NDIS access and psychosocial disability START MODULE TABLE OF CONTENTS logo Description This training is for health professionals who are supporting people with a psychosocial disability to apply to access the NDIS. The information in this module is general in nature. Every organisation does things differently and has different policies and procedures, so please interpret the content in this module with your organisation in mind and discuss any discrepancies with your line manager. Duration: Approximately 45 minutes to complete (note: you can close the training and pick up where you left off at a later date). Last updated: 14 September 2020 Content and links in this training were correct at the time of publication. We check these regularly; however, if you find broken links or errors, please contact
Training objectives Topic 1 of 11 Image of light bulb with text “Training objectives” Training objectives This training is for community mental health or allied health providers who are supporting people with psychosocial disability to access the NDIS. A separate access training module for clinicians (GPs, Psychiatrists) who are supporting people with psychosocial disability to access the NDIS is also available. Understand the access process and how to support people to apply Understand the NDIA access criteria and who is likely to be eligible Understand what information the NDIA need to determine eligibility for a person with psychosocial disability Understand your role in supporting a person to apply for the NDIS Know which forms to complete and how to provide helpful evidence Image of open book with text “Assumed knowledge” Assumed knowledge This module assumes a general understanding of the NDIS, it's purpose and what types of supports are funded. The below training modules (also available on our website) cover these topics in detail: NDIS explained Recovery and the NDIS Reasonable and necessary and the NDIS Resources (image of books) This training was developed based on the following resources: The National Disability Insurance Scheme Act 2013 (Legislation) National Disability Insurance Scheme (Becoming a Participant) Rules 2016 (Legislation) Access to the NDIS operational guidelines (Webpage) Mental Health and the NDIS webpage (external link) NDIS mental health snapshot series (external link to download) Summaries of Administrative Appeal Tribunal hearings (website) Consultation with mental health providers and NDIA representatives as part of activities conducted by the Transition Support Project team.
Access overview Topic 2 of 11 This lesson provides a summary of the access criteria and how decisions are made, the rest of the training will focus on understanding the criteria for people with psychosocial disability, and how to provide useful evidence. What are the access criteria? To be eligible to receive NDIS funding a person must meet all the 'Access Criteria' described in the National Disability Insurance Scheme Act 2013. There are three broad criteria that a person must meet to be eligible for funding: Age: Must be under the age of 65 at the time of applying (NDIS Act Section 22). Residency: Must be an Australian citizen, holder of a permanent visa or protected special category visa (NDIS Act Section 23). Disability: Must meet all five disability criteria (NDIS Act Section 24). The disability criteria People who meet the age and residency requirements will then need to provide evidence to show that they meet all the disability requirements. Person must have a disability (24(a)) Section 24(a) the person has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or to one or more impairments attributable to a psychiatric condition; In the NDIS, 'disability' is the term used when a person's health or mental health condition results in impairments that substantially impact the person's capacity to participate in every day activities. The disability is likely to be permanent (24 (b)) Section 24(b) the impairment or impairments are, or are likely to be, permanent; A disability is considered 'likely to be permanent' if there are no known, available and appropriate evidence based treatments that would be likely to remedy (cure or substantially relieve) the impairment (rule 5.4 of the Becoming a Participant Rules). The disability results in substantially reduced functional capacity (24 (c)) Section 24 (c) the impairment or impairments result in substantially reduced functional capacity to undertake, or psychosocial functioning in undertaking, one or more of the following activities: communication, social interaction, learning, mobility, self-care, self-management. A person's disability must substantially impact their ability to participate in every day activities. The NDIA will consider what a person can and cannot do within the six activity areas mentioned above in the legislation. Substantially reduced functioning is when a person cannot do most activities within at least one of the areas without support. The disability affects capacity for social and economic participation (24 (d)) Section 24 (d) the impairment or impairments affect the person’s capacity for social and economic participation; For the purposes of the NDIS a person's disability is considered to impact a person's capacity for social and economic participation when the impairments make it difficult for them to find or maintain work or volunteering opportunities, or to participate in social activities like playing sport, going out with friends or traveling. The person is likely to require NDIS support for their lifetime (24 (e)) Section 24 (e) the person is likely to require support under the National Disability Insurance Scheme for the person’s lifetime. The NDIS funds supports that are related to challenges with everyday living, it does not fund clinical and other supports that are the responsibility of existing mainstream systems (e.g. services like education, housing, medical and dental - that are available to everyone). When determining if a person meets this criteria the NDIA will consider what types of supports the person with a disability requires to live an everyday life and whether these supports are best provided by the NDIS, or other systems. The NDIS is individualised The NDIS operates under the assumption that disability affects everyone differently. Each application is considered on an individual basis against the criteria. Exceptions Image of tick list There is a list of specific conditions ( List A) for which access is likely to be granted based on evidence of a diagnosis alone. The list includes conditions for which functional impact is likely to be substantial and lifelong for everyone with that diagnosis regardless of individual circumstances (e.g. intellectual disability - moderate to profound, Autism Spectrum Disorder level 2 or 3). There is second list of conditions (List B) for which access may be granted based on evidence of a diagnosis and an assessment of functional capacity. This list includes conditions for which the impairments are likely to be lifelong, but require further evidence to determine the extent of functional impairment (e.g. rheumatoid arthritis, or movement disorders). In both instances, diagnosis and functional capacity information must be provided by an appropriate clinician. There are no mental health conditions on these lists. However you may work with people who have co-occurring conditions that are on this list so it is always a good idea to check because it can speed up the access process. How are access decisions made? Decisions about who can and cannot access the NDIS are made by access assessors in the National Disability Insurance Agency (NDIA) using evidence provided in an application. Image of man carrying brief case Access assessors are people who are trained in understanding NDIS legislation and applying it. They are not mental health professionals.. Access assessors, like all staff in the NDIA, have undergone mental health training to understand the needs of people with a mental health condition. However, they rely on information provided by relevant professionals to determine how a mental health condition impacts the individual who is applying to the NDIS.
Understanding psychosocial disability Topic 3 of 11 True or false? Psychosocial disability is a different way of saying “mental health condition”. True or False. False is correct. Psychosocial disability is the term used to describe the experience of people with impairments related to mental health conditions. Not everyone who has a mental health condition will experience psychosocial disability. So even though the two ideas are related, they are different. The best way to differentiate the two is to think about a psychosocial disability as the impact of a mental health condition. The NDIS is a disability support scheme. To be eligible for individualised funding a person must experience disability as a result of their conditions. Terms used in the NDIS Mental health conditions A mental health condition is a broad term that refers to symptoms that may be caused by a range of factors including life events and genetic factors. A mental health condition can be temporary or lifelong and include mood, anxiety, personality, psychotic, and compulsive disorders. The focus of the NDIS is not the condition itself, but how the condition impacts a person's life. Impairments resulting from mental health conditions An impairment is a loss of, or damage to, physical or mental function. When considering access to the NDIS for a person with a mental health condition, impairments will usually be about loss or damage to mental function. Mental functions are perception, memory, thinking and emotions. Psychosocial disability Psychosocial disability occurs when a person faces considerable difficulty with everyday activities as a result of impairments relating to their mental health condition. It is important to remember that not everyone who has a mental health condition will experience psychosocial disability (e.g. their impairments don't impact their ability to participate in everyday activities). However, those that do can experience severe effects and social disadvantage. Example: mental health condition resulting in psychosocial disability Pic of stethoscope Schizophrenia 1. Condition - Schizophrenia is the condition. Pic of brain Emotional regulation 2. Impairment - Emotional regulation is an example of one type of impairment that someone with schizophrenia might experience. Not everyone with schizophrenia will have impaired emotional regulation. Pic of two people side by side Difficulty making and keeping friends 3. Impact on daily life - A posible impact of impaired emotional regulation is difficulty making and keeping friends. Not everyone who experiences impaired emotional regulation will experience difficulty with friendships. When people do experience substantial difficulties as a result of the impairments, this is knows as psychosocial disability. This is the main focus of the NDIS - how the condition impacts the persons's life. Scenario The below scenario describes two people with the same mental health condition. Someone who has a mental health condition but doesn't have a psychosocial disability (Frank) and someone who has both a mental health condition and a psychosocial disability (Bob). Frank Frank has schizophrenia and severe anxiety. He has difficulties socialising with others, and with concentration and memory which often result in him forgetting to take important medication or pay bills. Frank has a part-time job, the night before his shift he makes sure he sets his alarm so he won't sleep in (a side effect of his medication). He enjoys his job, sometimes things can get a bit too much for him at work but he has some strategies that help him deal with this and knows what types of things might trigger his anxiety. With the help of his sister he has set up a system of reminders and calendars that make sure he stays on top of his personal administration and his health. Bob Bob also lives with schizophrenia and severe anxiety and experiences difficulties with social interaction and managing his health and finances. Bob experiences extreme anxiety when out in public and often lashes out at others or withdraws completely. He does not have strategies for managing his social difficulties and is very socially isolated. Bob relies on his support worker to prompt him with daily reminders to take his medication, and on the suppport of his mother to manage his finances and pay bills on time. Diagnoses and the NDIS Pic of womans hands on keyboard next to stethoscope A diagnosis of a specific mental health condition is not a requirement to access the scheme but it is helpful. To meet the access criteria people need to demonstrate that they have difficulties with daily activities as a result of one or more mental health conditions. If a specific diagnosis is available this is very helpful; however, it is also sufficient to use general terms like 'mental health condition' or 'psychiatric condition' if necessary. Access and episodic mental health To access the NDIS people need to demonstrate that they experience daily difficulties as a result of impairments relating to their mental health conditions. However, the NDIA do recognise that the impact of mental health conditions can fluctuate; that some days may be worse than others or that the impact of the impairments may vary over time. What is important is to show that, on an average day, the person experiences disability as a result of impairments related to mental health conditions despite these fluctuations. Image of ocean waves Source: NDIS operational guidelines 8.2 'When is an impairment likely to be permanent?"
