NDIS access and psychosocial disability
START MODULE
TABLE OF CONTENTS
logo
Description
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 or Psychiatrists), who are supporting people with psychosocial disability to access the NDIS, is also available.
User Guide: Navigating this training module
To begin this training module, click the 'Start Course' button located below the course title.
Alternatively, you can navigate the course by scrolling down to each lesson heading.
Please note that the lessons must be completed sequentially, starting from the first heading titled 'Training Objectives.'
It's essential to follow the chronological order of the lesson headings within the module. You cannot skip ahead to later lessons using the menu.
Completion of all lessons is necessary to receive the Certificate of Completion.
Duration: Approximately 30 minutes (note: you can close the training and pick up where you left off at a later date).
Module Disclaimer
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.
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 cpspempower@flinders.edu.au(opens in a new tab).
Last updated: February 2024
Training objectives
Lesson 1 of 12
Image of light bulb with text “Training objectives”
Training objectives
In this module you will learn about
the NDIS access process and how to support people to apply
the NDIA access criteria and who is likely to be eligible
the information the NDIA need to determine eligibility for a person with psychosocial disability
your role in supporting a person to apply to the NDIS
the forms you need 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 following training modules (available on our website) cover these topics in detail:
NDIS explained
Recovery and the NDIS
Reasonable and necessary in 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 Flinders University Project Team.
Access overview
Lesson 2 of 12
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 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 psychosocial disability.
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 to remedy (cure or substantially relieve) the impairment (rule 5.4 of the Becoming a Participant Rules).
The NDIA also need to know if there are any treatments yet to be tried that are
- known, available and effective
- appropriate for the person and their specific impairment(s)
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 travelling.
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 (e.g., services like education, housing, medical and dental) that are the responsibility of existing mainstream systems, which 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. moderate to profound intellectual disability and Autism Spectrum Disorder (levels 2 or 3).
There is a 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 good 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
Lesson 3 of 12
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 NDIS does not focus on the condition itself, but on how the condition impacts a person's life.
Impairments resulting from mental health conditions
The NDIA defines an impairment as a loss or significant change in at least one of a person's body functions, structure or how they think or learn. In relation to psychosocial disability, this means the person has reduced capacity to undertake daily life activities and tasks as a result of their mental health condition.
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. Frank who has a mental health condition but doesn't have a psychosocial disability and Bob who has both a mental health condition and a psychosocial disability.
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.
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.
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
Lesson 4 of 12
Evidence of psychosocial disability form
Picture 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.
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. their 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.
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
Initiate the Access Process
In October 2023, the process for applying to the NDIS changed. All access applications are now undertaken by Local Area Coordinators (LACs). The LAC helps the applicant understand what supports might be available through the NDIS, mainstream or community services. They also help gather evidence for the NDIS application.
Contact the NDIA:
To begin the access process call the NDIS National Contact Centre on 1800 800 110 with the applicant present. They will help you to get referred to an LAC in your area. If a person lives in an area without LACs, alternate contacts will be provided.
Meet with the LAC:
Support the applicant to meet with the LAC and accompany them if they wish you to do so. At the meeting, the LAC will ask about:
the person's situation and how their mental health condition affect their daily life
the NDIS eligibility criteria
how to apply to the NDIS
the information and evidence required
what to expect from the application process, including timelines
The LAC will begin the application and enter information directly into the NDIS computer system PACE.
Step 3
Confirming identity
The NDIS needs to verify the applicant's identity as part of the access process. The documents required are listed on the Evidence of Identity Factsheet(opens in a new tab). If the person can't provide any of the documents, the LAC will provide help depending on the person's situation.
Age
To demonstrate that the applicant is younger than 65, they can
consent for the NDIA to access their Centrelink records
provide copies of identity documents or other evidence requested by the LAC
Residency
To show that the applicant is an Australian citizen or permanent resident, the applicant can
consent for the NDIA to access the applicant's Centrelink records
provide copies of identity documents or other evidence requested by the LAC
The applicant must also demonstrate they live in Australia. The LAC will ask the applicant
if they live in Australia.
where their immediate family live.
if they work or volunteer in Australia.
if they own property in Australia.
how much time they spend out of Australia.
Step 4
Gather evidence of disability
The LAC will advise what evidence is required.
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(opens in a new tab).
Step 5
Submit and monitor
Send the completed evidence of psychosocial disability form to the LAC, along with any attachments/consent forms and the completed ARF (if applicable).
