7 February 2019.
Australia’s psychosocial support services are facing significant challenges thanks to funding changes brought in with the National Disability Insurance Scheme (NDIS), says a senior mental health researcher.
In a new paper in Public Health & Research Practice, a peer-reviewed journal published by the Sax Institute, Dr Sebastian Rosenberg and colleagues say the NDIS is having serious repercussions on Australia’s fragile psychosocial service sector, which covers non-clinical support for people recovering from mental illness.
The paper, a case study looking at the impact of the NDIS on a mental health rehabilitation service in the ACT, suggests that NDIS funding arrangements are reducing the service’s capacity to transition clients towards recovery and increasing the likelihood of relapse.
“Psychosocial services are critical to allowing people with mental illness to live well and with dignity in the community. The arrival of the NDIS should in theory wash significantly more resources into this sector, but paradoxically it is having the reverse effect,” says lead author Dr Rosenberg, who is a Senior Lecturer at the Brain and Mind Centre, University of Sydney, and a Research Fellow at the ANU’s Centre for Mental Health Research.
Dr Rosenberg says the key problem is that instead of providing mental health organisations with a block grant, which would allow them to offer longer-term contracts to skilled support workers, the NDIS funnels money directly to the clients themselves.
“This means organisations are now reliant on the recipients of NDIS support packages coming to them to seek services. And that is not a sufficiently stable financial basis on which to retain a workforce.”
Dr Rosenberg says the psychosocial support sector – which provides services to help people with mental health issues manage their daily lives, find accommodation and prepare for employment – was already underfunded before the advent of the NDIS.
“It was probably no more than 7% of total mental health spending. So you’re already talking about a very fragile sector, which now has this done to it. It was stunted before, and now it’s in crisis.”
He says an additional problem is that only a very small number of people with mental illness actually qualify for an NDIS package of care.
“The vast majority of people with bipolar disorder or schizophrenia will not qualify for the NDIS. What happens to them? Where do they go? Many of them will be in and out of hospital for acute and sub-acute care, which is expensive, dangerous and traumatic.”
Dr Rosenberg says there are ongoing discussions between the mental health sector and the NDIS about how to make things better, but they are happening very slowly.
“In the meantime, this very fragile workforce is disintegrating. There is very little focus on service providers except where market failure applies. I’d suggest that’s where we’re heading. We may be in a situation where the government will have to disburse emergency funds to providers.”
Dr Rosenberg says the questions driving funding models have been about who pays and not what works.
“We don’t have patient-centred care, we have funder-centred care.”
Dr Rosenberg points to what’s happening across the Tasman as a good model of what we could do here.
“In New Zealand, spending on psychosocial support services is about three times what it was here at its apex. New Zealanders have community-based inpatient centres and a whole range of alternative services to admission to hospital. That’s what we badly need here.”
Click here to access the article referred to in this story.
Public Health Research & Practice is an open-access, peer-reviewed, Medline-listed quarterly online journal published by the Sax Institute. Click here to subscribe for free.