Psychosocial Disability – where mental health meets disability

Since its launch on July 1st 2013, the National Disability Insurance Scheme, NDIS, has delivered funding for individuals with disabilities across Australia. The scheme has been gradually rolling out across different regions and is expected to fully operative across Australia by July 2019.
Questions remain about whether NDIS covers individuals with mental health diagnosis such as generalised anxiety disorder and depression.
The National Disability Insurance Agency (NDIA), which runs the NDIS, has bilateral agreements and works in partnership with the mental health sector to develop shared understandings of mental health recovery. Although clinical management of mental illness remains the responsibility of health and mental health services, strengthening mainstream supports for people with disabilities is a key component of the NDIS.
Psychosocial disability is the term used to describe a disability that arises from a psychiatric diagnosis. While not all individuals suffering a mental illness experience disability related to their mental health condition, others experience severe effects and social disadvantage.
Although it is difficult to define psychosocial disability, its impacts are profound and include homelessness, low income, interrupted education, poor labour force participation, poor physical health, a high level of co-occurring conditions, stigma and discrimination as well as social isolation.
Accessing NDIS funding for support based on psychosocial disability as a primary diagnosis, requires evidence of the likelihood that the disability will be permanent and can be provided by a GP or psychiatrist. The impact of the psychosocial disability on everyday life can be assessed by an allied health professional such as occupational therapist, psychologist or social worker by completing a functional assessment.

At present, psychosocial disability has the highest ineligibility rates with the NDIS. According to the Independent Advisory Council for the NDIS’s Advice on Implementing the NDIS for People with Mental Health Issues, “one in four applications requesting access due to primary mental illness are being determined as ineligible compared to one in nine for applicants across the rest of the Scheme”.
The proposed explanation lies in the conflict that arises between the concept of recovery in mental health and its episodic nature, and the NDIS core eligibility criteria of permanency — ie. The likelihood that the impairment is permanent. Complicating the problem, achieving eligibility largely relies on the assessor’s skills.
When people talk about mental health recovery, they do not mean a life without symptoms of mental illness, something that may not be possible for some people. Due to the episodic nature of mental illnesses, future episodes of relapse can occur even when individuals are in clinical recovery.
Although this poses a challenge to accessing NDIS funding for individuals with psychosocial disability, the concept of ‘permanency’ is not irreconcilable with the concept of recovery.
Paul O’Halloran (MHINDS) offers a definition of recovery that is in line with the NDIS Act: “from a psychosocial disability perspective, recovery means learning or maintaining skills to cope with the daily tasks of living, overcoming barriers to economic and community participation and accessing opportunities for greater social inclusion.
“Outcomes are optimised where consumers and families have choice about and access to whatever aspects of recovery are needed to support their efforts to cope with, adapt to, or overcome the impact of mental illness.”

References
O’Halloran, P. (2014). Psychosocial Disability and the NDIS: An Introduction to the Concept of Holistic Psychosocial Disability Support https://ndis.gov.au/html/sites/default/files/O’Halloran%20paper.pdf
Mainstream Interface Mental Health

Independent Advisory Council for the NDIS Advice on Implementing the NDIS for People with Mental Health Issues
https://ndis.gov.au/about-us/governance/IAC/iac-advice-mental-health.html

Psychosocial disability, recovery and the NDIS
https://www.ndis.gov.au/medias/documents/heb/h21/8799160959006/Fact-Sheet-Psychosocial-disability-recovery-and-the-NDIS-PDF-774KB-.pdf

Mainstream Interface Mental Health
https://www.ndis.gov.au/medias/documents/h48/hcb/8800552026142/Factsheet-MainstreamInterfaces-Mental-Health.pdf

Completing the Access Process for the NDIS: Tips for Communicating about Psychosocial Disability
https://www.ndis.gov.au/medias/documents/ha5/h5b/8797799415838/Completing-the-access-process-for-the-NDIS-Tips-for-communicating-about-psychosocial-disability-PDF-KB-.pdf

Psychosocial Supports Design Project: Final Report
https://www.ndis.gov.au/people-disability/fact-sheets-and-publications.html

Psychosocial Disability and the NDIS: https://www.ndis.gov.au/medias/root/h18/hc6/8803227533342/Psychosocial-Disability-Key-Products-And-Resources.pdf