Make sure the evidence of psychosocial disability form is returned in the time frame specified by the NDIA.
Check in regularly with the person you are supporting to see if the NDIA have made a request. Sometimes, the NDIA will need more information to make a decision. 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 6
Decision
Once a decision has been made, the LAC will contact the person or their nominated contact, telling them if they have met the criteria, and the next steps in the process. See 'Receiving your access decision(opens in a new tab)' for more information.
Step 7
Review options
If a person is found ineligible and wishes to appeal, this is called requesting a 'review of a decision(opens in a new tab)'. 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:
1. provided evidence of age, residency and consent to access the scheme by completing the ARF or the VAR.
2. provided evidence of disability by completing the evidence of psychosocial disability form.
3. Provided consent to the NDIA that they want their support worker to assist with their access request. This is optional.
Our 'How to apply(opens in a new tab)' page includes a comprehensive overview of the process and a check list (opens in a new tab)for support workers helping someone to apply.
Ways to support people during access
Educate about support options (1 of 5)
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 requirements.
Discuss the process (2 of 5)
Talk to participants about contacting the NDIA , the evidence gathering process and what type of information will be collected at each stage.
Discuss wait times (3 of 5)
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 (4 of 5)
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 (5 of 5)
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.
FAQS
Completing the forms
How do I know which evidence form(s) to complete?
There are a number of different ways for people to 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 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 LAC will advise which forms should be completed.
Can a support worker do the access process on a person's behalf?
The person who is applying must be present at the meeting with the LAC and be willing to speak to the LAC. You can support them to do this and may be able to answer some of the questions on their behalf after the LAC have confirmed the person's identity and consent.
If you are working with someone who is not comfortable talking to the LAC, ring the national call centre to discuss other options.
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 decide whether or not they meet the access criteria. If this happens, they will contact the person to request this information, and the person needs to provide the information within the specified timeframe, or the access request may be withdrawn or cancelled.
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
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 immediately 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 reapply. 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 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.
What support options are available for people who do not meet access?
The 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 outcome of the person's application.
If the person did not meet the criteria, they can talk to their Local Area Coordinator about other funded supports and mainstream services. Their LAC can develop a community connection plan to assist the person to access alternate supports. More information about supports available outside of the NDIS is available on the Department of Health website(opens in a new tab).
How many times can a person apply?
People can apply to access the NDIS as many times as they like before they turn 65. Re-applying for NDIS access is ultimately the participant's decision.
There will be people with whom you work who are 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 their wellbeing. In these scenarios, you may want to chat about linking them in with other supports.
Community Connections
Lesson 5 of 12
If a person does not meet the age, residency or disability requirements to access the NDIS, it can still provide support by helping the person connect to mainstream community supports.
Community Connections might suit someone who
looks for short-term support
is supported through existing mainstream or community supports
needs more information about their disability
wants to connect with people with similar experiences
needs help to apply to the NDIS
Community Connections do not provide NDIS funded supports.
How to get Community Connections?
A person can access Community Connections by contacting the NDIS or the Local Area Coordinator in their area. The person will be given a dedicated NDIS contact, who will have conversations with them to determine what their goals and support needs are. LACs will use this information to put together a Community Connections plan.
Community Connections Plan
The Community Connections plan records the goals and current supports a person accesses, community and/or mainstream supports that might help them to reach their goals and the next steps the person needs to take.
If you want to know more about Community Connections plan, please check the following links:
Community Connections booklets and factsheets(opens in a new tab)
NDIS Community Connections summary doc
Frequently asked Questions
Does a person need to trial a Community Connections plan before applying to the NDIS?
No. A person can choose not to trial a Community Connections plan and apply to the NDIS. The LAC will gather information about the applicant to complete the access application if they meet the access requirements.
Understanding the functional criteria
Lesson 6 of 12
What information do the NDIA need?
Broadly, information gathering falls into two key areas: clinical and functional evidence. The diagram below shows how this maps to the 5 access criteria, and who should provide this information.
Disability Criteria Section 24
24 (a) Disability attributatle to a mental health condition
24 (b) Impairements are likely to be permanent
Clinical evidence?
Clinical history relating to the person's mental health condition including:
diagnosis (if available)
treatment history and efficacy
prognosis and treatment recommendations
This information is to be provided by a clinician, usually a GP or psychiatrist. It is generally recommended that the treating mental health clinician provide this information. A GP who is not the primary treating clinician but who manages referrals to the treating clinician and/or has access to the relevant treatment records can also provide this information.
