Article summary:
- The APS is actively advocating for psychology to be enshrined in the NDIS, and has had recent advocacy wins such as the 3.9% increase to psychologists’ NDIS price limits.
- Psychologists help NDIS participants with capacity building, not just mental health challenges
- They are also critical enablers of education and support for families, loved ones and the support workers of NDIS participants
- Psychologists can help NDIS participants advocate for themselves and their rights, ensuring they get to use their funds in the most appropriate and beneficial way
- A lack of funding in rural and regional areas in Australia is a significant gap within the Scheme -the APS has advocacy to address this.
- The involvement of a psychologist helps to reduce costs in the long-term, as they enable greater independence of participants who then rely less on ongoing support work.
Psychologists are integral to supporting NDIS clients to build capacity and enhance their quality of life. Three members of the APS NDIS working group outline the impact psychologists are having on the scheme.
Jennifer (Jeni) Langdon MAPS was so passionate about the role of psychologists within the National Disability Insurance Scheme (NDIS) that she took an entire career change when the Scheme was first introduced in 2013.
“I got into psychology with the intention of becoming an NDIS psychologist. When I first heard about the Scheme, I changed my career – I used to be a counsellor – because I thought the Scheme had some legs and that it could really, really help people,” says Langdon, who is a clinical psychologist and Board-approved supervisor.
And help people it has. Over 646,000 participants are currently being supported by the NDIS, and we can estimate that roughly a quarter of these people have received psychological support. More than half feel the NDIS has improved their health and wellbeing, and over three-quarters now feel they have greater control in their lives.
These great results wouldn’t be possible without the contributions of the psychology workforce.
“Psychologists can help people with disabilities and others involved in their lives come together to progress issues such as choice and self-determination,” says Keith McVilly MAPS, clinical psychologist and Professor of Disability and Inclusion at the University of Melbourne.
Psychology services are vital within the NDIS, adds Langdon, and it goes beyond providing mental health care.
“We make a connection between mental health and functional capacity, which impacts on people's day-to-day activities, their social interactions, their education and their employment.”
What role does psychology play?
Having a psychologist included as part of an NDIS package ensures the services offered to the participant are in line with their specific needs.
“When you put somebody on the NDIS, it’s easy to make a big, long list of what they need. However, we also need to assess what they really need," says Langdon.
"At my clinic, we view the NDIS as a way of enabling participation in the community. We don't view it as disabling people further, and so we're always quite goal-orientated to ensure that people on the NDIS have the opportunity to participate in things they want to do,” she says.
Psychologists' extensive training allows them to provide an accurate diagnosis of not only mental health conditions, but also psychosocial disabilities, she adds.
“For example, if you've got somebody who's been diagnosed with complex PTSD, dissociative identity disorder or even a physical disability, such as an amputation, they may experience significant barriers to community participation, social interactions and day-to-day activities outside of their home.
“A psychologist can offer tailored interventions and evidence-based coping strategies for that person."
Psychologists can also facilitate trauma-informed care, says psychologist Dr David Hammer MAPS.
There is a lot of trauma in disability – a lot of historical, generational and institutionalised trauma. So unpacking that and helping [clients] understand that, and building trust with the system, is essential.
“Support workers might have their own traumas from working within disability. So providing care and education helps to build a stronger workforce that helps to sustain the NDIS.”
There are also substantial economic gains to come down the line from psychological intervention in the NDIS, with less funds needed to secure ongoing high-touch support work for these individuals as they gain further independence and self-confidence.
“For example, a person might be quite anxious about things, and we're building capacity to help them manage that anxiety,” says Dr Hammer. “Then that person may not call a support worker at night or may not require the level of current support overnight in the long-term."
Langdon has seen this happen.
“We’ve got them regulated and functioning again, which is a key benefit that psychology brings.”
The power of capacity building
Psychologists’ work within the NDIS is strongly focused on capacity building for participants to enhance their decision-making skills, promoting greater independence over time.
“Many people with disability have struggled in the past because they haven't been validated, they haven't received the care and attention they need, and they often haven't been heard. A psychologist can teach that person how to be heard, what to say, when to say it, where to say it, and how to self-advocate for themselves,” says Langdon.
Psychologists can also work with people's support networks.
“Support workers, their family members, their loved ones, anyone in their neighbourhood, any carers who might be involved in their day-to-day activities, or in their lives – we help that community build the skills and strategies needed to manage challenging situations through the positive behaviour support plans.
"We can teach them how to assist the participant with regulation, how to motivate them when days are tough… and how to actually allow the participant to socially engage and get more involved in their community, while ensuring what they're doing aligns with their NDIS goals and the individual support that they need."
Dr Hammer concurs: “Some of the support workers who’ve been in the system for a long time can have quite institutionalised views of disability, and so from a psychological perspective, we can help them to shift that view.
