Culture clash? Recovery in mental health under Australia's National Disability Insurance Scheme - a case study

Abstract

Objective: Using a case study, we aim to report on the compatibility of funding and policy settings under Australia’s National Disability Insurance Scheme (NDIS) with the delivery of evidence based, recovery-oriented psychosocial services. Type of program or service: We refect on the impact of the NDIS on a psychosocial rehabilitation service run by Woden Community Service (WCS), one of the major service providers in the Australian Capital Territory, and specifcally its Transition to Recovery (TRec) program. Methods: We examine NDIS funding and policy settings and consider the recovery-oriented practices underpinning psychosocial programs like TRec. The construct of the program, its staffng and related issues are considered. The article draws on a formal evaluation of TRec conducted in 2015. Results: The NDIS is having a seismic impact on Australia’s psychosocial sector. Despite its positive evaluation, the future of the TRec program is problematic. Practically, service exit points have disappeared, reducing the program’s capacity to properly transition clients between services and effectively increasing the likelihood of relapse. More generally, current NDIS policies are threatening the fdelity of WCS’s approach to recovery practice. Lessons learnt: This case study highlights tension between a new public insurance scheme primarily aimed at better managing consistent conditions and circumstances, and the recovery philosophy which has emerged in relation to episodic mental illness. This has implications for psychosocial services nationwide. The psychosocial rehabilitation sector has always been a peripheral element of Australia’s mental health service mix. The advent of the NDIS offers hope that this may change. However, WCS’s experience suggests that the NDIS must reconsider how best to foster recovery-oriented practice in mental health. This should be part of a more fundamental reconceptualisation of the role of psychosocial rehabilitation services in contemporary mental health care, not just for NDIS recipients. This work is urgent if Australia is to nurture its already rare psychosocial rehabilitation workforce and not see it dissipate.