Accessing the NDIS with Mental Health or Psychosocial Disability | MyCareSpace

Accessing the NDIS with Mental Health or Psychosocial Disability

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What is the difference between a mental health condition and a psychosocial disability?

A mental health condition refers to symptoms that may be caused by a number of factors including life events and genetics.

Symptoms can range from personality issues, psychotic or compulsive disorders, to anxiety and mood swings.

A mental health condition can be temporary or lifelong.

A psychosocial disability is a disability arising from a mental health condition.

A psychosocial disability can result in difficulties doing everyday things such as banking, shopping and looking after yourself.

Not everyone who has a mental health condition will have a disability, but for those who do, it can be severe and longstanding and significantly impact on their life and potential recovery.

Can I access the NDIS if I have a Mental Health Condition?

If you have a mental health condition and want to access the NDIS, you must meet the *NDIS disability criteria. This means that you need to provide evidence that:

  1. your mental health condition has caused difficulties in your everyday life AND
  2. the difficulties you experience as a result of your mental health condition mean you will *likely to require lifelong support to participate in community and/or work life​ AND
  3. the difficulties you experience as a result of your mental health issue have substantially reduced your ability to do everyday activities (the fancy term for this is 'reduced functional capacity'). 

You also need to:

  1. Meet the residency requirements e.g. be an Australian citizen, hold a permanent visa or hold a special category visa (SCV).
     
  2. Be under 65 years old when you apply

What is meant by "likely to require lifelong support to participate in community and/or work life"?

People who are eligible for NDIS funding generally need assistance (and will continue to need *assistance throughout their life) to carry out key everyday tasks in at least ONE of these 6 life skill areas:

  1. Communication:
    Includes being understood in spoken, written, or sign language, understanding others, and the ability to express needs.
     
  2. Social interaction:
    Includes making and keeping friends, interacting with the community, behaving within limits accepted by others, and the ability to cope with feelings and emotions in a social context.
     
  3. Learning:
    Includes understanding and remembering information, learning new things, and practicing and using new skills. Learning does not include educational supports.
     
  4. Mobility:
    Means the ability of a person to move around the home and community to undertake ordinary activities of daily living requiring the use of limbs.
     
  5. Self-care:
    Relates to activities related to personal care, hygiene, grooming, feeding oneself, and the ability to care for own health care needs.
     
  6. Self-management:
    Means the cognitive capacity to organise one's life, to plan and make decisions, and to take responsibility for oneself. This includes completing daily tasks, making decisions, problem solving, and managing finances.

*Assistance includes things like physical assistance, guidance, supervision or prompting.

 It is not necessary to have substantially reduced functional capacity in all six of the life skill areas. A person only needs to have substantially reduced capacity in ONE area. The NDIA considers both what a person can and cannot do within each life skill area.

​The most common life skills areas considered to have substantially reduced functional capacity for people with a psychosocial disability are: social interaction; self-management; and self-care.

Do I need to provide a mental health diagnosis to access the NDIS?

Not necessarily. You need to provide evidence that you have a mental health condition. Diagnosis of a specific and named mental health condition is not required (although extremely helpful if available).

What evidence do I need to provide to request access to the NDIS?

The NDIA accepts evidence in the way you chose to send it.

Useful information includes:

  • past and current treatment/interventions you have undertaken (including information about planned treatment/interventions)
  • assessment forms (e.g. application for Disability Support Pension) completed by your support provider or clinician; and
  • how your disability affects you on a day-to-day basis, which can include functional assessments such as World Health Organisation Disability Assessment Schedule (WHODAS) and Life Skills Profile 16 (LSP-16).

The best way to provide evidence is to have someone appropriately qualified (usually a mental health professional) complete a functional assessment to demonstrate your functional capacity.

Appropriate assessments include the Life Skill Profile 16 (LSP-16) which is the preferred psychosocial functional assessment tool of the NDIA or the World Health Organisation Disability Assessment Schedule (WHODAS).