How to apply Topic 4 of 11 Evidence of psychosocial disability form Pic of Disability Form The Evidence of psychosocial disability form is the preferred way for people with psychosocial disability to provide evidence of disability when applying to access the NDIS. The form has been developed to assist mental health professionals to gather the necessary information to address the five disability criteria for someone with a mental health condition(s). The Evidence of psychosocial disability form can be downloaded from the 'Mental Health and the NDIS' page of the NDIS website, or from the 'How to apply' page of our website. Using the Evidence of psychosocial disability form Access process for psychosocial disability Anyone can use the Evidence of psychosocial disability form, but it is primarily designed to be used by support workers helping their clients to put together an NDIS request, in conjunction with a clinician. Here is a summary of the steps involved in supporting a person to apply to the NDIS using the Evidence of psychosocial disability form. START Step 1 Discuss consent options An applicant can provide their consent for another person (e.g. support worker) to assist them during the access process. Options include: Consent for the NDIA to share information (e.g. the status of an access request) with a designated support worker. This will allow another person to contact the NDIA on an applicant’s behalf; however, the applicant will remain the primary point of contact for any correspondence from the NDIA e.g. the access decision. Complete our ‘consent to assist in completing an access request’ form to do this. Consent for another person to be the primary point of contact for all NDIA communications. This consent can be provided in part C of the Access Request Form where it says ‘do not contact me directly, instead contact [name]’. Although a support worker can be listed here it may be more appropriate to list a carer or other trusted representative to receive all NDIA communications. Step 2 Address age and residency To start, the NDIA need to determine if the person gives consent to participate in the access process, and if they meet the age and residency criteria. There are two ways a person can do this: Option 1: Download and complete the Access Request Form (ARF) Complete parts A–E and sign part H. Complete the questions in part F that relate to injury, compensation and primary disability type. Check the box to indicate disability evidence will be provided as an attachment (Evidence of psychosocial disability form). Leave the rest of part F blank (clinician does not have to complete) Option 2: Call the NDIA and ask to complete a Verbal Access Request (VAR) Call the NDIA and provide the required information verbally. The applicant must be present and willing to speak to the NDIA to begin this process. Make a note of the person’s NDIA reference number which will be provided during the call. Make a note of any timeframes specified by the NDIA in relation to providing disability evidence (the next step in the process). Step 3Step 3 Gather evidence of disability Support the person to complete the Evidence of psychosocial disability form. The form needs to be completed by an appropriately qualified mental health professional, or professionals, who can provide information about a person’s clinical history and their daily function. The rest of this training will focus on how to provide helpful evidence using this form. The Evidence of psychosocial disability form is the preferred way of providing disability evidence for people with a primary psychosocial disability. People with other disability types can provide disability information by asking their health professionals to complete part F of the ARF, or the Supporting Evidence Form. You can read about the options for providing disability evidence on the NDIS website. Step 4 Submit and monitor Send the completed Evidence of psychosocial disability form to the NDIA, along with any attachments/consent forms and the completed ARF (if applicable). If the person completed the VAR instead of the ARF make sure the Evidence of psychosocial disability form is returned in the time frame specified by the NDIA. Sometimes the NDIA will need more information to make a decision. Check in regularly with the person you are supporting to see if the NDIA have made a request. If a request for further information has been made, follow up quickly to avoid delays. Tip: make a note of the date that the application was submitted. If the NDIA do not provide a decision to the person within 21 days, contact the NDIA to follow up and check that there are no outstanding information requests (if you have the person's consent to do so). Step 5 Decision Once a decision has been made the NDIA will send a letter to the person telling them if they have met the criteria, and the next steps in the process. See 'Receiving your access decision' for more information. Step 6 Review options If a person is found ineligible and wishes to appeal this is called requesting a 'review of a decision', you can read about the steps involved and different levels of review on the NDIS website. If a person wants to review the decision they must do this within 3 months of receiving their original decision. If a person is found ineligible, and their circumstances change in the future, they can reapply at any time. Summary To complete their access request a person must have: Provided evidence of age, residency and consent to access the scheme: by completing the ARF or the VAR. Provided evidence of disability: by completing the Evidence of psychosocial disability form. Optional: Provided consent to the NDIA that they want their support worker to assist with their access request. Our 'How to apply' page includes a comprehensive overview of the process and a check list for support workers helping someone to apply. Ways to support people during access Educate about support options (1 of 6) It is important that people have enough information to make an informed decision about whether or not to apply to the NDIS. This includes understanding what the NDIS could fund, who might be eligible, and what happens if they dont meet access. Discuss the process Talk to participants about calling the NDIA , the evidence gathering process and what type of information will be collected at each stage. Discuss wait times NDIS wait times have improved since the scheme started but it is still a process. Sometimes you won't get a decision straight away and people need to be prepared for that. Let them know how you can support them while they wait. Access before planning Not everyone who applies to the NDIS will be granted access to the Scheme. It is important to focus on one step at a time and not start planning for NDIS supports before access has been granted. Manage expectations The NDIS is an exciting prospect for many people. It is also a big change and can be overwhelming. It is important that you are realistic with people about the access process and the potential outcomes of an access request. Connect with LACs Local Area Coordinators (LACs) are organisations funded by the NDIA to deliver on-the-ground support for people who need help to understand and/or access the NDIS. People without formal support services to assist them with access may be able to get this assistance via the LACs in their region. FAQS Completing the forms How do I know which evidence form(s) to complete? There are a number of different ways that people can provide evidence of disability to the NDIS. These include: by asking health professionals to complete the Evidence of psychosocial disability form (psychosocial disability only) by asking health professionals to complete part F of the ARF (all disability types) by asking health professionals to complete the NDIS Supporting Evidence Form (all disability types) by providing existing reports, assessments or letters that show the impact of the person's disability (all disability types). The person can choose the option that best suits their disability type. The Evidence of psychosocial disability (in combination with a completed VAR or relevant parts of the ARF) is recommended for people with a psychosocial disability. If the NDIA sends a specific form to the person, do they have to complete it? The NDIA may automatically send a person the Supporting Evidence Form after completing the VAR. This is because this form is part of the standard process for providing evidence of disability for all disability types. A person with a psychosocial disability can choose to complete the Evidence of psychosocial disability form instead of the Supporting Evidence Form. Can a support worker do the VAR on a person's behalf? The person who is applying must be present to do the VAR and be willing to speak to the NDIA on the phone. You can support them to do this and may be able to answer some of the questions on their behalf after the NDIA have confirmed the person's identity and consent. If you are working with someone who is not comfortable talking to the NDIA, the easiest option is to download the ARF instead. Requests for further evidence What is a 'request for further information'? Sometimes, the access assessor will require further information about the person's disability to make a decision about whether or not they meet the access criteria. If this happens, they will contact the person to request this information. If this happens, the person needs to provide the information within the specified time frame or the access request may be withdrawn or cancelled (meaning the person won't receive an access decision). If the information cannot be provided, the person or their representative should call the NDIA and seek further clarity on the request. Sometimes there may be alternate ways of providing the information so that the request can be fulfilled. When might 