By Dr Kylie Morgan – Mental Health
Originally posted: DSC Group

Understanding what evidence the NDIA requires to prove a person’s psychosocial disability has left both Participants and professionals confused. In particular, professional reports frequently miss the mark. These reports often describe symptoms of the condition rather than the impairments resulting from the condition or they fail to show that all reasonable, evidence-based treatments have been tried. The current Access Request Form (ARF) technically covers all the necessary details. However, many professionals have found it difficult to use the form to provide an accurate picture of psychosocial disability.

The NDIA has responded by releasing an evidence form specifically for psychosocial disability. From what I can see, this form is not compulsory, and even if Participants choose to use it, they will still be required to complete a Verbal Access Request or an Access Request Form. Either way, this new form provides a fantastic resource for professionals assisting people with a psychosocial disability to access NDIS.

The form itself comprises two sections. Section A is completed by the applicant’s psychiatrist, GP, or the most appropriate clinician. Section B is completed by the applicant’s support worker or appropriate person. The form clearly outlines the evidence required. So whether it is being completed in its entirety, or used as a resource to write a letter or report, it will ensure there is no missing information when submitting an NDIS application.

However, this is right about where my excitement ends when looking at the form as an independent resource. The odds of a single professional being able to complete section A of the form in its entirety are slim!

The History of the Psychosocial Disability

Section A, question 1, asks the professional about the presence of a mental health condition. They ask the professional how long they have been treating the applicant, confirmation of the mental health condition, year diagnosed and the history of hospitalisations. In theory, this is brilliant; however, in practice, this may present some challenges. To answer this question, professionals will need to have access to the full clinical history of the person. While this sounds very basic, the reality of living with a mental illness often comes with a complex history involving many different treating professionals, resulting in these sorts of details being dispersed.

Functional Impairment

Section A, question 2, asks the professional to do two things. Firstly, review section B of the form, which is a completed Life Skills Profile (LSP-16). The Life Skills Profile should be filled out by a support worker or other appropriate person. This might present a barrier to people with psychosocial disability who do not have any current supports in their life. It asks the support worker to rate how much difficulty the person would have in performing tasks associated with everyday life. Such as “initiating and responding to conversation.” This is then signed off by the health professional.

As a side note, this also means that section B has to be completed before Section A – go figure!

The professional must then describe the person’s functional impairments in six domains- social interaction, self-management, self-care, communication, learning and mobility. This section is extremely important, and one of the keys to a successful application. If you do not prove that there is a substantial functional impairment in one of the six domains, which are both attributable to the mental health condition and experienced daily, there is little chance of success.

While this is a very practical way of approaching the gathering of the required evidence, I do wonder just how many people with a psychosocial disability will be able to get this section of the form completed. Furthermore, why is the individual not asked to comment on their disability? Indeed if every participant is assumed to have capacity as far as reasonable, then they should also be presumed to have capacity to discuss their disability and how it affects them daily.

Likely to be Permanent

Section A, questions 3 asks the professional to confirm if the mental health condition is likely to be permanent. This is another extremely important question because if the evidence is not provided, then the application will be rejected. To provide this evidence, the form asks for a summary of the treatment to date. Much like in question 1, this will require the professional to have access to the person’s full mental health history. These records must include details of dates each treatment started and stopped, along with the effectiveness of each treatment. Fingers crossed the professional either has or can get a copy. Now double-cross your fingers that the professional has the time to troll through years of records and document every tablet and treatment ever tried!

The form then moves on to whether or not there are any appropriate evidence-based clinical, medical or other treatments likely to remedy the impairment/s. This is about where I threw my hands in the air! Here they are asking for both medical and other treatments, which I presume would include psychological therapies. This creates a problem. If a clinical psychologist were completing the form, they would not be able to answer this question in its entirety as they are not medical professionals. Conversely, if the form was being completed by a medical professional, they may not be aware of all the evidence-based psychological therapies available. A psychiatrist or mental health nurse clinician MAY be able to complete this form in its entirety. However, getting an appointment with one of these professions often requires extensive wait periods and an out of pocket expense that just can’t be afforded by many.

Both Sections A and B of the form provide the option for attachments, comments, explanations, or further information to be provided.

Checklist

I have torn the new form to bits in terms of its practical application, which is not fair. By providing a thorough checklist of the evidence required by the NDIA, it does present as an incredible resource for professionals, support people, and those with a psychosocial disability . However, there remains the practical difficulties of how a person with a psychosocial disability is to get this form completed. Firstly, section B needs to be completed prior to section A. Secondly, section A can only be completed in its entirety by a professional who has access to the full medical history of the person, can attest the disability is permanent, and can attest to past and potentially future treatments, including medical and psychological therapies. If you are unable to find a professional who can complete Section A in its entirety, all is not lost! I suggest that you get the professional (e.g. Medical Practitioner) to fill in as much as possible. If there are any missing sections, then ask the second professional (e.g. Psychologist) to put their responses to these sections in a letter and attach this to your application.

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