Access and planning
This chapter discusses access to NDIS services and explores the establishment
and review of plans for NDIS participants with a psychosocial disability.
It deals with terms of reference e) the planning process for people with
a psychosocial disability; and g) the role and extent of outreach services to
identify potential NDIS participants with a psychosocial disability.
Entry to the Scheme begins with an access request lodged through a form
or being completed by telephone. The NDIA has 21 days to respond. If the
applicant meets the eligibility criteria, the planning process begins. Supports
are allocated through a plan, which is prepared through conversations between a
planner and the participant.
The committee heard there were a number of key barriers to access NDIS
services. Inquiry participants reported lack of information, unclear referral
pathways, emerging service gaps and means of communications used by the NDIA as
contributing factors to jeopardising access as well as developments of adequate
Online engagement and phone
The committee heard that key communication tools (website, myplace portal
and phone) used by the NDIA can lead to adverse outcomes and contribute to a
number of individuals with psychosocial disability missing out on services.
Access to the internet and some degree of digital literacy are required
to engage in the NDIS. Accessing information about the Scheme, engaging with
the access and planning process as well as managing plans are mostly done
online. According to the Commonwealth Ombudsman, this is a source of concern
because many people with psychosocial disability do not access the internet for
a variety of reasons including lack of access to a computer, cost of services
and mistrust of the technology.
Ballarat Community Health explained how the need to use online tools is
a barrier to accessing the NDIS:
That the eligibility process does rely on participants
accessing MyGov, the Portal and using IT skills that they do not have (or lack
confidence with) is further isolating and will ensure many do not commence or
proceed with NDIS.
One Door Mental Health reported that 'there does not appear to be an
alternative to or supports for the participants to use the online portal, myplace,
for those that do not have access to, or are unable to use computers'.
Central Adelaide Hills Partners in Recovery (CAH PIR) reported that
participants found 'there was limited or no promotion or information from the
NDIA and that the website is not user friendly'.
Queensland Program of Assistance to Survivors of Torture and Trauma also
commented on the difficulty to navigate the NDIS website and to access
information for non-English speakers:
It is not sufficient to have translated material in 10
languages (we work with more than 70 languages each year) tucked away under a
sub-heading on the website. People would not be able to access this site if
they cannot speak English let alone find the right links.
As stated on the NDIS website, due to the large number of people
entering the Scheme over the next few years, the NDIA offers to undertake most
access requests over the telephone.
Communicating by phone can be extremely problematic for people with a
mental health condition. Inquiry participants have reported experiences of
people with psychosocial disability not answering or not returning calls for a
variety of reasons. Due to the nature of their mental health condition, this
includes feeling not comfortable speaking over the phone and not wanting to
answer calls from numbers they do not know.
In addition, it can put the participant under undue pressure and excludes the
family and carer from the initial and subsequent planning discussions.
Accessibility of information and
role of primary health care professionals
The first professional encounter for many people seeking help for a
mental illness is their GP.
GPs are often the 'frontline' access point to treatment and can play a critical
role in identifying potential NDIS participants and providing them with
However, to date, many health professionals and organisations find it
difficult to obtain information about how to access the NDIS and navigate the
planning process. This leads to health professionals being unable to
adequately assist individuals to access or prepare for NDIS assessment. Mental
Health Australia said:
The most obvious sources of referral to the NDIS, i.e.
assertive outreach services, general practitioners, mental health nurses and
allied mental health professionals, are yet to receive the information and
resources they need to assist people to access the NDIS.
Dr Meyer, Director, Operations Support, Aftercare, reported:
We are seeing a very particular gap around accessibility, and
that is in the information and support provided to GPs and other health
professionals in assisting people to do the assessments.
The Queensland Alliance for Mental Health reported that a lack of
knowledge of the NDIS amongst GPs and other clinical service providers has
resulted in major barriers to access an NDIS package in some areas of
The Royal Australasian College of Physicians (RACP) recommended that the
NDIS provides information about how physicians and specialists can
appropriately refer people with psychosocial disability, especially children to
Similarly, at a public hearing in Penrith, Ms Jaime Comber, Policy
Officer with BEING, recommended:
...I think they [NDIS] need to work with health professionals
to make sure that that information is getting out there. What we propose in our
submission is doing more education with GPs and people who are having the
frontline interactions with people.
