The National Disability Insurance Scheme (NDIS)
and Mental Health in NSW
Navigating the NDIS:
Lessons Learned through
the Hunter Trial
July 2016
MENTAL HEALTH COMMISSION OF NSW AND MENTAL HEALTH COORDINATING COUNCIL NDIS AND MENTAL HEALTH ANALYSIS PARTNERSHIP PROJECT
Acronyms
For any further information please contact: ADHC Ageing, Disability and Homecare (Department of FaCS)Mental Health Coordinating Council Building 125, Corner of Church & Glover Streets Lilyfield NSW 2040 CANSAS Camberwell Assessment of Need Short Appraisal Schedule PO Box 668 Rozelle NSW 2039 CMO Community managed organisation 02 9555 8388 info@mhcc.org.au DSS Department of Social Services www.mhcc.org.au (Commonwealth government department) When referencing this paper please cite as follows: Mental Health Coordinating Council (2016). The National FaCS Family and Community Services Disability Insurance Scheme (NDIS) and Mental Health in (NSW government department)NSW – Navigating the NDIS: Lessons Learned through the Hunter Trial. MHCC, Sydney. Author: Tina Smith HNELHD Hunter New England Local Health District © Copyright Mental Health Coordinating Council (July 2016). HNEMHS Hunter New England Mental Health Service Disclaimer and limitations of liability MHCC provides the information contained in this report in HONOS Health of the Nation Outcome Scale good faith. The report derives information from sources believed to be accurate and current as at the date of IFP Individual Funded Packagespublication.
Acknowledgments MHCC respects and promotes people’s fundamental human ILC Information, Linkages and Capacity-building rights. We acknowledge the traditional custodians of the land and value the lived experience of people recovering from IT Information technology mental health related conditions – both past and present. We also acknowledge the contributions of mental health LAC Local Area Coordination (an element of ILC; but also consumers, their families and carers, and service providers to Local Area Coordinators, which is an outsourced NDIAthe consultative processes conducted during the course of the NDIS and Mental Health Analysis Partnership Project. job role in NSW) MHCC developed this guideline, supported by the Mental Health Commission of NSW. LHD Local Health District
LSP Life Skills Profile
MHCC Mental Health Coordinating Council
NDIA National Disability Insurance Agency
NDIS National Disability Insurance Scheme
NMHCCF National Mental Health Consumer and Carer Forum
NSW New South Wales
PHaMS Personal Helpers and Mentors Service
PIR Partners in Recovery
PHN Primary Health Network
RAS-DS Recovery Assessment Scale (Domains and Stages)
SVDP Saint Vincent de Paul
UNCRPD United Nations Convention on the Rights of Persons
with Disabilities
WHODAS World Health Organisation Disability
Assessment Schedule
Table of Contents
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Introduction $4$
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The National Disability Insurance Scheme (NDIS) $7$
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NSW NDIS trial site mental health experience $9$
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Lessons learned $12$
Work to engage consumers and carers in the NDIS opportunity $12$
Assist consumers to gather evidence of impairment/disability $13$
‘Your’ client is now a customer $13$
You will need customer service skills $14$
Expect innovations in service delivery $15$
Documentation of service delivery will be more frequent $16$
The NDIS will not solve everything $17$
Stay positive about the opportunities presenting $17$
Enhanced integration and coordination of services $18$
Embrace the learning arising and pursue reflective practice $19$
- Essential NDIS knowledge $20$
Summary of NDIS Support Categories and Outcomes Framework $21$
NDIS Individual Funded Packages (IFP) $22$
Choice and Control $22$
Eligibility $22$
Access $23$
Access Review $23$
Service Planning $24$
Service Coordination $24$
Service Review $25$
Individual Funding Management $26$
NDIS Information, Linkages and Capacity-building (ILC) $26$
Local Area Coordination $26$
Other ILC Activities $26$
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Next steps & concluding remarks $27$
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References $31$
Introduction
The Mental Health Commission of New South Wales (NSW) collaborated with the Mental Health Coordinating Council (MHCC) between June 2013 and 2016 to undertake a National Disability Insurance Scheme (NDIS) and Mental Health Analysis Partnership Project. This activity supported directions of Living Well: A Strategic Plan for Mental Health in NSW 2014 – 2024, adopted by the Government in December 2014.1
The project focused on the three communities within the Hunter New England Local Health District (HNELHD) chosen to trial the NDIS: Newcastle, Lake Macquarie and Maitland.
This document shares experiences and some key lessons learned from the NDIS trial. Others in NSW entering the NDIS environment from 1 July 2016 will benefit from the document. MHCC developed this document to give guidance to local communities in NSW where the NDIS implementation will occur over the next two years.
| Potential increase in NSW |
|---|
| NDIS participants |
| with psychosocial disability |
| UP TO 19,000 | | participants in NSW with a | | psychosocial disability by | | the end of June 2019 |
| 1022 | | participants in the Hunter trail site | | with psychosocial disability at the end | | of June 2016’ |
1 NSW Mental Health Commission (2014). Living Well: A Strategic Plan for Mental Health in NSW 2014-2024. Sydney, NSW Mental Health Commission.
Why did we develop this document?
The Hunter trial site experience has demonstrated a high impact of the NDIS for service providers working with people affected by mental health conditions. It is important that others have the benefit of understanding, and learning from, these experiences.
The document supports local communities in NSW in their readiness to enter the NDIS environment. MHCC developed it for organisations that provide services to people affected by mental health conditions, and their carers and families.
It describes lessons learned from the Hunter trial site in order to maximise NSW readiness for opportunities presenting through the NDIS.
Another major achievement of the NDIS and Mental Health Analysis Partnership Project was the establishment of the Hunter NDIS and Mental Health Community of Practice. A complimentary guideline written to support local communities to establish a mental health Community of Practice to enhance learning arising from NDIS implementation and other mental health sector reform accompanies this ‘lessons learned’ report.3
MHCC published a detailed report on the first two years of the NDIS and Mental Health Analysis Partnership Project from a community managed mental health sector perspective in August 2015. 2 This brief three-year report summarises experiences and lessons learned from the Hunter trial site for broader dissemination across NSW.
Section 2 provides some basic knowledge about the NDIS. This is provided because mental health sector knowledge of the NDIS, while variable, is mostly still at a relatively low level and this is especially so outside of the trial site.
Section 3 briefly describes NSW NDIS trial site mental health experience of the NDIS and Mental Health Analysis Partnership Project and challenges associated with this.
Section 4 shares some of the lessons learned by people in the NSW NDIS trial site from a community managed mental health sector perspective.
A key lesson learned during the NSW NDIS trial in the Hunter is that knowledge of the NDIS is essential. Section 5 provides additional information briefly describing the basics of what people need to know to navigate the NDIS from a mental health perspective.
The guideline concludes by providing some guidance on next steps for local communities in NSW entering the NDIS environment (Section 6).
2 Mental Health Coordinating Council (2015). Further Unravelling Psychosocial Disability – Experiences of the National Disability Insurance Scheme in the NSW Trial Site: A Mental Health Analysis. MHCC, Sydney.
3 Mental Health Coordinating Council (2016). The National Disability Insurance Scheme (NDIS) and Mental Health in NSW: Guideline for Establishing a Local NDIS Community of Practice to Enhance Learning and Sector Reform. MHCC, Sydney.
NAVIGATING THE NDIS: LESSONS LEARNED THROUGH THE HUNTER TRIAL [MHCC 2016] 5
NDIS language and psychosocial disability
In entering the NDIS Psychosocial Disability Psychosocial disability refers to the disability experienced by people with mental health conditions due to cognitive and functional difficulties. These difficulties could include the loss of or limitation to physical, social, emotional, cognitive or sensory function, reduced ability to experience full physical health, participation restrictions and many more.
