Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697643311287.pdf (Australia)
The Australian Society of Rehabilitation Counsellors Ltd (ASORC) Submission to the Joint Standing Committee on the National Disability Insurance Scheme On The provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition February 2017 Emailed to: Committee Secretariat Joint Standing Committee on the National Disability Insurance Scheme PO Box 6100 Parliament House Canberra ACT 2600 Phone: +61 2 6277 3083 Fax: +61 2 6277 5829 ndis.sen@aph.gov.au PO Box H189 Hurlstone Park NSW 2193 Telephone: 1800 643 155 E-mail: admin@asorc.org.au www.asorc.org.au ACN 6169 71 138 The provision of services under the NDIS for people with psychosocial disabilities related to a mental health conditionSubmission 61 Table of Contents Introduction ..................................................................................................................................... 3 Executive Summary ....................................................................................................................... 4 Recommendations ......................................................................................................................... 5 Terms of Reference 1a .................................................................................................................. 6 Terms of Reference 1i ................................................................................................................... 8 References ....................................................................................................................................... 9 ASORC Submission to the Joint Standing Committee on the NDIS – February 2017 2 The provision of services under the NDIS for people with psychosocial disabilities related to a mental health conditionSubmission 61 Introduction The Australian Society of Rehabilitation Counsellors Ltd (ASORC) thanks the Joint Standing Committee on the NDIS for its inquiry into the provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition.
ASORC is the peak professional body representing rehabilitation counsellors throughout Australasia.

Established in 1976, ASORC is a non-party political, non-sectarian and not for profit organization.

The mission of ASORC is to promote the profession of rehabilitation counselling and to foster the professional capability of its members.
Rehabilitation Counsellors are Allied Health Professionals who work within a counselling and case management framework to assist people who are experiencing disability, a health condition or social disadvantage to participate in employment or education, or to live independently and access services in the community.

ASORC provides:  A long standing and respected voice for the profession (over 30 years since inception).
 Resources, education, mentoring and supervision necessary for members to achieve career advancement and enhanced credibility in the profession and in the community.

 A robust set of core competencies and code of ethics  Access to latest research and academic commentary through the ASORC ® Journal (AJRC).

 Access to a network of similarly skilled and minded professionals across Australia.
We are pleased to provide our submission and have chosen to provide responses to the following two of the Committee’s nine terms of reference (TOR):  TOR 1a: the eligibility criteria for the NDIS for people with a psychosocial disability  TOR 1i: any related matter ASORC Submission to the Joint Standing Committee on the NDIS – February 2017 3 The provision of services under the NDIS for people with psychosocial disabilities related to a mental health conditionSubmission 61 Executive Summary ASORC is concerned that the National Disability Insurance Authority has not accurately estimated the number of people with mental health disability, especially in the context of an holistic approach to individuals’ level of combined physical and psychological functioning.
Similarly, ASORC is concerned that NDIS’ existing assessment processes do not assess the individual’s experience of overall disability but rather focus on assessing disability in a compartmentalized manner, thereby excluding people from the system when their whole-of- life experience of disability may be severe-profound in its impacts on education, employment and social inclusion.
This narrowly-framed approach has significant economic impacts on Australia’s productivity and frustrates the capacity of the NDIS to achieve the national impact it was designed to achieve.

ASORC also believes that work-related mental health disability is an important consideration when allowing for provisions under the NDIS.
Given that many people experiencing psychological conditions do so within workplace settings where conflict or harassment may have been experienced, many such workers may fall outside of workers' compensation systems and rely on various forms of community care.

This type of psychological disability is often acute and rapid requiring prompt interventions.

Depending on their level of incapacity individuals may or may not be eligible for NDIS services.
ASORC notes that professional standards and competencies exist for the accreditation of individuals who provide assessments of people with disability.

ASORC is concerned about the extent to which individuals conducting disability assessments under the NDIS have achieved an appropriate standard of competency.

To this end the Society proposes the following four recommendations.
ASORC Submission to the Joint Standing Committee on the NDIS – February 2017 4 The provision of services under the NDIS for people with psychosocial disabilities related to a mental health conditionSubmission 61 Recommendations Recommendation 1: That the NDIA estimates of the number of people to be included within its service framework be revised to properly account for the needs of people with psychological disability.
Recommendation 2: That the assessment of disability with regards to eligibility for NDIS services focuses on: i. ii.

the individual’s overall experience of disability, rather than discounting the experience of disability by taking a compartmentalised approach to a person’s experiences of differing impairments the socio-economic impacts of disability (e.g.

disability serves as barrier to education, employment or social inclusion) rather than on abstracted, clinical measures of impairment.

iii.
iii.

