS. It remains unclear whether people who do qualify for NDIS will be able to continue to access support through the primary health network, or whether that would be considered “double dipping”. There is uncertainty about how this will work and whether people currently accessing support through the primary health network will be eligible for NDIS. The primary health care network addresses the need for many people in our community to access therapy to address mental health issues such as anxiety and depression. This would not qualify them for eligibility to Community Mental Health Services provided by the Territory Government which are targeted at people with a serious mental illness.
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Provision for clients with dual or more diagnoses It is expected that service providers in the Northern Territory will continue to see an increase in the number of people who would qualify for disability support in multiple areas (dual or multiple diagnoses). Individuals may present with issues from childhood trauma, substance abuse, mild cognitive impairment, personality disorders, less significant but debilitating conditions and family histories of mental health do not fall neatly into one category of disability. At this point in time, the NDIS system does appear to have the flexibility to effectively support individuals with dual or multiple diagnoses, or cases of complex trauma.
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Conclusion Australia is a world-leader in the area of mental health services. The NDIS scheme has the potential to improve on these services by providing Australian’s living with disability to access comprehensive, tailored support at every stage of their lives and the help to move toward recovery when possible. Mental health conditions are amongst the most complex illnesses to diagnose and treat, and as such, must be given careful consideration under the new scheme. Now is the time to look closely at the approaches that are working well, and those that are not, to ensure that no Australian is left without access to the services that will help them to thrive.
Beth Walker
Public Guardian
27 February 2017