August For inquiries please contact. Systemic Advocacy and Policy Officer. Delese Betti

Transcription

1 Response to the Western Australian Association of Mental Health (WAAMH) Survey re Psychosocial Disability Support through WA National Disability Insurance Scheme (NDIS) and My Way Trials Carers WA August 2014 Delese Betti Systemic Advocacy and Policy Officer For inquiries please contact Delese Betti

2 Western Australian Association of Mental Health (WAAMH) Survey re Psychosocial Disability Support through the WA NDIS/My Way Trials Question 1. Core Principles International best practice and national policy in mental health is driven by the recovery approach; a deeply personal, unique process of changing one s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life even within the limitations caused by illness. Recovery involves the development of new meaning. There are some unique elements of the recovery approach, such as the centrality of hope and the redefining of self, that are critical to the engagement of and the provision of support to PWPD in the NDIS that can be seen in the detail below WAAMH Proposed response: - Design and deliver an induction and training program on recovery for all NDIS My Way area coordinators and other key NDIS My Way staff. - We support the proposed response, but suggest that as part of this induction staff are trained on the part that carers can play in supporting and helping to empower the people they care for to reshape their identities as part of the recovery process, and how to facilitate this. - Co production principles be implemented within agencies to ensure that carer concerns and needs are embedded throughout organisational processes. - Training to staff on the impact of caring on and carers need to have own supports and to maintain own wellbeing. - The systems must ensure that carers are identified and assessed to maintain the resilience of informal supports. Question 2 Consultation and Communication The mental health sector has a specific context which requires a tailored communication approach; for example PWPD do not generally identify as disabled. Carers WA 2014 Page 1

3 WAAMH proposed response: - Develop and promote a systematic, structured consultation process with the Community Managed Mental Health (CMMH) sector, consumers, families and carers on all aspects of NDIS and My Way as they relate to PWPD. - Similar to people with PWPD not generally identifying as disabled, many carers do not tend to identify themselves as carers, rather they may instead identify with other roles they play in an PWPD s life such as mother, son or friend. It is important that language utilised is normalised. Question 3. The NDIS Act requires that the impairment or impairments are, or are likely to be, permanent. While permanency is generally intrinsic to definitions of disability, most people with psychosocial disability have support needs that fluctuate over weeks, months or their lifetime, often related to the episodic nature of their illness. Further, more than 50% of people with severe and persistent mental illness achieve symptomatic recovery in their lifetimes and it is often difficult to predict which people will require long-term support and which will recover sufficiently to no longer require them. - Establish policy regarding permanency of likelihood of permanency that supports access for PWPD. - Identify effective assessment tools and requirements for determining eligibility for NDIS My Way for PWPD. - Design effective processes (that ensure access and choice), to be followed in determining eligibility for PWPD. - Monitor the number of PWPD being assessed as eligible for Tier 2 and Tier 3 and compare to the coverage predicted by the Productivity Commission and National Mental Health Planning Framework. - Monitor the people assessed as ineligible and identify characteristics and support needs. - Many PWPD who function reasonably well in society, require significant levels of care from their family and friends. It is suggested that a policy of referral to support services that exist outside the NDIS be established. This will ensure that carers are linked in adequately with community and other relevant supports even when the person is not deemed to be eligible for NDIS. Carers WA 2014 Page 2

4 Question 4. The NDIS Act and Rules establish criteria for funding and provision of reasonable and necessary supports, and the specific supports are not set out. The nature of supports for PWPD may be significantly different than for other disabilities, because of the particularity of recovery-oriented support and because the boundaries between clinical and non-clinical support in the mental health system are structurally different to those of other disabilities. That is, under the NDIS, the clinical supports within the mental health system sit within the boundaries of other disabilities. That is, under the NDIS, the clinical whereas the clinical supports for other disabilities has progressed to being considered as part of what is required for the person to live a good life in the community and are firmly in the disability system and not defined as clinical or non-clinical. - Define and articulate best practice and evidence based reasonable and necessary supports within a recovery framework with PWPD. - Secure for NDIS My Way through the Regulations for the DSA Amendment Bill changes to the Supports for Participants Rules, Section 7.7 to enable greater flexibility for PWPD than that articulated, particularly with regard to non-clinical recovery supports. - Identify the boundaries between clinical/specialist/non-ndis My Way services and non-clinical/community support as they apply to PWPD. - Define early intervention supports that are within NDIS non clinical early intervention psychosocial and recovery supports and outside NDIS. - Implement an effective recovery-oriented safeguards/quality assurance system for PWPD. - Assess carers needs and capacity to undertake care. It is necessary that assessors do not assume that carers have the capacity to undertake caring activities, regardless of their previous or current caring role. Equally an enhanced and more participative life within the community of the PWPD may create additional responsibilities for carers who may have to provide additional support to facilitate the new lifestyle. - Recognise the role that carers can play in enabling improved functionality/recovery of PWPD Impact on Other Services NDIS My Way will have a substantial impact on current commonwealth and state mental health programs as these are negotiated through the bilateral agreements Carers WA 2014 Page 3

5 between state and commonwealth for the scheme in each state. There is a risk that PWPD and carers currently supported by commonwealth or state community programs will lose them if they are found not to be eligible for the NDIS. - Map the impact on current service recipients current and future access to services under the bilateral agreements (ensuring no individual is disadvantaged). - Map the impact on future service recipients of these (i.e. identify systems gaps). - Clarify model of services and provision of supports for PWPD eligible for Tier 2 including for families and carers. - Support all proposed responses - Identify what services carers of PWPD require, identifying any gaps in current and future service provision Capacity Building International evidence clearly identifies that capacity building for services, consumers, families and carers is a key determinant of success for person directed service reform. - Plan and deliver an effective locality based and state-wide consumer, family and service capacity building strategy for NDIS My Way specific to PWPD. - Identify and plan a comprehensive response to the workforce demands of NDIS My Way specific to PWPD. - Support proposed responses. - Identify the capacity of organisations who provide support to the PWPD, to provide additional support measures to the carers of PWPD. Identify any gaps in knowledge, skills, and resources. Evaluation Because there are particular dynamics to the provision of support to PWPD in NDIS, the evaluation of the two models in WA should include in its design a consideration of the two models effectiveness with PWPD. Carers WA 2014 Page 4

6 - Ensure the issues for PWPD are attended to in the evaluation of My Way and NDIA, particularly with regard to eligibility, supports for participants (recovery and non-clinical supports), supports for carers and impact on other services. - Assess the effectiveness of each model to provide necessary supports and service provision to carers of people with PWPD. Carers WA 2014 Page 5