Engagement and assertive outreach
Outreach services are essential to identifying and supporting people with
psychosocial disability. They are often isolated and face other barriers such
as a lack of knowledge of services available and negative prior experience with
service providers. It is likely that a group of people who are eligible will
not access services through NDIS, or will not make full use of allocated plans,
without active outreach.
BEING recommended that the NDIA develops an assertive outreach plan for
people with psychosocial disability, particularly regarding how to reach those
without regular contact with current Commonwealth funded programs such as PIR
Many inquiry participants
stressed the need for appropriate services to engage with hard-to-reach
populations, including CALD, LGBTI and Aboriginal and Torres Strait Islander
Data from the NDIA indicates that people who identify with
Aboriginal and Torres Strait Islander heritage or from Culturally and
Linguistically Diverse communities are not accessing the Scheme at a rate that
is reflective of the needs in these communities. Special attention needs to be
paid to ensure that culturally appropriate and safe outreach strategies,
processes and other elements of the Scheme are developed in consultation with
The Queensland Alliance for Mental Health gave the example of the NDIS
rollout on Palm Island where utilising an outreach model to support the transition
Experiences of the NDIS rollout on Palm Island and in some
other Aboriginal and Torres Strait Islander communities have uncovered the
importance of working with a community to identify tailored ways in which to
support the transition utilising an outreach model. Identifying activities
appropriate to the community, ensuring appropriate methods for measuring
outcomes are employed, appropriately resourcing and acknowledging the
importance of family supports are all important aspects of outreach that should
be considered for many communities. This includes CALD communities as well as
Aboriginal and Torres Strait Islander communities.
The issue of funding to deliver assertive outreach was brought to the
attention of the committee on several occasions.
Mental Health Australia noted:
In the long term, without specific policy and funding
arrangements, there is a risk assertive outreach for people with severe mental
illness and complex needs will no longer be delivered, either through the NDIS
or elsewhere. Assertive outreach takes place before someone accesses the NDIS,
so NDIS registered service providers are not able to charge the NDIA for
outreach services (regardless of whether a consumer ultimately becomes an NDIS
participant). Further, the very low prices on offer for NDIS supports mean that
providers of psychosocial services have no scope to cross-subsidise assertive
outreach activities. Without direct funding for assertive outreach, the
organisations that regularly work with hard to reach people are unlikely to
continue this activity.
Assertive outreach services provided by the NDIS can only be delivered
through the Local Area Coordination (LAC) function However; submitters noted
that the current LAC approach does not have the capacity to take on functions
such as outreach and advocacy services.
The ILC framework and LAC function are discussed in chapter 4.
According to their submission, the NDIA is currently using the learning
from a number of projects to develop an approach for those participants who may
be regarded as 'hard to reach'. At the time of writing, no strategy or approach
has been made public by the NDIA.
In their submission, the Office of the Public Advocate Victoria highlighted
the importance of outreach advocacy so people who are currently not in funded
services get access to information and advocacy.
This view is shared by many organisations,
including the Victorian Mental Illness Awareness Council (VMIAC), which explained
at the public hearing in Melbourne how it has played an active advocacy role
for mental health consumers in the NDIS Barwon trial site. Their work includes
the development of education resources for consumers as well as a touring
musical theatre production -NDIS: The Musical. VMIAC recommends that
resources and support be made available for advocacy services:
It is our recommendation that the culturally appropriate
independent advocacy services be resourced to safeguard vulnerable people—this
includes hard-to-reach-and-engage populations including Aboriginal and Torres
Strait Islanders, CALD and LGBTI communities—to ensure that the national
disability standards continue to underpin and then inform all NDIS activities.
Victorian Council of Social Service (VCOSS) members reported that
disability advocacy services in the Barwon trial site experience substantial
increase in demand that cannot be met. They identified a need for funding
independent advocacy to assist people to access and participate in the NDIS and
to help people ineligible for NDIS services to access appropriate services.
