Culture clash? Recovery in mental health under Australia’s National Disability Insurance Scheme – a case study

Abstract

Objective: Using a case study, we aim to report on the compatibility of funding and policy settings under Australia's National Disability Insurance Scheme (NDIS) with the delivery of evidence based, recovery-oriented psychosocial services. Type of program or service: We reflect on the impact of the NDIS on a psychosocial rehabilitation service run by Woden Community Service (WCS), one of the major service providers in the Australian Capital Territory, and specifically its Transition to Recovery (TRec) program. Methods: We examine NDIS funding and policy settings and consider the recovery-oriented practices underpinning psychosocial programs like TRec. The construct of the program, its staffing and related issues are considered. The article draws on a formal evaluation of TRec conducted in 2015. Results: The NDIS is having a seismic impact on Australia's psychosocial sector. Despite its positive evaluation, the future of the TRec program is problematic. Practically, service exit points have disappeared, reducing the program's capacity to properly transition clients between services and effectively increasing the likelihood of relapse. More generally, current NDIS policies are threatening the fidelity of WCS's approach to recovery practice. Lessons learnt: This case study highlights tension between a new public insurance scheme primarily aimed at better managing consistent conditions and circumstances, and the recovery philosophy which has emerged in relation to episodic mental illness. This has implications for psychosocial services nationwide. The psychosocial rehabilitation sector has always been a peripheral element of Australia's mental health service mix. The advent of the NDIS offers hope that this may change. However, WCS's experience suggests that the NDIS must reconsider how best to foster recovery-oriented practice in mental health. This should be part of a more fundamental reconceptualisation of the role of psychosocial rehabilitation services in contemporary mental

The National Disability Insurance Scheme and people with severe and persistent mental illness/psychosocial disability: A review, analysis and synthesis of published literature

“… NDIS: National Disability Insurance Scheme; NDIA: National Disability Insurance Agency; PSD: psychosocial disability. † Numbers listed in this column refer to the following publications: 1, Aitken et al (2019); 2, Barclay et al (2020); 3, Cashin (2014); 4, Dickinson and Carey (2017); 5, Diminic et al (2019); 6, Furst et al (2018); 7, Gillieatt et al (2018); 8, Hancock et al (2017); 9, Hayes et al (2018); 10, Horsfall et al (2018); 11, Isaacs et al (2018); 12, Kay and Kendall (2017); 13, Maker et al (2017); 14, Malbon et al (2019); 15, McGorry and Hamilton (2016); 16, Mellifont (2017); 17, Mulder (2017); 18, New South Wales Nurses’ Association (2019); 19, Pereira et al (2020); 20, Reppermund et al (2018); 21, Rosenberg (2017); 22, Rosenberg et al (2019); 23, Salvador-Carulla and Einfeld (2014); 24, Schweizer et al (2018); 25, Simpson et al (2016); 26, Stewart et al (2018); 27, Trollor (2014); 28, Williams and Smith (2014). …”

“…• That as a result of the NDIS, there will be a further fragmentation of the system, a reduction of collaboration between providers due to the competitive nature of the system and that this might lead to risk of duplication or gaps in supports 3,6,14,20,21,22 • That NDIA separation of service coordination and provider roles might fragment service access experiences for participants…”

“…While some highlighted the opportunities for enhanced integration of the service system (Cashin, 2014;Isaacs et al, 2018;Mulder, 2017), many spoke of the inherent weaknesses associated with a lack of clear distinction between what was to be provided through existing services and what was to be provided through the NDIS, especially for people with complex needs and cooccurring conditions (Bonyhady, 2014;Reppermund et al, 2018;Simpson et al, 2016;Trollor, 2014). Additionally, many publications spoke of a multitude of threats to the community-managed mental health system, including loss of qualified staff, casualisation, threats to financial Australian & New Zealand Journal of Psychiatry,54(12) viability, lack of access to services for rural and remote communities and loss of services for individuals not eligible for NDIS (Furst et al, 2018;Malbon et al, 2019;Rosenberg et al, 2019). Commissioned reports evidence that some established services have not survived, and others have adapted by changing business models and reducing services (Smith-Merry et al, 2018) but the broader aim of achieving an integrated services system goes beyond the NDIA and requires cooperation between NDIA, NDISfunded services and various government and non-government services to enable seamless referral pathways between mental health services, employment, family, education, housing and primary care services.…”

W(h)ither psychiatry? Contemporary challenges in Australian mental health workforce design

“…Psychosocial services, always a marginal element of Australia’s mental health service landscape, have now largely been subsumed into the NDIS and are struggling to maintain their expertise and workforce. 11…”

Exploring the personal, programmatic and market barriers to choice in the NDIS for people with psychosocial disability

“…Equally, for people with a mental health condition and those with psychosocial disability, the recovery approach (which is the basis of community‐based service delivery) aligns with the CRPD and its recognition of individual autonomy. A recovery approach emphasises empowerment, with the focus on the promotion of a meaningful life with a positive sense of identity founded on hope and self‐determination (Byrne et al., 2018; Rosenberg et al., 2019). Tew et al.…”