The requirement for NDIS assessors to have the necessary qualifications, accreditations, professional memberships, competencies and experience to assess the rehabilitative needs of people presenting for care of work-related mental disorder that fall outside compensation and rehabilitation systems Recommendation 3: ASORC seeks clarification as to the level of disability that the NDIA associates with work-related mental disorders such that an individual would qualify for a package of services.
Recommendation 4: ASORC members be utilsed/employed in private and public service provision facilities across Australia, to provide essential work related mental health assessment, counselling and case management services and that Counsellors with this level of expertise be involved in all aspects of care of people seeking NDIS services with regard to these conditions.
ASORC Submission to the Joint Standing Committee on the NDIS – February 2017 5 The provision of services under the NDIS for people with psychosocial disabilities related to a mental health conditionSubmission 61 Terms of Reference 1a The eligibility criteria for the NDIS for people with a psychosocial disability In addressing this TOR we raise the following three specific issues: (i) The need for NDIS to recognize the needs of people who experience a psycho-social disability arising from their work experience Work related mental distress is a significant issue in Australia, accounting for 5% of all work- related compensation claims (Safework Australia 2006).
More recently, in 2013–14, injury and musculoskeletal disorders led to 90 per cent of serious claims and the most common were traumatic joint/ligament and muscle/tendon injuries (45 per cent).

Diseases led to 10 per cent of serious claims and the most common were mental disorders (6 per cent) (Safework Australia 2013).

These conditions can result from exposure to trauma or work related distress.
These claims are associated with a significant cost to the individuals and the economy, with individuals out of the workforce either for extended periods of time, or permanently.

Safework data demonstrates that on average 5,000 people lodge a claim for this condition each year with such claims constituting 20% - 30% of all work related occupational disease claims over time.
Of those who return to work, individuals may have spent between 15 and 43 weeks away from, with longer absences correlated with non-return to work.

Work-related psychological injuries may contribute to or instigate psychological disability.

Rehabilitation Counsellors serve as the first line of assistance for workers with work related mental distress.

These counsellors are involved in client needs assessment, counselling services of various kinds, clinical service referral and case management.
These are complex tasks requiring the expert skills of properly trained health professionals.

Given that many people experiencing these conditions do so within workplace settings where conflict or harassment may have been experienced, then such workers may fall outside of workers' compensation systems and be forced to rely on various forms of community care.
The work of Rehabilitation Counsellors is vital both in the provision of such care and in assisting individuals who are able, to return to work over time.

Under NDIS, eligible individuals can receive individual and group supports and rehabilitation services which focus on support for employment, vocational training and higher education.
Therefore, Rehabilitation Counsellors not only serve as an initial line of assistance but also provide a wide range of services that are supported under the NDIS to enable individuals to undertake employment or community engagement.
Given that Rehabilitation Counsellors may assist in placing individuals with mental disability into work and also manage negative effects of work on the individual’s mental health following a Workers Compensation claim, they are uniquely placed to comment regarding current concerns with the NDIS model relating to the eligibility criteria for the NDIS for people with a psychosocial disability broadly and in a work-related context.
(ii) Clarification of NDIS assessment criteria for determining access to NDIS for people with a non-compensable work-related psycho-social disability The NDIS is designed to attend to the needs of people with a severe to profound experience of disability.
However, it is far from evident, particularly in the case of mental illness, how the NDIS defines such a level of disability nor is it evident, the kinds of assessment tools or indicators that would be used, such that there is a coherent national approach to the management of these peoples’ needs.

Clarification is required as to the level of disability that the NDIA associates with work related mental disorders such that an individual would qualify for a package of services under the NDIS.
ASORC also points out that the effects of work related mental disorders may be severe and permanent in nature, particularly if left untreated.

Attributes of this condition may include the inability to return to work, loss of capacity to pay bills etc, substance use, secondary mental health disorders such as agrophobia, anxiety, depression and so on.
ASORC Submission to the Joint Standing Committee on the NDIS – February 2017 6 The provision of services under the NDIS for people with psychosocial disabilities related to a mental health conditionSubmission 61 ASORC wishes to draw the Inquiry’s attention to the episodic nature of psycho-social disability and the impact that episodic experiences of severe to profound psycho-social disability may have in terms of access to the NDIS.
ASORC raises this issue with particular regard to the overall productivity goals that have underpinned the development of the NDIS as well as its assumptions as to the nature of disability.

Without appropriate and often sustained levels of support, a person with a psycho-social disability, such as that resulting from work-related distress (e.g.

a community volunteer fire fighter) may not be able to sustain employment, and in addition experience a cascade of negative socio-economic effects.
Similarly, the experience of psycho-social disability differs greatly from physical or intellectual disability, to such an extent, that an unconscious bias may exist within the NDIS assessment process.

That is, that the assessment process is driven by taken-for-granted, untested assumptions, held by system designers and assessors, as to what is a disability (e.g.

physical) and what is not (e.g.

psycho-social disability).

Such unconscious bias needs to be urgently addressed by the NDIS.
ASORC similarly expresses its concern that the developing NDIS system with regards to psycho-social disability will result in a reduction of services in terms of access or availability, wherein people do not qualify for a suitable NDIS package of services.

