Gateways and gatekeepers: An exploration of the opportunities and challenges faced by people with episodic mental illness during transition to Australia’s National Disability Insurance Scheme (NDIS)

<p>The National Disability Insurance Scheme (NDIS) is transforming the way social support is being delivered to people with disabilities in Australia by joining with other individualised funding (such as self-directed support [SDS]) programs to further the global social care reform agenda. The individualised funding model aims to revolutionise social support provision by providing greater choice and control to people with disabilities (Glasby & Littlechild, 2016; Needham & Dickinson, 2018). Since being launched in 2013, the NDIS has gained much attention across the domestic social and political landscapes. It has garnered bipartisan political endorsement, support from the disability and community service sector, and notable praise from people with disability. At an estimated cost of AUD$22 billion each year when fully operational, it is the nation's largest social reform since the introduction of universal health care - Medicare - in 1976 (Productivity Commission, 2017).</p> <p>Although in-principle support for the NDIS is widespread, little is known about its effect on the policy and processes for people experiencing mental illness. While resources are being diverted away from existing services towards the NDIS, those deemed ineligible face an uncertain future in the absence of continuing community mental health support. As the NDIS design premise is based on entitlement to support, located in aspirational notions of social inclusion and equity, this Australian study explores the extent to which the policy rhetoric translates to practice for people experiencing episodic mental illness (i.e., people with psychosocial disability). Aligned with a constructivist/interpretive framework, semi-structured interviews were held with 20 people with mental illness (including a mix of NDIS eligible and ineligible participants) and 10 NDIS professionals across metro Melbourne and regional Victoria. Interviews were conducted and analysed according to the principles of constructivist grounded theory (CGT) (Charmaz, 2014).</p> <p>Findings from the study reveal that system-level structural barriers and rationing decisions applied by NDIS professionals (who serve as gateway operators to the scheme) lead to differential pathways for people experiencing mental illness, exposing issues of social justice and fairness in the system. The results also emphasise the structural challenges in the NDIS design. Reflections from both interview groups indicate that the scheme is not yet well equipped to support the specific needs of people with psychosocial disability, especially given the fluctuating nature of mental health. Additionally, the study highlights the importance of understanding the different perspectives that people bring to the meaning of recovery in mental health. Principles of personal recovery, such as autonomy, empowerment and social inclusion - the domain of the personal recovery approach (Roberts & Wolfson, 2004) - are exemplified in the person-centred ethos promoted by the NDIS.</p> <p>This research offers a timely contribution to the emerging discourse regarding the NDIS and to the broader scholarly work on self-directed service delivery internationally. It adds to the small but growing body of literature that emphasises consumers' experience of the scheme, and is one of the few international studies that investigates how people with mental illness engage with SDS models of service delivery, serving as a foundation for future research on this topic. It also presents policy and practice implications for the support of people with episodic mental illness, highlighting the need for flexible policy provision and delivery to reduce the risk for consumers of exclusion and division in the NDIS.</p>