Psychosocial disability is distinct from psychiatric disability in that psychosocial disability refers to the social consequences related to mental illness, whereas psychiatric disability focuses on the impacts of medically defined symptoms.
A strong and shared understanding of the concepts underlying these words is useful to reconcile notions of permanent disability and recovery and enhance opportunities arising through the NDIS for people living with mental health conditions. The term mental health condition describes the broad range of features that characterise a mental illness whether it is diagnosed or not.
The NDIS Act 2013 does not require a person with a mental health condition to have a diagnosed mental illness. 5 However, a potential NDIS participant must demonstrate impairment/s related to a ‘psychiatric’ (i.e., mental health) condition that result in substantially reduced functional capacity that is – or could be – permanent. While diagnosis by a health professional can be useful evidence to demonstrate disability, either diagnosis nor disability mean that recovery from a mental health condition is not possible. Promoting a culture and language of hope and optimism that recovery is possible is foundational to recovery-oriented practice.6
The United Nations Convention on the Rights of People with Disabilities (UNCRPD) uses the term psychosocial disability to describe mental health related disability.7 Historically, the term psychiatric disability has been used and this emphasises perceived deficits that a person may experience (i.e., illness and symptoms). Psychosocial disability is about the social and economic participation restrictions that a person with a mental health condition may experience. The NDIS is all about reducing social and economic participation barriers of people with disabilities.
2. The National Disability Insurance Scheme (NDIS)
The Australian Government developed a National Disability
Strategy, which includes the NDIS, to help Australia meet
Help for all Australians its obligations under the UNCRPD. While psychosocial The NDIS is an insurance scheme disability (i.e., people with impairments related to a mental based on the premise that anyone health condition) is included in the UNCRPD the Australian can develop a disability at any Government did not make a decision to include people with time, and that the likelihood of psychosocial disability until quite late in its planning. The The operational detail of the NDIS has changed as different NDIS is helping to ensure that parts of Australia test the original thinking about it and as the people who need and choose to benefit from disability experience is built through trial. As the NDIS scales up both in related recovery support services can do so. NSW and nationally the learning and refinement will continue. The inclusion of people living with a psychosocial disability The NDIS gives people with a disability greater control due to a mental health condition in the NDIS is important and choice over the services they receive. It fundamentally because it increases the likelihood of them being able to changes the way disability support services are provided in access disability related services and supports. Australia. Substantial growth, restructuring and transformation The NDIS might be called an investment scheme because it in the provision of disability/recovery support services will is investing in the health and wellbeing of Australia through occur through the NDIS. Those eligible under the scheme, as ensuring economic and social participation and inclusion! opposed to disability service providers, receive their funding directly under the NDIS. This will elicit innovation and reform (see more information about individual funding management In 2012, the Commonwealth Government announced plans on p. 25). to establish the NDIS. This is a no-fault insurance scheme The NDIS approach with individualised funding means a shift designed to help people with a disability and their carers away from block funding for organisations providing disability receive access to the support services they need. The National support services. It also means that community managed Disability Insurance Agency (NDIA) was established in 2013 to organisations (CMOs) providing psychosocial disability implement and administer the NDIS. support services must compete with each other to secure The NDIS is part of a larger Australian National Disability work in the disability services ‘market’. The NDIS has three main platforms. The NDIS Price Guide describes ‘support categories’ (i.e., Individual Funded Packages (formerly known as Tier 3; service types) that are evolving over time along with an 430,000 people)* accompanying outcomes framework.8, 9 It is not the intent of this report to describe the history or evolution of these need to meet eligibility criteria and develop a plan important frameworks, or to challenge the pricing and costing assumptions underlying them, but it is important to know that assist individual’s identify goals and aspirations they exist (see Summary of NDIS Support Categories and assist individual’s develop comprehensive plans to Outcomes Framework in ’Essential NDIS Knowledge; Section achieve their goals 5, p. 21).
fund reasonable and necessary supports to enable goals The importance of understanding – and engaging to to be achieved contribute to the development of - the evolving support categories and outcomes framework, and including the Information, Linkages and Capacity-building (formerly emerging Information, Linkages and Capacity-building (ILC) known as Tier 2; 4 million people with a disability and their commissioning framework, is an important continuing element 800,000 primary carers) of lessons learned from the Hunter trial. This engagement will better link individuals to mainstream supports help to shape the NDIS for people with psychosocial disability for years to come. assist services to be more inclusive and responsive to the needs of people with disability
direct investment towards evidence based interventions that improve outcomes for the individual Help for all Australians (22.5 million people)
minimise the impacts of disability through public awareness campaigns
provide information to all members of the public
assist in reducing social constraints of disability by supporting the purposeful integration of mainstream and other services.
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Recently increased to 460,000 with around 51,000 anticipated to have mental health 8 National Disability Insurance Agency (2016 a). NDIS Price Guide (Vic/NSW/Qld/Tas - Valid conditions. from: 1 July 2016) 9 National Disability Insurance Scheme (2015 b). Outcomes Framework Pilot Study: Summary Report.
NAVIGATING THE NDIS: LESSONS LEARNED THROUGH THE HUNTER TRIAL [MHCC 2016] 7
The Future of the NDIS in NSW
The NDIS will be rolled-out within NSW Local Health District (LHD) catchments between July 2016 and June 2018 according to the timetable summarised below.
From 1 July 2016 ## From 1 July 2017
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the remaining population of the HNELHD (i.e., other - Illawarra Shoalhaven than the three trial site LGAs) - Mid North Coast
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the remaining population of Nepean-Blue Mountains - Murrumbidgee (i.e., other than the early start from 1 July 2015 for young people) - Northern NSW
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Central Coast - South Eastern Sydney
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Northern Sydney - Sydney
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South Western Sydney - Western NSW
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Southern NSW - Far West
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Western Sydney
From 1 July 2016, the NDIS will begin to roll out across NSW. In the first year, seven districts will transition to the NDIS including Central Coast, Northern Sydney, South Western Sydney, Southern New South Wales, Western Sydney, and the remaining populations of Hunter New England and Nepean- Blue Mountains.
From 1 July 2017, the NDIS will be begin to be available in the districts of Illawarra Shoalhaven, Mid North Coast, Murrumbidgee, Northern New South Wales, South Eastern Sydney, Sydney, Western New South Wales, and Far West New South Wales.
People currently receiving supports through the NSW government Department of Family and Community Services (FaCS) Department of Ageing and Disability (ADHC) specialist disability services program will be moving to the NDIS first. The NDIS will replace existing Commonwealth and state-based disability supports for those eligible.
The NDIS will be operating statewide by July 2018, ultimately providing support to about 140,000 people. This will include up to 19,000 people with psychosocial disability. The NSW government has established a website to provide more information about how and when people will move to the NDIS.10
During transition there is a ‘guarantee of service’ to ensure that people currently accessing Commonwealth and State funded services will continue to do so through to July 2018 as the NDIS is scaled up.
Continuity of support arrangements
Governments have committed to ensuring people with disability who are currently receiving services are not disadvantaged in the transition to the NDIS. Continuity of support means that people not meeting the NDIS access requirements will continue to receive support consistent with their current arrangements.
3. NSW NDIS trial site mental health experience
The NDIS and Mental Health Analysis Partnership Project Consumer and carer experience utilised a Project Officer employed by MHCC to explore the NDIS experiences of people affected by mental health At the end of March 2016, 616 people in the NSW Hunter NDSI conditions, and those providing services and supports to trial site with a primary psychosocial disability had accessed them. Numerous individual, program, organisational and the NDIS. 12 While this number is lower than the anticipated Hunter NDIS and Mental Health Community of Practice 13% of all trial NDIS participants it is clear that more people in contacts contributed to the success of the project. Contacts Newcastle, Lake Macquarie and Maitland with mental health were with people affected by mental health conditions and conditions are receiving funded disability/recovery services those that provide services and supports to them. and supports than previously. There is a need for research to understand people’s health and well-being experiences and outcomes resulting from enhanced access to disability support services.
