Informed, engaged communities for health

Search
Generic filters
Filter by Categories
Aged care
Budgets
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
Climate and health
Climate emergency
Heatwaves
#CoveringClimateNow
#HealthyCOP27
#HealthyCOP26
COVID collection
Long COVID
COVID-19
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
Choosing Wisely National Meeting 2022
Equally Well 2022 Symposium
GiantSteps22
Croakey Professional Services
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
#PHAAThinkTank 2022
Summer reading 2022-2023
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Discrimination
Racism
Justice and policing
Poverty
Newstart/JobSeeker
Education
Housing
Internet access
Justice Reinvestment
Social policy
Commercial determinants of health
Alcohol
Digital platforms
Food and beverages
Sugar tax
Tobacco
Vaping
Plain packaging
Gambling
Pharmaceutical industry
Arms industry
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
#QldVotesHealth
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Uluru Statement
The Voice
Community controlled sector
Cultural determinants of health
Cultural safety
Social and emotional wellbeing
Indigenous education
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Consumer health matters
Cancer
Cardiovascular disease
Chronic conditions
Non communicable diseases
Diabetes
Oral health
Disabilities
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
Medical marijuana
Mental health
Suicide
Trauma
LGBTQIA+
HIV/AIDS
Women's health
HRT
Abortion
Men's health
Youth health
Child health
Pregnancy and childbirth
Organ transplants
Pain
Sexual health
Infectious diseases
Influenza
Mpox
Swine flu
Death and dying
Euthanasia
Global health matters
Global health
WHO
Conflict and war
Asylum seeker and refugee health
#WorldInTurmoil
Ebola
NHS
Health policy and systems
Health reform
Workforce matters
Health financing and costs
Health regulation
Strengthening Medicare Taskforce 2022
Co-design
TGA
Royal Commissions
National Commission of Audit 2014
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Healthcare
Primary healthcare
Social prescribing
Rural and remote health
General practice
International medical graduates
Primary Health Networks
NDIS
Nursing and midwifery
Australian Medical Association
Allied healthcare
Pharmacy
Paramedics
Pathology
Naturopathy
Hospitals
Emergency departments and care
Palliative care
Safety and quality of healthcare
Adverse events
Choosing Wisely
Co-payments
Out of pocket costs
Complementary medicines
Conflicts of interest
Health ethics
Digital technology
Telehealth
E-health
Equally Well
Health Care Homes
Medicare Locals
MyHospitals website
Screening
Surgery
Tests
Media and health
Media-related issues
Public interest journalism
Misinformation and disinformation
Social media and healthcare
Health & medical marketing
The Conversation
Media Doctor Australia
News about Croakey
Public health and population health
Australian Centre for Disease Control
Public health
Prevention
Health inequalities
Health literacy
Health communications
Health in All Policies
Health impact assessment
Human rights
Vaccination
Air pollution
Physical activity
Sport
Obesity
Road safety
Transport
Gun control
Illicit drugs
Injuries
Legal issues
Marriage equality
Occupational health
Violence
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Government 2.0
Web 2.0
Nanny state
National Preventive Health Agency
Research matters
Health and medical research
#MRFFtransparency
Evidence-based issues
Cochrane Collaboration
Health and medical education
NHMRC
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2021
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2019
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010
Support non-profit public interest journalism
Search
Generic filters
Filter by Categories
Aged care
Budgets
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
Climate and health
Climate emergency
Heatwaves
#CoveringClimateNow
#HealthyCOP27
#HealthyCOP26
COVID collection
Long COVID
COVID-19
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
Choosing Wisely National Meeting 2022
Equally Well 2022 Symposium
GiantSteps22
Croakey Professional Services
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
#PHAAThinkTank 2022
Summer reading 2022-2023
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Discrimination
Racism
Justice and policing
Poverty
Newstart/JobSeeker
Education
Housing
Internet access
Justice Reinvestment
Social policy
Commercial determinants of health
Alcohol
Digital platforms
Food and beverages
Sugar tax
Tobacco
Vaping
Plain packaging
Gambling
Pharmaceutical industry
Arms industry
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
#QldVotesHealth
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Uluru Statement
The Voice
Community controlled sector
Cultural determinants of health
Cultural safety
Social and emotional wellbeing
Indigenous education
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Consumer health matters
Cancer
Cardiovascular disease
Chronic conditions
Non communicable diseases
Diabetes
Oral health
Disabilities
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
Medical marijuana
Mental health
Suicide
Trauma
LGBTQIA+
HIV/AIDS
Women's health
HRT
Abortion
Men's health
Youth health
Child health
Pregnancy and childbirth
Organ transplants
Pain
Sexual health
Infectious diseases
Influenza
Mpox
Swine flu
Death and dying
Euthanasia
Global health matters
Global health
WHO
Conflict and war
Asylum seeker and refugee health
#WorldInTurmoil
Ebola
NHS
Health policy and systems
Health reform
Workforce matters
Health financing and costs
Health regulation
Strengthening Medicare Taskforce 2022
Co-design
TGA
Royal Commissions
National Commission of Audit 2014
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Healthcare
Primary healthcare
Social prescribing
Rural and remote health
General practice
International medical graduates
Primary Health Networks
NDIS
Nursing and midwifery
Australian Medical Association
Allied healthcare
Pharmacy
Paramedics
Pathology
Naturopathy
Hospitals
Emergency departments and care
Palliative care
Safety and quality of healthcare
Adverse events
Choosing Wisely
Co-payments
Out of pocket costs
Complementary medicines
Conflicts of interest
Health ethics
Digital technology
Telehealth
E-health
Equally Well
Health Care Homes
Medicare Locals
MyHospitals website
Screening
Surgery
Tests
Media and health
Media-related issues
Public interest journalism
Misinformation and disinformation
Social media and healthcare
Health & medical marketing
The Conversation
Media Doctor Australia
News about Croakey
Public health and population health
Australian Centre for Disease Control
Public health
Prevention
Health inequalities
Health literacy
Health communications
Health in All Policies
Health impact assessment
Human rights
Vaccination
Air pollution
Physical activity
Sport
Obesity
Road safety
Transport
Gun control
Illicit drugs
Injuries
Legal issues
Marriage equality
Occupational health
Violence
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Government 2.0
Web 2.0
Nanny state
National Preventive Health Agency
Research matters
Health and medical research
#MRFFtransparency
Evidence-based issues
Cochrane Collaboration
Health and medical education
NHMRC
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2021
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2019
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010

