7 May 2018

Mental health crisis looms over NDIS

Government Mental Health TheHill

GPs will face added pressures as patients with mental illness are stripped of services to pay for a national scheme that won’t support them, advocates say.

A report commissioned by leading mental health NGOs in Victoria warns of a “growing catastrophe” affecting patients with psychosocial disability as the National Disability Insurance Scheme is rolled out.

“It is a very concerning picture for a host of reasons,” Angus Clelland, CEO of Mental Health Victoria, told The Medical Republic. 

“There are potentially tens of thousands of people who won’t get access to a service,” he said. “They will likely have to fall back on general practitioners.” 

But if they didn’t do that, as many wouldn’t, they would likely end up in acute care, Mr Clelland said.

The organisation says some 180,000 people, or 3% of Victoria’s population, are on the “severe and complex” end of the psychosocial disability spectrum. 

But only a small portion – about 10-15% – will receive NDIS packages, while their community-based support, prevention and rehabilitation services are being dismantled to fund the national scheme.

Last week’s Victorian state budget came as a massive disappointment for the sector, bringing a welcome lift for acute mental health care and facilities but no rescue for community services.

“Chronic underfunding has seen Victoria gain the dubious distinction of having the lowest per-capita expenditure on mental health in Australia,” Mental Health Victoria said in its budget response.

“In the past four years, the number of emergency department mental health admissions has jumped by 19% to more than 52,000 per year – that is one admission every 10 minutes,” it said.

“Further investment is needed, not only in bricks and mortar, but in services delivered in the community to prevent people getting into crisis. These services are inexpensive and are proven to reduce hospital admission rates.”

Amanda Bresnan, chief executive of Community Mental Health Australia, said systemic problems with the NDIS and mental health patients were universal. 

People with mental illness had trouble engaging with NDIS assessors, they tended to withdraw from complex application procedures, and episodic mental illness was “a poor fit” with the bureaucratic concept of permanent disability. 

But Victoria had particular difficulties because the Napthine Liberal government had agreed in 2013 to transfer its community funding into the NDIS.  

“I think Victoria is going to be a bit of a flashpoint,” Ms Bresnan said.

Around the country, GPs and psychiatrists would face heavier workloads to help eligible patients qualify for the NDIS, she said.  They would also need to know where to refer patients if community supports fell away. 

“GPs are a crucial part of this process. They need access to information about what is required through the NDIS process, because it is different from what they are used to providing,” Ms Bresnan said.

“Mental illness is a diagnosis, but the NDIS is about people’s ability to function every day. That’s a real challenge – making those two things fit together. 

“GPs and psychiatrists need to know that it’s not just about diagnosis, it’s about functionality,” Ms Bresnan said. 

In many cases, NDIS assessors had rejected patients because doctors’ reports were deemed inadequate, she added. 

The Victorian report,  Mind the Gap: NDIS and Psychosocial Disability, describes the defunding of community-based mental health services to pay for the NDIS as a “short-sighted quick fix”. 

The report was commissioned in response to concerns that that lessons from the NDIS roll-out in the Barwon region of southwest Victoria – one of the first four NDIS trial sites in 2013-16 – were not being heeded. 

“Of great concern is the loss of psychosocial rehabilitation, a central pillar of community mental health, which is the step down from clinical or acute care,” it says. 

It points to the loss of programs that help people avoid acute, expensive episodes of illness. 

“This method of funding the NDIS may well lead to a greater proportion of Victorians ultimately reaching the level of disability needed to qualify for the scheme.” 

State-backed drop-in centres and recovery-focused rehab services – considered key in monitoring hard-to-reach patients – are expected to disappear by mid-2019. 

Nationally funded programs, such as Personal Helpers and Mentors (PHaMs), Day to Day Living, and Mental Health Carer Respite Support, are also being scaled back as their funding is transferred to the NDIS.

The report was compiled by researchers at Sydney University’s Policy Lab from interviews with providers, carers and clients in the Barwon region and elsewhere in the state. 

“Stakeholders explained that the severe impact has been partially hidden for the short term because organisations have been providing non-sustainable ‘free’ services,” the report says. 

“The goodwill of the community sector is temporarily and unsustainably plugging many service and support gaps for Victorians living with severe mental illness.”