Through the NDIS and Mental Health Analysis Partnership Many consumers were initially overwhelmed by their lack Project, it was evident that the Hunter NDIS and mental of knowledge about, and experience of, the NDIS and this health/psychosocial disability experience mostly related to: 1) sector readiness for the NDIS; and, 2) NDIS ‘Individual Funded changed with time as people began sharing their experiences. Packages’ (IFP) access, planning and review. However, there continues to be a need for outreach, advocacy and support services to help people understand and navigate Given the late inclusion of people with mental health the NDIS. in the NDIS there has been much evidence of the need for a greater emphasis on sector readiness for the NDIS. A full description of this is beyond the remit of the current report and discussions about the matter continue with various As knowledge and experience has built across the three years of government departments, Community Mental Health Australia of the trial, it is clear there is a long way to go to facilitate and Mental Health Australia. people’s participation in the NDSI at both an individual and dystemic levels. While the NDIS is all about participant choice and control, strengthened approaches to supported decision making are also required. 13
Much of the experience during the NDIS trial has been on The understanding of the interface of both NDIS IFP and ILC
The access of people with mental health conditions to, and activities with other mainstream services, including health
to management and delivery of, IFPs. People ineligible for,
or choosing not to access, IFP may in the future benefit from and mental health services continues to evolve. As other
ILC activities. Ways forward for the ‘commissioning’ of ILC NSW communities enter the NDIS environment they will be
activities are still under development and more information contributing to the learning commenced in the Hunter trial
about this is available on p. 26. 11 site.
Challenges identified by people affected by
The understanding of the interface of both NDIS IFP and ILC mental health conditions
activities with other mainstream services, including health Next discussed are the experiences of both people with
and mental health services continues to evolve. As other mental health conditions in the NSW NDSI trial site and the
government departments, Community Mental Health Australia government and community sector organisations that provide
and Mental Health Australia. services and supports to them. ‘Lessons learned’ perspectives
of representatives from each of these groups are shared in the
Much of the experience during the NDIS trial has been on form of reflections about NDIS challenges.
The access of people with mental health conditions to, and
to management and delivery of, IFPs. People ineligible for,
or choosing not to access, IFP may in the future benefit from - Lack of knowledge and information about what the NDIS next discussed are the experiences of both people with
ILC activities. Ways forward for the ‘commissioning’ of ILC mental health conditions in the NSW NDIS trial site and the
activities are still under development and more information government and community sector organisationsthat providetoservicesandsupportstothem.‘Lessonlearned’
perspectivesofrepresentativesfromeachofthesegroupsaresharredintheformofreflectionsaboutNDISchallenges.-InadequateoutreachandengagementbytheNDIAtocapturethispopulationofgroup-Insufficientsupporttoaccess-theNDIS-Barriers-toadvocacy-support-in-review-of-access-requestssWorkforcequality-andavailability-Therethinkmarketforpsychosocialdisability/recoverysupports(i.e.,itisbecomingincreasinglydifficult
tofindgoodandrelevantservices).
**Sector Panel Discussion at the Getting Ready for the NDIS MHCC Forum in 2015 in Sydney.
Community managed mental health sector Challenges identified by the community experience managed mental health sector In July 2013, there were about 20 CMOs delivering a range of programs for people affected by mental health conditions in - High levels of outreach and engagement are required for vulnerable and marginalised people with mental health conditions, and other complex health and social problems, to consider accessing the NDIS the three communities that make up the NSW trial site. CMOs have welcomed opportunities to provide additional services to people with psychosocial disability through the NDIS. These opportunities are redefining who the sector is and how it delivers services. Most organisations developed NDIS specific business development, customer service and other strategically placed roles as they entered the NDIS environment. Most aspects of work and service delivery practices required substantial review. Most CMOs have grown because of their NDIS experience and benefited from opportunities to improve efficiency and effectiveness within their organisations. Many entered the NDIS trial experience with a high degree of confidence, but also uncertainty, as to what the organisational and client impacts might be. Both knowledge and experience of the NDIS are required to support organisational and sector readiness. There is a greater understanding of the challenges associated with NDIS implementation at the end of the trial. The range of identified organisational and sector readiness challenges include:
- High levels of outreach and engagement are required for vulnerable and marginalised people with mental health conditions, and other complex health and social problems, to consider accessing the NDIS
- NDIS pricing does not always cover the costs of services and, while business efficiencies need to be sought, the actual cost of providing psychosocial disability/recovery support services need to be better understood
- Rapidly growing but more casualised CMO workforce requiring more flexible workforce approaches
- Data collection, information technology (IT) and other ‘back of office’ business systems require substantial upgrading to meet NDIS requirements
- An escalation of competitive funding environments and cultures
- Low levels of consumer, carer and community representation and participation in NDIS planning, implementation and evaluation. Feedback from Hunter NDIS and Mental Health Community of Practice Forum participants (29 March 2016) The cost/price involved in delivering NDIS services and sector/organisational sustainability Workforce skills and associated service delivery quality and safety considerations Concerns about the sustainability of the community managed mental health sector ‘market’. 14 Many opportunities present through the UNCRPD principles that underpin the NDIS. As the NDIS is scaled up there is still much work to be undertaken to ensure it achieves optimal outcomes for people affected by mental health conditions. Community Mental Health Australia (2015). Developing the Workforce: Community Managed Mental Health Sector National Disability Insurance Scheme Workforce Development Scoping Paper Project. Sydney: Mental Health Coordinating Council.
Hunter New England Mental Health Service
Challenges identified by the HNEMHS experience
- Clinical governance - health policy, guidelines and procedures to support staff around a range of NDSI and mental health issues
The Hunter New England Mental Health Service (HNEMHS) report this to have been a very exciting time for their organisation, the people they serve, and their families and carers. HNEMHS has worked closely with the NDIA and, as a result, have resolved many issues at a local level.
The HNEMHS Executive provided direction, and support for future directions, of the NDIS within mental health. They implemented a clear governance and internal meeting
- Additional workload for clinical staff in supporting NDIS applications and planning processes -Timeframe of NDIS processes exceeds most inpatient frameworks around the length of stay -Duality in language experienced between the NDIS and structure. An initiative implemented in early 2014 was the appointment of NDIS ‘champions’ in each mental health team, who act as a local resource to ensure a seamless transition to the NDIS. HNEMHS ‘Champions’ interface with NDIA planners at the Mental Health and NDIS Subject Group. The purpose of this meeting is for collaboration and coordination between government departments. At a district level, mental health representatives also attend other NDIS Working Groups and Operational Groups and HNEMH Executive attends a HNELHD transition to NDIS project meeting. In April 2015, HNEMHS appointed a full-time Senior Project Manager position for twelve months (NDIS & Community Managed Organisation Partnerships Project Manager). Consumers, carers, families and staff were well supported throughout this major reform through this position that helped ensure movement through the NDIS transition phase. HNEMHS are extremely happy with the progress to date and many people living with metnal [sic] health conditions are experiencing an improvement in their health and well-being as a direct result of the funding and support they have received through the NDIS.
Due to the changing mental health landscape, HNEMHS has been engaging heavily with CMOs, including some services that have not traditionally collaborated with health. In addition, because of NDIS, there are many new organisations that are now entering the mental health sector (i.e., that were previously working with other disability types). HNEMHS have been engaged in conversation about how they can assist to enhance their capability to support clients with complex mental health needs (e.g., through shared care arrangements).