Section 31 of the NDIS Act states that the development of a plan should
so far as reasonably practicable be individualised, directed by the participant
and maximise participant choice and control.
The planning process involves discussions about the participant's goals
and aspirations and an assessment of function and support needs, before a
support package is put together. Once a support package has been put together,
the participant and planner decide how the plan will be managed and when the
plan will be reviewed. Before the plan is finalised, it must be approved by the
CEO of the NDIA.
The NDIS has developed a range of resources about the planning process
and management of plans which are accessible from the NDIS website. This
includes an access kit aimed at assisting people with a psychosocial disability
entitled Completing the access process for the NDIS-Tips for Communicating
about Psychosocial Disability.
Experience, skills and training of
Many inquiry participants expressed concerns about the insufficient
knowledge of psychosocial disabilities by NDIS staff, which can impact on
access to the Scheme, planning process and quality of plans.
The IAC identified major variations in the knowledge and skill base not
only of the NDIS teams but more recently in regards to LACs in relation to
mental health expertise.
New England Partners in Recovery noted:
In addition, early experiences in our region of New England
NSW suggests that in many locations Local Area Coordinator (LAC) teams and NDIS
Planners generally have a low level of understanding of mental health issues.
Many of these staff appear to have backgrounds in physical or intellectual
disability, and as a result their understanding of mental health, and in
particular its episodic nature, is still developing.
The lack of understanding of psychosocial disability by NDIS planners
was also noted by Psychiatric Disability Services of Victoria (VICSERV):
Individuals don't always know what they can ask for or how to
articulate their disability and it has been reported that NDIA planners do not
have an adequate understanding of psychosocial disability and mental illness to
support them through the planning process.
Mr Greg Franklin, Administrator, Mental Health and NDIS Facebook Support
The experience I have had with NDIS planners is that their
backgrounds are very diverse. The highest level of training I have had with any
NDIS person in a planning role has been a former occupational therapist. The
rest of them have come basically from ADHC, other government departments as
they shift to the NDIS and that type of thing. I have been told by an ex-NDIS
planner that they got two weeks intensive training, closely supervised
training. That was it. As far as access people go, they have very minimal
training and absolutely none in mental health.
BEING reported that the planning experience is heavily dependent on the
NDIA planner and that 'a recurring issue for consumers, carers and support
workers was that planners did not have a good understanding of psychosocial
VCOSS members working in the Barwon launch site also reported 'examples
of planners lacking relevant knowledge, such as being unaware of the role of
peer workers' which resulted in inappropriate plans for some participants.
Ms Mary Burgess, the Public Advocate of Queensland talked about how the
knowledge and skills of NDIS planners play a critical role in the planning process:
We have also been advised by service providers that the
successful transition of people with psychosocial disability into the NDIS and
the development of well-constructed plans is heavily reliant on the knowledge
and skill of the NDIS planners. Anecdotal reports, including recent media
comments from the CEO of the national peak body for disability services,
National Disability Services, suggest that capability of planners varies widely
and leads in some cases to poorly constructed plans, which then have to be
reviewed and altered.
Ms Burgess concluded:
In summary, I would respectfully request that the committee
consider recommending (...) that key NDIA personnel receive training in the
specific needs of people with psychosocial disability and recognise the
centrality of the recovery framework in their treatment when interacting with
applicants from this cohort; and, finally, that the NDIA ensure that planners
and other key staff, such as local area coordinators, are appropriately
experienced and skilled in identifying and addressing issues associated with
Support during the pre-planning and
Inquiry participants reported that people with psychosocial disability
need and require a significant amount of support to demonstrate their
eligibility and prepare for the first planning meeting. There are concerns that
without this support available many people with serious mental conditions will
The Mental Health Coordinating Council (MHCC) reported that providers in
the Hunter trial site, including but not limited to PIR, reported an average of
40 to 60 hours of functional assessment work to support NDIS access. MHCC noted
that these activities are currently funded at only up to $750.
