Public Health Association of Australia
submission on the provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition
Contact for recipient: Joint Standing Committee on the
National Disability Insurance Scheme
A: PO Box 6100, Parliament House,
Canberra ACT 2600 28 February 2017 E: ndis.sen@aph.gov.au T: (02) 62773083
Contact for PHAA:
Michael Moore – Chief Executive Officer
A: 20 Napier Close, Deakin ACT 2600 E: phaa@phaa.net.au T: (02) 6285 2373
Contents
Introduction ………………………………………………………………………………………………………………… 3
The Public Health Association of Australia ………………………………………………………………………………………. 3
Vision for a healthy population ……………………………………………………………………………………………………… 3
Mission for the Public Health Association of Australia ……………………………………………………………………… 3
Priorities for 2017 and beyond ………………………………………………………………………………………………………. 3
Preamble ……………………………………………………………………………………………………………………. 4
Health Equity ………………………………………………………………………………………………………………………………. 4
Social Determinants of Health ……………………………………………………………………………………………………….. 4
PHAA Response to Terms of Reference …………………………………………………………………………….. 5
1a. The eligibility criteria for the NDIS for people with a psychosocial disability ………………………………….. 5
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; i. whether these services will continue to be provided for people deemed ineligible for the NDIS; ………………………………………………………………………………………….. 6
1c. 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; ………………………………………………………………………………………….. 6
Conclusion ………………………………………………………………………………………………………………….. 7
References ………………………………………………………………………………………………………………….. 7
20 Napier Close Deakin ACT Australia, 2600 – PO Box 319 Curtin ACT Australia 2605 2
Introduction
The Public Health Association of Australia
The Public Health Association of Australia Incorporated (PHAA) is recognised as the principal non government organisation for public health in Australia and works to promote the health and well-being of all Australians. The Association seeks better population health outcomes based on prevention, the social determinants of health and equity principles. PHAA is a national organisation comprising around 1900 individual members and representing over 40 professional groups.
The PHAA has Branches in every State and Territory and a wide range of Special Interest Groups. The Branches work with the National Office in providing policy advice, in organising seminars and public events and in mentoring public health professionals. This work is based on the agreed policies of the PHAA. Our Special Interest Groups provide specific expertise, peer review and professionalism in assisting the National Organisation to respond to issues and challenges as well as a close involvement in the development of policies. In addition to these groups the Australian and New Zealand Journal of Public Health (ANZJPH) draws on individuals from within PHAA who provide editorial advice, and review and edit the Journal.
In recent years PHAA has further developed its role in advocacy to achieve the best possible health outcomes for the community, both through working with all levels of Government and agencies, and promoting key policies and advocacy goals through the media, public events and other means.
Vision for a healthy population
The PHAA has a vision for a healthy region, a healthy nation, healthy people: living in an equitable society underpinned by a well-functioning ecosystem and healthy environment, improving and promoting health for all.
Mission for the Public Health Association of Australia
As the leading national peak body for public health representation and advocacy, to drive better health outcomes through increased knowledge, better access and equity, evidence informed policy and effective population-based practice in public health.
Priorities for 2017 and beyond
Key roles of the organisation include capacity building, advocacy and the development of policy. Core to our work is an evidence base drawn from a wide range of members working in public health practice, research, administration and related fields who volunteer their time to inform policy, support advocacy and assist in capacity building within the sector. The aims of the PHAA include a commitment to: Advancing a caring, generous and equitable Australian society with particular respect for Aboriginal and Torres Strait Islanders as the first peoples of the nation; Promote and strengthen public health research, knowledge, training and practice; Promote a healthy and ecologically sustaining human society across Australia, including tackling global warming, environmental change and a sustainable population; Promote universally accessible people centered and health promoting primary health care and hospital services that are complemented by health and community workforce training and development; Promote universal health literacy as part of comprehensive health care; Support health promoting settings, including the home, as the norm; Assist other countries in our region to protect the health of their populations, and to advocate for trade policies that enable them to do so;
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Promote the PHAA as a vibrant living model of its vision and aims.
Preamble
PHAA welcomes the opportunity to provide input to the Joint Standing Committee on the NDIS. The reduction of social and health inequities should be an over-arching goal of national policy and recognised as a key measure of our progress as a society. The Australian Government, in collaboration with the States/Territories, should outline a comprehensive national cross-government framework on reducing health inequities. All public health activities and related government policy should be directed towards reducing social and health inequity nationally and, where possible, internationally.
Health Equity
As outlined in the Public Health Association of Australia’s objectives:
Health is a human right, a vital resource for everyday life, and a key factor in sustainability. Health equity and inequity do not exist in isolation from the conditions of society that underpin people’s health. The health status of all people is impacted by the social, political, and environmental and economic determinants of health. Specific focus on these determinants is necessary to reduce the unfair and unjust effects of conditions of living that cause poor health and disease.
The PHAA notes that: Health inequity differs from health inequality. A health inequality arises when two or more groups are compared on some aspect of health and found to differ. Whether this inequality (disparity) is inequitable, however, requires a judgement (based on a concept of social justice) that the inequality is unfair and/or unjust and/or avoidable. Inequity is a political concept while inequality refers to measurable differences between (or among, or within) groups.1 Health inequity occurs as a result of unfair, unjust social treatment – by governments, organisations and people,2 resulting in macro politico-economic structures and policies that create living and working conditions that are harmful to health, distribute essential health and other public services unequally and unfairly, preventing some communities and people from participating fully in the cultural, social or community life of society.