NAVIGATING THE NDIS: LESSONS LEARNED THROUGH THE HUNTER TRIAL [MHCC 2016]
Lessons learned
Work to engage consumers and carers
Building on lessons learned through the NDIS trial in the NDIS opportunity. It is important to undertake outreach to engage with people with high levels of psychosocial disability who might be eligible for the NDIS and to familiarise them with the Scheme and the NDIA who are implementing it. Building your relationships with NDIA staff will be critical to this process. enabled MHCC to support members engaging with the NDIS and to contribute to the national discourse on NDIS implementation in the context of mental health reform. Both service providers and families/carers need to help people with mental health conditions to identify their hopes and dreams for ‘an ordinary life’. Many will have become unaccustomed to making life choices. Work to identify people that may be able to access an NDIS IFP and/or benefit from other forthcoming ILC activities. Discussions about their hopes and dreams should begin well in advance of approaching the NDIS, and with the person’s documented agreement include friends, family and existing service providers. must not be eroded through NDIS implementation. This is equally important for both NDIS participants with psychosocial disability and for other people with mental health conditions who do not access NDIS funded services and supports.
Flourish Australia NDIS experience
Peer work roles in the Hunter trial site have been very effective in undertaking outreach and engagement to enhance NDIS access. The lessons learned presented next support NDIS implementation and with particular reference to the Between 2013 and 2015, Flourish Australia (previously known as RichmondPRA) assisted 29 people transitioning from ADHC and Commonwealth block funded programs to the NDIS. We now support over 160 people with NDIS funding who are living with a mental health issue including tensions related to workforce and NDIS pricing and costing. The NDIS offers people the opportunity of choice and control around the types of services they want. With the assistance of our Senior Peer Worker in the Hunter more people are empowered to negotiate the services to help them reach their goals and aspirations. Growth under the NDIS means that our workforce has continued to grow. We have been able to increase our peer workforce in the Hunter to about 50 (there are now 117 peer workers across our entire organisation). Ten key lessons from the Hunter trial site follow alongside with some examples of sector responses to them. January 2016
Assist consumers to gather evidence
‘Your’ client is now a customer
disability NDIS participants can choose between providers and services based on the goals agreed in their support plan. You will need to provide a quality and effective service to maintain your customers in an NDS world.
The NDIA’s Access Request Form does not readily lend itself to the kinds of evidence that demonstrates a high level of psychosocial disability (i.e., its focus is more on personal care than cognitive-behavioural difficulties). A range of psychosocial functional information will be required as evidence of disability. It is not sufficient for a GP or other health professional to provide a letter providing a mental health related diagnosis and stating that a person is permanently disabled.
Where an organisation is using routine consumer outcome measures such as the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), Behaviour and Symptom Identification Scale (BASIS; 32 item), Recovery Assessment Scale (Domains and Stages: RAS-DS) and World Health Organisation Disability Assessment Schedule (WHODAS) this can provide useful information.
NDIS participant
The 16 item Life Skills Profile (LSP-16) and Health of the Nation Outcomes Scale (HoNOS) are under discussion for use in development of NDIA psychosocial disability ‘reference packages’. This is of some concern given that these tools have symptoms as their focus and not functioning.
Hunter Partners in Recovery (PIR) evidence example
This is a Hunter PIR Access Request Form evidence example related to the life area of ‘learning’. The MHCC NDIS website has more examples.
Functional impact
Mary often states she is interested in participating in study in her area of interest (Nursing) and eventually gaining part-time work in this area. Mary is interested in volunteering in a nursing home but has been unable to engage in this to date independently due to her high level of anxiety. Mary has completed a Certificate III several years ago and feels that with support she can achieve these goals.
Type & frequency of support
A person will assist Mary to engage in study. Purchase of equipment for the purpose on studying online.
NAVIGATING THE NDIS: LESSONS LEARNED THROUGH THE HUNTER TRIAL [MHCC 2016] 13
You Will Need Customer Service Skills
Organisations will need to market themselves to potential customers and adopt customer service approaches to New Horizons: Just Ask Sandra maintaining customers. All workers providing services should have customer service skills, and organisations providing NDIS IFP services will require strong strategies for ensuring high quality customer services.
Sufficient, and sufficiently skilled staff, are increasingly hard for organisations to find. The relationships required for high quality and timely psychosocial disability/recovery support work can be compromised because of this. Be proactive in thinking about your community’s mental health related NDIS workforce development needs.
As a Lifestyle Planner for New Horizons in the Hunter, Sandra Carle works closely with customers and families to answer all their NDIS questions.
Sandra understands how the NDIS can offer real choice, more options and more individualised supports. The aim of the NDIS is to provide quality of life and build independence.
“I believe that by supporting people to discover their own potential, customers enjoy better outcomes – because they’ve designed their wellbeing goals themselves!” Sandra said.
This was just one of the reasons Sandra was chosen to feature in a New Horizons NDIS advertising campaign.
“I was definitely surprised to be asked – I certainly wasn’t expecting it!” Sandra laughs. “I said ‘are you sure you want me on a billboard?’ And I was assured they did!”
“When people pick up the phone and call New Horizons to ask questions about the NDIS, I’m the one they speak with. Hopefully with the help of this campaign, people will know who they’re talking to in advance. That’s what we’re all about – being personable with customers.” Got NDS questions? Just Ask Sandra, your NDIS Guru.
Expect Innovations In Service Delivery
Consumer voice: Deb Hamilton speaking at the Getting Ready For The Ndis Forum In 2015.
The ndis price guide describes a range of costs associated with funding for ifp support categories. Fourteen support further examples of ndis innovations categories relate to core, capacity building, and capital type funding and eight outcome domains (see p. 21). The 14 An ndis participant in the hunter was funded for life support categories break down further to include more than coaching services to help her reflect upon and plan 100 different types of services; each with their own unique strategies to be better able to articulate and strive to identifying code. These support categories help to guide achieve her plan goals (i.e., hopes and dreams). MHCC choice, planning and review. However, It is predicted that in asked this person to present at a ndis readiness event. The future there will be no Price Guide as services are driven ndis funding allowed the person to pay for coaching to by participant choice and market response thus resulting in assist in preparation to deliver the speech. This included innovation (e.g., opportunities for consumer cooperatives coaching on her presentation content and timing, as well and more consumer run services). The need for innovations as increasing confidence to contribute to events. In service delivery will continue to increase as organisations Another NSW Ndis Participant Identified an interest In strive To become More efficient against NdIs pricing And As bridlery (this Is an Industry Involved In leather crafts to dis participants Become More vocal about the Services they make bridles For horses). The ndis funded this Person TO want and value. undertake Leatherwork and Bridlery classes. The Person IS now earning income from making bridles and selling these At local markets.
NAVIGATING THE NDIS: LESSONS LEARNED THROUGH THE HUNTER TRIAL [MHCC 2016] 15
Technology and the NDIS
One Hunter organisation provides all NDIS direct care workers with i-pads so that records about service delivery occur in real time. This is resulting in considerable service efficiencies including timelier billing to the NDIA to help manage cash flow.
NDIS participants are also increasingly exploring the use of IT in achieving their plans as illustrated by PIR evidence example provided on p. 13.
Working with the NDIS
Click to play: www.ndis.gov.au/providers
The NDIS Provider and Participant Portal: mypalce
Aftercare’s NDIS experience In June 2016, the NDIA made changes to their IT portal that will change the process for becoming an NDIS registered provider and for documentation of service delivery information and billing. Aftercare’s services as an NDIS provider in Hunter trial site began transitioning from block funding to individualised funding in the final year of the trial. Aftercare has worked on developing tools to support people to identify their life goals and to understand the supports they might need to achieve those goals. So far Aftercare has assisted 25 people to transition from ADHC and Commonwealth block funded programs to the NDIS. We are currently providing NDIS supports to over 40 people, many of whom were receiving little or no supports prior to the NDIS. All have retained at least the same level of funding with most receiving significantly higher levels of funding.
