FURTHER UNRAVELLING PSYCHOSOCIAL DISABILITY: EXPERIENCES FROM THE NSW HUNTER NDIS LAUNCH SITE Tina Smith, Senior Policy Advisor/Sector Development Presentation to SFNSW 16 April 2014, Sydney

“ … we are yet to really see the NDIS land on the ground for mental health consumers and we've really got to see how services will work together …." Mr Bradley Foxlewin, Deputy MH Commissioner (3/7/13 Media Release)

What is the NDIS/NDIA? NDIS is National Disability Insurance Scheme NDIA is the National Disability Insurance Agency The NDIS and NDIA is an insurance scheme to increase the social and economic participation of people with disability/s (< 65 yrs) MH (psychiatric/psychosocial disability) is included Change from block to personalised funding (‘choice and control’) Tiers 3, 2 & 1

NDIS Launch Timing

MHCC & NSW MH Commission Partnership outcomes are to better understand … 1.How will PSD be understood and included under the NDIS? 2.The wider NDIS and health services interface (eg, physical health, substance use) 3.People with co-existing difficulties (eg, intellectual, physical, sensory and other disability) 4.The suitability of the assessment tool/s 5.Contribute to the national discourse regarding the situating of psychosocial disability within the NDIS … what is the NDIS and how it will affect people living with mental health concerns?

NDIS Eligibility (Tier 3) Is the person’s condition permanent or likely to be permanent i.e. are there any known … medical treatments that would remedy it? Is there any future treatment planned? If yes, please provide details of the expected outcome of the treatment. Is this condition likely to have a significant impact on the person’s functional capacity for the rest of their life? What is the functional impact of the condition on the following areas of the person’s life: communication/social interaction; learning; mobility; self-care, self- management? NDIA presentation to HMH Interagency Meeting, July 2013

NDIS/NDIA: Managing a person’s ongoing functional impairment ongoing functional impairment enable activities of daily living and participation community-based, non-clinical Health system: Diagnosing and treating a mental health condition diagnosis clinical treatment (in the community or in health settings) residential care, including inpatient treatment or clinical rehabilitation all early intervention Examples: general practitioner, psychiatry, psychology, pharmaceuticals. Examples: assistance with planning and decision making, community access. MH: Guiding principles

NSW Hunter Trial Site Trial commenced July 2013 and there has been a lot of MH/psychosocial disability (PSD) related activity 10K people of all disability types Yr /14 Newcastle – 3K Yr /15 Lake Macquarie – 5K Yr /16 Maitland – 2K Only Year 1 launch site nationally with high levels of MH activity

How many people might be helped? Psychosocial Disability (13% of NDIS population?) 1,300/10K in launch site 2013/16 The number of ‘existing’ and ‘new’ clients is unknown (ie, the total number of ‘transitioning’ people with ‘primary’ psychosocial disability is unknown as is the number of people receiving Commonwealth ‘phasing in’). Commonwealth clients are considered to be ‘new’? 19/140K in NSW 57/430K in Australia Intersect with Partners in Recovery? Intersect with existing state funded community MH programs?

Hunter Launch Site Activity Learning Learning from consumers, carers and service providers in the launch site Liaison with the NDIA, HNELHD/MH, FACS/ADHC, NDS, etc. Reconciling ‘permanent disability’ with the philosophy and practice of psychosocial disability and & recovery support service delivery Engagement with 2013/14 MHCA NDIS Capacity Building Project (now extended) Watching Tracking ‘transitions’, ’phasings’ & ‘new’ referrals of people to the NDIA (eg, PHAMS) Interface between NDIA and the new Partners in Recovery program Understanding ‘in-scope’ and ‘out-of-scope’ community sector programs What the NDIS means for people that are not Tier 3 eligible Influencing … establishment of the Hunter NDIS and MH ‘Community of Practice’

Hunter NDIS & MH ‘Community of Practice’ 70 participants Process Sharing and reflecting on NDIS/NDIA experiences Client transitions and new referrals (eg, planning) Organisational readiness (eg, price) NDIA processes and liaison with current services providers (eg, portal) Other implementation issues? NDIA Update HNEMH Update MHCA Update

Hunter Access & Eligibility NDIA Hunter data As at February, 89 people at NDIA Hunter with ‘primary’ PSD and 75 now had plans (what happened for the other 14?) Processes to assess whether someone meets the access requirements for permanent PSD (eg, length of period of illness, and the level of effect it has on someone’s life and how this is measured)? HMH data  As at March, 63 referrals of people to NDIA from HMH inpatient sites  19 accepted and some are still being assessed  Uncertain of how many have been deemed ineligible ( some of the reasons why are: insufficient evidence; over 65; outside of launch site; not a permanent disability; not substantially reduced functional capacity)  Now auditing HMH community team referrals and also their caseloads to identify potential referrals … thank you NDIS, HMH & Partners in Recovery!