Disability Criteria Section 24
24 (c) Impairements result in substantially reduced functional capacity to undertake activities within one or more of the specified life domains
24 (d) Impairements affect capacity for social or economic participation
24 (e) Person is likely to require support under the NDIS for their lifetime
Functional evidence?
Functional impact
Information about how the person's mental health impairments impact their daily life including:
• a description of the impairments
• a summary of the areas of functioning that are impacted
• functional assessments
A GP or other treating mental health clinician will need to verify the impact of the impairments on the areas of function. Further detail and functional assessments can be provided by a suitable health professional who knows the person well for example a community support worker, allied health worker or clinical mental health worker.
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
To access the NDIS, individuals 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, the difficulties 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 one's 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 lerning domain include:
inability to learn basic tasks such as catching a bus alone or making a cup of tea
getting easily confused or distracted leading to an inability to safely complete simple tasks
significant memory issues, such as the inability 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 about the person's capacity to move around using their arms and legs. Therefore, it is very unlikely to see substantial mobility impairements 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 difficulties this domain 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
being unaware of the importance of maintaining a healthy diet or lifestyle
Self-Management?
Ability to organise one's life including planning and making decisions.
Examples of difficulties in the self-management domain include:
inability to budget and manage one's own money
inability to manage a tenancy and maintain a house (e.g. cleaning)
being disorganised and forgetting to pay bills or take medication
Knowledge check
Quiz
What is a substantial reduction in capacity?
Picture of blocks spelling out the word SUPPORT.
To meet the access criteria, a person needs 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 do 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.
Loss of ability: is the person unable to do a task or activity or do they have the capacity to do the task, but choose not to do the task? To demonstrate there is a substantial reduction, you need to show that the difficulties experienced are not due to person's choices or preferences.
An example in the social interaction domain.
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 interactions. 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 shopping 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. This example is particularly helpful if you want to see how the legislation is interpreted.(opens in a new tab)
NDIS Access Snapshot 4: (opens in a new tab)Functional Capacity and Mental Health Issues(opens in a new tab)
Access to the NDIS, Operational Guidelines(opens in a new tab) available on the NDIS website.
Functional evidence requirements
Lesson 7 of 12
What information do the NDIA need?
The evidence should show that:
1 The person has impaired daily functioning as a direct result of their psychosocial disability
2 The impairments are in at least one of the six domains of daily functioning
3 The impairments are substantial
Who can provide this information?
Evidence can be provided by a community mental health support worker or 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 on their daily life.
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. When completing section A of the form, the clinician 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:
1. To serve as a cover letter for the application - summarising and directing the assessor to relevant information in the request.
2. 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 explanations or further information.
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 the person's current functioning.
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.
Tip: Consider the attachments carefully:
Do they provide new information?
Do they contain personal non-relevant information?
Do they contain any information that conflicts with other information in the application?
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
Focus on average days - Access to the NDIS is based on how a person functions between acute episodes. Describe difficulties that a person experiences on an average day.
Desbribe functioning without support - Sometimes, it might be tricky to identify areas that a person struggles with because they have a strong support network. It is important to describe functioning if that support was not there.
The following prompts can help identify areas where people are getting support with daily activities:
What other services or supports are you using at the moment? And what do they help you with?
Who helps you on a daily basis?
Tell me about your day. Does anyone come to your house to help you do things? Does anyone help you to get out of the house, for example, to the shops or to the doctor?
Provide examples - Access assessors don't get to meet the person whose application they are reviewing. It is, therefore, helpful to provide examples like what follows:
instead of saying "Sally has difficulty making friends" say "Sally experiences severe anxiety and paranoia when leaving the house along. As a result, she is socially isolated and stays at home most days"
Link the difficulties to the disability - Clear links - you need to clearly show that the difficulties a person experiences are directly related to their disability and not to other factors. For example, if you say that a person cannot leave their house because they don't have access to a car, this is not clearly linked to the person's disability.
If you say that a person experiences paranoid thoughts because of their psychosocial disability, and consequently cannot leave the house because they cannot be out in public along, this is clearly linked to their disability.
