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National Disability Insurance Scheme (NDIS): Information for psychiatrists

This page provides an overview of Australia's National Disability Insurance Scheme (NDIS), and explains the role of psychiatrists in helping people with a disability to access the scheme. 

The information displayed here is a guide only. Guidance should be sought from the National Disability Insurance Agency directly to ensure current information is obtained relevant to individual circumstances. Please refer to the NDIS webpage for further information.


What is the NDIS?

In brief

  • The NDIS is a national scheme to provide support for Australians with disability, including psychosocial, their families and carers.
  • The NDIS was initiated due to significant issues with disability support arrangements and the need for sector reform. It is funded and governed by the federal, state and territory governments.[1]
  • The NDIS is designed to fund the support needs of people with significant and permanent disability who struggle to perform everyday tasks or participate in activities
  • The NDIS takes a lifetime approach and aims to help people participate in work, society and other aspects of life.
  • The NDIS does not replace or fund mental health or treatment services provided through the health system. 
  • The NDIS does not replace the Disability Support Pension (DSP) and will not provide an allowance. It is possible for someone to be receiving the DSP but not be eligible for the NDIS, or vice versa.
  • The NDIS began in July 2013 as a trial in four locations and in July 2016, the Scheme began rolling out at sites across Australia. The NDIS is expected to serve around 460,000 participants. The psychosocial stream of the NDIS, aimed at helping those with severe or persistent mental health issues, will support 64,000 once at full capacity.[2]

Definitions

Episodic: a mental health condition can be permanent (lifelong) but be experienced episodically by participants. 

National Disability Insurance Agency: the government agency responsible for delivering the Scheme (NDIS). 

National Disability Insurance Scheme: a national scheme to provide support for Australians with disability, their families and carers.

Participants: people who are accessing the Scheme.

Permanent: likely to be lifelong.

Psychosocial disability: refers to how barriers arising from a mental health condition/s may affect how people think, feel and interact within the social and economic environment preventing equality with others. The individual nature of mental health conditions will mean not everyone with a mental health condition will experience psychosocial disability as described by the NDIS.

Recovery: achievement of an optimal state of personal, social and emotional wellbeing, as defined by each individual, whilst living with or recovering from a mental health issue.

Service providers: an individual or organisation delivering a support or a product to a participant of the NDIS which directly helps them to fully participate in the social and economic environment. 

Significant: severe impact on someone’s life and potential recovery, specific to their social and economic functioning. 


Role of psychiatrists

Assessment

Psychiatrists have a role in providing evidence of a significant and permanent disability as part of the assessment process for the NDIS. A specific diagnosis is not required, as the NDIS focuses on the functional impact of impairment on a person’s day-to-day life.

Assessment tools

The NDIS accepts several types of assessment tools when looking at evidence for participant suitability. These include (in order of preference):

1. Health of the nation survey (HONOS)

2. Life skills profile – 16 item (LSP-16)

3. World Health Organisation disability assessment schedule (WHODAS) 2.0 (17 years and over) or,

4. PEDI-CAT (16 years and under) – though this tool is not used for assessing psychosocial disability.

A request for evidence may be received from the:

  • patient
  • patient’s GP
  • mental health service provider, or
  • the NDIS Local Area Coordinator (LAC).

Assessment tools (see breakout box) can be used to provide evidence. Information about the person’s disability can also be provided by either completing the NDIS Supporting Evidence Form or completing the Access Request Form.

Supporting evidence of psychosocial disability and the functional impact it has on the person’s life may need to be provided in the form of relevant medical reports, assessments or letters.

The NDIS requires that the psychosocial disability has resulted in significantly reduced functioning in at least one of the following areas: [3] 

  • Communication: includes being understood in spoken, written or sign language, understanding others and the ability to express needs.
  • Social interaction: includes making and keeping friends, behaving within limits accepted by others and interacting with the community.
  • Learning: includes understanding and remembering information, learning new things and skills.
  • Mobility: the ability to move around the home and in public to undertake everyday activities.
  • Self-care: the ability to perform personal care, hygiene and everyday functions for themselves (including feeding, grooming, etc.).
  • Self-management: has the capacity to organise their life including being responsible and making plans for themselves (such as problem solving, managing finances, daily tasks, etc.).

Service provision

Due to the definition of ‘significant and permanent’ and the nature of the types of services funded by the NDIS, psychiatrists will have a limited, if any, role in the provision of services funded by the NDIS. Service providers generally provide ‘reasonable’ and ‘necessary’ supports which directly address participant barriers to fully participating in the social and economic environment.

