Eligibility with Psychosocial Disability

There is a lot of confusion about mental illness and NDIS eligibility. Understandbly so, as it is a complicated area of policy and one that really only applies to a small proportion of the total number of people with live with mental illness.

Nearly half (45%) of all Australians will experience some form of mental illness during their lifetime. That is 8.6 million people. Moreover, at any given time 2-3% of the population is living with severe mental illness. Based on the 2016 population, that is an estimated 730,00 people (AIHW, 2018).

But the Productivity Commission estimates that just 64,000 people with psychosocial disability will meet the eligibility criteria to access the Scheme. Of the nearly 8.6 million people who will experience some form of mental illness in their lifetime, only 0.74% are expected to receive an individualised NDIS package.

So who are the people who will be eligible?

1. Psychosocial Disability

Mental illness does not necessarily equate to psychosocial disability. So what exactly is psychosocial disability? Well, a mental illness becomes a psychosocial disability when it substantially impacts a person’s functional capacity and ability to complete tasks of daily life. The NDIS measures functional impairment as a reduced ability to complete tasks in at least one of six domains- mobility, communication, social interaction, learning, self care or self management.

2. Substantial Functional Impact

In order to access the NDIS, a person’s condition needs to have a ‘substantial’ impact on their ability to complete tasks in one of the six domains. ‘Substantial’ is quite a high bar to meet.  If the person has workarounds that enable them to complete the task in a different way, then this does not count as substantially reduced capacity. For example, if a shopping trip takes longer than usual, but the person is still able to complete it, then the impact of their condition on that area of their life might not be considered substantial.

This concept is particularly complex in the mental health space, where the impact a disability has on a person’s functional capacity can fluctuate. The NDIA have responded by saying they will look at the individual’s functional capacity between acute episodes.

3. ‘Personal Recovery’ versus ‘Clinical Recovery’

Furthermore, to be eligible for the NDIS, a person needs to have a disability that is likely to be permanent. This means that they have explored all evidence based treatment options that could lead to recovery. In the mental health space, a distinction has been made between ‘personal recovery’ and ‘clinical recovery.’

To access the NDIS, the person needs to have explored all options for clinical recovery. The NDIA defines clinical recovery as:

  • The absence of symptoms of the mental health condition as a result of treatment and/or intervention and the person being cured; or

  • The absence of symptoms because the treatment and/or interventions is/are supressing or controlling them

Once it has been determined that clinical recovery is highly unlikely, then the focus becomes on enabling personal recovery. NDIS supports can promote personal recovery by allowing the Participant to live a meaningful life, as defined by their own personal goals.

 

As a sector, we have a responsible to ensure that people who are eligible get accepted into the Scheme. But we also need to encourage governments to guarantee that the other 99.3% of Australians who experience mental illness receive the support they need. It is an uphill battle, but one that knowledge of the rules of eligibility can only aid.