Mental Health OT, Psychosocial Disability & The NDIS

The National Disability Insurance Scheme (NDIS) holds many opportunities for mental health occupational therapists to make meaningful and lasting contributions to peoples’ lives and journeys. The NDIS offers the potential to work within a social model of disability, meaning occupational therapists can enable participants to work towards their goals in the areas of occupation, social participation and economic participation. Sounds like a dream come true, right?

Finally, mental health occupational therapists can work in a manner true to an occupational philosophy, focused on person-centred goals. However, as many are aware, working within the NDIS space is not without its challenges. At the Occupational Therapy Australia (Vic) July Mental Health Interest Group meeting, we hosted a panel discussion to unpack some of these practice challenges and opportunities, with a view to assist mental health occupational therapists navigate this complex landscape.

Challenge and Opportunity

“This is a positive time to be a mental health OT, possibly the most promising period in over ten years”, describes Anita Volkert, National Manager, Professional Practice and Development, Occupational Therapy Australia. “The NDIS allows us to focus on the outcome of participation, and this is a gift to occupational therapists as it allows us to return to our core philosophy.” 

For many years, mental health occupational therapists have had difficulty holding a full focus on occupation and participation, due to a rise in ‘generic’ mental health roles broadly within the mental health sector. A current workforce challenge is building the confidence and skill of mental health occupational therapists who are recently graduated, and those who have reached mid-career and had limited practice experience utilizing living skill, and occupation-specific, intervention. There is need for CDP opportunities, alongside skilled mentoring and supervision, to enable these core skill areas to flourish.

New graduates have a strong theoretical grounding, however will need substantial supervision from more experienced therapists who can offer the necessary learning experiences.

Additional mental health occupational therapy workforce challenges include the relatively low numbers of new graduates opting for mental health as a practice area, combined with a high risk of burnout and a high attrition rate, reflecting the challenges experienced by the occupational therapy profession broadly.

Strategies needed to address these issues include a greater emphasis on student placements in mental health settings; and excellent new graduate internship programs. Establishing a database of experienced mentors and clinical supervisors will also be an important part of the solution matrix.

There is such potential for satisfying career paths for occupational therapists in mental health, and we need to do the groundwork to ensure we can build these career paths in sustainable ways. Mental health occupational therapists need to continue to build the evidence base, and document practice outcomes.

The Participant Perspective

Implementation of the NDIS for people living with psychosocial disability continues to evolve, and will continue to develop looking to the future. Psychosocial disability is complex, often invisible, and may be episodic or fluctuating. People experiencing psychosocial disability have experienced unique challenges in accessing and navigating the Scheme.

Neil Turton-Lane, NDIS Manager at VMIAC, noted the shortage of experienced mental health occupational therapists, making accessing an OT difficult from the person’s perspective. He also encouraged clear communication with consumers around what to expect from engaging an OT, and what the functional assessment process will involve. For consumers, the prospect of assessment can be daunting. And a focus on the ‘worst day’ experiences can leave the person feeling vulnerable. A trauma-informed, supportive and collaborative approach delivered by an experienced mental health occupational therapist is required.

“Consumers need to feel heard, and have a sense of trust. Many have had traumatic experiences within mental health systems”, Neil highlights.

Neil also described the potential for creative approaches to working alongside consumers in future. There is much to be gained from recognising the knowledge and value of lived experience, and in genuine collaboration between consumers and occupational therapists. This prospect was welcomed by all panellists.

Mental Health Occupational Therapy Assessment and Intervention

Occupational therapists play a pivotal role in providing assessment, and evidence of disability under the NDIS criteria, as well as capacity building and enabling a skill-building focus once participants have entered the Scheme. All this, while aiming to maintain a recovery-orientation, a trauma-informed perspective, and of course, a focus on occupational, social participation and economic participation.

What are some practical strategies to ensure optimal assessments and reports for participants? We posed this question to Malitha Perera, Senior Manager, Local Area Coordination (Brotherhood of St. Laurence), who has a mental health occupational therapy background.

“Mental health occupational therapists need to have an awareness of the language, priorities and frameworks of the NDIS—which may be different to those of the health and mental health systems. Remember, the audience is your client and their advocates, and potentially also people with non-health backgrounds”, Malitha advises.

It is important to keep the purpose of assessment very clear. Writing assessment reports for access to the NDIS is different to writing for planning stages, and different again for review stages, or appeals. Be mindful of the stage of the participant’s pathway.

For example, access reports need to speak to the access criteria. This is a deficit focused process, so reports need to structured accordingly. Maintain a focus on functional impairment and likely permanence. This is in contrast to a recovery focus, which can pose a tension for occupational therapists. However, it is important to keep the access criteria to the fore to ensure fair outcomes for the person.

At the planning stage, it can be helpful to include a focus on the person’s strengths alongside functional capacity issues. At review, describe what has worked and what has been difficult. It is important to pitch the mental health occupational therapy report to the correct stage of the pathway.

Looking to the future, there is potential for new and innovative approaches to life-skill development and goal-focused programs offered by occupational therapists under the NDIS. These will be evidence-based and needs led, and contribute substantially to capacity building pathways, and better outcomes, for participants.

High Rates of Co-Morbid Physical Disability and People With Psychosocial Disability

It is well documented that many clients with psychosocial disability also experience physical disability. If there is a physical health condition that meets access criteria, that co-exists alongside psychosocial disability, then it is important for occupational therapists to document this clearly in assessment and reports. Name the primary disability as the condition that has the most significant functional impairment (for mental health occupational therapists, this is usually the psychosocial disability).

If there is a physical health condition that meets access criteria, that co-exists alongside psychosocial disability, then it is important to document this clearly. If there is substantial functional impairment, address the NDIS eligibility criteria accordingly.

A Final Word: Build Your Peer Networks!

Many mental health occupational therapists working within the NDIS are independent providers, or sole traders. While others are the sole mental health occupational therapist within a broader team. 

“It is important to build a support network amongst peers,” recommends Rachel Collins, Occupational Therapy Chief, NorthWestern Mental Health. “This offers personal and professional support, and helps prevent burnout. So reach out!”

Rachel recommends collaborating with other independent occupational therapists, but also with local networks of mental health occupational therapists based in area mental health services. This build connections, partnerships, offers shared learning experiences/CPD, and leads to better outcomes for participants.

About The Author

Muriel Cummins is the Convenor of the Victorian Mental Health Interest Group.

Note that this article arose out of discussions at the Victorian Mental Health Interest Group Meeting (July 2019):

Venue: VicHealth Pelham St, Carlton, VIC; and via Webinar 

Topic: Mental Health OT and NDIS. A panel was organised to answer SIG member questions focused on Mental Health OT and NDIS. Thank you to everyone who submitted questions, in advance and on the day—both in person and via webinar.

Convenors: Muriel Cummins and Dev Rai, MH SIG Convenors 2019

A sincere thank you to our panellists for offering such insightful perspectives:

·         Neil Turton-Lane, NDIS Manager, Victorian Mental Illness Awareness Council

·         Anita Volkert, National Manager, Professional Practice and Development, Occupational Therapy Australia

·         Malitha Perera, Senior Manager, Local Area Coordination, Brotherhood of St. Laurence

·         Rachel Collins, Occupational Therapy Manager and Chief, North Western Mental Health