'requests for further information' occur? Requests for further information can happen if the person: Didn't provide age, residency or consent information Didn't provide enough information about their disability for the NDIA to make a decision Provided confusing or conflicting evidence of disability that requires further clarification. Helpful link: NDIS operational guidelines '4.7 what will the NDIA do if an access request is not valid'. Reviews and alternate supports What support options are available for people who do not meet access? he NDIA will send the person a letter telling them if they have met the access criteria or not. This letter includes information for next steps depending on the person's outcome. If the person did not meet the criteria they can talk to their Local Area Coordinator or other support networks in their region for information about other funded supports and mainstream services. More information about supports available outside of the NDIS is available on the Department of Health Website. People who were previously participants of Commonwealth Mental Health Programs (Partners in Recovery, Day to Day Living, Personal Helpers and Mentors) who have an access not met decision from the NDIA will be eligible for the Continuity of Support program. Contact your Primary Health Network for information on Continuity of Support providers in your region. Is it better to review or reapply? A review of an access decision must occur within 3 months of receiving the original decision. This is a good option for someone who wants to try again quickly and has access to further evidence to support their request. In this situation, their review will be considered by a new NDIA staff member who was not involved in the original decision. They may ask for further information to consider the review. If the decision was made more than 3 months ago the person will have to re apply. It is important to note that information provided in past requests will remain in the NDIS system and may be considered when looking at the new request. If you are supporting a person to review or reapply it helps to understand why the original access not met decision was made. This can help clarify what information you need to include in the next request/review. Call the NDIA for more information, noting you will likely need the person's consent or have them with you when making the call. How many times can a person apply? People can apply to access the NDIS as many times as they like before they turn 65. Reviewing and re-applying for NDIS access is ultimately the participants decision. There will be people who you work with who are simply not eligible for the NDIS and whose support needs can be met by other systems. Continued applications to the NDIS for someone who is very unlikely to meet criteria can have implications for the person's well being. In these scenarios you may want to chat about linking them in with other supports.
Understanding the functional criteria Topic 5 of 11 What information does the NDIA need? Broadly, information gathering falls into two key areas: clinical evidence and functional evidence. Diagram showing maps to 5 access criteria The Evidence of psychosocial disability form is a helpful guide to evidence gathering. To support clinicians to provide their information effectively, we recommend completing section B of the evidence form (functional evidence) first. Functional evidence criteria - the legislation Section 24 (c) - The impairment or impairments result in substantially reduced functional capacity to undertake, or psychosocial functioning in undertaking, one or more of the following activities: communication, social interaction, learning, mobility, self-care, self-management. Six domains of daily functioning For someone to access the NDIS they will need to show how their disability impacts their ability to complete tasks of daily living within at least one of the six activity areas or 'domains'. These domains are described below. People with a psychosocial disability are most likely to have difficulties in the domains of self-care, self-management and social interaction. However, as always, it will depend on the individual. Click on the question marks for examples of difficulties within the domains. Communication - Ability to be understood and to understand others ? Examples of difficulties in the communication domain include: -only using “yes” or “no” answers in conversation -having disorganised or nonsensical speech patterns that others cannot follow -inability to express own needs either verbally or with sign language -inability to understand others Social Interaction - Ability to interact with others in the community and to make and keep friends ? Examples of difficulties in the social interaction domain include: -significant fear or mistrust of other people -inability to manage emotions or feelings around other people -behaving in ways not generally accepted by other people -having no, or very limited social networks Learning - Ability to learn new skills ? Examples of difficulties in the learning domain include: -inability to learn basic tasks such as how to catch a bus along or how to make a cup of tea -easily confused or distracted leading to an inability to safely complete simple tasks -significant memory issues, unable to retain new information. Note: Academic ability (e.g. struggling to complete a university degree) is not generally considered to be a learning difficulty. Mobility - Physical ability to move around the home and the community using arms and legs ? Mobility is specifically about the person’s capacity to move around using their arms and legs. Therefore it is very unlikely to see substantial mobility impairments for someone with psychosocial disability. Examples of difficulties in this domain include: -being unable to walk -being able to walk only with significant support and mobility devices -unable to use arms for daily tasks like lifting everyday objects, opening doors etc. Self-Care - Ability to take care of personal health and wellbeing ? Examples of difficulty with self-care include: -needing constant reminders to take care of personal hygiene -inability to maintain a healthy diet -inability to follow health professionals advice or attend appointments as required -unaware of the importance of maintaining healthy diet or lifestyle Self-Management - Ability to organise one’s life including planning and making decisions ? Examples of difficulty in the self-management domain include: -cannot budget and manage their money -unable to manage a tenancy and maintaining a house (cleaning etc) -disorganised and forgets to pay bills or take medication Knowledge check Match the impairment with the domain: Table of checks What is a substantial reduction in capacity? Image of blocks with word “support” To meet the access criteria a person need to show that their life is impacted by their disability in at least one of the domains. They also need to demonstrate that the impact on the domain is substantial. A substantial reduction in capacity is much more than experiencing difficulty with a task or taking longer than most people to complete a task; it is when someone is unable to effectively participate in most activities within the domain. To determine if a person experiences substantial impairment consider functioning: Without support: sometimes people are doing really well in an area because they have great support. To determine if there is a substantial reduction in functioning you need to consider what a person's life would look like if the support was not there. Between acute episodes: the person experiences difficulty with the activities on a daily basis rather than only when very unwell. Relative to a person in the community of a similar age who does not have a disability: The NDIS aims to support people to overcome barriers that people without a disability don't face. To determine if someone has substantial reduction it helps to consider whether this is something that people without a disability might also struggle with. An example in the social interaction domain Pic of two people at a desk only showing hands Stephanie has lived with psychosocial disability for a long time. She has been diagnosed with obsessive compulsive disorder, major depressive disorder and borderline personality disorder. Stephanie is seeking access to the NDIS on the basis that her mental health conditions result in substantially reduced capacity for social interaction. Stephanie is a member of various sporting clubs; however, she doesn't always maintain her commitment to them. She has a small group of trusted friends whom she feels comfortable going for walks with, but finds it difficult to trust new people. She recently tried to join a new club but after conflict with another member doesn't want to go back. She does her shopping herself but never goes at peak times because crowds make her uncomfortable. Do you think Stephanie meets the criteria for substantially reduced capacity for social interaction Yes No Unsure Correct answer is No. Stephanie certainly has reduced capacity for social interaction as a result of her mental health condition; however, her evidence shows that she does actually interact with people. She perhaps doesn't interact well with everyone she meets, but she has a circle of close friends and other social contacts. Resources The social interaction scenario (Stephanie) is based on a real appeal to an access decision which was lodged with the Administrative Appeals Tribunal (AAT) of Australia. You can read more about the evidence and the tribunal's decision making on the AAT website. This example is particularly helpful if you want to see how the legislation is interpreted. NDIS Access Snapshot 4: Functional Capacity and Mental Health Issues Access to the NDIS Operational Guidelines available on the NDIS website.
