Later this week, a Senate committee is expected to deliver its report into legislation to tighten eligibility for the National Disability Insurance Scheme (NDIS). The committee’s inquiry was extended and the bill amended in a deal with the Greens in June.
Author
- Lisa Grech
Senior Research Fellow, Psychology, Deakin University
This clears the way for a Senate vote on the legislation. If passed, Australians will need to show they have a permanent disability and have undertaken all appropriate and publicly funded treatment options before being allowed onto the scheme.
This will make it even more difficult for people with psychosocial disabilities , which arise from mental illness, to access the scheme.
People with psychosocial disabilities, including from conditions such as schizophrenia and major depression, may have symptoms and impacts that fluctuate. And they may have greater difficulty showing they’ve tried other treatments.
It’s already hard to show your disability is permanent
Just one in four people who apply to the NDIS with a psychosocial disability are approved for scheme access. This compares with about four in five applicants overall.
The access rate for people with psychosocial disability has fallen by nearly two-thirds in five years, from 66% to 25%, while access rates across all disabilities have remained steady.
To get onto the scheme, a person must currently show they have a permanent and significant disability that substantially reduces their functional capacity. They must provide evidence from their treating doctors, specialists and allied health professionals.
National Disability Insurance Agency (NDIA) planners currently weigh clinicans’ reports against the NDIS Act 2013 access criteria . Yet for psychosocial disability, the clinician’s voice can be set aside because the disability is not deemed permanent.
Consider a common scenario . The NDIA accepts an applicant with schizophrenia meets the psychosocial impairment criteria, then refuses access because the impairment “could not be shown to be permanent”. This is despite schizophrenia having no cure and the person already taking the first-line treatment for schizophrenia: antipsychotic medication.
It will be difficult to show you’ve exhausted all available treatments
The NDIA already asks participants to show evidence they have trialled appropriate treatments, as a way to show their disability is permanent. Under the proposed changes, this would be written into legislation.
This will make it harder to challenge NDIA decisions about disability permanence, as once it is written into the act , the tribunal must apply it.
The Greens deal reduced the burden from “all appropriate treatments” to any treatment that is publicly funded.
However this doesn’t mean it will be accessible . Medicare covers just ten psychology sessions a year, gap fees of well over A$100 a session are common, and public mental health waiting lists are long.
It’s unclear what further treatment assessors will expect, or why it’s assumed a person’s treating clinicians wouldn’t have already recommended anything likely to help.
People with psychosocial disability often have difficulty with memory, concentration and juggling tasks, planning and decision-making. Yet the system demands relentless self-advocacy.
Years of disability, poverty, isolation and unstable housing often mean people with psychosocial disability don’t have neat treatment records. These circumstances shouldn’t block access to support.
Prioritising scores rather than clinical assessment is risky
In 2021 the government tried to introduce “independent assessments” to replace reports from their own clinicians. These were supposed to be brief, standardised assessments by an assessor the participant hadn’t met before. The proposal was dropped after fierce opposition , including from researchers who found it lacked a robust evidence base.
The new NDIS legislation risks reviving this model, by shifting eligibility away from a evidence of disability provided by a clinician, to a standardised measure of “functional capacity” from 2028. This will assess how much a person can manage in their day-to-day life without supports or adjustments.
The tool’s assessment framework is yet to be determined or validated. The expert group tasked with working out this assessment is not expected to report its findings in full until 2027 – well after the legislation is expected to pass.
It will become harder to appeal wrong decisions
Across a three year period (2019-2021), 76% of the NDIA’s decisions have been overturned or varied when they made it to an independent review tribunal. Queensland Advocacy for Inclusion ‘s casework showed almost every participant who appealed ended up with more funding.
Yet the NDIS bill risks removing participants’ right to appeal. National Legal Aid warns a refusal to reassess a disputed plan would no longer be open to internal review.
Given the Administrative Review Tribunal can only accept applications once an internal review has been performed, that would close off the tribunal as a route of appeal as well.
For people with psychosocial disability, being told your impairment isn’t severe or permanent enough is destabilising. If the eligibility changes are legislated, more people could simply give up trying to access the support they need and fall through the cracks.