“We can develop reflective practice workshops for them, or work with them in their understanding of mental health explaining what a diagnosis is and how they can support a person."
Under the NDIS, Dr Hammer may only get to see a participant for one hour per week or fortnight, so he is focused on enabling those support workers, who are with them eight hours a day.
“If they're dependent on this person for their daily experiences, how are they interacting? What does this person know about a person with schizophrenia? Do they have any understanding of what might be happening when the person is getting upset and yelling? Psychology can help in supporting that person to be able to put strategies in place that can affect change.”
The impact of psychologists' work
Psychologists can support NDIS participants to navigate potentially harmful situations.
For example, Langdon shares the example of an NDIS participant with severe psychosis who experienced paranoia, which led to them cancelling their plan.
“In this critical situation, the support worker took control without consulting medical professionals or following established protocols,” says Langdon. “The lack of involvement from a psychologist … resulted in the participant's abrupt disconnection from NDIS support services.”
This oversight highlights a severe risk in the system, exposing the participant to potential harm and the NDIS to liability for failing to ensure adequate care, she adds.
“A psychologist could have assessed the participant’s mental state, provided crisis intervention, and ensured continuity of care by advocating against the cancellation of essential services. This professional involvement is crucial to manage such high-risk cases effectively, ensuring that decisions are made in the participant's best interests and based on sound clinical judgement.”
In a more positive example, Langdon refers to a young woman who lives with Autism, ADHD, and borderline personality disorder. She had received $30,000 in support coordination funds, which were poorly managed and led to exploitation.
“The focus seemed to be on disabling rather than enabling the participant.
“Her eventual engagement with a psychologist led to significant personal development, including employment and improved family relationships. The psychologist’s intervention was crucial in educating her about her rights and managing her complex needs effectively.
“The psychological care… proved more effective and economical in the long run compared to the ongoing costs of ineffective and mismanaged supports.
“This case highlights the importance of qualified psychological care in preventing exploitation and enhancing participant autonomy. She was also able to function independently without the need for 20 hours of support worker services each week, saving the NDIS funds.”
NDIS and Medicare
Research of 800 APS members in July 2023 found that 84% noted their NDIS clients had been inappropriately told to access MBS-subsidised psychology sessions instead of NDIS funding for psychology support.
To those who question the role of psychology within the NDIS and suggest that psychological care is best kept within the Medicare system, Langdon says that ignores the realities of many NDIS participants' experiences.
Many participants are on Centrelink payments due to their disability, she says, so it’s not financially feasible to cover the gap fees of the Medicare subsidised sessions – let alone the full fees that come into place following the end of the tenth session in that calendar year.
Also, 10 sessions are rarely enough time to develop a comprehensive support plan for someone living with both complex mental health and disability, says Dr Hammer.
“You're working across myriad presentations and 10 visits doesn't seem adequate to be able to effectively explore, build capacity with that person and to be able to look at the implementation of strategies,” he says.
Gaps that need to be addressed
Despite gains that have been made due to APS advocacy, such as the 3.9% increase to psychologists’ NDIS price limits for this financial year and the establishment of NDIS ‘navigators’ – who are service coordinators with specialist skill sets – there are still significant barriers and gaps to address.
APS's 2023 research showed that one-third of psychologists had an overall negative experience working within the NDIS based on a range of factors, such as having their professional opinions ignored and the high administrative burden associated with being a registered provider. In response to the latter point, recent APS advocacy contributed to the NDIS Provider and Worker Registration Taskforce recommending that AHPRA registration should be recognised as registration for the NDIS.
Another one-third of members saw that the NDIS achieved good outcomes for their clients, but at considerable cost and stress to themselves professionally.
Part of this stress comes down to a lack of funding.
“The significant gap at the moment is the inconsistencies in funding for psychological services,” says Langdon.
The APS research found that 91% reported that their clients have experienced inappropriate cuts or reductions to psychological support in their plans, and 51% said this happened frequently.
“I've had a client I was working with for two years, making great gains, and then at the next review stage, psychology was just cut. This person’s deterioration has been massive because of this.”
Langdon would like to see further funding for psychological services in the NDIS.
“We have a clinical neuropsychologist in my clinic, and quite often if somebody's treatment-resistant or if they've got an acquired brain injury… then we need to get that psychologist to assess them, to then guide their treatment plan. But the budget's not there to do that.”
This funding would have a strong return on investment, she adds, because it would mean more targeted and useful treatments for individuals which are more likely to be effective.
Another challenge is the lack of services that are available within rural communities.
“There are a lot of psychologists who will temporarily go out and do rural assessments for the NDIS, but then there are no services to deliver on that – which [poses an ethical challenge]. And that person might not be able to use telehealth services due to their disability."
