The announcement that ‘mental health’ was going to be included in NDIS was met with a mixture of excitement and worry. For as long as I can remember there have been calls for mental health reform and many people held out hope that NDIS would be the ‘solution’. As NDIS rolls out across the country, we are seeing data that suggests people with mental illnesses are not receiving the supports they expected and have been left feeling disillusioned. Consequently, the NDIS is quickly coming to be seen as another mental health failure. This left me wondering whether the blame lies with the NDIS, the health system or with a gap between the two?
This article explores the following three areas:
Supports for a person with a mental illness under the NDIS
Mental health supports in the health care system
Gaps between the systems
1. MENTAL HEALTH and NDIS
The NDIS does not and has never been intended to provide ‘treatment’ for a mental illness. This remains the responsibility of the health care system. Instead, the NDIS can provide funding for people with a permanent and significant psychosocial disability to improve their functional capacity. As outlined in the COAG document Principles to Determine the Responsibilities of the NDIS and other Service Systems:
“The NDIS will be responsible for ongoing psychosocial recovery supports that focus on a person’s functional ability, including those that enable people with mental illness or a psychiatric condition to undertake activities of daily living and participate in the community and in social and economic life. This may also include provision of family and carer supports to support them in their carer role, and family therapy, as they may facilitate the person’s ability to participate in the community and in social and economic life.”
Furthermore, the document outlines that the NDIS will provide reasonable and necessary supports for eligible people with a psychosocial disability in the following domains:
a) Support for community reintegration and day to day living […]
b) Allied health and other therapy directly related to managing and/or reducing the impact on a person’s functional capacity of impairment/s attributable to a psychiatric condition […]
c) Capacity building support to help the person access and maintain participation in mainstream community […]
d) Community supports aimed at increasing a person’s ability to live independently in the community or to participate in social and economic activities […]
e) The coordination of NDIS supports with the mental health system and other relevant service systems.
Please refer to the COAG document for the full descriptions of each of these domains.
There are resources available to help people with mental illnesses navigate the system, including https://reimagine.today/, which DSC has previously profiled. Such resources can help people understand how the NDIS criteria relates to mental illness and assist them to use NDIS language to describe their functional impairment.
2. MENTAL HEALTH and the HEALTH CARE SYSTEM?
As we have established, the NDIS does not fund treatment and will only provide support for a small portion of the population experiencing mental illness. However, this obviously raises the question of what supports will be available to people with mental illnesses who do not meet the eligibility criteria for the NDIS. The COAG document outlines the following as the responsibility of ‘other parties’:
Services and therapies in which the primary function is to provide treatment of mental illness targeted towards people affected by mental illness or a psychiatric condition, including acute and non- acute residential services, mental health crisis assessment services, hospital avoidance services and post-acute care services.
Early intervention designed to impact on the progression of a mental illness or psychiatric condition, especially where delivered by health services (notwithstanding the note above).
Intensive case coordination operated by the mental health system where a significant component of case coordination is related to the mental illness.
The provision of acute and tertiary mental health services will continue to be provided by the healthcare system. These services provide community and inpatient care for people with acute and/or severe mental illness. Additionally, the Primary Health Networks are commissioned to offer regional mental health services within the stepped care model. The Commonwealth Government is also providing digital mental health services for people with mild mental illnesses.
3. MENTAL HEALTH GAPS between the SYSTEMS?
If (and this is a big IF) people are informed about the supports available under NDIS and have the support and skills to request them, it is possible to get some psychosocial recovery supports within a plan. However, for people who either do not receive these supports or are ineligible for NDIS, there are currently very few options available for recovery-orientated supports.
In a recent AAT case, an applicant requested early intervention supports for her mental illness. Substantial evidence was provided about the benefits she receives from weekly psychology sessions, which she currently pays for out of her own pocket. These sessions assist her to function more effectively and live an ordinary life. Despite her mental illness being recognised as permanent, the appeal was denied on the basis that the supports required are clinical in nature and best funded by the health system. The fact that they are not being provided is another story altogether.
All this leaves me wondering ‘have some of the state governments stuffed this all up?’ Did they really understand the full implications of agreeing to give Community Mental Health Support funding to NDIS (e.g. MHCSS, HASP, HASI)? To which the answer is evidenced in the recent commitment of an additional $160 million over the next four year for psychosocial supports. Many people require intensive, ongoing mental illness support that will not be funded by the NDIS. We are in a situation where a large number of Australians who live with permanent mental illness, do not have access to ongoing supports. Will this additional psychosocial funding be enough to address the gap in the system or will we continue to hear more calls for reform of the mental health care system?