The APS is pleased to share news that our advocacy efforts have been recognised as a new Determination for the Disability Support Pension (DSP) Impairment Tables was announced by the Department of Social Services (DSS). This important news will have beneficial impact for many Australians living with a disability or caring for someone with disability.
The new Determination will take effect from 1 April 2023. The new Legislation and Impairment Tables can be found here.
Read on for our detailed analysis of these changes.
The APS has been consistently advocating for changes to the DSP and the Impairment Tables over the past few years, involving many meetings and consultations with DSS, Senate Inquiries, as well as submissions and engagement with members. As APS President I have also represented the APS and the profession of psychology on national committees related to disability.
APS has called for recognition of the skills of all psychologists in assessing and diagnosing mental health disorders, removing the need for a mental health-related disability to be permanent, and other changes.
In line with APS focus on professional unity we have also actively called upon the DSS to broaden DSP assessments under Table 5, beyond clinical psychologists, to include other psychologists recognised as having completed advanced training. We recommend further consideration be made to recognise the expertise of all psychologists in making a formal diagnosis of mental health conditions, not just medical practitioners.
Whilst we recognise and appreciate that the changes were carefully considered by the Advisory Committee, we also note that some of the APS’ recommendations have not been included. However, this is still a hugely positive result and a powerful example of the strength of the APS in action, advocating for our members and Australians alike.
Below you will find a snapshot of the work we’ve been doing since 2021 on this issue as well as a more detailed analysis of the changes to the Tables and what it means for you.
APS advocacy on the Disability Support Pension
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July 2021 – The APS responded to the initial consultation from the DSS’ Review of the Disability Support Pension (DSP) Impairment Tables.
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October 2021 – APS meeting with the DSS.
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October 2021 – APS provided a response to additional questions DSS asked specifically of the APS.
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November 2022 – APS responded to the Proposed changes to the Disability Support Pension (DSP) Impairment Tables.
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January 2023 – APS meeting with the DSS.
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January 2023 – DSS requested further information from APS (specifically re Table 7 – Brain Function).
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January 2023 – Based on input from members, the APS responded to the request for more information to the DSS.
APS detailed analysis of the changes and what it means for your practice:
Changes for psychologists to Table 5 Mental Health Function and Table 6 – Functioning related to Alcohol, Drug and Other Substance Use.
We support the inclusion of registered psychologists as being able to provide evidence to support the diagnosis of a mental health condition for the purpose of Table 5 – Mental Health Function and Table 6 – Functioning related to Alcohol, Drug and Other Substance Use.
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Table 5 previously required evidence to support a diagnosis from a clinical psychologist. It can now be provided by a registered psychologist.
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Table 6 previously remained silent on whether a psychologist could provide evidence. It now specifies a “psychologist”, in the examples of who can provide corroborating evidence.
In terms of Table 6, we have previously noted that psychologists frequently work with clients with substance use disorders and have an important role in the assessment, diagnosis and treatment of people with addiction issues, particularly psychologists working within primary healthcare settings. We believe that psychologists are well-equipped to provide supporting evidence of functional impairment due to excessive use of alcohol, drugs or other harmful substances.
Whilst we recognise and appreciate that the changes to Table 5 and 6 were carefully considered by the Advisory Committee, we also note that the diagnosis requirements for these Tables remain set to a “medical practitioner”. In our submissions and also during further consultation between the APS and the DSS, we recommended that all registered psychologists should be able to make mental health diagnoses, particularly for the purpose of Table 5 (and arguably Table 6 should also be included in this), and that this should occur without the need for an additional diagnosis from an appropriately qualified medical practitioner. Whilst the ship has largely sailed for the next 10 years before this will be reviewed again, we recommend further consideration be made to recognise the expertise of all psychologists in making a formal diagnosis of mental health conditions, not just “medical practitioners”.
Other changes to Table 5 - Mental Health (including Operational improvements)
Based on member input, in our submission and during further consultations between the APS and the DSS, we highlighted the suitability of the DSP Impairment Tables reporting against the WHODAS domains.
We are therefore supportive of the changes to Table 5 – Mental Health Function, which now better aligns with the functional domains of the World Health Organization Disability Assessment Schedule (WHODAS). This will also ensure greater consistency between the DSP and the NDIS, with many participants needing access to both systems.