The NDIA finds these types of assessments helpful because they provide a picture of your functioning over time (not when you are having a particularly good or bad day).

Your other supports such as family, friends, and/or support workers can also provide helpful information on your functional capacity as they see you in your day-to-day life.

This information (and/or a statement from you saying how your impairment affects you) is helpful in addition to information provided by a mental health professional.

If you have any other formal documentation such as assessments given to Centrelink or other government departments, or if there are any formal orders in place, this can help the NDIA with determining functional impact.

What is functional capacity and how does the NDIS differentiate between ‘reduced’ and ‘substantially reduced’ functional capacity?

Functional capacity is the ability to carry out tasks in a variety of everyday situations.

A person’s functional capacity is highly individualised.

Some people experience difficulties with carrying out tasks.

Taking longer to complete an activity or carrying out activities in a slightly different way to commonly accepted practice, is not considered a substantial reduction in capacity. This is reduced functional capacity

Others may be unable to effectively participate in or complete a task. This is substantially reduced functional capacity.

A person who has a disability as a result of a mental health condition needs to have substantially reduced functional capacity in one of the 6 life areas listed above.

What if you are unsure whether your impairment is likely to be lifelong?

A person will only be eligible for the NDIS if their treating clinician confirms that their impairment is likely to remain across their lifetime.

What if there are co-existing drug or alcohol dependency issues? 

To meet the NDIS access requirements for psychosocial disability, substantially reduced capacity must be the result of impairment caused by a mental health condition.

Where co-existing drug or alcohol dependency issues may be present, evidence must demonstrate that the substantially reduced functional capacity remains regardless of the status of the co-existing issues.

What if I am not eligible for NDIS supports?

The NDIA assists people who are not eligible for individualised NDIS support to obtain information about relevant services in their community.

General support is available from a Local Area Coordinator (LAC) to assist people to access a range of supports within the mainstream and community sector.

LAC support enables the NDIS to offer peace of mind and access to practical support for every Australian – for anyone who has, or might acquire, a disability, including disability as a result of a mental health issues.

Please contact the NDIS to be linked to an LAC in your area. NDIS 1800 800 110

What if your application is rejected and you believe the NDIS has made the wrong decision?

The first thing they need to do is contact the NDIA and ask them to explain the reasons for the decision.

If they are not satisfied with the outcome following these discussions they need to request an internal review of the decision.

An internal review of the decision is a new decision made by the NDIA, independent of the original decision.

If you are not satisfied with the review decision then you can apply to the Administrative Appeals Tribunal (AAT) to have the decision reviewed outside of the NDIA.

It is important to note that the AAT will not be able to review your decision until the NDIA has completed the internal review.

The AAT is an independent statutory body set up to provide an independent merits review of a wide range of decisions made by Commonwealth government bodies. An independent merits review means that the AAT will stand in the shoes of the original decision maker and consider all evidence provided when making a new decision.

Evidence of Psychosocial Disability forms

Evidence of Psychosocial Disability form (PDF 196KB) – to be completed by your most appropriate clinician, and your support worker or appropriate person. This evidence form makes it easier for people with a psychosocial disability and supporters to collect evidence for NDIS eligibility. 

Verbal Access Request (VAR) or Access Request Form (ARF) still needs to be completed. This form is a collaboration with the Department of Social Services funded Transition Support Project team at Flinders University.

Everyone who applies to the NDIS must meet eligibility criteria. These include age, residency, and disability requirements. You must also live in an area where the NDIS is being rolled out.

To find out more go to How to apply.

 

 

 

 

Sources:

 

*The disability criteria (Section 24 of the NDIS Act) require that they must meet all of the following:

  • The person has an impairment attributable to a psychiatric condition
  • The impairment is likely to be permanent
  • The impairment results in substantially reduced functional capacity
  • The impairment affect the person’s capacity for social or economic participation
  • The person is likely to require support under the NDIS for their lifetime

 

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