- To browse information regarding registrations,
- Documents and payment history
- To lodge new claims for payment, including reporting episodes of in-kind support.
The Participant Portal is a secure website for participants, nominees and contacts who are approved to view and direct NDIS plans and, where applicable, to make self-managed claims online.
Page 17
The NDIS will not solve everything
The NDIS does not duplicate the mainstream services. NDIS implementation creates circumstances where important discussions about service coordination and closing service gaps occur:
- Health
- Mental health
- Early childhood development
- Child protection and family support
- School education
- Higher education and Vocational Education and Training (VET)
- Employment
- Housing and community infrastructure
- Transport
- Justice
- **Aged care.
The health/mental health and NDIS interface is still very much evolving through experience as is the case for all mainstream services.
Service diversification
Adam is a previous PHaMS client who was receiving about three hours of support a week, Monday through Friday during 9-5 working hours, but wanted and needed a lot more help. PHaMS workers supported Adam to access the NDIS and he is now receiving 15 hours of support weekly across seven days and including outside of 9-5 working hours.
Adam is using some of his support hours for study support to help him obtain a driver’s licence as he hopes to gain PT employment driving a truck or working as a labourer’s assistant. Another supporter is paid to assist him to attend weekly horse racing events where he is gaining friendships with others who share this interest.
While initially uninterested in the NDIS as he did not understand the need for change Adam is quickly embracing the range of new possibilities this might mean for his life.
This situation has prompted some larger CMOs to look for innovations in affordable housing including preparing for future opportunities that may present to purpose build housing through the NDIA’s Specialist Disability Accommodation Support initiative.
These directions also build on the considerable social capital that is the relationship between the community managed mental health and community housing sectors that has developed over decades through the provision of supported accommodation initiatives including the NSW Ministry of Health funded Housing and Accommodation Support Initiative.
Enhanced integration and coordination of services
‘Coordination of supports’ is one of the most helpful NDIS support types being accessed by people with psychosocial disability (this is similar to what PIR does). Most people with disability and other complex and diverse health and social issues will benefit from this type of support. If an NDIS planner does not offer coordination of supports then a person can ask for it.
Three coordination of supports categories of varying intensity were included in the NDIS Price Guide in late 2015. The intent here is to build people’s capacity to manage their own supports over time and to ensure access to care/service coordination at a skill level that best meets a person’s need (i.e., the higher intensity the coordination of supports need is the more skilled the worker providing it needs to be). The process of applying for NDIS access in itself means that an extensive review of all disability, mainstream and informal services will occur. Service review, when combined with coordination of supports, contributes to enhanced integration and coordination of services. The learning about this very important practice must continue and this discourse will escalate as national mental health reform directions now ask Primary Health Networks (PHNs) to provide clinical care coordination for people with severe mental illness.
10. Embrace the learning arising and pursue reflective practice
Reflective Practice: Participants at the NDIS Work Force Roundtable in 2016.
The complexities of navigating the NDIS from a mental health perspective must not be underestimated. When the Establish a Community of Practice to enhance learning arising from the NDIS NDIS started in the Hunter trial site mental health service providers (i.e., practitioners) in both the government and non-government sectors, as well as consumers and their families and carers, began to have a lot of contact with the NDIA. However, much of this contact was occurred in isolation for workers, programs, organisations and their clients, families and carers.
A Community of Practice is a group of people who share a concern or interest. A Community of Practice can evolve naturally because of the members’ common knowledge, interest or connections. A goal of gaining knowledge related to a specific field is a reason for deliberately creating a Community of Practice. It is through the process of sharing information and experiences with the group that the members learn from each other, and have an opportunity to develop themselves.
Passing knowledge from novice to veteran, and between peers, helps groups to develop. Members of a Community of Practice have the opportunity to develop both personally and professionally, while working towards solving problems facing the group.
Establish NDIS and Mental Health Communities of Practice, or other approaches to maximising learning arising through NDIS implementation, at the local level, as every local community’s experiences will be different. The NDIS is a national program and each local community has a unique infrastructure, including choices and preferences, upon which it is being built.
The NDIA initially prevented community managed service providers from supporting people in NDIS access due to the priority of ‘choice and control’. That is, the NDIA did not want service providers making or unduly influencing decisions for people. The NDIA used collaborative practice approaches when the benefits of this, where required and agreed, were better understood.
Coinciding with this change was the establishment of a Hunter NDIS and Mental Health Community of Practice. The Community of Practice embraced the learning arising from the NDIS and to pursue reflective practice as this relates to both the NDIS and mental health reform environment.
MHCC has developed a guideline to compliment this report encouraging the establishment of NDIS and Mental Health Communities of Practice across NSW. 19 As the learning arising from NDIS implementation continues, you are encouraged to embrace the learning arising and pursue reflective practice by establishing a Community of Practice in your area.
Essential NDIS knowledge
Navigating the NDIS is challenging and you need to have essential knowledge about it to navigate it. Many people with mental health conditions and their families/carers have found it hard to understand, navigate and access the NDIS and require advocacy and support to do so.
The key lesson learned is that knowledge about the National Disability Insurance Scheme (NDIS) is essential.
Section 2 provides some basic background information about the NDIS (p. 7)
The information provided in this section seeks to build on this knowledge through providing further detail.
for developing organisational and workforce capability in delivering National Disability Agency (NDIA) funded services.
As the NDIS is expanded - and continues to be delivered and built –, the experience of local communities will now be contributing to this state and national knowledge base to improve services for people affected by mental health conditions.
Much of the focus of the NDIS trial has been on access to and management/delivery of ‘Individual Funded Packages’ (IFPs). Through the NSW Hunter trial site experience we have learned that people ineligible for, or choosing not to access, IFP may in the future benefit from Information, Linkages and Capacity Building (ILC) activities. However, we do not yet understand ways forward for the ‘commissioning’ of the Information Linkages and Capacity-building (ILC) framework activities.
The NDIS Price Guide describes IFP ‘support categories’ (i.e., service types) that are evolving over time along with an accompanying outcomes framework. The NDIS Support Categories and Outcomes Framework current as at 1 July 2016 is summarised over page. The framework summary is useful to understand key elements (i.e., steps) in accessing IFP.
Some of the key elements of accessing and negotiating IFPs are then summarised next. Some information about the ILC activities of the NDIS then follows.
Getting ready for the NDIS
Click to play: www.ndis.gov.au/ndis-ready
Summary of NDIS Support Categories and Outcomes Framework
NDIS Support Categories (as at 1 July 2016)
The NDIA Price Guide is arranged into 15 categories that align to the purpose of the funded supports and the NDIA Outcomes Framework.
| SUPPORT PURPOSE | SUPPORT CATEGORY |
|---|---|
| Core | 1. Assistance with Daily Living |
| 2. Transport | |
| 3. Consumables | |
| 4. Assistance with Social & Community Participation | |
| Capital | 5. Assistive Technology |
| 6. Home Modifications | |
| Capacity Building | 7. Coordination of Supports |
| 8. Improved Living Arrangements | |
| 9. Increased Social and Community | |
| 10. Finding and Keeping a Job | |
| 11. Improved Relationships | |
| 12. Improved Health and Wellbeing | |
| 13. Improved Learning | |
| 14. Improved Life Choices | |
| 15. Improved Daily Living |
Funding has increasingly been made flexible and bundled meaning that resources can be moved around against client’s choices or in relation to variations in the intensity of support needs that may be experienced by people with mental health conditions.
