Mind the gaps: Mental health and the NDIS

The National Disability Insurance Scheme (NDIS) is designed to give people with a disability and their carers more choice and agency. For the first time, people with disabilities will have a say in what types of services they would like to take advantage of. We had the chance to speak to Frank Quinlan, Chief Executive of the Mental Health Council of Australia about managing the transition process, the impact of competition on the market and the challenges for integrating mental health into the NDIS.

IIR Healthcare: With the introduction of the NDIS the role of the patient changes from passive consumer to active agent who chooses their services. What infrastructure does the healthcare sector need to put in place to successfully manage the transition?

Frank Quinlan: The changes are required at a number of different levels. The first and most important change is the fundamental shift in philosophy which is giving people choice and control over their services. I think that this will also mean a fundamental shift in the kinds of services made available. Where once organisations would have developed a service and essentially made this available to clients or patients we are now going to see a shift towards clients directly initiating a demand for services. They will have the dollars in their hands to pay for those services.

But this shift will then bring a whole raft of new challenges to the traditional functioning of organisations. Service providers were once built around a forward-looking grant-based model where they might have received block grants for providing a certain amount of customers with a certain amount of services over a certain amount of time. It is likely that this whole dynamic will shift. Service providers will increasingly have to attract customers. They will have to invest upfront in order to establish services in the hope that these services are utilised and paid for in the future.

IIR Healthcare: Do you think that this shift will impact on the quality of services that are being offered due to more competition in the market?

The danger would be to believe that more competition necessarily leads to quality. I think competition can bring quality, but the greatest risk is that we run into the same sort of situation that we have in our supermarket industry in Australia. You can have any choice you like as long as it is Coles or Woolies. They actually don’t look very different from each other except for the labelling on the door. Same range, same products, same prices.

What that says to me is that we need something in addition to competition to ensure that we have a thriving and healthy industry that can actually respond to individual needs and can develop services in local communities that respond to local needs and built on the back of local assets and social capital. There needs to be regulation from government, but also an enhancing and strengthening of consumer advocacy groups to ensure that advocacy is taking up robustly and on the basis of evidence. It would be a mistake to believe that every individual is able to be their own best advocate for services. We don’t all have the same skill set. I would be surprised if consumers and carers didn’t want to find agents they trust to represent their interests on a broader scale and to prosecute some of those issues around quality and choice at a macro level rather than just the individual level.

IIR Healthcare: What characteristics differentiate people with psychosocial disabilities from people with other disabilities? How will these differences impact the way people with psychosocial disabilities utilise services offered through the NDIS?

Frank Quinlan: I think across the disability spectrum – if I can call it that – it is easy to generalise, but fundamentally it is about the individual needs of individual people. We can make some generalisations in that the sort of services that are built around the provision of physical aides are different from the services that are providing social and community support. In the mental health space we talk roughly about the 80/20 rule which is to say that about 20% of people’s needs are likely to be provided by the health system. About 80% of people’s needs such as employment and housing are likely to be serviced by social and community based supports. The two are interdependent, because providing the health services without providing the social and community services is likely to lead to failure. But similarly providing the social and community services without the health services is likely to lead to failure.

There is an enormous challenge there to coordinate different services from a range of different providers. I think that this is going to be the fundamental challenge when it comes to integrating the NDIS in the psychosocial disability space. We need to ensure that all those offers are well-coordinated, that we avoid duplication and avoid leaving people in gaps between available services.

IIR Healthcare: Do we face different challenges in regional areas compared to urban areas?

Frank Quinlan: Very much so. We know that the distribution of services is very much biased towards urban centres and metropolitan areas. It will be a key challenge for everyone involved in the integration of the NDIS to ensure that people are able to get a comprehensive range of services in more regional areas.

IIR Healthcare: In what areas do you currently service gaps in mental healthcare?

Frank Quinlan: There are enormous gaps in the current mental health system. I am inclined to say that we don’t actually have a mental health system. We have a range of services that sometimes relate to each other, but often don’t. We have all sorts of gaps particularly in the kinds of services we provide in the community. A lot of our attention is focused around emergency and acute care providers out of the hospitals, but the gaps in community care are enormous. When moving to the NDIS we need to make sure we are not creating further gaps or allow those gaps to perpetuate.

IIR Healthcare: Where do you see potential pitfalls for integrating mental health into the NDIS?

Frank Quinlan: The potential pitfalls are really twofold. First of all we need to manage the transition. I think that the NDIS is a huge and new initiative and any scheme of this scale is bound to experience some teething problems. The period in which those issues are being addressed is a difficult time both for service providers and consumers and carers. There is the risk that gaps are opening up quite quickly and are not addressed quickly enough.

In the long run there is another issue that I see unfolding. Many of the services that we currently have on the ground such as the Partners in Recovery program and the Personal Helpers and Mentors program are integrated into the NDIS, which will arguably lead to a richer a and better service when all the teething problems are solved. The danger is that we will create an oasis in the middle of the desert. You will potentially have a great new program in the NDIS, but you will have absorbed all the programs around it. The risk will be that all those who rely on services outside the NDIS are finding themselves without services at all, because of the focus on integration into the NDIS.

IIR Healthcare: You will be speaking at the inaugural Integrating Mental Health into the NDIS conference. What discussions would you like to have at the event?

Frank Quinlan: The time has really come for us to address some of the fundamental challenges I have described before. We all had a sense that in the lead-up to the elections and the announcement that were made about the NDIS that this is really something we wanted to get over the line. Advocates were united in their calls to both sides of politics to get behind the NDIS and to get it underway. It is now time to face up to the challenges of the details of design and the sustainability of the scheme.