An oasis or a mirage? On the NDIS and psychosocial care

Clearer, fairer pathways are needed for people seeking psychosocial care, writes Dr Sebastian Rosenberg, Senior Lecturer, Brain and Mind Centre, University of Sydney.


Sebastian Rosenberg writes:

At the 4th NDIS and Mental Health Conference, hosted recently by Community Mental Health Australia in Sydney, Minister Bill Shorten reminded attendees that the NDIS was established as a new public insurance scheme for people with a disability, designed to operate AS PART of an overall ecosystem of care and services.

He noted that for many people, accessing these services, mostly from the health system, remained very difficult, particularly in mental health. He described this situation as leaving the NDIS as an oasis in a desert.

In the absence of other services, gaining entry to the NDIS has become vital for those seeking psychosocial care.

NDIS spending

Minister Shorten then explained that almost $4 billion is now being spent each year on the 60,000 Australians who qualify for the NDIS with psychosocial disability as their primary disability.

Just under $1 billion was spent in the first quarter of 2022-23, a 35 percent increase from the same time in the previous year. This equates to annual per capita spending of nearly $67,000 across these NDIS recipients.

By contrast, about 3.3 million Australians receive mental healthcare under Medicare or through services run by the states and territories, mostly hospital-based care. The governments together spend about $11 billion each year providing this care.

On this basis, annual per capita spending would be $3,333 for those in receipt of federal or state mental healthcare.

By these calculations, NDIS recipients receive 20 times as much funding to respond to their mental illness than those who do not qualify for the NDIS. This will be an underestimate, because while non-NDIS recipients cannot receive NDIS-funded services, NDIS recipients are entitled to use hospital and Medicare services. In other words, NDIS recipients receive part of the $11 billion government mental health budget.

We know that mental health has been underfunded. The NDIS would be even more of an oasis if its more generous levels of financial support clearly led to better outcomes.

The most recent NDIS data indicate fairly small increases in social and community participation, as well as in education outcomes, and no change in employment status for either clients or their families/carers.

It would be useful to know more about the access of NDIS clients to mainstream healthcare services, to build a fuller picture, both of costs and of need.

For example, has NDIS funding reduced emergency department (ED) or inpatient admissions by NDIS recipients? Sixty-one percent of psychosocial NDIS clients are deemed to have ‘medium’ functioning, with 31 percent reporting low level functioning. Given these assessments, it is likely that many NDIS clients may well have frequently required the acute mental healthcare support currently only available in hospitals.

The NDIS publishes data on the value of average support packages across all recipients. In the 12 months to 30 September 2022,  $61,700 was the average payment for a participant with a psychosocial disability, an 11 percent increase compared to the previous year. This averaging masks likely significant disparities between smaller and larger NDIS support packages.

Psychosocial sector

Presentations to the Sydney conference indicated that while spending on NDIS clients is already considerable and rising rapidly, it does not seem as if this funding, or much of it, is finding its way to the typically community-managed organisations who had been providing psychosocial care.

Despite good evidence to justify expenditure on psychosocial support to be a partner to clinical care, these organisations (like NEAMI, the Mental Illness Fellowship of Australia, Mission Australia) were never funded to be more than a peripheral element of Australia’s mental health service mix (receiving less than seven percent of state and territory spending on mental health services).

It does not appear that the advent of the NDIS has changed this situation, with new evidence demonstrating in some jurisdictions either a reduction in overall access to these psychosocial supports or a reduction in the diversity of services available.

Show me the money!

This raises a fundamental question.

If $4 billion of NDIS spending on psychosocial care is not going to the community sector organisations with decades of (underfunded) experience in providing this kind of housing, employment, education and social support to people with psychosocial needs, where exactly is this money going?