We also initially supported the proposed changes to the Exposure Draft of the Determination regarding the introduction of Table 5 – Mental Health Function to mention the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization International Classification of Diseases (ICD) as acceptable diagnostic tools. In our submission to the Exposure Draft, we also recommended updating Table 5 to ensure the most current version of the DSM and ICD is referenced. That is, the Diagnostic and Statistical Manual of Mental Disorders 5th edition Text Revision (DSM-5-TR) and the International Classification of Diseases 11th Revision (ICD-11). However, in the final determination we note that the references to the DSM and ICD have been removed altogether and it now simply states: “Diagnosis and evidence should make appropriate reference to the diagnostic tool used.”
Changes to Table 7 – Brain Function
In our submission we recommended the inclusion of a social skills descriptor to capture mental health and other neurological disorders (such as ASD). A new social skills descriptor has now been included in Table 7 – Brain Function. We are supportive of adding the social skills descriptor to Table 7 – Brain Function, as it will aid in recognising difficulties a person may experience in social situations and also ensures people with conditions, such as ASD, can be better captured within the descriptors.
However, we note that this addition of the social skills descriptor has increased the number of descriptors contained in each level, from 9 to 10 descriptors. Due to the increase in number of descriptors, the DSS has increased the qualification requirement from having to meet one descriptor to two. That is, a person now needs to meet 2 of the 10 descriptors for a rating to be assigned under the Table 7, rather than the previous requirement of only needing to meet 1 of 9 descriptors.
We acknowledge that there is a high likelihood that a person with ASD may present with impairments in more than one area detailed under the brain function table, although we are concerned that increasing the requirement to meet at least two descriptors rather than one may result in some people becoming ineligible for the DSP under the new system who would have otherwise met the criteria under the old system.
We recommended that it would have been more appropriate to retain the requirement that a person only needs to meet one descriptor for the relevant impairment rating to be assigned, or only one in addition to social skills if this was identified as a relevant descriptor.
The DSS also consulted with the APS regarding our advice about specific wording and examples of the descriptors in Table 7. A number of changes and recommendations made by the APS have been included. For example, the use of terminology such as “cognitive flexibility” and “self-stimulatory behaviour”.
Changes to Table 8 – Intellectual Function
We note that the DSS has updated the assessments in Table 8 – Intellectual Function as recommended in our submission. That is, the Adaptive Behaviour Assessment System (ABAS-3) and the Vineland Adaptive Behaviour Scales (Vineland-3).
Further, we recognise the changes made to Table 8 – Intellectual Function whereby the Table now specifies the most appropriate descriptors. That is, intellectual function has been replaced with adaptive functioning. We recommended this change and are therefore supportive of the changes.
However, we note that the range provided in Table 8 – Intellectual Function for low intellectual function (IQ score of 70 to 85) has not been updated to align with the Weschler classifications as we recommended in our submission (July 2021). While there are other tools available to measure IQ, we recommended aligning these scores to the Wechsler Scales as they are the most widely used and fit-for-purpose IQ measures. The Wechsler Scales are the contemporary gold standard for a well-validated, reliable and objective measure of cognitive functioning.
*Please note: We understand there is some confusion about changes to Tables 8 and 9.
APS analysis shows that the previous determination allowed for psychologists to provide evidence under Tables 8 and 9. There are no changes to either of these Tables in terms of whether or not psychologists can provide supporting evidence.
Changes to Fully diagnosed, treated and stabilised (FDTS) requirement
We had previously raised concerns with DSS regarding the requirement of conditions needing to be ‘permanent’ and ‘fully diagnosed, treated and stabilised’ on the basis that it is not easily applied to most mental disorders and that certain mental conditions have better established prognostic indications than others. We raised concerns that these issues were resulting in the criteria being difficult to satisfy and recommended the terms be amended to provide clarification.
We are therefore supportive of the changes to remove the term ‘permanent condition’ and to amend ‘fully diagnosed, treated and stabilised’ to ‘diagnosed, reasonably treated and stabilised’. We believe these changes are likely to improve clarity and provide ease of application to mental disorders.
Changes to chronic pain
We note that in the final determination the changes demonstrate a greater representation of chronic pain throughout the Tables. However, we are aware that these changes only apply to certain Tables. For example, Table 5 – Mental Health Function remains silent on the psychological impact and mental health sequalae of chronic pain. We had recommended that when assessing chronic pain, any resultant impairment should be considered using the Impairment Tables relevant to the area of function affected. We acknowledge that while pain is often considered a physical sensation, it also has biological, psychological, and emotional factors, which we believe are important in the context of mental health functioning. That is, both psychological and emotional factors also need to be addressed to treat pain effectively.
Thank you to our members and colleagues who worked tirelessly on this issue.
Dr Catriona Davis-McCabe FAPS GAICD
President