NDIS Outcomes Framework (Adults)
The NDIS Outcomes Framework for adults The adult outcomes framework also has five consists of eight participant domains: family/carer domains:
-
Choice and control 1. Families have the support they need to care
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Daily activities 2. Families know their rights and advocate effectively for their family member with disability 4. Home 3. Families are able to gain access to desired 5. Health and wellbeing services, programs, and activities in their community
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Lifelong learning
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Work 4. Families have succession plans
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Social, community and civic participation. 5. Families enjoy health and wellbeing
It is likely that the Outcomes Framework will change as our understanding of the NDIS continues to evolve.
NDIS Individual Funded Packages (IFP)
The NDIS will fund services and supports that are ‘reasonable and necessary’ for a person with a disability to live an ‘ordinary life’. Our understanding of what this means continues to evolve. NDIS participants’ speak about their experiences of funded services and supports frequently now. The Mental Health Commission of NSW has developed a video describing the experiences of two NDIS participants and one of their carers who are accessing IFPs. You can view the NDIS Mental Health Perspectives video on YouTube.
Choice and Control Eligibility
An important foundation of the NDIS Act 2013 is that people To be eligible for the NDIS you must: with disability are able to exercise choice and control in have a ‘permanent disability’ that significantly affects your pursuing their goals and in the planning and delivery of their ability to take part in everyday activities
The type of support, when and how it is provided, and how to measure if it is helping a person to achieve their be aged less than 65 when you first access the scheme goals are all self-directed by the NDIS participant. be an Australian citizen, live in Australia and hold a
The concept includes the principle that people with disability permanent visa or hold a Protected Special Category Visa. must be involved in decision-making processes that affect them, and where possible make decisions for themselves. While the NDIS Act 2013 says that a participant’s condition This NDIS concept of ‘self-directed supports’ is the same as must be, or is likely to be, permanent this does not mean that the recovery concept of ‘person-centred and self-directed recovery is not possible. The NDIS trial taught us about ways practice’. of understanding ‘permanency’ in a mental health context. Even though the languages of the mental health and disability sector can vary notions of ‘choice and control’ are entirely compatible with recovery.
The mental health/psychosocial disability early intervention
pathway to the NDIS remains to be better understood.
Has the trial determined eligibility benchmarks?
No. Clear benchmarks for NDIS eligibility of people with
psychosocial disability are not established (that is, who
can get an IFP and who cannot). At the end of March 2016,
only 9% of people accessing the NDIS in NSW had primary NDIS - Mental Health Perspectives
psychosocial disability. In Victoria, this figure was 14%
Click to play, https://www.youtube.com/watch?v=9X-ea-O50Vg 23 (consistent with Productivity Commission estimates).
The NDIA needs to research access differences as
Not all choices are the same psychosocial disability NDIS experience grows. Simon Duffy from the UK Centre for Welfare Reform considered a founder of international personalised funding approaches, notes that not all choices are the same, true choice arises from control, or self-management, of personalised funding.
For example, he describes one man with mental health
issues related to a brain injury who, instead of being
depressed in a day centre, chooses to flourish as he uses
his personal budget to make music with his old band-
mates.
ABC Radio National Life Matters, 20 May 2016
23 National Disability Insurance Agency (2015 b). Op. cit.
Access Review
Supporting people who are in immediate need of assistance, and do not currently receive support, is important during the rollout. There is some capacity during the rollout for people who have not previously received supports to access the NDS when it starts in their local area.
To access the NDIS you need to contact the NDIA. You can make contact by phone, via the internet or in person. The NDIA sends an NDIS Access Request Form to the applicant to be completed. A family member, friend and/or substitute decision maker (for example the Public Guardian) can also complete the form. A health professional is required to completed part of the form.
A copy of the Access Request Form and a sample letter of support that can be useful for organisations supporting a person in their access to the NDIS are available on MHCC’s NDIS website. The sample letter of support includes examples of how to describe the functional impact and implications specifically in the areas of mobility, communication, social interaction, learning, self-care and self-management.
Following return of the Access Request Form to the NDIA, will make an appointment with the person. The appointment can be at the NDIA office or another location, if necessary. The NDIA in NSW is still determining where their offices will be outside of the Hunter trial site and early launch in the Nepean Blue Mountains.
The NDIA must provide you with an access determination letter explaining the outcomes of the access request in case you want to request a review. A sample of an access determination letter is also available at the MHCC NDIS website.
Contacting the NDIA
The best way to contact the NDIA is Phone - 1800 800 110 or Web - www.ndis.gov.au NSW NDIA office locations are not yet been made public.
Reasons for declining an access request
Hunter service providers have identified that the most common reason for declining an access request for people with psychosocial disability appears to be lack of sufficient evidence of disability/impairment.
Disability Advocacy NSW has had a role to play in the NDS by ensuring that people with a disability receive fair treatment in their dealings with the NDIA and the range of services and individuals who provide services with NDIS funds (Ph.1300 365 085). The government funded Disability Advocacy NSW in the trial site to support people with External Merits Review processes of an NDIS decision through the Administrative Appeals Tribunal (Ph. 1800 228 333). It is unclear if this arrangement will continue as the NDIS scales up.
The Commonwealth Ombudsman’s Office also supports people who have a concern about their access interactions with the NDIA (in addition to the NSW Ombudsman’s Office who mainly have a role in relation to NDIA funded services and supports after access has been gained):
- Commonwealth Ombudsman’s Office: Ph. 1300 362 072
- NSW Ombudsman’s Office: Ph. 02 9286 1000 or Toll free (outside Sydney metro) 1800 451 524.
Review decisions Data is not publically reported about how many people with psychosocial disability applying were found ineligible for the NDS and/or ‘choosing’ not to apply. Access to this data is important to understand and, where necessary, to respond to the experiences people are having.
In December 2015, the NDIS independent Advisory Committee noted that: “… data from the trial sites indicates that ineligibility rates from access requests from people with primary mental illness are significantly higher than other disability types with 1:4 applications requesting access due to primary mental illness being determined as ineligible compared to 1:9 for applicants across the rest of the Scheme” This means that access rates for all people of all other disability types are higher than for people with mental health conditions and public data is needed to have an inclusive and productive discussion about this.
Service Planning
Service Review
Review of NDIS participants’ individual plans is required at least annually. However, a person can request a plan review at any time. A plan review can also follow a change to a person’s goals or life circumstances including, but not limited to, hospitalisation.
Plan reviews are linked to measuring whether NDIS participants’ are achieving their goals (p. 22). The NDIS Outcomes Framework supports this outcomes focus.
In early 2016, the NDIA began to review plans over the telephone. Service providers report that some people with mental health conditions who are NDIS participants were confused and unsettled by this process. The NDIA has asked organisations to provide the names of people who prefer in-person reviews.
My NDIS Pathway
Click to play: www.ndis.gov.au/planning-process
The NDIA and others have developed pre-planning guides to help people have conversations about their NDIS eligibility and their hopes and dreams (i.e., their NDIS plan goals). These are available on the NDA website. A recent example of this is the NDIS Ready ‘My First Plan’.
To participate in service planning it is helpful to have knowledge about NDIS support categories (p. 21). It is a good idea for NDIS service providers to think about how their current service offerings align with these support categories.
MHCC’s NDIS website provides sample support plans for people with psychosocial disability. MHCC seeks to identify good practice in NDIS funded psychosocial disability/recovery support and build knowledge of innovation in service delivery.
For people with mental health conditions accessing the NDIS it is useful to ensure that their plan includes arrangements for when they have both good and not so good mental health (i.e., to accommodate for variations in intensity of disability support needs).