Functional evidence requirements Topic 6 of 11 What information do the NDIA need? To address the access criteria that the person's disability substantially impacts their daily life the evidence will need to show that: 1 1 The person has impaired daily functioning as a direct result of their psychosocial disability 2 2 The impairments are in at least one of the six domains of daily functioning 3 3 The impairments are substantial. Who can provide this information? Evidence can be provided by a community mental health support worker or other mental health professional who: is providing, or has provided, mental health services or supports to the person in a professional capacity has completed training to use the recommended functional assessments knows the person well and can provide details about the impact of the person's psychosocial disability. Steps for gathering evidence Image of form to be completed by applicants support worker Here is a summary of the steps involved in providing evidence of functional capacity using the Evidence of psychosocial disability form. Step 1 Identify impairments: functional assessments Image of Abbreviated Life Skills Profile examples The Evidence of psychosocial disability form includes the Life Skills Profile (LSP) 16 functional assessment tool. This is a helpful way to start to identify areas that a person struggles with because of their psychosocial disability. To complete the LSP-16 you need to first complete the training which is provided on the AMHOCN website. Optional: The WHODAS (World Heath Organisation Disability Assessment Schedule) is another functional assessment tool that you can complete to complement the LSP-16 if you choose. Training for the WHODAS is available on our website. Step 2 Identify impairments: talk to the person Functional assessments are a helpful way of identifying activities that people have difficulty with as a result of their disability. You should also talk to the person about the areas of their life they find difficult and match these up to the relevant domains. You may have already discussed some of these challenges when you first starting working with the person, e.g. via an intake or needs assessment. This information may also be helpful for starting conversations. Step 3 Describe impairments Image of Table of Domain with Social Interaction Describe the person's substantial impairments for the relevant domains. You only need to provide information for the domains that are substantially impacted, if the person does not experience difficulty in a domain because of their disability you can leave that box blank. The clinician, when completing section A of the form, will be asked to confirm if they agree with your description of impairments, or if they would like to add their own information. When describing impairments it is helpful to provide examples - we will discuss this in greater detail later. Step 4 Write a support worker letter Image of someone writing a letter at desk A support worker letter is an important part of the evidence that you can provide. A support worker letter has two functions: To serve as a cover letter for the application - summarising and directing the assessor to relevant information in the request. To provide further evidence of functional impairment - by elaborating on the information provided in the Evidence of psychosocial disability form if necessary. Download our Guide to Writing a Support Worker Letter for suggestions about what to include and tips for structuring your letter. Step 5 Attachments Image of table to add any comments or additional information or explanations. If you have any further comments or attachments relating to functional capacity you can add those at the end. Attachments should only be included if they are relevant to the access criteria and do not conflict with other information provided on the form. Examples include: Letters from other health professionals or support teams involved in the person's care (provided they focus on current function). Additional functional capacity assessments provided they focus on functional difficulties resulting from mental health impairments. Financial guardianship or administrative orders (these can help to show that a person has difficulty in the self-management domain). Summary The focus of section B is to address the criteria relating to functional capacity. After you have completed this section and prepared your support worker letter, a clinician will need to complete section A. Tips for writing your evidence The key to a good access request is providing clear and concise information that addresses the access criteria. Here are some tips to consider. Do Don’t Focus on average days Describe functioning during acute Presentations/crisis Describe functioning without support Discuss gaps in mainstream services Provide examples Describe trauma histories Link the difficulties to the disability Describe future support needs Think about language It is important to use language that is clear, concise and doesn't leave any room for misinterpretation. This can be tricky when you are used to phrasing things in a more positive way. Always keep the access criteria in mind and use language that aligns with the requirements. Image of words some crossed out Activity Most of the time problematic language can lead an access assessor to think one of two things: "This doesn't sound substantial" "This sounds episodic" For the below activity - pretend you are an assessor, what do you think the following phrases suggest? 0/14 Cards Correct REPLAY Has low self-esteem Would benefit from.... When well Feels depressed Can be..... Sometimes will..... On bad days Is unmotivated Feels anxious In times of crisis Lacks confidence On good days Currently is experiencing.... When unwell Suggests not substantial Suggests episodic
Co-occuring conditions and AOD Topic 7 of 11 Image of 3 boxes saying No Yes Maybe When people have more than one condition the NDIS needs to be able to separately assess each one to determine which one(s) meet the criteria. A person may therefore gain access on one condition, but not another, or could gain access for both. If a person has multiple disabilities they should gather evidence to prove that they meet the criteria for each disability. If a person has psychosocial disability and multiple health conditions (that won't meet disability criteria) then focus evidence gathering on the psychosocial disability only. Psychosocial disability and co-occurring health conditions If the person has a psychosocial disability and other conditions that make their life difficult, but wouldn't meet NDIS criteria, you need to focus the application on the psychosocial disability only. Tips for doing this include: 1 1Leave out any mention of difficulties that result from the health condition alone. 2 2Consider how the person's mental health condition impacts their management of their physical or other conditions - perhaps you could include this as an example of the persons psychosocial disability resulting in difficulties in the self-care or self-management domains. At the end of this training we will go through a fictional access scenario that will help you identify what to include, and what to leave out, when preparing applications for people with co-occurring psychosocial disability and other conditions. Multiple disabilities If the person has a psychosocial disability and another co-occurring disability that may meet criteria, you need to present the evidence in a way that makes it easy for the access assessor to consider these separately. Tips for doing this include: 1 1Complete two evidence forms: provide information relevant to the psychosocial disability in the EPD form, and information relevant to the other disability in the Supporting Evidence Form. 2 2Always make it clear which impairments result in which difficulties, don't jumble the two conditions. An example of how to do this is shown below. 