The into the ³Ô¹ÏÍøÕ¾ Disability Insurance Scheme (NDIS) has been released and it recommends some big changes. This is not a report that just moves the deck chairs – it changes the whole layout of the ship, including its approach to .
Author
Jennifer Smith-Merry
Director, Centre for Disability Research and Policy, University of Sydney
The NDIS refers to mental illness as when it is severe and disabling. Clear definitions psychosocial disability is not a diagnosis in itself. It has a functional impact and presents barriers to equality when someone with a mental health condition interacts with a social environment. It can affect their ability to work, learn, socialise or care for themselves.
The ³Ô¹ÏÍøÕ¾ Disability Insurance Agency (which administers the scheme) views it separately to cognitive disability and other specific conditions such as autism.
The mismatch between and key aspects of the NDIS have been . So will the review’s recommendations make a difference?
Who gets support?
There are 63,010 people in the NDIS , making up around 10% of participants. They are older – 83% are over 35 compared to 32% of other participants. They have half the employment rate of participants aged 15 to 64 (11% compared to 23%) and experience lower social and community engagement. They have different needs but, in the scheme’s ten years, have been largely offered the same supports.
The recommends “a new approach to NDIS supports for psychosocial disability, focused on personal recovery” and to develop mental health reforms to better support people with severe mental illness.
These include an early intervention pathway and requiring providers delivering psychosocial supports to be registered and comply with new standards. In line with other review recommendations, the review says all Australian governments should provide foundational supports and improve the interfaces between the NDIS and mental health systems.
Currently, many people with severe mental illness who apply for the NDIS do not get access. And programs were defunded to fund the scheme.
One fundamental issue has been that NDIS access requires disability to be “permanent”. This is , which strongly underpins Australian mental health policy. Recovery views mental illness as neither permanent nor static and that supports may therefore be more needed at some times than others.
Making the list
For many people permanent disability has been difficult to demonstrate. No mental illness-specific conditions were included on the “likely to meet access requirements” for the scheme. This has led to .
The review assessment based on functional needs rather than diagnosis, doing away with access lists. This will remove inequity where people with psychosocial disability must work hard to prove permanent functional impairment, .
Experiences on the scheme
Those who do make it into the NDIS have of the scheme more poorly than others. Studies have highlighted stigma and by staff and providers who , which damages .
The review participants should have access to a “navigator” who has expertise in psychosocial supports and is trauma-informed.
The review argues competencies in mental health (such as training) should be linked to the registration of providers offering psychosocial supports.
This registration requirement is the most , with choice over providers – registered or not – to attaining participant choice and control.
Unregistered providers have been the choice for most scheme participants (including ), with registration processes viewed as a burden on providers and .
However, this is a failure of the registration model rather than registration per se. Understanding the role of people with disability as will be essential in getting registration right.
Foundational psychosocial support
The number of people entering the scheme over age 35, when most people are likely to be diagnosed with a serious mental illness at a much younger age (), points to failures in support outside of the scheme.
It tells the stories of people with mental illness gradually losing access to formal and informal supports until their illness becomes disabling and they need support from the scheme.
The review repeatedly emphasises the need to improve the operation of supports outside of the scheme, considering that NDIS supports have the best outcomes when broader needs are also met. These “foundational supports” are widely supported by the mental health sector who a strong, broad network of supports for people with psychosocial disability.
A road to recovery
The review calls for recovery to be re-centred within the operation of the scheme, with increased independence as a desired outcome. Currently providers have no obligation to try to improve a person’s recovery.
People with psychosocial disability who entered the scheme prior to 2021 experienced an increase in social and community engagement . Their rate of employment rate did not increase at all. The review’s focus on early intervention and recovery could change this.
All review recommendations are just that. It is now up to the government to enact reforms. In doing so it is important they put the needs and experiences of people with psychosocial disability front and centre .
Jennifer Smith-Merry receives funding from the Australian Research Council for a fellowship focusing on psychosocial disability and the NDIS. The ³Ô¹ÏÍøÕ¾ Disability Insurance Agency provides in-kind support for that project and funds a project PhD student. She has collaborated with many of the researchers and advocacy groups whose work is cited in the article, including the Australian Psychosocial Alliance and its members.
