‘On my worst day …’ How the NDIS fosters a deficit mindset and why that should change
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The National Disability Insurance Scheme (NDIS) was designed to empower and support people with disability. But ten yearsinto the scheme, many participants are finding their encounters with the NDIS dehumanising and burdensome.
And, according to the scheme’s architect Professor Bruce Bonyhady, service gaps are now pushing people to present “the worst version of themselves or their children” to secure the supports they need.
With the NDIS independent review well underway, here’s why the scheme needs to reclaim its strengths-based roots and what’s currently getting in the way.
To become an NDIS participant, applicants must provide evidence of a permanent disability that significantly impacts their life or requires early intervention. Evaluating impairment is important for accurate support planning.
But assessments that focus on a person’s deficits can put them in a vulnerable and confronting position. Re-assessments may even impact mental health.
Once accepted into the scheme, NDIS participants might expect this experience is behind them – but personal accounts included in last week’s NDIS independent review interim report suggest this is not the case. As one family member told the review:
According to participants, this frequently occurs during the yearly evaluation of plans, which has been described by NDIS Minister Bill Shorten as a “traumatic process.” The proposed revisions to these assessments aim to reduce their frequency in order to alleviate the associated distress.
The World Health Organization describes disability as an interaction between health conditions, environments, and personal factors. Contrary to an insurance mindset, disability can’t be medically “fixed” while discrimination and access barriers persist.
Strengths-based practice helps us to account for this complexity and is a common approach in psychology, mental health recovery and education. Strengths-based planning defines capability in relation to someone’s self-identified goals and in the context of support.
While a “worst day” description could indicate that NDIS participant “Maggie” is unable to shower independently or maintain personal hygiene, a strengths-based assessment would highlight the following:
Regardless, the interim review calls for a shift in responsibility away from people with disability, onto the National Disability Insurance Agency staff to show:
Consequently, NDIS applicants feel pressured to report about their “worst days” and not showcase their strengths, in order to boost their chances of being accepted and retained in the scheme. These presentations are a symptom of competition in an under-resourced system.
This article was first published on The Conversation, and was written by Kate Anderson, Vice Chancellor's Senior Research Fellow, RMIT University, Darryl Sellwood, Scholarly Fellow, Disability and Community Inclusion, Flinders University, Flinders University
And, according to the scheme’s architect Professor Bruce Bonyhady, service gaps are now pushing people to present “the worst version of themselves or their children” to secure the supports they need.
With the NDIS independent review well underway, here’s why the scheme needs to reclaim its strengths-based roots and what’s currently getting in the way.
Evaluating impairment
The NDIS is what’s called a “personalisation scheme” that allows people with disability to control their government-funded services and resources.To become an NDIS participant, applicants must provide evidence of a permanent disability that significantly impacts their life or requires early intervention. Evaluating impairment is important for accurate support planning.
But assessments that focus on a person’s deficits can put them in a vulnerable and confronting position. Re-assessments may even impact mental health.
Once accepted into the scheme, NDIS participants might expect this experience is behind them – but personal accounts included in last week’s NDIS independent review interim report suggest this is not the case. As one family member told the review:
The need for strengths-based planning
Given the scheme’s design means NDIS participants have a verified permanent disability, they should not have to justify that they still need essential services. However, scheme participants report facing interrogation about whether they are “disabled enough” to warrant funded support. They are regularly advised by providers and advocates to imagine their “worst day” when detailing the support they might need.According to participants, this frequently occurs during the yearly evaluation of plans, which has been described by NDIS Minister Bill Shorten as a “traumatic process.” The proposed revisions to these assessments aim to reduce their frequency in order to alleviate the associated distress.
The World Health Organization describes disability as an interaction between health conditions, environments, and personal factors. Contrary to an insurance mindset, disability can’t be medically “fixed” while discrimination and access barriers persist.
Strengths-based practice helps us to account for this complexity and is a common approach in psychology, mental health recovery and education. Strengths-based planning defines capability in relation to someone’s self-identified goals and in the context of support.
While a “worst day” description could indicate that NDIS participant “Maggie” is unable to shower independently or maintain personal hygiene, a strengths-based assessment would highlight the following:
The voice of NDIS planners is rarely heard in research, so it’s hard to know why the strengths-based approach isn’t taken more often. However, suggested reasons include a lack of disability expertise and unclear eligibility criteria. Planners may also be safeguarding against potential sympathy bias in providers’ recommendations, although there is little evidence to show this bias exists in practice.
Regardless, the interim review calls for a shift in responsibility away from people with disability, onto the National Disability Insurance Agency staff to show:
And research suggests NDIS paperwork has a notable impact on the information NDIS participants can share about themselves, and how their capabilities and needs are considered in planning. Revised assessment protocols that celebrate strengths and account for social barriers could scaffold a more collaborative and empowering approach to decision-making across the scheme.
An oasis in the desert
The NDIS was intended to benefit all Australians with disability by investing in mainstream services and community inclusion. But those outside the scheme have been left behind, forced to self-fund essential services or go without.Consequently, NDIS applicants feel pressured to report about their “worst days” and not showcase their strengths, in order to boost their chances of being accepted and retained in the scheme. These presentations are a symptom of competition in an under-resourced system.
This article was first published on The Conversation, and was written by Kate Anderson, Vice Chancellor's Senior Research Fellow, RMIT University, Darryl Sellwood, Scholarly Fellow, Disability and Community Inclusion, Flinders University, Flinders University
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