Mr Peters, a consumer and user of Neami National services shared his
personal experience and explained the importance of having support in the
assessment and planning process:
If I had any take-home messages, they would be that it was
not my experience that I could do this learning process alone, or walk into a
planning meeting with my goals and needs articulated in order to be funded. My
firm belief is that there is a definite need for ongoing funding in the current
service model to help people reach the stage where they can go into a planning
meeting and talk about their needs and goals. Without that capacity building
and support helping me to get where I am today I would still be isolated, alone
and in bed all day every day.
Providing pre-planning services is one of the functions of LACs but the
Committee did not see any evidence during this inquiry of the effectiveness of
LACs in this area. In its NDIS Costs position paper, the Productivity
Commission pointed that because of the speed of the rollout it has not been
possible for LACs to perform their pre-planning functions as envisaged.
The NDIA is reportedly identifying ways to improve communications to
assist people to navigate the NDIS. This includes using the ILC grant process
to fund community organisations to provide information and referrals.
Adequacy of planning meeting
A number of participants
expressed concerns about people being contacted by phone by an NDIA
representative to undertake an official planning meeting. As discussed
previously in terms of access, this often leaves people unprepared and not able
to be supported by family, friends or service providers during the assessment
process. This can lead to poor outcomes in terms of developing an appropriate
plan that meets the needs of an individual.
Ms Elizabeth Crowther, President, Community Mental Health Australia, explained
to the committee how the practice of phoning and sending mail is inadequate:
People have been telephoned and asked over the phone to
describe what their life needs are. Many of these people have major cognitive
problems just at that time and are unable to engage. The problem we then have
is that the person may or may not receive a letter. They do not know what to do
with that letter and our experience is that they may appear at a service some
nine or 10 months later not knowing what to do with it or where to proceed with
that letter. That is currently a major issue. I do not know how that is going
to resolve, but resolved it must be.
MHCSA submitted that people with psychosocial disability are likely to
require support during the assessment process:
Phone assessments are problematic – Consumers may not
understand that the phone call is actually an assessment, leading to poor
outcomes - There is a high degree of social isolation in the cohort eligible
due to psychosocial disability (PIR Annual Report, 2016) therefore telephone
assessments without significant support is unlikely to result in an effective
Dr Isabella Meyer, Director Operations Support at Aftercare described
to the committee why online and phone communications are not suitable for most
One of the things that we know about our clients is that less
than 24 per cent of them have access to a computer, and a similar number, 27
per cent, own a phone and are engaged in phone calls. For the rest of our
clients, this process of accessing forms online and having assessments and
planning done over the phone is traumatic, and it is inaccessible to them—they
do not do it. If they answer the phone at all, and the request is: 'We're doing
your plan now,' they will hang up. We know that. That has been our experience.
VICSERV explained that 'phone calls as a means to facilitate engagement
can cause significant distress for some individuals and will often result in
In its submission, VICSERV also highlighted how 'non-verbal communication is an
essential part of building rapport with people with a psychosocial disability'
While using technology plays an important role in increasing
access to services, a move away from face-to-face consultations will also mean
a lack of rapport and an increase in the number of people who will disengage
VCOSS members reported a high number of planning meetings occurring over
the phone and highlighted some key issues:
Conducting a planning session over the phone may prevent
participants with a psychosocial disability from fully understanding or
participating in the planning process, and makes assessment more difficult,
potentially leading to poorly informed decision making. Members report
instances where phone-based planning meetings have resulted in reduced support
and some cases where people were unaware the phone conversation constituted their
planning meeting until they received their plan in the mail.
Tandem also noted that planning meeting over the phone 'puts the
participant under undue pressure, and actively excludes the family and carer
from the planning discussions'.
At the public hearing held on 16 June 2017 in Canberra, the NDIA
reported that 65 per cent of all plans are currently developed in face-to-face
conversation and that an individual has always been given the opportunity to
book for face-to-face conversation rather than over the phone.
The role of carers
Mental Health Carers Australia (MHCA) and others
are concerned with the lack of engagement by NDIS planners with carers in the
planning process. MHCA reported that 'the common experience of mental health
carers is that they are not included in the planning process'.