Don't
Describe functioning during acute presentation/crisis - It is a common misconception to base an application on a person's worst day. Instead, you want to focus on how a person functions on an average day. Avoid describing crises scenarios in an access request. This includes things like:
current legal proceedings or court cases
custody proceedings
acute hospital presentations
relationship breakdowns
Discuss gaps in mainstream serices - The NDIS is not designed to fund gaps in mainstream services. It is, therefore, not helpful to include information that suggests that the person is experiencing dicciculties because of problems with these services (e.g., long waitlists).
Describe trauma histories - The NDIS do not need to know the origin of a person's condition. Sharing trauma histories is not necessary for access and helps to protect a person's privacy.
Describe future support needs - It is important to discuss current supports, and how they help the person. it is not helpful to suggest supports that the person needs in the future. This can be saved for planning discussions.
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 with some words crossed out.
Activity
Feedback
Language that sounds episodic:
when unwell/well
on good/bad days
in times of crisis
currently is experiencing
Sometimes will....
Can be.....
Tip: Remove this language completely. If the difficulties occur most days say so. If they don't occur often (e.g., times of crisis, hospitalisations) don't focus on them.
Language that suggests impairments are not substantial:
would benefit from
needs guidance and prompting
feels anxious/depressed
is unmotivated
lacks confidence/low self esteem
Tips: These phrases sound like things that a lot of people struggle with. Avoid 'everyday' phrases and provide more clarity about the person's daily difficulties.
Examples
Below are some examples of unhelpful and helpful ways that show how to describe common difficulties in an access request to clearly demonstrate the connection between a person's disability and their functional capacity.
Unhelpful vs Better
Unhelpful - Childcare - Karen's children were taken out of her care which Karen finds very distressing.
Unhelpful - Money - Karen cannot afford to maintain her car and often struggles bo buy groceries. This exacerbates her poor health and social isolation.
Better - Disability focus - Karen has substantial difficulty with self-management as a result of her psychosocial disability. She requires constant support to manage her finances and make the decisions necessary to maintain a safe home environment.
Better - Disability focus - Karen has substantial difficulty with self-management as a result of her psychosocial disability. She often spends her money quickly or will give it away if people ask her for help. She requires constant support to budget.
Resources
Our 'Recovery and the NDIS(opens in a new tab)' training module includes further information about writing for access in a way that is consistent with recovery-focused practice.
For further tips about writing for access see our 'Guide to writing a great support worker letter(opens in a new tab)' resource.
Co-occuring conditions and AOD
Lesson 8 of 12
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 separately.
If a person has psychosocial disability and multiple health conditions that won't meet disability criteria, 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 Leave out any mention of difficulties that result from the health condition alone.
2 Consider 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 a person has a psychosocial disability and another co-occurring disability that may meet the NDIS 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 Complete 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 Always 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 Don't describe health and mental health conditions as linked, this leads the assessor to question the permanency of both. For example, if the person's 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 functioning 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
Lesson 9 of 12
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 them 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.
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.
Should all treatment options 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.
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
Lesson 10 of 12
Evidence of likely permanence
WHAT IS NEEDED?
To meet the access criteria stipulated in the NDIS Act sections 24(a) and 24(b), indicating a likely lifelong psychosocial disability, individuals must provide evidence demonstrating one of the following requirements:
A mental health condition is present, and the diagnosis if available.
Appropriate treatments have been tried (e.g., therapies as well as medications), and they have been effective.
There are no further treatments that would remedy the impairments, or no other treatments need to be tried to demonstrate the permanency of the impairments.
WHO SHOULD PROVIDE IT?
The NDIA generally prefer evidence that comes from a treating professional who
is the most appropriately qualified person (e.g., psychiatrists, GPs or psychologists) to provide evidence of the primary disability. The NDIA will also accept evidence of likely permanence from other suitably qualified clinicians, such as clinical mental health nurses if GPs or psychiatrists are not available.
has treated the applicant for a significant period of time (at least six months).
is registered to practice in Australia or New Zealand.
provides disability evidence (such as a medical report) that is original, genuine and specific to the applicant.
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 (This is optional, they can 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.
Clinical psychologists/other clinicians
Clinical 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 be selected if they are available. Situations in which a psychologist or mental health nurse may be better suited include cases involving individuals 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 her 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 want to attach to the request, it is ideal 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
Referral letters or treatment updates often lack detail and context and assume knowledge of the patient's treatment history. They are unlikely to contribute meaningfully to a request.
Scans or x-rays
Click to flip
Assessors are not trained to read these. If they are relevant to the application, a clinician can summarise the information they provide in plain language.
