NDIA Accountability Project

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

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Victoria Alcohol & Drug Association

VAADA Submission on the Provision of Services Under the NDIS for People With Psychosocial Disabilities

VAADA Vision

A Victorian community in which the harms associated with alcohol and other drug use are reduced and well-being is related to a mental health condition.

VAADA Purpose

To represent the membership by providing leadership, advocacy and information within the AOD sector and across the broader community in relation to alcohol and other drugs (February 2017)

About VAADA

The Victorian Alcohol and Drug Association (VAADA) is the peak body for alcohol and other drug (AOD) services in Victoria. We provide advocacy, leadership, information and representation on AOD issues both within and beyond the AOD sector.

As a state-wide peak organisation, VAADA has a broad constituency. Our membership and stakeholders include ‘drug specific’ organisations, consumer advocacy organisations, hospitals, community health centres, primary health organisations, disability services, religious services, general youth services, local government and others, as well as interested individuals.

VAADA’s Board is elected from the membership and comprises a range of expertise in the provision and management of alcohol and other drug services and related services.

As a peak organisation, VAADA’s purpose is to ensure that the issues for both people experiencing the harms associated with alcohol and other drug use, and the organisations that support them, are well represented in policy, program development, and public discussion.

Introduction

VAADA appreciates the opportunity to contribute to the Joint Standing Committee on the NDIS - Mental health review entitled, ‘The provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition.’ The relationship between alcohol and other drug (AOD) and mental health (MH) problems within our community have been well documented. Estimates indicate that at least 35% of individuals with substance use issues have a co-occurring MH problem, and although anxiety and affective disorders are the most common, there are elevated rates of bipolar and psychotic disorders amongst those individuals seeking treatment in AOD services1. Studies have also indicated that whilst treatment does improve outcomes, those with co-occurring AOD and MH problems tend to have reduced improvements in physical and mental health, and continue to use a greater amount of substances 2 .

Individuals with co-existing AOD and MH problems often present with complex problems such as acquired brain injury, homelessness and unemployment, requiring significant psychosocial support in addition to treatment. The issues experienced by these individuals may be long-standing, but not necessarily permanent or life-long, and good outcomes can be achieved with them through the provision of intensive and appropriate services. However many of these individuals are reluctant to engage with services due to concerns that any diagnosis will result in being stigmatised. The stigma associated with mental health and substance use is also particularly prevalent amongst some ethnic groups3 .

Eligibility Criteria

The requirement of a clinical “permanent disability” to access NDIS will make it extremely difficult for individuals with co-existing MH and AOD to prove eligibiity due to the following:

  • Many individuals experience episodic clinical problems which can be immensely debilitating and cause ongoing psychosocial disability, but might not meet the criteria for being “permanent”.
  • Individuals experiencing co-occurring AOD and MH problems can be difficult to diagnose due to the potential cross-over in symptoms, and in many instances MH problems can take years to diagnose. This may exclude young people from being able to access services.
  • Many individuals do not wish to be labelled with a clinical diagnosis given the potential stigma associated with such a condition/s even though they would meet the criteria.

A majority of agencies work with their clients utilising recovery-based models of service provision. The concept of permanent disability also appears to directly contradict this.

Recommendation:

  • That the definition of “permanent” disability eligibility criteria for NDIS be amended to include psychosocial disability, so that it may be flexibly applied in instances where individuals present with episodic clinical conditions and co-existing enduring psychosocial impacts .

Establishing Access

Individuals with co-existing MH and AOD problems typically present with a range of problems which can discourage initial engagement with services. The chaotic nature of co-existing MH, AOD and homelessness means that establishing the burden of proof can be problematic. Attending appointments and obtaining documentation can be immensely difficult for an individual who does not even have credit for a telephone and public transport, or one who has poor literacy skills, and those not fluent in English. These people require outreach services and support from specialist services who routinely work with complex clients and those from special needs groups such as culturally and linguistically diverse (CALD) communities.

Recommendation:

  • That third parties (e.g. service providers, family members and signficant others) be able to provide supporting information where appropriate.
  • That support be provided for individuals with psychosocial disability to apply for, and complete their NDIS application.

Assessment and Planning

Individuals presenting with complex needs require assistance and support as soon as is possible, and time is a critical factor in engaging them. Client assessments therefore need to be undertaken in a timely manner, and the time between assessment, planning and referral minimised. Delays at any of these stages may result in client disengagement, and place the client at risk.

Complex presentations in clients also require a highly trained workforce who have an understanding of the psychosocial impacts of mental health, substance use, trauma and homelessness and how these issues translate to client needs (eg suicidality, risk of overdose) to undertake a planning role. This is particularly relevant where clients present with forensic disabilities. Planners also need skills to engage clients and their families, and staff from specialist agencies during the planning process.

Recommendation:

  • That clinical assessors and planners be required to have a minimum level of qualifications and training which is comensurate with the current MHCSS sector within Victoria, and that NDIS be resourced to deliver the appropriate workforce development to ensure this occurs.

Impact on Services and Clients

An inability to meet the eligibility criteria and experiencing problems with access have the potential to exclude new presenting clients from NDIS who would have previously received support from Mental Health Community Support Services (MHCSS). In Victoria, the transition of existing clients with psychosocial disabilities to NDIS will potentially result in the state government withdrawing funding for MCHSS services resulting in a large group of individuals left without this support.

These are some of the most marginalised people within our community, and there is potential for many of them to fall through the cracks. Many will present to already overburdened services in other sectors, in particular the AOD sector ,which is not currently funded and/or equipped with the resources to pick up the shortfall.

The episodic nature of MH and co-occurring AOD issues means that with appropriate and ongoing psychosocial support, the risk of relapse can be minimised. However, a lack of support to maintain stable mental health clearly has the potential to result in increased substance use and risk of overdose amongst this population. This increases the cost to the AOD sector and other related health services required to provide acute care. Many of these individuals also require workers who have specialist mental health training, for which the AOD sector is not currently resourced.

Concluding Comments

In Victoria it appears that most existing MHCSS clients will transition across to the NDIS without difficulty. However, given the previously outlined potential issues relating to client eligibility and engagement, many new clients may be denied a service who would have previously qualified for psychosocial support from the MHS sector.

These clients are amongst the most marginalised in our society, and a loss of services in this area may result in services from other sectors becoming overburdened whilst having to ‘pick up the slack’.

VAADA recognises the challenges associated with minimising disadvantage in implementing a new service approach, however we urge that consideration be given to all of these issues associated with working with these groups, and the potential solutions to these. Consideration must be made, at least in the short term, to retaining some funding to existing MHCS services to plug any gaps in the new NDIS model of service provision. Further, thorough evaluation of the impact of the NDIS roll-out on clients with mental health and psycho-social disabilities in Victoria should be undertaken prior to the withdrawal of the funding.