NDIA planners undertook planning during the NDIS trial. Outsourced ‘Local Area Coordinators’ (LACs) will have a greater role in gathering information to assist people with NDIS planning in NSW over the next two years (see more about LACs on p. 26).
My First Plan
The government advises that ADHC and Commonwealth funded mental health program clients transitioning to the NDIS over the next two years will get 12-month initial plans called ‘My First Plan’. This means that people phase into the NDIS at their existing service levels.
This is a concern for some people with psychosocial disability funded at low levels against their actual support needs. They will be disadvantaged despite the intergovernmental ‘continuity of service’ arrangements.
A person’s actual disability/recovery support needs can be reviewed against ‘My First Plan’ arrangements and decisions appealed as needed. For more guidance on this, see ‘Access Review’ on p. 23.
NDIS Ready
NDIS Ready is a community awareness-raising project aimed at preparing people with disability, their families and carers, service providers and the community for the roll out of the NDIS from 1 July 2016. It celebrates the successes of the NDIS to date and creates a platform for people to express their support for the NDIS. This new webpage contains information on the simple steps people and providers can take to get ready for the NDIS and a range of new NDIS resources and videos, including the NDIS Ready Communications Toolkit.
NDIS Ready includes a Communications Toolkit and accompanying fact sheet for families and carers to assist people with planning. The toolkit provides individuals and organisations with communication materials that can help spread the word about the NDIS across a range of communications channels, including websites, intranets, social media platforms and electronic and printed newsletters.
Service Coordination
Individual Funds Management
Expanding NDIS coordination of supports items helps to Under the NDIS, funds will go directly to participants rather enhance the integration and coordination of services (p. 18). The key message here is that many people with psychosocial disability that also have complex and diverse health and social problems will require some level of coordination of supports (i.e., service/care coordination). P. 18 provides a further illustration of good service coordination practice.
If an NDIA planning process does not offer some level of ‘coordination of supports’ for a person with psychosocial disability then providers should support people to obtain information about these services. They will need to ask the NDIA about them. The same or different service providers can make coordination of supports available to that which provides disability/ recovery support services. Where a person has no natural supports (i.e., family and friends) in their life to help guide their decisions it can be an added safeguard to separate coordination of supports from disability/recovery support service provision. Knowing, and having discussions about, the range of individual funds management arrangements is important to increasing NDIS participant’s choice and control.
Individual funds management
Very few NDIS participants are currently managing their own funds. Self-managed funding accounted for only 7% of plans at the end of March 2016. 25
Most plans are solely agency managed (58%) and some are a combination of both self and agency managed (35%).
Information, Linkage and Capacity Building
(ILC)
Other ILC Activities
The ILC Policy Framework states that other suggested activity streams of ILC are:
- Information, linkages and referrals - to make sure people with disability and their families have access to reliable and relevant information.
- Capacity building for mainstream services - to make services more accessible for people with disability.
- Community awareness and capacity building - to make it easier for people with disability to fully participate socially, economically and in their communities,
- Individual capacity building - to help people with disability develop the skills and confidence to achieve their goals.
LAC will incorporate every other ILC activity stream and support ILC initiatives within local communities (i.e., IFPs).
There are approximately 800,000 Australians who need assistance with activities of daily living at least weekly but only 460,000 are likely to access the NDIS as individually funded participants. About 61,000 of these will be people with psychosocial disability. ILC activities and other mainstream and community based services where these are available will support people who are not eligible for IFP.
ILC is a key component of the NDIS insurance model. It will contribute to the sustainability of the NDIS by building the capacity of the community, people with disability, their families and carers, potentially achieving greater community inclusion. ILC developments over time reduce demand for specialist disability support required by many people with disability (i.e., IFPs).
The Disability Reform Council released the ILC Policy Framework in August 2015. Consultation and trialling to develop the ILC is continuing. Between February and April 2016 the NDIA talked further with people about ideas related to the ILC. The NDIA now developing second version of the ILC Commissioning framework.
Innovative regionally-based reforms require consumer, carer and community co-design strategies (the importance of this discussed further MHCC’s NDIS Mental Health Community Practice guideline).
Local Area Coordination (LAC)
LAC backbone of ILC Different states territories trying alternate approaches LAC roles functions:
NDIS LAC roles and function NSW outsourced arrangement until June 2018 Two organisations providing LAC service: Saint Vincent de Paul Uniting.
- Saint Vincent de Paul - South Western Sydney Central Coast Hunter New England districts that commenced in 2016; Sydney Southern Sydney district commencing in 2017.
- Uniting: Nepean Blue Mountains Northern Sydney Western Sydney Southern NSW districts starting from 2016 Illawarra Shoalhaven district which will commence in 2017.
Not yet announced are arrangements for Mid North Coast Murrumbidgee Northern NSW Western NSW Far West districts.
First instance focus on planning required support transition ADHC funded clients to NDIS because NSW government plans stop delivering services through ADHC by July 2018. Role SVDP Uniting LAC workers supporting Commonwealth-funded mental health programs client their access or planning processes unclear.
6. Next steps & concluding remarks
Next Steps People with primary psychosocial disability
currently accessing specialist disability supports The NDIS in NSW will be rolled-out between July 2016 and
June 2018 according to the LHD timetable described on p. 8. ADHC funded clients typically do not have primary mental health conditions/ psychosocial disability. ADHC fund some The NSW focus is on transition of 78,000 ADHC clients people with psychosocial disability in some parts of NSW. For receiving disability support services. As previously noted, example: this is because the NSW government plans to stop delivering ADHC funded services by July 2018 and following this will Central Coast (mostly participants at an ADHC funded withdraw from the delivery of specialist disability support centre based activity program) services in NSW (i.e., and close ADHC). According to the NSW Bilateral Agreement people residing in ADHC’s Large Blue Mountains (mostly ex-boarding house residents) Residential Centres and group homes will be a first priority to Inner-west of Sydney (mostly current and ex-boarding transition. 28 house residents).
The NSW Government has established the following priorities for NDIS access:
New participants
There is scope for a further 57,621 people of all disability types in NSW to be new participants over the next three years and access NDIS IFP as indicated in the table below.
| Q1 | Q2 | Q3 | Q4 |
|---|---|---|---|
| 2016/17 | 1,563 | 1,526 | 1,634 |
| 2017/18 | 6,107 | 6,138 | 6,405 |
| Subtotal 31,217 | |||
| 2018/19 | N/A | N/A | N/A |
| Total 57,621 | |||
| (Adapted from the NSW NDIS Bilateral Agreement) |
Furthermore, there is likely to be additional places available because of a predicted shortage in meeting the NSW trial site target of 10,000 people accessing the NDIS (this shortage is thought to be about another 2,000 places).
The NSW mental health sector will need to test the requirement for people with high levels of psychosocial Disability that are new participants to have no support and be in immediate need of assistance. The NSW Ministry of Health will support some vulnerable and marginalised people living with a mental health condition through funded mental health programs that continue to be block funded, or by their family and friends. However, the level of support they access is not always adequate to ensure their participation in the economic and social lives of our community.
Consumer and carer participation at the Hunter NDIS and Mental Health Community of Practice Forum in June 2016
New participants include NDIS eligible Commonwealth funded mental health program clients:
New NDIS participants with mental health conditions can be supported in their access by their families and friends, and workers from across a range of government and community sector service providers.
Estimates are that it takes 20 to 60 hours of work to gather evidence to support a person’s access to an NDIS IFP. Hunter service provider’s report that this time includes:
- activity to identify potentially eligible people
- outreach to engage people in taking forward an access request, and
- working with the person, and their family and carers where required and agreed, to gather sufficient documentation of evidence of disability/impairment
- attending and/or supporting a person to attend access and planning meetings.