Legal documents
Click to flip
These are often very long, written for a very specific purpose and include personal details not relevant to an access request.
Mental State Examinations
Click to flip
These describe a person's functioning at a specific point in time, not their average day and are not helpful to a request.
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 Tips
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 can:
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) which 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
It is likely that the clinician needs a double appointment to complete the form. You can also speed things up by sending the form in advance.
Explaining access
Some clinicians have good knowledge and experience of the NDIS. Others 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(opens in a new tab) 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
Lesson 11 of 12
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. While 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 working. 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 believes that further treatment would not remedy her impairments. Her GP has recommended various treatments and strategies for her pain and 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 gives 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 makes 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.
Quiz
0/11 Cards
Which of the following cards are directly related to mental health impairments OR not directly related to mental health impairements
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
Answers
The following difficulties are a result of Marree's mental health impairments and are, therefore, relevant to the NDIS.
Difficulties managing money
Difficulty leaving the house alone
Difficulty managing health conditions
Difficulty keeping the house clean
Difficulty joining in conversations
Difficulties forming relationships
The following difficulties make Marree's life harder, and also negatively impact her mental health. However, they are not a direct result of her mental health impairments and/or are related to her physical conditions.
Difficulties with the blood pressure medication
Difficulties walking distances longer than a kilometre
Difficulties doing physical activity
Difficulty affording food and a car
Difficulties getting enough sleep
Domains
Based on the daily difficulties that we identified as relevant to Marree's application (scroll up to the sorting answers for a reminder), in which of the following domains does Marree experience substantially reduced capacity?
Mobility
Self-care
Self-management
Communication
Learning
Social Interaction
Correct answer is Marree's difficulties are substantial in the areas of self-care, self-management and social interaction
Flick through the cards below for more information on Marree's difficulties under the six domains.
Mobility
Click to flip
No – Marree has some difficulties in this domain, but they aren’t related to her mental health condition and do not fit the substantial criteria. For example, some pain when walking is not substantial. But an inability to walk or to be able to walk even short distances is substantial.
Learning
Click to flip
No - Marree didn't finish school and has had difficulties getting back into study. But these are more likely to be a result of social interaction difficulties than an inability to learn simple tasks.
Social Interaction
Click to flip
Yes - Marree has considerable difficulty with all aspects of the social domain. She has very few social connections beyond her mother and support worker and experiences significant difficulties interacting with others or being in public alone.
Communcation
Click to flip
No – Whilst Marree does have some difficulty joining in conversation, there is no evidence to indicate she can’t be understood and/or doesn’t understand others.
Self-Care
Click to flip
Yes - Marree’s mental health condition impacts her ability to care for her mental and physical wellbeing. She forgets her medications and needs her mother to make sure she keeps her house clean and eats regularly.
Self-management
Click to flip
Yes - Marree isn’t able to plan ahead or budget which has consequences for other parts of her life. She doesn’t manage her own medications, or organise various aspects of her life like her finances or health.
Do you think Marree is likely to meet the criteria for substantially reduced functional capacity?
Yes
No
Correct answer is Yes
At least one of the domains is substantially impacted. Marree is likely to meet the criteria if explained adequately as per our writing tips.
Is Marree likely to meet the criteria for reduced social and economic participation?
Yes
No
Correct answer is Yes
Marree clearly experiences difficulties with social interaction and doesn't work or participate in volunteer work (that we know of). She would likely meet this criteria based on the description of her daily difficulties.
Do you think Marree is likely to require NDIS support for her lifetime?
Yes
No
Correct answer is Yes
Marree’s difficulties with social interaction, self-care and self-management cause her daily difficulty and the required supports to increase independence (assistance with self-care etc, support to engage in the community) would be NDIS responsibility. Her health challenges, blood pressure, weight management etc would continue to be a mainstream health responsibility. She may also continue to access her psychiatrist through the mainstream system whilst getting NDIS support.
Additional resources
If you want to see examples of written applications that are related to the scenario discussed above, you can download the below files. A more complex example for someone with a dual disability is also provided. You should consider these training resources alongside the information provided in this training.
Example applications Marree(opens in a new tab) (psychosocial access)
Example applications Karen(opens in a new tab) (dual disability)
Certificate of completion
Lesson 12 of 12
Complete our feedback survey and download a certificate of completion for your records.
Button: Go to survey