David Meldrum, Executive Director

Who will be eligible for an individually funded package? Can the Scheme stay on target ? What do we know about their needs and challenges? How have we responded to those needs and challenges so far? What more does the NDIS offer to these people and their families?

People with severe and persistent mental illness and the NDIS

The Australian adult population in need of NDIS individually funded supports as result of psychosocial disability related to mental illness is expected to be 0.4 %: that is 12% of people with severe and persistent mental illness. Productivity Commission 2011

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Description Care Needs NDIS coverage Episodic mental illness (est. 321,000 people)

Clinical services both during episodes of illness

and to maintain remission between episodes

Disability support services may occasionally be

required, particularly during a lengthy episode

of illness

Not included Not included

Severe and persistent mental illness but can manage own access to support systems (est. 103,000 people)

Clinical services

Social inclusion programs

Not included Not included

Complex needs requiring

coordinated services from

multiple agencies (est. 56,000)

One on one support from a carer (paid)

Supported accommodation, where appropriate

Clinical services

Social inclusion programs

Included Included Not included Included

NDIS – 56,000

Complex, severe, ongoing disabilities resulting from severe and persistent mental illness (with recent diagnostic evidence). Additional evidence might be several of— •frequent hospitalisation for mental illness •current or recent history of being on the caseload of public mental health services •minimal employment in recent years •poor physical health •insecure housing •extreme social isolation

Until we are clear about who is in we can’t plan for those who will be out

A proposed definition

0 5 10 15 20 25 30 35 40 45

Financial Support

Loneliness & isolation

Lack of employment

Poor physical health

Uncontrolled symptoms of MI

Lack of stable/suitable housing

Stigma/discrimination

No family or carer

Inability to access spec MH services

Diff getting to medical appts

People Living with Psychosis – self identified needs

80:20 Principle- Supporting a person living with serious mental illness

Recovering Quality of Life

Mental and Physical Illness Management

Peer support

Supported Accommodation

Carer Education & Support

Activity Programs

Education

Employment

Social Security

Support Groups

Housing & Home support

Justice

Child protection

Hospital (General and Psych)

General Practitioner

Psychiatrist

Psychologist

Private Mental Health

Medical specialists (various)

Emergency Department

Community Clinical Services

Families, friends & carers

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Packages of support do exist for NDIS-eligible people and their carers in most states and territories including: IPRSS/HASI/My Way/ICLS/HASP (mainly hybrids of block and individual funding) Complex care coordination has also developed, including: Services Integration Coordinator (SIC – Qld) Multiple and Complex Needs Initiative (MACNI – Vic) Partners in Recovery (PIR—Commonwealth)

What intensive disability supports we offer now

Supply—not enough intensive support, waiting lists, black holes No guarantee of continuity Limited providers in any given place—few choices The NDIS promises to address all of these

The limits up till now

•Maintaining hope

•Finding meaning

•Acceptance and learning •Social support •Regaining emotional and psychological equilibrium •Community participation

And I would want to add.....preventive impacts of a recovery focus, particularly in the costs to government

Recovery - Steps to more effective coping & adaption

Paul O’Halloran MHINDS - NDIS 2015

• Easy access to support

• Early intervention

• Help for significant distress

• Effective, evidence-based medication

• Someone to talk to

• Access to information & help about recovery

• Family interventions

• Support for good physical health and wellbeing

• Practical help to coordinate

• Outreaching and intensive

• Recovery support to create choices and explore opportunities

What we offer

Paul O’Halloran MHINDS - NDIS 2015

The need for simultaneous, intense and multiple types of support due to interlocking factors that span disability, health, behavioural and social issues (Rankin & Regan, 2004)

Some, or all, domains may be experienced by an individual with complex support needs but no ‘generic’ case

Domains can change throughout the individual’s life course

Not a static or permanent experience. Instead, more likely to arise in certain situations, episodes or life stages such as at key transition points or in times of crisis

Defining complex support needs

Assoc Prof Leanne Dowse, Chair Intellectual Disability Behaviour Support, UNSW

Natalie Total Cost

Police $ 475,179

DoCS $ 46,290

DCS $ 90,788

DJJ $ 103,151

Housing $ 13,837

Health $ 64,014

Courts $ 17,188

Legal Aid $ 28,794

PHDAS $ -

Centrelink $ 113,730

Justice Health $ 18,430

ADHC $ 4,700

Total $ 976,106

Baldry, E., Dowse, L., McCausland, R. & Clarence, M. (2012) Lifecourse institutional

costs of homelessness for vulnerable groups. Report for the National Homelessness

Research Agenda 2009-2013

Assoc Prof Leanne Dowse, Chair Intellectual Disability Behaviour Support, UNSW

Intra and inter-agency collaboration

Proactive rather than reactive

Comprehensive case management

Specialist mental health, positive behaviour and trauma support

Challenges for a ‘complex needs capable’ workforce

Assoc Prof Leanne Dowse, Chair Intellectual Disability Behaviour Support, UNSW

“I felt like a speck in the ocean. I felt like I was going in circles as I got no answers. I have turned around since PIR has come in. I’m accessing an occupational therapist, speech therapist and a dietician, starting fishing again as well as going to church. I am about to start seeing a counsellor. I don’t feel so isolated now.”

PiR participant and staff comments

“The benefit for participants and carers is that PIR takes away the stress and fear that can be associated with trying to contact agencies. Many of our participants can find the thought of having to talk to someone daunting, which can affect their anxiety. The fear of rejection by a service can stop them reaching out for help and support. PIR takes this pressure away.”

“Before PIR I would miss appointments and fall behind on my health regime. Since PIR began to help, I am able to link in and get to all these services. My Support Facilitator has come to appointments with me and advocated for me. My standard of living has improved enormously.”

Carers and the NDIS COAG Disability Reform Council 13 November 2015 Communiqué Ministers reconfirmed the significant role that carers play in supporting people with disability, including NDIS participants, and agreed that the role and inclusion of carers in the NDIS should be promoted. They requested that the NDIA reviews its policies and other resources to ensure appropriate inclusion of carers in all aspects of the NDIS.

So.... Get the target group right and stick to it Be realistic and honest about who is not eligible, and plan for their supports Plan all interventions around a recovery (and prevention) focus Make our responses more holistic, not less Recognise that complex care coordination is central and indefinite Build on the workforce that has those skills, beginning with explicit valuing of their skill-sets Acknowledge the limits of choice and control

It’s important to build on this progress

National Disability Insurance Scheme Act 2013

Part 2 Div 2 Section 34

(1) ....Reasonable and necessary supports

(c) support represents value for money

(d) support will be, or is likely to be, effective and beneficial

(e) support takes account of what it is reasonable to expect families, carers, informal

networks and the community to provide;

(f) the support is not more appropriately funded or provided through other general systems

of service delivery or support services

Let’s not look back in 2020 and say

I have squandered my resistance for a pocketful of mumbles, such are promises

(Simon and Garfunkel, The Boxer)