This is another area where the APS has been advocating for change. Our recommendations include, but are not limited to:
- Adequately remunerating travel costs to improve accessibility for participants.
- Addressing the cost of providing services in rural, regional and remote locations to increase availability, responsiveness, consistency and effectiveness of supports for participants.
- Incentivising psychologists to be based in regional, rural and remote locations to optimise participant choice and control.
Read the APS’s full NDIS participant experience in rural, regional and remote Australia submission here.
“It’s really important that we can get this treatment to rural communities – people’s presentations can be a lot more complex [in these areas].”
Professor McVilly says more funding is needed for multidisciplinary intervention.
“I am a very strong exponent of multidisciplinary and, indeed, transdisciplinary teamwork. I don't think there is enough emphasis in the way that the funding schedule is structured to emphasise the importance and, more importantly, the enablement of multidisciplinary teamwork.”
When the NDIS was first creating its funding model, McVilly advocated for an idea, which wasn’t taken up, that mimicked the Medicare Chronic Disease Management Plan (CDMP).
“[For a CDMP] the GP is a fund holder, and they can instigate the Medicare item under the chronic disease management plan, where they can get at least three other disciplines involved.
“So for diabetes, [the patient] might have a podiatry appointment, they might have a dietitian providing dietary advice and they might see an ophthalmologist to monitor their eyes. I think that a Medicare-like item, which intentionally brings several disciplines around the person in order to trigger the funding, is something that could be taken up within the NDIS.”
Behaviour support is a critical area where a multidisciplinary team, inclusive of psychology, could make a big difference.
"Too many behaviour support plans are being developed by ‘behaviour support practitioners’ without the necessary training in psychology. As a consequence, these fail to make any substantial difference in people’s lives. This comes at a major cost to the NDIS and, more disturbingly, at a cost to the safety, health, wellbeing and quality of life of individuals,” says Professor McVilly.
All streams of psychology are important
Professor McVilly stresses that all psychologists are critical to the NDIS system.
“While I'm a clinical psychologist, I have a great deal of respect for my colleagues in organisational psychology. And, to be quite honest, I don't think we draw upon their expertise sufficiently, and that’s both within the NDIS as an agency, but also within the services and the support systems supporting people with disability.
Often, I find the big barriers to people experiencing choice and self-determination and a high quality of life is not so much their disability… but oftentimes the pathology is inherent in the service system and supporting organisations.
"I'd love to see us drawing upon the skills of organisational psychologists supporting organisations to build better systems around people, to understand the dynamics of where stakeholder communications are breaking down, for example.”
When it comes to supporting the teams of people surrounding the NDIS participant, Professor McVilly says we can draw on the principles of coaching psychology.
“I think a lot of those coaching and enabling skills that sports psychologists bring are important – not so much telling people what to do but encouraging them and getting them to realise what they're good at doing.”
Education and developmental psychologists also have useful expertise for NDIS participants, he adds.
“[They can utilise their] assessment skills and ability to design bespoke curriculum to enable people to learn the skills they need to be more independent and to exercise choice and control are a vastly underutilised psychological resource.
“They can also support with things such as task analysis, systematic instruction, chaining techniques, and the whole process of teaching, learning and helping people to acquire the skills they'll need to act more independently.”
Where to from here?
The NDIS is a world-class system that changes people’s lives, says Langdon.
“There’s nothing else like it in the world. We need to keep the budget there. It just needs to be affordable and sustainable.”
We need to utilise the full suite of psychologists’ skills and expertise in the NDIS. It's not just about providing mental health services but supporting and enabling NDIS participants to “overcome the disabling elements of their life,” says Professor McVilly.
“I think sometimes where we fall short as psychologists, particularly in the NDIS reports that we write, is that we keep coming from this mental health point of view, which the NDIS does not want to listen to. So let's not go there. Let's draw on all these other skills and facets that we bring,” he says.
By doing this, McVilly hopes the government will see just how important psychology services are to the NDIS and that it will become commonplace to factor these services into someone’s plan.
“If psychology is not included in someone's plan proposal, a NDIS planner should ask the question, ‘You've got an OT. You've got a speechie. Where’s the psychology service? Might this person benefit from that?’ I would really like NDIS planners not to be rejecting us because they've mistakenly just seen us as ‘a mental health provider,’" says Professor McVilly.
"I would love the NDIS to see our role in supporting and enabling people to understand and reach their potential such that they're asking for our services to be written into plans."
Further reading
During the current period of NDIS reforms, the APS continues to advocate for the role of psychologists within the NDIS. Some of our recent advocacy wins include:
APS would like to thank all members of our NDIS working group for their contributions to our ongoing advocacy about psychologists’ role within the NDIS.