The chairman of the National Mental Health Commission, Allan Fels, has warned that the National Disability Insurance Agency (NDIA) lacks the resourcing to properly consider claims for psychosocial disability, potentially putting its rollout targets in jeopardy.
Fels has also criticised the increasing use of phone calls to determine whether those with severe mental illness are eligible for the national disability insurance scheme.
“The commission shares concerns across the mental health sector on the adequacy of the NDIA’s resources, and the timeframes the agency has been asked to work within to implement the scheme,” Fels said in a statement to Guardian Australia.
On Monday Guardian Australia published a list of individuals with severe, long-term mental illness, who had been rejected for psychosocial disability support under the NDIS.
It included an individual with a 40-year diagnosed history of paranoid schizophrenia, who had been admitted to hospital at least five times, and given regular depot injections.
The mental health sector has expressed alarm at recent access decisions by the NDIS, saying they were inconsistent, ignored expert evidence from psychiatrists or GPs, and appeared to be compromised by a lack of resources coupled with tight deadline pressures.
The use of phone interviews to make decisions about the eligibility of those with mental health issues drew particular concern.
A communique of an NDIS mental health sector stakeholder group meeting in March suggested 70% of planning conversations were being conducted over the phone.
“The agency’s increasing reliance on telephone processes for eligibility assessment is also an obvious concern for people with severe mental health issues,” Fels said.
He also warned that projections of those who would be covered by the NDIS – 64,000 to 90,000 people – were only the tip of the iceberg in terms of mental health need.
Fels pointed to government modelling, using the national mental health services planning framework, which suggested more than 280,000 people with some level of psychosocial disability needed support to deal with their condition. He said it appeared the lower projections were now being treated as targets.
“This risks the agency being distracted from implementing the scheme in a consistent and sustained manner for this highly vulnerable cohort,” Fels said.
Labor and the Greens are pressuring the federal government to respond to 24 recommendations on mental health made by the joint standing committee on the NDIS.
The shadow disability services minister, Jenny Macklin, said the concerns held by the mental health sector were legitimate.
Macklin said the NDIS’s requirement to prove permanency of disability, which runs contrary to the recovery-oriented approach of modern mental health treatment, must be resolved.
“The government must consider reviewing the NDIS Act to assess the permanency provisions and the appropriateness and effectiveness of including the principle of recovery-oriented practice for psychosocial disability,” Macklin said. “This is a very complex issue, but one that would benefit from a very carefully considered review.”
Fels aired similar concerns about the NDIS’s use of the notion of permanent disability.
“While the NDIA has sought to reconcile permanence with the recovery model, there continues to be an underlying tension, and for many people with mental illness, having their condition ‘labelled’ as permanent can be confronting and may undermine their willingness to undergo the NDIS access and eligibility process,” he said.
“There may therefore need to be some adjustments to the NDIS eligibility criteria to address this issue.”
A spokesman for the social services minister, Christian Porter, said the government was considering the report’s recommendations and would respond “in due course”.
An earlier statement from the NDIA said the mainstream mental health system would continue to be responsible for the broader group of people requiring psychosocial support outside of the NDIS.
It was developing specialist resources in the national access team, and was reviewing pathways to the NDIS for participants and considering the joint standing committee report.
The government has made a commitment to provide support for people in existing programs, who are not found eligible for the NDIS.
But Fels is concerned that the “the scope and nature of that continued support is still not clear”.
“It also does not extend to people who would, in the future, have been eligible for those programs but who will have nowhere to go if they are not able to access the NDIS,” he said.