This is particularly the case as state jurisdictions pass over their responsibilities and budgets for such services to the Commonwealth.
If this were to occur, it would result in a situation, referred to as the oasis effect, wherein one group of people are provided with a high level of assistance, while the needs of the rest are left unattended.

A transparent, coherent and integrated model of service provision is required such that it is evident and apparent as to how the needs of people within and without the NDIS system will have their mental health needs addressed, and to what extent.
Similarly, the service delivery model must make transparent, where jurisdictional responsibilities lie in this regard.

(iii) Need for properly qualified assessors Access to the NDIS is determined by assessments conducted by NDIS appointed assessors.
ASORC contends that such assessors must have obtained a recognised level of skill and expertise in the assessment and appropriate management of the impacts of psycho-social disability and rehabilitative needs of people with a non-compensable work-related psycho- social disability that determine access We express our concern as to the extent to which NDIS assessors presently have achieved this level of competency.
Where assessors have failed to obtain this level of competency ASORC contends that such assessments be referred to a properly qualified Rehabilitation Counsellor.
ASORC Submission to the Joint Standing Committee on the NDIS – February 2017 7 The provision of services under the NDIS for people with psychosocial disabilities related to a mental health conditionSubmission 61 Terms of Reference 1i Any other related matters In consultation with ASORC members it is within the work context that ASORC draws the inquiry's attention to two important issues and concerns with regards mental health and the NDIS.
(i) Capacity to choose ASORC wishes to draw the Inquiry’s attention to the support needs and people with severe to profound psycho-social disability with regards to choosing a service provider, particularly when they are acutely impaired.

We note that when experiencing this level of impairment, an individual's capacity to negotiate the development and provision of a range of services may be sufficiently compromised that they are unable to engage in such processes without assistance or support.
A process of planning for services is required that serves to inform and educate the clients in such a way that it empowers them to navigate a program of service delivery that meets their needs.

(ii) Cumulative experience of disability Problematically, the NDIS is designed on the assumption that a person with a disability lives with the experience of a single impairment that is permanent in nature.
The assessment, funding and management processes under the NDIS make little provision for the fact that people may experience, for example, several disabilities concurrently that are moderate to severe in nature and that this combined experience of disability results in the person having needs for permanent support from a person or needs for aids/equipment to do everyday things for themselves.

An analysis of data from the Survey of Disability Ageing and Carers illustrates this point.
In its submission to the Joint Parliamentary Inquiry on Hearing and the NDIS, ASORC provided evidence of just one of many examples wherein the joint experience of multiple, moderate to severe disabilities, in functional terms, equated to the experience of severe to profound single disability.
We therefore make the following recommendations: Recommendation 1: That the NDIA estimates of the number of people to be included within its service framework be revised to properly account for the needs of people with psychological disability.

Recommendation 2: That the assessment of disability with regards to eligibility for NDIS services focuses on: i. ii.
the individual’s overall experience of disability, rather than discounting the experience of disability by taking a compartmentalised approach to a person’s experiences of differing impairments the socio-economic impacts of disability (e.g.

disability serves as barrier to education, employment or social inclusion) rather than on abstracted, clinical measures of impairment.

iii.
iii.

The requirement for NDIS assessors to have the necessary qualifications, accreditations, professional memberships, competencies and experience to assess the rehabilitative needs of people presenting for care of work -related mental disorder that fall outside compensation and rehabilitation systems Recommendation 3: ASORC seeks clarification as to the level of disability that the NDIA associates with work-related mental disorders such that an individual would qualify for a package of services.
Recommendation 4: ASORC members be utilsed/employed in private and public service provision facilities across Australia, to provide essential work related mental health assessment, counselling and case management services and that Counsellors with this level of expertise be involved in all aspects of care of people seeking NDIS services with regard to these conditions.
ASORC Submission to the Joint Standing Committee on the NDIS – February 2017 8 The provision of services under the NDIS for people with psychosocial disabilities related to a mental health conditionSubmission 61 References Australian Bureau of Statistics (2003; 2012) Survey of Disability Ageing and Carers.
Catalogue 4430.0 Canberra http://www.abs.gov.au/ausstats/abs@.nsf/mf/4430.0) Hogan, A; O’Loughlin, K; Kendig, H; Davis, A.; (2009) Hearing loss and employment International Journal of Audiology, 48:3 117-12.
WORK-RELATED MENTAL DISORDERS IN AUSTRALIA, SafeWork Australia 2006 - http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/416/Workrela ted_Mental_Disorders_Australia.pdf AUSTRALIAN WORKERS COMPENSATION STATISTICS, Safework Australia 2013-2014- http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/961/Australia n-Workers-Compensation-Statistics-2013-14.PDF ASORC Submission to the Joint Standing Committee on the NDIS – February 2017 9 The provision of services under the NDIS for people with psychosocial disabilities related to a mental health conditionSubmission 61