People receiving an NDIS package can either manage their own package (themselves or through a plan managers) or they can have an agency manage their package for them.  In September 2022, the split was around 60/40 in favour of self-managed packages.

For people self-managing their plans or using a plan manager, payments were made to 46,514 providers for NDIS-funded services, of which 82 percent were unregistered providers.

For agency-managed participants with a psychosocial disability, 4,979 providers received a payment, with 100 percent registered.

A registered provider is an approved person or provider of supports who is registered with the NDIS Quality and Safeguard Commission. While a registered provider can provide supports to all participants, an unregistered provider can only provide supports to participants who use a plan manager or who are self-managed.

Where agencies manage plans on behalf of individuals, as opposed to the individuals themselves, there is a clear preference to pay for services provided by registered providers.

NDIS data reveal that of 48,106 total providers of psychosocial services, 57 percent of these operate as individuals or sole traders. Given the severity or complexity of NDIS clients, it is likely they need support from a team of people. However, as is the case with fee-for-service healthcare in Medicare, it is not likely these funding arrangements encourage multidisciplinary, team-based care.

Allied health providers, psychology services and professional bodies have understood the opportunity associated with the advent of the NDIS. They refer to ‘improved daily living’ and ‘functional’ rather than ‘clinical’ improvement, as goals to emphasise for clients wishing to include psychological care as part of their NDIS funded packages, and to avoid confusion with Medicare-funded services.

It is worth noting here that for 50 minute appointments, a Medicare rebate of $89.65 applies for people with a Mental Health Care Plan referral from a doctor, with sessions capped (now) at 10 per calendar year.

The national peak bodies, the Australian Association of Psychologists Inc. (AAPi) and the Australian Psychological Society (APS) recommend a fee of $280 for a 50 minute session of psychology care under the NDIS, and there are no caps. There are strong incentives for psychologists to prioritise NDIS work over Medicare work.

In July 2018 Senator Rachel Siewert asked the NDIS (Question 884) if it knew how much it spent specifically on psychology. It did not.

Making the most of the NDIS opportunity

Minister Shorten also described the NDIS as the only lifeboat in the ocean.

There are 60,000 psychosocial clients in the Scheme now. It has been estimated that 64,000 Australians with severe and persistent mental illness would be eligible for the Scheme.

This suggests there are almost no places left on the lifeboat. Each year, around 700,000 Australians living with complex mental health conditions require psychosocial supports to live well and connect as contributing members of their community.

The fabled Tier 2 support services, designed to provide support to people outside the NDIS, have failed to emerge. This means the circumstances separating the 64,000th NDIS client from the 64,001st are massive and growing, raising issues of equity and fairness. This inequity is testament to the poverty of Australia’s mental health ‘ecosystem’, particularly its undeveloped psychosocial service sector.

The psychosocial sector provides opportunities where people can experience, develop and sustain their autonomy, adaptability and personal agency. This includes provision of useful tools and strategies helping people to connect to community and live contributing lives.

As it stands, the evolution of the NDIS as a funder of psychosocial services in Australia is hampered by a lack of accountability, standards and definition. Rare and precious psychosocial services, always peripheral, now face existential threats.

While significant new NDIS spending may have benefited some providers, it has not resulted in people being able to easily contact a vibrant and healthy psychosocial service sector.

An NDIS package should not preclude aspirations for recovery and opportunities to flourish. It should be the core focus and measuring outcomes along these lines should be a fundamental requirement. From this standpoint, ‘choice and control’ looks a mirage.

The Federal Government has instituted a review into the NDIS. As a priority, it should consider how to better understand and respond to the psychosocial needs of Australians. This would fit with recommendations made by the Productivity Commission in 2020.

There is still the potential for the NDIS to be the motor for the clear articulation of the role and potential for psychosocial services, driving their development to become fully fledged partners to clinical care, in prevention and across primary, secondary and tertiary mental health settings.

This work should be undertaken as part of an overall process of mental health service design, taking into account urgent re-design of corollary services in the health system, especially Better Access, so that we can capitalise on our valuable, finite human resources and create clearer, fairer pathways for people seeking psychosocial care.

Oasis, lifeboat, mirage.  Each of these metaphors indicate that for all the potential and excitement surrounding the NDIS and psychosocial support, it is in danger of becoming just another disconnected piece in Australia’s already fragmented response to mental illness.

• Dr Sebastian Rosenberg is Senior Lecturer, Brain and Mind Centre, University of Sydney

Note: Croakey asked Minister Shorten’s office for a copy of his speech to the conference, but this was not forthcoming. We had hoped to be able to provide a link for readers.


See Croakey’s archive of articles on the NDIS

 

Comments 1

  1. Keith says:

    Bill Shorten has elsewhere pointed to the cost shifting that has occurred with the states and territories vacating their own disability and psychosocial programs and pushing people into NDIS funded services with the strong inference that this is now primarily a Commonwealth responsibility.
    State Governments need to be brought to account on this virtual rorting of the purpose of the NDIS.
    (Note from Croakey editor: minor edit made for our editorial style).

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Search by: Categories or tags

Search