Social Determinants of Health
The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries. This is particularly pertinent when considering issues such as the NDIS policy.
The determinants of health inequities are largely outside the health system and relate to the inequitable distribution of social, economic and cultural resources and opportunities. Health inequities are the result of the interaction of a range of factors including: macro politico-economic structures and policy; living and working conditions; cultural, social and community influences; and individual lifestyle factors.
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PHAA Response to Terms of Reference
1a. The eligibility criteria for the NDIS for people with a psychosocial disability
The NDIS is a significant change in the landscape on mental health care in Australia. This will see the
transition of federally funded services being moved to NDIS funding. Important considerations during this
transition include that no individual is disadvantaged throughout the process of transitioning services to
NDIS. The eligibility criteria and service provision for those deemed ineligible will be central to this.
There should be clarity of the definition of psychosocial disability that is enduring and lifelong. The process
of defining eligibility should be transparent in its criteria and how eligibility will be determined. The process
should be in consultation with national and state mental health commissions, professional bodies, mental
health advocacy agencies and carer organisations. People with lived experience should also be consulted on
the process. Assessment tools for disability support services must involve carers/other support workers and
be specifically tailored towards people with psychiatric disability.
Clear and defined standards of care provision should be established so that service providers are able to
provide optimum support for people living with a psychological disability. It is essential that these targets
and standards address areas such as physical health care and mental health, work provision and support for
meaningful activity, safety of accommodation and engaging isolated populations such as the homeless,
people living with a psychological disability who are incarcerated and any other populations who have
difficulty engaging with support services. This will also need to include people with cognitive issues that
affect personality, behaviour and decision making.
In the area of psychiatric disability in particular, there needs to be a very close relationship between clinical
mental health services, disability support services and other important services such as housing, in order to
achieve stable mental health and stability in other life areas.
Assessment of the NDIS services should thus consider ‘social inclusion’ outcomes for people with
psychiatric disability (housing, employment, social support).
20 Napier Close Deakin ACT Australia, 2600 – PO Box 319 Curtin ACT Australia 2605 5
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; i. whether these services will continue to be provided for people deemed ineligible for the NDIS;
1c. 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;
Mental health disability has a devastating effect on individuals and it should be a priority that there are no
gaps in service provision during this process. People living with a mental disability are currently dependent
on services and any gap in services may have adverse impacts. This will present a challenge for the
implementation and transfer of services from the current models to the new funding models. Service
providers will need to prepare for provision of care under the NDIS and this may challenge resources if they
are redirected towards funding models rather than care delivery.
Services will face the challenge of structuring and delivering care. Current service delivery has worked
under a recovery based approach. This has been supported by the National Mental Health Commission and
state mental health commissions, and will need to be clarified with the provision of services under NDIS.
The NDIS is funding people with a permanent psychological disability. Clarity will be needed to determine if
the recovery based approach will be a part of this new NDIS service delivery and if, not where these types
of services will be available if they are not available through the NDIS.
Funding for alternative mental health services will need to remain for people living with a mental disability
who are not eligible for NDIS. This population will require ongoing access to mental health services and
provision must be made to ensure that targeted and appropriate services remain available. NDIS funding
should be independent of services that are provided for vulnerable populations such as Aboriginal and
Torres Strait Islanders, Culturally and Linguistically Diverse, former defence personal, GBLTIQ, farmers,
women affected by DV and people living in rural areas, fly in fly out workers and youth and adolescent
services. Funding should also be independent from services providing alcohol and other drug support.
There should be national, state and local strategies implemented towards promotion and prevention of
mental health to stem the increasing rates of mental health issues within Australia. These should be
coordinated and be targeted at all populations across Australia.
The capacity of people with psychiatric disabilities to manage their own care options should be considered.
It is recognised that some people with a psychiatric disability may lack insight into their condition or may
lack the skills to negotiate their own care packages. Due to the nature of mental health conditions, they
may also lack family members or friends who would be willing to act as substitute decision makers. Due to
the episodic nature of mental illness, substitute decision makers may also need to be short term. These
issues should be taken into account when considering access to psychiatric disability support services.
20 Napier Close Deakin ACT Australia, 2600 – PO Box 319 Curtin ACT Australia 2605 6
Conclusion
PHAA supports the broad directions of the provision of services under the NDIS for people with
psychosocial disabilities related to a mental health condition. However, we are keen to ensure clarity of
eligibility and continuity of service provision in line with this submission. We are particularly keen that the
following points are highlighted:
Eligibility - eligibility criteria need to be clearly defined and be determined in consultation Continuity of service provision – for those who are deemed ineligible, funding for services must
remain.
The PHAA appreciates the opportunity to make this submission. Please do not hesitate to contact me
should you require additional information or have any queries.
Michael Moore BA, Dip Ed, MPH Michael Smith
Chief Executive Officer PHAA Convenor
Public Health Association of Australia Mental Health Special Interest Group
28 February 2017
References
1 Kawachi et al. (2002) ‘A glossary for health inequalities’. Journal of Epidemiology and Community health. Vol. 56, pp. 647-652. 2 Whitehead, M. (1990) The Concepts and Principles of Equity and Health. Copenhagen: WHO Regional Office for Europe.
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