End the disability support postcode lottery

Most people who do get psychosocial support receive it through the NDIS. About 65,000 Australians get NDIS packages for their psychosocial disability, averaging about $89,000 per year.

But those who don’t qualify for the NDIS face a bleak picture of sparse and inadequate services. In fact, more people currently miss out altogether than receive support from other government programs.

These are people living with significant psychosocial disability: that is, people whose mental health challenges have a profound impact on their day-to-day life.

When you picture support for people with mental health challenges you will most likely think of a psychologist’s office, a GP clinic, or a psychiatric hospital.

But clinical treatment is only one aspect of the support people with psychosocial disability need. Psychosocial supports are non-clinical services that help people to live a meaningful life in the community, regardless of whether they continue to experience symptoms of their mental health conditions.

This includes programs that help people to build social connections, learn the skills to manage their daily life, or maintain stable housing. Access to these supports can reduce the likelihood of someone needing for be hospitalised for their mental health, or coming into contact with the justice system.

Promising programs that existed before the NDIS, such as Partners in Recovery, were wound up during the transition to the NDIS from 2016 to 2019, despite many of the people that relied on them never getting onto the NDIS.

Our new Grattan Institute report shows that the availability of non-NDIS psychosocial support varies greatly between states.

In the ACT, about 370 people with significant psychosocial disability received psychosocial supports in 2022-23, from either federally or territory-funded programs like the Transition to Recovery program, run by Woden Community Service, or St Vincent de Paul Society’s Compeer Friendship program.

The proportion of the population getting support in the ACT is less than a third of that in Queensland, but still far higher than other states like Tasmania or NSW. At the two extremes, the proportion of people accessing services is seven times higher in Queensland than in Tasmania.

And for people who do get support, the amount of support they get varies widely, too.

While a relatively large proportion of the Queensland population get some support, they each receive less than 30 hours per year on average.

In NSW, a far smaller proportion get support, but those who do get a lot: an average of nearly 340 hours per year. That’s more than 10 times what people in Queensland get and the difference between an hour per fortnight and an hour each day.

In the ACT, the average is closer to an hour a week.

Access to support should be determined by people’s needs, not their postcode. The variation that currently exists in service availability and intensity across jurisdictions is impossible to justify.

While the NDIS has an important role for people with the most intensive needs, it shouldn’t be the only option available, nor should people face a cliff-edge of funding and services at its limit.

Australian governments have acknowledged there is a problem. But progress to fix it has been too slow, due to overlapping responsibilities, contested roles, and fiscal constraints.

Mental health policymaking has focused on improving clinical services; NDIS reform has so far prioritised alternative supports for children with developmental delay and autism. Efforts to build up non-NDIS psychosocial supports are yet to get out of the starting blocks, despite a national cabinet commitment to them made almost two years ago.

This cannot continue. Our new report shows how governments can establish a new National Psychosocial Disability Program that can provide services to 130,000 people who currently receive nothing. And this can be done without governments having to find new money.

This is possible because the current system is out of balance. Last year, Australian governments spent $5.7 billion on NDIS support for people with a psychosocial disability, while expenditure on the whole of the rest of the mental health system, which supports millions of Australians, was around $13 billion.

While the NDIS does support people with more intensive needs, the concentration of this much funding on such a small population is too extreme and comes at the expense of a more equitable distribution of support.

By slowly rebalancing the way funds are spent across these systems, governments can maintain the important role of the NDIS, while also ensuring that many more Australians get the psychosocial support they need, regardless of where they live.

The new program we propose would expand on existing pockets of best practice, delivering a consistent service and level of support across the country, while leaving space for local tailoring to meet different needs in each community.

Over a four-year build-up, the program would establish a new workforce of support facilitators and substantially increase funding for other psychosocial supports, including specific services tailored to the needs of First Nations people.