3 3Don't describe health and mental health conditions as linked, this leads the assessor to question the permanency of both. For example, if the physical condition were remedied, would they also no longer experience impairments from their mental health condition? Conditions not separated Click to flip Because of her conditions, Karen has difficulty taking care of her health. She struggles to exercise or walk long distances, and forgets to take her medication. Click to flip Conditions separated Due to her back injury Karen is unable to mobilise without the assistance of her scooter. This limits all physical activity. She is unable to shower safely without support. Due to her psychosocial disability, Karen often forgets to take the medication required for her health conditions and can become very unwell. She also requires constant reminders to eat regularly and take care of her diet to control her diabetes. Important: It is only necessary to separate conditions as shown above when the person has co-occurring psychosocial disability and another type of disability (e.g. physical disability). If a person has multiple mental health conditions you do not need to discuss these separately. Alcohol and Drugs Access to the NDIS for people who are currently misusing alcohol or drugs (AOD) is difficult. The NDIA need to be confident that the functional difficulties result from the mental health condition and are not a result of current AOD misuse. Evidence options to show this include: Functional assessments or reports about function from a time when a person was not using AOD (e.g. an inpatient facility, extended hospital stay, rehab clinic) Statements from clinicians that confirm the disability exists independently of AOD misuse (e.g. the person was diagnosed with likely permanent mental health conditions prior to AOD misuse) Neuropsychology assessments - these can document impaired brain function that is likely to be permanent. Access to these type of assessments will not be feasible for everyone and can be costly. If applicable, consult with a neuropsychologist about the potential use of an assessment for access purposes prior to proceeding down this path.
Understanding the clinical criteria Topic 8 of 11 The main focus of the clinical evidence is to show that impairments exist (as a result of a mental health condition) and that these impairments are likely to be permanent. In the NDIS, disability is considered to be (likely) permanent when there are no known, available and appropriate evidence-based clinical, medical or other treatments that would remedy the impairment(s). Clinical versus personal recovery in the NDIS Clinical recovery Click to flip Clinical recovery is when a person's symptoms are remedied and/or there is significant functional improvements as a result of treatments. If there are available treatments likely to result in clinical recovery, the person is unlikely to meet the likely permanent criteria. Click to flip Personal recovery Personal recovery refers to an individual's journey toward living a productive and satisfying life, whilst living with the impacts of mental health conditions. If there are available treatments that will support a person's personal recovery, but not their clinical recovery, they are likely to meet the likely permanent criteria. Known, evidence-based and available treatments Image of stethoscope The NDIA will need to see evidence that a best-practice treatment approach for the impairment(s) has been explored if reasonable/accessible. It is up to the treating clinician to specify the best-practice approach for the individual taking into consideration the conditions, the impairments and individual factors (e.g. cultural practices). The NDIA will consider the extent to which best-practice treatment options are available to the participant and reasonable to expect that the person could engage with. Note however that it is not helpful to describe gaps in mainstream services that prevent following appropriate treatment plans. Likely permanence and treatment FAQs How does likely permanence align with recovery practice? To access the NDIS people will need to show that they have a likely permanent disability and that they have substantial difficulties in at least one domain of daily life. Some people may find this challenging and feel like it is contradictory to the principles of recovery-oriented practice. However, it is important to remember that recovery is not about ignoring the impacts of mental health conditions, or the potential for impairments to remain across a person's life. Recovery is about recognising that people can have contributing lives whilst living with mental illness and helping people to achieve their goals. Confirming that the person’s impairment is likely to remain across their lifetime has no reflection on whether the person has achieved their best possible version of personal and emotional wellbeing. See our Recovery and the NDIS training module for more information. You can also download the NDIS Access Snapshot 3: Recovery and the NDIS from the mental health page of the NDIS website. Is likely permanence assumed for people with severe and persistent conditions? There are a number of mental health conditions that are generally known to be severe and persistent, these include but are not limited to, schizophrenia, personality disorders and major depression. For the purposes of gaining access to the NDIS a person needs to show that the impairments resulting from the condition are likely to be permanent. Whilst is it recognised that many mental health conditions will remain with the person over their lifetime, the impact or major symptoms of the conditions may be managed with medications and/or therapies. It is very important not to assume the likely permanence criteria is automatically met when there is a diagnosis of a severe and persistent condition. The NDIA needs to understand the treatment history and likely outcomes for people on an individual basis. Do all treatment options have to be tried? The treating clinician will decide on appropriate treatment for a person. The NDIS requires evidence that provides a history of treatment and the rationale relating to any decisions made by the clinician not to pursue a known treatment/intervention option. What about people who have only recently been diagnosed? People who have only recently begun to experience difficulties with their mental health will likely need to wait until they have explored some treatment options before attempting to access the NDIS. Do all treatments need to be completed? There is no requirement that treatment or interventions must be completed for an impairment to be considered likely to be permanent. However, they must be explored to the extent that clinical recovery is no longer likely and that ongoing treatment is centred on personal recovery (e.g. supporting the person to live a contributing life whilst living with impairments related to mental health conditions). Knowledge check Ben is 22 and has just been diagnosed with schizophrenia. The impact of the schizophrenia on his life is quite severe. His GP has just referred him to a psychiatrist who has established a treatment plan. Is Ben likely to meet the likely permanence criteria? Yes No No is the correct answer. It is probably too early for Ben to access the NDIS. He has not yet explored his treatment options and therefore it will be difficult to establish whether Ben's impairments are likely to be permanent and what impact they will have on his life. Ben may consider accessing the NDIS in the future. Maria has experienced significant difficulties with her mental health for over 10 years. She has seen a number of different psychiatrists who have been unable to reach a consensus on a diagnosis. Maria has undergone a number of different therapies and is taking medication which helps to manage some of her symptoms however she continues to experience daily difficulties. She continues to work with her psychiatrist on therapies that maintain her current level of function but there are no treatment recommendations that will remedy her impairments. Is Maria likely to meet the likely permanence criteria for the NDIS? Yes No Yes is the correct answer. Maria is likely to meet the likely permanence criteria for the NDIS, she has explored treatments with an appropriate clinician and continues to experience ongoing daily difficulty. Resources NDIS Access Snapshot 3: Recovery and the NDIS NDIS operational guidelines 8.2 When is an impairment permanent or likely to be permanent?
Clinical evidence requirements Topic 9 of 11 Evidence of likely permanence WHAT IS NEEDED? To address the access criteria that the person has a psychosocial disability (24(a)) that is likely to be lifelong (24 (b)) they will need evidence to show that: A mental health condition is present (and the diagnosis if available) Appropriate treatments have been tried (e.g. therapies as well as medications) and their effectiveness There are no further treatments that would remedy the impairments WHO SHOULD PROVIDE IT? A clinician should provide this evidence. This is because the focus is on diagnoses, treatments and effectiveness. Clinicians e.g. psychiatrists and GPs, are qualified to diagnose and treat mental health conditions. The NDIA will also accept evidence of likely permanence from other suitably qualified clinicians e.g. psychologists and/or clinical mental health nurses if GPs or psychiatrists are not available. IN WHAT FORMAT? The Evidence of psychosocial disability form (Section A) will direct clinicians to provide the necessary information including: • Diagnosis • Treatments • Statement of permanency • Description of impairments resulting from the conditions (optional, they could instead choose to tick a box to agree with the description provided in Section B) You can also add attachments to the evidence form to confirm or expand on the information provided on the form. Examples include: • Summaries of medications prescribed for mental health • Summaries of treatments tried and their efficacy (prepared by the treating clinician) • Statements from treating clinicians that confirm likely permanence of impairments • Discharge summaries/statements from clinical mental health services • Supporting letters from treating clinicians Selecting suitable clinicians, considerations Psychiatrists If the person has a treating psychiatrist they are a great option if readily available and inexpensive. However, there is usually no need to pay a psychiatrist specifically for the purposes of NDIS access. Instead, a GP could refer to existing psychiatrist evidence, or use their correspondence with the psychiatrist (e.g. referrals and treatment updates) to provide this information. General Practitioner GPs are usually the best option for gathering clinical evidence. Ideally the GP knows the person well and has access to their history. If not, they can still review clinical evidence and provide their rationale for likely permanence. The latter may require a few visits, and/or a considerable amount of existing evidence for the GP to be able to make a clinical judgement. Psychologists/other clinicians Psychologists and other clinicians e.g. clinical mental health nurses are also qualified to comment on treatment efficacy and likely permanence. However it is generally recommended that a GP or psychiatrist are selected if they are available. Situations where a psychologist or mental health nurse may be better suited include people in rural or remote areas where access to other clinicians is limited. The clinician statement of permanency Image of clinician statement of permanency, part A Evidence of psychosocial disability form. The clinician will be asked to tick a box to verify that they consider the impairments to be permanent. It is critical that they also provide their justification for why the impairments are likely to be permanent (using the 'please explain' section - see image). A good statement of permanency provides a clinical justification for why this is likely to be the case by referring to prior treatment efficacy, and the likely benefits of any further treatment. "Sarah has a psychosocial disability which was first diagnosed in 2010. She has undergone a range of psychological therapies and manages some of her symptoms with medication (refer to previous page for details). The treatments have helped to manage her symptoms a little better and I consider her condition to be fully treated and stable. The impairments (her difficulties interacting socially, and managing her self-care as discussed in section B) significantly impact her life and are likely to be lifelong. Further treatments are not likely to remedy the impairments." Example GP statement of permanency referring to supporting evidence in the Evidence of psychosocial disability form note: never use form sentences, copy and paste statements from one application to another, or write on behalf of the clinician. The above is an example only. All statements should be authentic, individualised and supported by the evidence in the application. Checklist for reviewing attachments Sometimes people will have a lot of reports and assessments about their treatments and conditions. For every piece of evidence you are considering attaching to the request you want to be able to answer 'yes' for each of the following questions: Does this evidence address at least one of the access criteria? Does this evidence complement (give the same message, or expand on an important point) the other information included in the request? Does this evidence reflect the person's current situation? (e.g. do not include old assessments of function or diagnoses/treatment recommendations that have since changed) Was this evidence prepared by an appropriately qualified health professional (ideally who knows the person well/has a treatment history with the person)? Does this evidence relate directly to the person's psychosocial disability? Will the assessor (who is not a trained medical professional) be able to understand this evidence? Examples of unhelpful attachments Letters between clinicians Click to flip Examples include referral letters or treatment updates. These often lack detail and context and assume knowledge of the patient's treatment history. Unlikely to contribute meaningfully to a request. Click to flip Scans or x-rays Assessors are not trained to read these. If they are relevant to the application a clinician could summarise these in plain language. Legal documents These are often very long, written for a very specific purpose and include personal details not relevant to an access request. Mental State Examinations These describe a person's functioning at that specific point in time, not their average day. 1 of 4 Image of animated person with light bulb above hand Tip Assessors have to read everything that is sent to them with an access request. Be selective with your evidence and try to keep applications short and to the point. A good way to manage this is to get clinicians to summarise a person's history rather than asking the assessor to read through reams of information collected over a person's lifetime. The Evidence of psychosocial disability form will help with this. Working with Clinicians FAQs Billing GPs can charge for their time filling out this form via the appropriate Medicare item (they choose this at their