Mental health interventions such as medication, treatments, psychotherapy and social interventions are not the types of support funded by the NDIS.

To be funded by the NDIS, supports provided by service providers must:

  • be related to the participant’s disability
  • not include day-to-day living costs that are not related to a participant’s disability support needs
  • represent value for money
  • be likely to be effective and beneficial to the participant, and
  • take into account informal and formal supports given to participants by families, carers, networks and the community.

Currently there are no psychiatrists listed as service providers as part of the NDIS. Psychiatrists wishing to register need to determine if they are eligible for NDIS funding, depending on the service they provide to participants. More information can be found in the Provider Registration Guide to Suitability.

The process and requirements for becoming a service provider varies between states and territories. Further information can be found in the Provider Toolkit.

Appeals / provision of further evidence

Psychiatrists may be asked to provide further evidence in an appeals process. The appeals process is led by the participant and the NDIA. More about the NDIS appeals process.


Fees

The most recent advice from the Department of Health is that the Medicare Benefits Schedule (MBS) can be utilised for assessments as part of the NDIS assessment process. Any service billed to the MBS needs to meet MBS item descriptions and any other relevant requirements.

The Department of Health has advised there are no MBS item numbers allocated for preparing reports outside of an associated service without a patient present or for providing further evidence for appeals.

It is important to note that all requirements of MBS item numbers need to be met.


How to access the NDIS

Criteria

Once the NDIS becomes available in a particular area, residents can apply to be a participant of the NDIS.

The NDIS has specific access criteria for those seeking to access the scheme due to a psychosocial disability.

To apply to access the Scheme participants must[4] 

  • have a psychosocial disability which is likely to be permanent (i.e. it is likely to be lifelong)
  • have the psychosocial disability significantly affect their ability to perform everyday tasks or participate in activities
  • likely require support to perform everyday tasks or participate in activities for their lifetime
  • be under 65 years of age
  • be an Australian citizen, a permanent resident or hold a Protected Special Category Visa
  • live in an area where the NDIS is available (the process differs slightly across states and territories, and pathways are impacted if participants already receive support from a state or territory government disability program).

Participants need to consent to access the Scheme and direct their own plan of support.

Participants will need to consult a health professional to assist in providing evidence of their disability. This includes information on the nature of the disability, how long it will last and its impact on work and other aspects of life.

Steps in the application process

Typical steps in the application process may include:

  • Participant contacts their Local Area Coordinator office (LAC)
  • Participant gathers evidence as required
  • Participant returns all forms and evidence to the relevant office for processing
  • The NDIA should make a decision within 21 days of a completed application being submitted.

Those who are not eligible for the NDIS

There will be individuals who will not be eligible for the NDIS. Those who are not eligible but require assistance can contact the Local Area Coordinator in their area to be referred to appropriate services.

The Australian Government committed $80 million over four years to Primary Health Networks (PHNs) to provide psychosocial support services to assist people with severe mental illness resulting in reduced psychosocial functional capacity who are not more appropriately funded through the new NDIS services. This commenced in January 2019.

Continuity of Supports (CoS) is a psychosocial support program for clients of Partners in Recovery (PIR), Personal Helpers and Mentors (PHAMS) or Day to Day Living (D2DL) but who were found ineligible for the NDIS.[5] 


RANZCP Submissions

The RANZCP has prepared a number of submissions to inform the development of the NDIS.

External links


References

This material is drawn from guidance on the NDIS and reimagine websites, Australian Department of Health and the National Disability Insurance Agency.

1. Buckmaster, L., & Clark, S (2018) The National Disability Insurance Scheme: a chronology, Research paper series, 2018-19, July 2018. Available at: https://parlinfo.aph.gov.au/parlInfo/download/library/prspub/6083264/upload_binary/6083264.pdf (accessed 25 July 2019).

2. National Disability Insurance Scheme (2018) Government announces improved NDIS mental health support. Available at: https://www.ndis.gov.au/news/400-government-announces-improved-ndis-mental-health-support (accessed 9 April 2019).

3. National Disability Insurance Agency (2017) Accessing the NDIS: A guide for mental health professionals. https://www.ndis.gov.au/media/121/download (accessed 11 July 2019).

4. Please note these are a guide only and are subject to change so please consult with the National Disability Insurance Agency (NDIA) directly to ensure you have the current NDIS access criteria.

5.Australian Department of Health (2019) Psychosocial support for people with severe mental illness. https://www.health.gov.au/internet/main/publishing.nsf/Content/psychosocial-support-mental-illness (accessed 11 July 2019).


For more information, or to provide feedback on how the NDIS works in practice, please contact policy@ranzcp.org.