Not just a label: rethinking psychosocial disability under the NDIS

Hana* has been rejected from the National Disability Insurance Scheme (NDIS) twice because her doctor has a policy of never saying a mental health condition is permanent. 

The NDIS provides support to people with permanent and significant disabilities. A person may be eligible for the NDIS if they have a disability which results in one or more permanent impairments.  

For someone like Hana, this would mean demonstrating impairments that are attributable to a psychosocial disability. If eligible, the NDIS could fund services including therapy and equipment to support Hana to live more independently and improve her quality of life.  

The issue is there is no single, agreed definition of the term ‘psychosocial disability’. 

The importance of a definition

For Terri Warner, a PhD scholar at the ANU School of Medicine and Psychology and a participant in the NDIS, the definition of ‘psychosocial disability’ is both intriguing and confusing. 

When Warner first tried to make sense of the concept, she came across several definitions, many of which predated the NDIS and were not at all consistent. 

Through her investigation, it was clear there was a disconnect between how the NDIS category was defined, and how ‘psychosocial disability’ was understood and used by the people with lived experience. 

“According to the NDIS, everyone with a psychosocial disability has a mental health condition, but not everyone with a mental health condition has a psychosocial disability,” Warner says. 

“The reality is more complex. If someone tells you they have a psychosocial disability, then they have a psychosocial disability, but that doesn’t mean they will be eligible for the NDIS.” 

“On the flip side, there are those who don’t identify with the term but someone, somewhere has officially applied a label to them that they must now use in order to access the services they need.” 

As someone who has navigated the system to access supports, Warner has seen firsthand what works and what doesn’t.  

Her thesis, which looks at individual and policy implications of the framing of mental health and disability in the NDIS, draws on the experiences of consumers with a mental health condition, carers, and people who work at the intersection of mental health and the NDIS. 

“Identifying or being identified as having psychosocial disability can have significant consequences, both in terms of eligibility for health and social support, but also in terms of how people see themselves, and are seen by others,” Warner says. 

“Policy decisions are being made on the assumption that the NDIS, healthcare providers, consumers and carers are on the same page about not just what people with a psychosocial disability need, but also what a psychosocial disability is.  

“Put simply, that is not the case.”  

Finding the same page

Instead of eligibility categories being defined by policymakers and their chosen stakeholders, Warner would like to see equal decision-making power given to people with lived experience. This would apply to foundational definitions as well the design of the services so that adequate funding and appropriate supports are on offer. 

“Policy creation should involve codesign with consumers at phase zero, not phase two or three when the foundational decisions have been made,” Warner says. 

“This extends to research, where consumers and carers should be involved in deciding what should be researched and how that research is designed.” 

“NDIS participants and advocates have described having supports denied or removed from their plans, or funding cut on the basis that their disability is psychosocial, and the decision maker feels that the support is not. This happens even when there is strong evidence that the person needs that support,” Warner says. 

“I believe if the NDIS was to base planning decisions on the person’s assessed need for support, rather than the category their primary disability is placed in, many of these problems would be resolved.  

“This would also better align with the original intention of the NDIS, which was to provide individual, tailored packages of funding for non-mainstream disability support.” 

*Hana is a pseudonym.