Current Hunter environment What’s working well? Relationship with NDIA is a very open learning environment Increasing collaborative practice with existing service providers Greater understanding of psychosocial disability related to mental illness Maturing implementation/operational structures including those required for strengthening the health/mental health & NDIS/NDIA interface What’s not working so well? Concern about pricing and support clusters Inconsistencies in eligibility and access processes and planning Costs related to eligibility/assessment/care planning for NDIA access (transitions, phasing and new referrals) Advocacy (especially where a person does not have family/friends) Problems with NDIA ‘portal’ and claims in arrears Data collections including outcome monitoring Consumer, carer and community engagement

1.Accommodation/ tenancy assistance 2.Assistance in coordinating or managing life stages, transitions and supports 3.Assistance to access and maintain employment 4.Assistance to integrate into school or other educational program 5.Assistance with daily life tasks in a group or shared living arrangement 6.Assistance with daily personal activities 7.Assistance with travel / transport arrangements 8.Community nursing care for high care needs 9.Development of daily living and life skills 10.Interpreting and translation 11.Early intervention supports for early childhood 12.Management of funding for supports under a participant's plan 13.Household Tasks 14.Participation in community, social and civic activities 15.Physical wellbeing activities 16.Specialised assessment of skills, abilities and needs 17.Therapeutic supports 18.Training for independence in travel and transport 19.Behaviour support NDIA Priced Support Categories

In-scope for NSW NDIS ADHC ‘MH programs’ (ie, ‘existing’ clients) Mostly Boarding House Reform related client group CBA (100%) – Community Based Activities (mostly ‘day centre’ type services for ex-BH residents) SA (100%) – Supported Accommodation (ex-BH residents, they typically also receive CBAs) ALI (100%) – Active Linking Initiative (for remaining BH residents) Commonwealth MH programs (‘new’ clients?) DSS, previously FaHCSIA, Target Community Care PHaMS (100%) – Personal Helpers and Mentors MHRCSP (50%) – Mental Health Respite Carer Support Program (NOT FMHSS – Family Mental Health Support Services)? DOH PIR (70%) – Partners in Recovery D2DL (35%) – Day to Day Living in the Community DEEWR DES Disability employment programs; these are shifting to DSS NOT NSW Health funded community sector MH programs

Out-of-scope for NSW NDIS NSW Health funded community sector MH programs: NGO Grant Program Tendered Programs NSW Health Housing and Accommodation Support Initiative (HASI) The Mental Health Family and Carer Support Program (MHF&CSP) Resource and Recovery Services Program (RRSP) ‘Ad hoc’ grants/programs? Other MH disability support programs currently delivered by NSW Health?

Emerging Sector/Organisational Issues Very new way of doing business Maximising opportunities (1,300 launch site, 19K NSW, 57K nationally) Services for people who are not NDIS Tier 3 eligible (Tier 1 & 2? services for families and carers?) Community sector engagement with NDIA, HMH and PIR on referral, assessment & care planning pathways (consent issues) Safeguards and collaborative practice approaches How to increase sector/organisation readiness (competition vs collaboration)? Workforce development ( casualisation) Parallel community sector reforms (new service delivery models) Potential impacts on MHCC (and other peak structures)

MHCA Capacity Building Project 2013/14 from $440K NDIA Sector Development Fund Stage 1 ‘scoping’ - June and December 2013 Project Advisory Group 5 workgroups: Scheme design and administrative arrangements Assessment and eligibility Monitoring and evaluation/service quality Diverse groups (including ATSI)/supported decision making Organisation readiness and workforce Stage 2 January to June 2014 (sector readiness report and recommendations) Now funded for 2014/16 ($1.5M) building-project

MH Sector Implications NDIS/NDIA will effect organisations and providers delivering services to people with a range of complex and disabling health and social problems – The way services are delivered – The way services are managed Opportunities to better understand the interface and have clearer pathways between health and disability – Interface with Health – Interface with MH What do we need to do to be NDIS ready?

THANK YOU FOR LISTENING For more information: reform/influence-and-reform/ndis-and-mental- healthpsychosocial-disability.aspx ….. Or Google ‘MHCC NDIS’ … or contact Tina Smith: