🔗 NDIS and Psychosocial Disability

I don't have a policy to propose, a complaint to prosecute, or a critique to render. But this is a topic which deserves accurate framing.

🔗 Background

Unlike Centrelink, which provides financial payments, the NDIS provides services. It provides a workforce to help you with daily tasks and help you build your abilities to self-manage. I am personally dependent on the NDIS for mobility: I can't significantly leave the house on my own because of my agoraphobia, and therapy can't fix this.

The Federal government has, for the last few years, been trying really really hard to offload psychosocial disability to a new state scheme.

The NDIS was not structurally designed to handle psychiatric disease. The mismatch is operationally extremely obvious.

The criteria for accessing the NDIS is that the condition causes "significant and permanent" impairment in functioning. While many psychiatric diseases are pretty much guaranteed to be lifelong, a guarantee of lifelong impairment of functioning cannot be made. Many of these conditions are inherently mutable, and may never fully settle in the way the legislation prescribes. It is often impossible to know.

"Capacity building" sort of doesn't make sense as a concept for this category of disability: pretty much all forms of it are interchangeable with some kind of treatment in every way except for how the reports are written. Providers know this. LACs know this. Delegates know this. It's half the reason there is so much distaste for funding psychology these days.

Supporting psychiatric disease is often a question of how long is a piece of string? — outcomes are not always clear, and working out how much help is reasonable and necessary can be a very difficult task. Would a person benefit from an extra 8 hours? Probably? Is it worth it? How do we calculate that? Planners end up having to use rules of thumbs based on condition precedent and very subjective data.

🔗 Stigma

The inclusion of psychosocial conditions in the NDIS was a rare act of equality for what is almost universally the punching bag of disabilities.

One employer I had gave me extra slack because hiring NDIS participants "makes them look good." Will the new system allow for this?

Are we going to get mentally ill numbers instead of NDIS numbers...?

Are employers going to proudly tell their shareholders that 5% of their workforce have severe and complex mental health conditions...?

There is no conceivable implementation of this policy which is not incredibly problematic — reframing someone as mentally ill rather than disabled is almost never in their interests. The only thing which might help it gain traction is the fact that most people with severe and complex mental illnesses are already very well accustomed to being treated in ways which are incredibly problematic.

🔗 The Main Problem

From a resourcing perspective, the core trouble with psychosocial disabilities in particular is that they are extremely disabling, extremely complex to treat, extremely intersectional, extremely misunderstood and extremely common.

Psychosocial disabilities are not the single largest category of NDIS participants, and they are also not the most expensive per-capita. They are towards the top end of both at once, but that is not the structural issue here.

The actual issue is: as of June 2023, there were around 65,000 participants on the scheme with psychosocial disability.

The AMA estimated in 2024 that there are around 800,000 Australians with severe (persistent or episodic) mental illness — serious conditions like schizophrenia, not moderate ones like depression. The only thing holding those floodgates shut is the discretion of clinicians and delegates, but realistically this is a challenge of a scale the NDIS was not designed or equipped to handle. It would only take a fraction of those people to completely overwhelm the system and render it inoperable.

If more clinicians knew the process well, and the "significant impairment" criteria of the legislation was adhered to entirely honestly, a large chunk of those people would likely qualify to access support.

🔗 The Future

NDIA leadership is undoubtedly scared shitless. And the Federal treasury is likely equally tense.

Back on the ground floor: in the event that psychosocial disability is palmed off to the states, whatever replaces the NDIS for these people (myself included) is factually going to be materially worse in almost every way (after they received an explicit lifetime commitment). That's kind of the point — the whole idea is to make the scheme less expensive so that it can scale better. People with this particular type of disease are quite simply politically easy pickings.

The states are also pushing back hard: the two most populous ones (Victoria and NSW) house the majority of the country's mentally ill population, and both are in significant financial trouble right now. They can not afford working schemes of their own even if they want one. So we end up at an impasse. Everyone agrees that there are multiple existential problems, but nobody can afford to solve them. And things can't continue like this. And a sudden dropoff in support to some of the most vulnerable people in society would be quite a mess.

I do not have an answer. There may not be one. The default trajectory right now is the whole thing receiving a giant austerity haircut or collapsing.

Checkin

Version: 1

Written: 2025-12-20

Written on: 7.5mg olanzapine since 2025-11-11 - likely causing significant cognitive impairment

Mental health was: poor - estimate 25% brain

Ps. If you're looking to do psychosocial access — it's extremely difficult right now, but I wrote down a method for doing requests that has an excellent success rate so far.

Keeping a copy for posterity: