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.
What is the NDIS?
The NDIS is a national scheme to provide support for Australians with disability, their families and carers. The NDIS is designed to fund the support needs of people with significant and permanent disability. The NDIS takes a lifetime approach and aims to help people participate in work, society and other aspects of life.
In the context of the NDIS, people accessing the scheme are called Participants. NGOs and other agencies or individuals who provide support to Participants through the NDIS are called Providers.
It is important to note that 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. The NDIS uses different eligibility to the DSP, and RANZCP members have noted that some people qualified for the DSP but were rejected by the NDIS, or vice versa.
The NDIS is only open to Participants under the age of 65, and will not replace or supplement support arrangements for older Australians.
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. In 2019, the NDIS is expected to be fully operational and serve around 460,000 Participants.
Accessing the scheme
Once the NDIS becomes available in a particular area, residents can apply to be a Participant of the NDIS. The NDIS has specific access requirements and Participants will need to meet the age, residency and disability or early intervention access requirements. 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 provide consent to join the scheme, and the system is designed to give Participants maximum choice. As much as possible, Participants 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. To qualify for the NDIS, the condition must be lifelong and permanent. Recent changes to the NDIS have more clearly recognised that mental illness tends to episodic and that recovery should always be a primary goal. However, it can still be very challenging to provide evidence of mental illness that causes permanent disability.
Typical steps in the application process include:
- The Participant consents and determines the NDIS is right for them. The Participant needs to contact the National Disability Insurance Agency contact in their local area to commence an application.
- The Participant gathers paperwork and completes the application, which includes evidence to support a request to access from a health professional who knows them well.
- Once the NDIS has received all the evidence they need to make a decision, they will inform the Participant of their decision, ideally within 21 days. An initial NDIS assessment interview may be called, or they will proceed to planning.
- The first planning meeting will be arranged by the NDIS and the Participant will be assigned a Local Area Coordinator. Advocates, carers or health professionals may also be invited by the Participant for support at a planning meeting.
- Plans are typically scheduled for review on an annual basis. Advocates, carers or health professionals may also be invited.
- If the initial assessment is not successful, Participants are able to re-apply and provide additional information. There may be a waiting period of around three months.
The total processing time for Participants varies and may take months. Many RANZCP members have noted that challenges and delays in accessing the NDIS are common.
The role of psychiatrists
The NDIS may feel complex and confusing and Participants may need support and guidance to access the scheme. Psychiatrists should familiarise themselves with the NDIS, particularly the access and eligibility requirements. Psychiatrists should have a clear understanding of what the NDIS will and will not fund.
The NDIS has been designed so that primary care providers, such as GPs, will provide evidence to support a request to access. However specialists (including psychiatrists) may be asked to assist Participants to complete relevant documents. Specifically this may involve:
- completing the NDIS Supporting Evidence Form or sections of the Access Request Form
- documenting that the person has, or is likely to have, a permanent disability
- providing copies of reports or assessments relevant to the diagnosis that outline the extent of the functional impact of the disability.
The official Access Request Form and Supporting Evidence Form can only be provided by the NDIS.
Participants will need to contact the NDIS to obtain a copy. See an example form from the NDIA psychological awareness initiative, reimagine
Participants are expected to obtain necessary reports from health professionals that they see regularly and with whom they already have a relationship. In NDIS communication material, GPs are advised that they do not need to refer a patient to specialists for supporting evidence. GPs are advised to summarise or attach existing medical reports that describe the diagnosis/condition and the impact of the disability on the Participant’s function. The NDIS does not provide additional funding to compensate health professionals for conducting assessments and completing documentation.
As outlined above, NDIS Participants develop a plan, which forms the basis for individualised supports the NDIS may fund. Plans are developed and reviewed at meetings, which are typically conducted on an annual basis. NDIS Participants can choose to include anyone they would like in their planning, such as a family member, carer, advocate, statutory decision-maker, service provider or a health professional (including a psychiatrist). These meetings may be held by phone, and are often scheduled with short notice. Psychiatrists may also be able to provide information in writing for consideration at a planning meeting. There is no additional funding to compensate health professionals for contributing to the development of plans or attending meetings.
The NDIS is designed to support people with a permanent impairment or an impairment that is likely to be permanent. These provisions have been recognised as problematic in the context of mental illness.
In October 2017, work began on dedicated ‘psychosocial’ pathways for people with severe mental health issues. Psychosocial disability is a term used by the NDIS to describe a disability that may arise from a mental health issue. Not everyone who has a mental health issue will have a psychosocial disability. For those that do, it can be severe, longstanding and have a significant impact on a person's recovery.
For a person with a psychosocial disability to access the NDIS, they need to have a permanent or likely-to-be permanent disability as a result of their mental health condition. The condition must have a significant impact on their day-to-day life and the person’s ability to participate in the community. It needs to be likely that the person will need support for the rest of their life. This is important for psychiatrists to keep in mind when speaking to patients about the NDIS, and when supporting access and planning.
The NDIS has developed five snapshot documents to provide information to people with psychosocial disability, their supporters and service providers.
What will the NDIS fund?
The NDIS is designed to fund supports to help people with a disability pursue their goals and increase independence. This includes funds for practical devices and aids, home modification, decision-making and help with household tasks. The NDIS also funds training and support to build skills to live independently, including help to build social relationships and manage finances.
While the NDIS recognises that people with a disability may have more complex healthcare needs associated with their disability, the NDIS is not intended to replace the supports or services provided by the health system. The NDIS will not fund:
- the diagnosis and assessment of health conditions, such as funding for consultations necessary for NDIS plans and assessments
- clinical services and treatment of health conditions, medical services such as GP consultations, care while admitted in hospital, surgery, or the cost of medical specialists
- medications and pharmaceuticals
- sub-acute care such as palliative care, geriatric and psychogeriatric care and post-acute care, including nursing care for treating health conditions and wound management
- additional health costs, such as out-of-pocket health expenses, gap payments and private health insurance fees.
A Provider is an individual or organisation delivering a support or a product to a participant of the NDIS. Organisations or individuals register through a state-based process and must meet requirements regarding qualifications, experience and capacity for the approved supports. Providers are mostly NGOs and disability support organisations, and are categorised based on the support they provide. This may include housing, employment, assistive devices, transport, nursing care, training, home and vehicle modifications or mobility services.
Among health professionals only a registered nurse, occupational therapist, physiotherapist, podiatrist or psychologist may register to become a NDIS provider, and will need to provide evidence of current registration with the Australian Health Practitioner Regulation Agency (AHPRA).
Medical doctors, including specialists such as psychiatrists, are not listed among the professions stated in the NDIS Provider Suitability Guides.
In most states, psychologists and social workers may be included as Providers for counselling support and group therapy delivered as part of what the NDIS refers to as Specialist Positive Behaviour Support, Early Intervention Supports for Early Childhood, Support Coordination or Therapeutic Supports. Counselling sessions may be included as part of a Participant’s own plan of NDIS supports. This may be separate to a care plan developed by a GP or psychiatrist. Ideally, the NDIS will review all current care plans at the initial planning meeting.
The RANZCP has prepared submissions to inform the development of the NDIS.
This material is drawn from guidance on the NDIS website and Guides for Physicians and Paediatricians
, produced by the Royal Australian College of Physicians.
For more information, or to provide feedback on how the NDIS works in practice, please contact email@example.com.