Exploring the numbers and experiences of people in Commonwealth funded mental health programs in NSW that access NDIS IFPs will be important over the next two to three years. Neither NSW nor national data about Commonwealth funded mental health program client access across the 2013 to 2016 NDIS trial is yet available.
The total number of Commonwealth funded mental health program clients in NSW is also unknown. However, both PIR and PHaMS capacity are around 7,000 people in each program in NSW. Assessments of NDIS IFP eligibility of more than 14,000 Commonwealth mental health program clients in NSW will happen over the next two to three years. The timeframe and processes for this to occur is not fully known with some 2016/17 contracts and transition planning still to be finalised.
MHCC has estimated that about 19,000 people with psychosocial disability should access NDIS IFP in NSW. This figure is 13% of the 140,000 people that will access the NDIS in NSW. Thirteen percent is the total burden of disability due to mental ill health in Australia.
The Hunter trial site was not successful in achieving this 13% benchmark (i.e., it achieved only 9% while access rates in Victoria were in-line with Productivity Commission estimates). At the end of March 2016 only 616 people in NSW with a primary psychosocial disability, and 1,492 nationally, had accessed an NDIS IFP and had a plan. The learning arising from this access experience will contribute to the considerable learning that has occurred through the experiences of the first people with psychosocial disability to access the NDIS in NSW.
Supporting people with high levels of psychosocial disability to access the NDIS For the period July 2018 to June 2019, you are encouraged to identify people with high levels of psychosocial disability due to a mental health condition and support their access as new participants to the NDIS. Ideally, these will be people with no or very few supports in place. Such people may or may not have current or past relationships with mental health treatment services or have a diagnosed mental illness. However, where public and private health and mental health practitioners, including GPs, have been involved in a person’s treatment this has facilitated NDIS access.
Some people with mental health conditions in the Hunter trial site have had request reviews of decisions made and/or reapproached the NDIS for access up to four times before accessing funded services and supports. It is through the process of exploring people’s NDIS access that the body of knowledge about the NDIS and mental health will continue to grow both in NSW and nationally.
Getting ready for the full roll-out of the NDIS
The full rollout of the NDIS in NSW will occur between July 2016 and June 2018. Some things to consider in getting ready if you are not in a trial site:
-
familiarise yourself with what NDIS is and stay informed about what we are learning about how it works
-
convene or participate in a local community meeting to discuss what your mental health sector can be doing to get ready for NDIS
-
understand the language of NDIS and learn how to reconcile this with recovery oriented language
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encourage the local public mental health service to conduct an audit of clients known to them that might be eligible for NDIS
-
begin to identify people with high levels of psychosocial disability that might be eligible for individually funded services and supports
-
encourage your local Partners in Recovery program, where these have been established, to develop a list of people known to them that may be eligible for the NDIS
-
engage in pre-planning with these people to:
- help potentially eligible people put together written information about how their disability affects their life
- assist potentially eligible people to think about their hopes and dreams for their lives
- support people in aspiring to their hopes and dreams
- ensure that the information about any current clients is up-to-date and comprehensive. This is especially true for people receiving PHaMS and Day-to-Day Living Program services, and for NSW, people with primary mental health conditions in receipt of ADHC funded disability support services (e.g. former boarding house residents)
-
become aware of and meet with the various support providers in your local area that might
-
where accessible use the National Disability Service NDIS capacity building resources, including the Organisational Toolkit, to assess and build the readiness of your community sector organisation for the NDIS
-
discuss with people their four options for personalised funding money management arrangements and what is required for self-management:
- ensure that your organisation’s policies, procedures and practices are NDIS ready
- create a new role within your organization for an NDIS Liaison Officer or similar who can assist frontline workers, people with psychosocial disability and their families and carers. Help people to prepare for the NDIS and understand funded services and supports.
-
NDIA managed
-
other managed
-
a combination of the above
Concluding Remarks
Full implementation of the NDIS is a major undertaking that will likely require generational change. Although national and NSW implementation is planned to conclude by July 2019, learning about the NDIS from a mental health perspective is likely to continue for many years.
The NDIS will profoundly change how people with psychosocial disability undertake activities of daily living, participate in the community and contribute to the social and economic life of Australia. National NDIS implementation will now see trial learning consolidated, scaled up and built upon. More people with psychosocial disability will access NDIS IFP. As the ILC builds through co-design approaches, the lived experience of the NDIS and mental health will grow. The interface of the NDIS with mainstream health/mental health and other services also continues to develop.
Our understanding of what is known evidence-based practice in mental health (e.g., employment/education, skills development, family and carer support, accommodation support, early intervention and promotion, psychological therapies, peer support, consumer operated services, cognitive remediation, etc.) will need to be reconciled with notions of choice and control.
This must include consideration of the capacity of the community managed mental health sector in entering the NDIS environment along with other health/mental health reform directions including, but not limited to, the emerging role of PHNs.
Other NSW communities will benefit from the experiences and lessons learned in the Hunter trial site. MHCC’s experiences can help other NSW communities to explore the opportunities and challenges presenting through the NDIS.
References
ACT Disability, Aged and Carer Advocacy Service (2016). NSW Mental Health Commission (2014). Living Well: A Supported Decision Making, Psychosocial Disability and the Strategic Plan for Mental Health in NSW 2014-2024. Sydney, NSW Mental Health Commission.
Australian Government (Department of Health; 2016). National Disability Insurance Agency (2016 a). NDIS Price PHN Primary Mental Health Care Flexible Funding Pool Guide (Vic/NSW/Qld/Tas - Valid from: 1 July 2016) Implementation Guidance: Primary Mental Health Care
National Disability Insurance Agency (2016 b). Quarterly Services for People with Severe Mental Illness. Report to COAG Disability Reform Council 31 March 2016.
Australian Government (2013). National Disability Insurance
Framework Pilot Study: Summary Report.
Commonwealth of Australia (2013). A National Framework for
Determine the Responsibilities of the NDIS and Other Service
Commonwealth and NSW Governments (2015). Bilateral Systems (2nd edition). Agreement between the Commonwealth and New South
Coordination of Wales: Transition to the NDIS.
Supports: Information for Providers.
Community Mental Health Australia (2015). Developing
National Disability Insurance Scheme Workforce Development
Plan Commitment between the National Disability Scoping Paper Project. Sydney: Mental Health Coordinating
Insurance Agency (NDIA), New South Wales Government Council.
and Commonwealth Government for Transition to Full
Disability Reform Council (2015). National Disability Insurance Implementation of the NDIS. Scheme: A Framework for Information, Linkages and Capacity
Unravelling Psychosocial Disability: A Position Statement
Building. Independent Advisory Council (2014). Advice on Implementing by the National Mental Health Consumer and Carer Forum the NDIS for People with Mental Health Issues. on Psychosocial Disability Associated with Mental Health Conditions, NMHCCF, Canberra. Mental Health Coordinating Council (2016). The National Disability Insurance Scheme (NDIS) and Mental Health in NSW: United Nations General Assembly (2006). Convention on the Guideline for Establishing a Local NDIS Community of Practice Rights of Persons with Disabilities. Resolution adopted by the to Enhance Learning and Sector Reform. MHCC, Sydney. General Assembly, 24 January 2007, A/RES/61/106, United Nations, Geneva. Mental Health Coordinating Council (2015). Further Unraveling Psychosocial Disability – Experiences of the National Disability National Disability Insurance Agency (2015). Commissioning Insurance Scheme in the NSW Trial Site: A Mental Health Framework for Information, Linkages and Capacity Building. Analysis. MHCC, Sydney.
nsw government ndis website: http://www.ndis.gov.au/nsw