Tandem has 'heard concerning reports of participants receiving phone
calls in which the carer and the family was not involved, pre-warned or
MHCA also reported that 'the majority of carers of NDIS participants
consulted as part of the Carers Australia's NDIS Carer Capacity Building
Project reported that NDIA staff had not made them aware of the option to have
a separate conversation with the planner or of the ability to submit a Carer
Similarly, Mind Australia stated:
Although carers can ask for a separate meeting with planners,
our observations are that very few people are aware of this, with the result
that carers needs are not taken into account.
Additionally, as Tandem explained, it is important that carers are
present during the planning conversations 'to ensure the planner is provided a
holistic and true understanding of the person support needs'.
VCOSS also highlighted the importance of engaging carers in the planning
process as 'this can help to effectively identify the participant's needs and
The lack of engagement of carers in the planning process has also
resulted in carers 'experiencing reduced access to respite care and other
The Mental Health Commission of NSW reported that the Carer
Recognition Act 2010 makes it clear that 'Carers should be considered as
partners with other care providers in the provision of care, acknowledging the
unique knowledge and experience of carers' and recommended:
This needs to be fully recognised during the planning process
as carers will inevitably be a key component in the implementation of any
VCOSS recommended engaging carers and family members in the planning
process to 'better identify the support needed for individuals and their carers'.
Poor communication, delays and
Submitters reported difficulty to contact NDIS staff and a lack of
responsiveness of NDIS planners during the planning process.
Mental Health Carers NSW Inc. reported that carers and support workers
find it difficult to contact NDIS planners, who often do not return phone calls
or meet agreed deadlines.
BEING explained some of the communication issues:
One recurring problem appears to be difficulty reaching NDIA
staff. Many survey respondents commented on the long phone hold times, the long
wait to find out application results, and NDIS planners not returning calls.
The Commonwealth Ombudsman has received a number of complaints from
people with psychosocial disability, covering a range of issues pertaining the
The bulk of these complaints reflected similar issues as
those complaints received from people with other disabilities including delays,
poor communication, dissatisfaction with plans and planning staff, and
difficulties with the review process.
Capital Health Network reported delays of up to 12 weeks before plans
have been approved.
VCOSS members in the Barwon launch site report 'delays of between four
and six months between when a participant is assessed as eligible and their
first plan being receive' with people 'unable to access funded mental health
services during this transition period'.
Similarly, Collaboration in Mind (CiM) stated 'the delay, sometimes a
matter of weeks, between approval of a plan and receipt of the plan is leaving
participants without access to support'.
Annual plan and plan reviews
Usually, a plan is established for twelve months and plan review occurs
as part of the planning cycle. However, unexpected plan reviews can be
triggered if the Scheme participant requests a plan review or changes their
statement of goals and aspirations. Currently, any changes to a plan require a
full plan review.
Given the episodic nature of conditions and symptoms, concerns have been
raised by participants that the annual plan approach does not build in supports
to intervene early and prevent relapse. For example, the Benevolent Society
We also have concerns that the NDIS planning process will be
unable to accurately measure and plan annually for needs which are sporadic in
This view was supported by Ms Meagher of the IAC:
There is an argument that all disabilities are also, to some
extent, episodic. When we look at the issues of permanency, they have to be
moderated by the understanding of episodic conditions, how extreme or not those
episodes could be and whether as an agency we are responsive to those
fluctuating needs. That would be amongst the work we need to do into the future
to determine how flexible plans can be—not just for people with psychosocial
disabilities arising from mental illness, but also for a range of disabilities.
found that the rigidity of the NDIS review process as well as long delays in
accessing reviews, do not allow for responsive plans and support to be put in
place for participants when crises occur or circumstances suddenly change.
As stated by National Disability Services (NDS) and other participants,
the current average three-month wait for a plan review is not appropriate for
people who have a sudden increase in their need for support.