discretion). Central Eastern Sydney PHN have developed a Billing resource for GPs that includes some helpful examples. A psychiatrist/psychologist may be able to complete the form as part of a Better Access/other bulk billed consultation if appropriate. You will need to discuss payment in advance as some may not offer this option. Gathering evidence in advance The Evidence of psychosocial disability form has been designed to minimise the amount of writing a clinician needs to do by encouraging support workers to complete the functional impact information (section B) before going to the clinician. Before going to the GP you could: complete section B prepare a support worker letter gather reports, assessments or any other information that the GP may not have access to (this will depend on their time working with the patient) that can help them to summarise a person's treatment and diagnostic history prepare a clinician cover letter (download a template from the 'how to apply' page of our website) The clinician can then refer to the above information when providing their evidence. Supporting people to attend Assist the person to make an appointment with their clinician to complete the evidence of psychosocial disability form Ask if they would like you to attend the appointment with them If someone from your organisation is not attending the appointment with the person, provide contact details of someone the clinician can call if they require further information. Booking long appointments The clinician will likely need a double appointment to complete the form. You can also speed things up by sending the form in advance. Explaining access Some clinicians will already have great knowledge and experience of the NDIS. Others will need some support to understand their role. The Evidence of psychosocial disability form and clinician cover letter template can help with this. You can also use your knowledge of the evidence requirements to guide them. We have developed an access training module designed specifically for clinicians which is available on our website for clinicians who want further information. The NDIA have also developed a fact sheet 'A GP guide to the NDIS- Psychosocial Disability' that describes the clinicians role and what type of evidence to provide.
Scenario Topic 10 of 11 Meet Marree Image of back of female Marree is considering applying for the NDIS and would like support to do so. Below is some information about Marree's background, diagnoses, treatments and daily difficulties. Read through the information and then we will ask some questions about Marree and the NDIS. Background Marree is 35 years old and has been struggling with her mental health since she was in her teens (low self-esteem, major anxiety and depression). At school she wanted to be a lawyer, however she did not complete year 12 and has not gone back to study. Conditions Marree was diagnosed with major anxiety, depression and bipolar disorder when she was 29. Marree also has high blood pressure and struggles with her weight as well as occasional back and knee pain from a car accident. She is on the Disability Support Pension (DSP) because her mental health conditions prevent her from being able to work. She also received previous compensation payments for her car accident. Treatments Marree takes medication and has undergone various therapies for her mental health conditions. Her psychiatrist considers her impairments to be fully treated and stable, and that further treatment would not remedy her impairments. Her GP has recommended various treatments and strategies for her pain and her health conditions but these still continue to cause problems for Marree. Daily difficulties Marree finds the following things difficult: Managing her money so that it lasts her the full week, often she will give it away to people if they ask for help or spends it all in one day Paying for things like a car or groceries due to her low income Walking distances longer than a kilometre because her knees start to hurt Doing other physical activity to help with her weight, she struggles with motivation to exercise and has sore knees Getting enough sleep which makes her feel unmotivated and more depressed Leaving the house alone because she is very fearful of others Managing her health conditions, without support from her mother to make sure she takes care of herself (eats regularly, takes her medication) she can become very unwell both mentally and physically Forming social relationships, she is estranged from everyone but her mother (carer) and support worker, due to her anxiety in social situations and emotional responses Lowering her blood pressure, her medication doesn’t seem to be working properly, this is making her very unwell, unmotivated and depressed Keeping her house clean, without her mothers support she risks losing her tenancy Joining in conversations because of her social anxiety, she rarely talks to people she doesn’t know. Likely permanence Based on the information provided above, do you think Marree is likely to meet the likely permanence criteria for her mental health impairments? (hint: look at the treatment section) Yes No Correct answer is Yes. Marree's psychiatrist is confident that her impairments will remain therefore she is likely to meet the criteria. In practice, we would need more information from the psychiatrist but we will discuss that in a later module. For the purposes of this activity, yes Marree's mental health impairments are likely to be permanent. Based on the information provided above, do you think Marree is likely to meet the likely permanence criteria for her physical health impairments? (hint: look at the treatment section) Yes No Correct answer is No. Marree's health conditions are not likely to meet criteria of likely permanence because her doctor has recommended effective treatments that, if completed, would likely resolve the impairments or at least considerably reduce their impact. Daily difficulties Based on what you know about Marree, which of the following difficulties are directly related to her mental health impairments, and are therefore relevant to include in her application? hint: look at the daily difficulties section to understand the relationship between the difficulties and the impairments. 0/11 Cards Correct difficulties forming relationships difficulty keeping the house clean difficulty walking more than a kilometre difficulties managing money difficulty joining in conversations difficulty managing health conditions difficulties getting enough sleep difficulty doing physical activity difficulty affording food and a car difficulties with the blood pressure medication difficulty leaving the house alone Directly related to mental health impairments Not directly related to mental health impairments
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