The NDIA is aware of the concerns raised about current planning
processes and practices. On 6 June, the NDIA announced it has undertaken a
participant pathway review to deliver a significantly upgraded quality of
participant and provider experience in a way that remains consistent with
maintaining the Scheme's financial sustainability.
Overall, the committee heard that there is need to put greater emphasis
on the pre-planning and planning stage to achieve good outcomes and quality
plans. Mental Health Australia and others stated that as result of poor
planning process many people reported receiving NDIS plans that are not fit for
purpose or tailored to their individual needs.
Information and assertive outreach
Given the critical role that GPs and other primary health care
professionals can play in identifying and referring people with psychosocial
disability to NDIS services, the committee recommends the NDIA develops and
proactively markets resources and training for health professionals, especially
about the NDIS referral pathways, access and planning processes.
The committee acknowledges the critical role assertive outreach and
advocacy services can play in identifying and engaging individuals with
psychosocial disability with NDIS services. With the transition of services
such as PIR and PHaMs it is important to ensure that service gaps do not emerge
in the area of assertive outreach and advocacy services. Given the reported
high number of people with psychosocial disability who do not want or cannot
utilise phone or online services, the NDIA must consider other ways to reach
and communicate, including proactively using assertive outreach services to
facilitate access to the NDIS.
Skills and expertise of planners
While mental health consumers, carers and providers have on many occasions
raised concerns about NDIA planners' understanding of psychosocial disability,
the committee recognises the efforts of the NDIA Mental Health Team work's to
address this important issue. Initiatives such as the establishment of an
internal NDIA community of practice on psychosocial disability and the
provision of training for staff must continue to ensure the planning process
results in providing the necessary supports for people with psychosocial
disability. Given that participants with psychosocial disability as their
primary disability are expected to account for about 13.9 per cent of all NDIS
participants by 2019–20, the NDIA should consider having a specialised team of
NDIS planners for people with psychosocial disability. This would ensure better
plan outcomes for participants, less need for reviews and ultimately contribute
to the sustainability of the Scheme.
Overall, the committee believes the planning process has not been
operating well for people with psychosocial disability and has resulted in many
cases with less than satisfactory experiences and outcomes for participants.
Furthermore, the reported delays experienced by participants in getting a
planning meeting, receiving their approved plan or reviewing their existing plan
are a cause of great concern for the committee. Given the episodic nature of
mental health conditions, an agile planning and review process is crucial to
ensuring that participants have continuity of appropriate support.
Notwithstanding the challenges of the rollout schedule, the committee urges the
NDIA to continue reviewing its current practices to address operational issues
around meetings taking place over the phone, waiting times and delays and lack
of responsiveness to people's changing needs.
As discussed in the general issues report, the committee acknowledges
that the NDIA is currently investigating the ways in which it can improve its
participant and provider experience. The committee expects that the pathways
review currently being undertaken will be published and made accessible to all
those involved in the Scheme. Those areas identified, particularly related to
mental health as requiring improvement should be incorporated into the NDIA's
Quarterly Reports and progress against those targets tracked over time.
3.82 The committee recommends the NDIA develops and proactively
markets resources and training for primary health care professionals about the
NDIS, especially in regards to access and planning processes.
3.83 The committee recommends the Department of Social Services
and the NDIA collaboratively develop a plan outlining how advocacy and assertive
outreach services will be delivered beyond the transition arrangements to
ensure people with a psychosocial disability and those who are hard-to-reach
can effectively engage with the NDIS and/or other support programs.
3.84 The committee recommends the NDIA, in conjunction with the
mental health sector, creates a specialised team of NDIS planners trained and
experienced in working with people who have a mental health condition as their
3.85 The committee recommends the NDIA develops an approach to
build flexibility in plans to respond to the fluctuating needs of participants
with a psychosocial disability, including allowing minor adjustments to be made
without the need for a full plan review.
3.86 The committee recommends the NDIA reports on the level of
engagement of carers in the planning process.
3.87 The committee recommends the NDIA publishes the
results of its participants and providers pathways review, particularly in the
areas related to mental health, and strategies in place to achieve improved
outcomes, as well as updates on progress against targets in its Quarterly
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