GYE, Mr Bill, Chief Executive Officer, Community Mental Health Australia

LOVELOCK, Mr Harry, Director, Policy and Research, Mental Health Australia

STEVENSON, Mr Tony, Chief Executive Officer, Mental Illness Fellowship of Australia

Evidence was taken via teleconference—

Committee met at 12:02

CHAIR ( Mr Andrews ): I declare open this hearing of the Joint Standing Committee on the National Disability Insurance Scheme for the inquiries into NDIS planning, NDIS workforce, and general issues around the implementation and performance of the NDIS. These are public proceedings, although the committee may determine or agree to a request to have evidence heard in camera. I remind all witnesses that in giving evidence to the committee they are protected by parliamentary privilege. It is unlawful for anyone to threaten or disadvantage a witness on account of evidence given to a committee, and such action may be treated by the Senate as a contempt. It is also contempt to give false or misleading evidence to a committee. If a witness objects to answering a question the witness should state the ground upon which the objection is taken, and the committee will determine whether it will insist on an answer, having regard to the ground which is claimed. If the committee determines to insist on an answer a witness may request that the answer be given in camera. Such a request may be made at any other time.

I remind those contributing that you cannot divulge confidential, personal or identifying information when you speak. If you wish to supplement your evidence with written information, please forward it to the secretariat after this hearing. I welcome our first witnesses. Thank you for appearing before the committee today. Information on procedural rules governing public hearings has been provided to witnesses and is also available from the secretariat. I understand that you would like to make some opening comments. Whoever would like to lead off, please do.

Mr Lovelock : Thank you, I will. Firstly, I'd like to acknowledge that I'm calling into this meeting on the land of the Wurundjeri and Woiwurrung people of the Kulin Nation and wish to acknowledge them as traditional owners. I'd also like to pay my respects to elders past and present and to any Aboriginal elders of any other communities who are listening today.

Mental Health Australia is the peak national non-government organisation representing and promoting the interests of the Australian mental health sector. We represent members including national organisations of consumers and carers, special needs groups, clinical service providers, public and private mental health service providers, researchers and state and territory community mental health peak bodies.

I'd like to thank the committee for inviting us to speak with you today and for your collective commitment to an NDIS which has been designed to meet the needs of people with living disability. A sustainable, well-qualified workforce is fundamental to supporting the choice, control and independence of people with a psychosocial disability. I will provide a brief overview of the particular needs of people with psychosocial disability in the workforce and the systemic recommendations we have made in our submission and then pass on to the representatives of Community Mental Health Australia and the Mental Illness Fellowship of Australia to discuss other recommendations to the committee.

Psychosocial disability is an outcome of complex interactions between the impacts of mental health conditions and the environment in which people live. People with psychosocial disability primarily experience cognitive, social and motivational barriers to everyday activities. NDIS data indicates that psychosocial support providers have the highest proportion of clients with complex behaviour needs. Recovery orientated care is accepted best practice in psychosocial support services. This means psychosocial disability workers need to be highly skilled in developing connection and capacity building as they support people to pursue what they find meaningful in life. Unfortunately, many service providers are finding it difficult to recruit and retain adequately skilled psychosocial workforce under the NDIS.

The Joint Standing Committee on the NDIS workforce has an opportunity to contribute to sustaining a viable NDIS psychosocial disability workforce by considering the strengthening of national governance and accountability across the developing policy environment. We contend that the Australian government should provide overarching strategic development coordination of the mental health and disability workforce for, while the psychosocial disability workforce is funded directly by the NDIS, primary health networks and jurisdictional programs, it is often the same staff who deliver these services. We also believe the government should be responsible for market stewardship and aligning the NDIS psychosocial workforce with broader strategic plans, such as the National Mental Health Workforce Strategy.

Given this, we are recommending the Australian government fund an NDIS industry plan. This plan would be developed in collaboration with the non-government sector and would strategically plan and coordinate development of the NDIS psychosocial workforce. We are also recommending the Australian government consider a national centre for mental health workforce development. The centre would support the integration and development of the Australian mental health workforce who are undertaking research, coordinating education and training and providing leadership in workforce quality improvement.

Finally, we're calling on the Australian government to lead in monitoring and resolving issues between the NDIS and other service systems. As my colleagues will discuss, the sector has lost highly skilled psychosocial disability support workers, who have moved to other health and community services where they can access better working conditions. We believe the Australian government should monitor and address such disparities, which impact upon the NDIS workforce. I will now pass on to Bill Gye from Community Mental Health Australia.

Mr Gye : Thanks, Harry. Community Mental Health Australia is the peak body for each of the eight state mental health peaks and, through that group, approximately 700 NGOs and other organisations across Australia. Our particular focus is on the need to move the centre of gravity of mental health services back out into the community, and therefore focus also on prevention and early intervention, as well as developing and maintaining the capacity of the community mental health sector—as in the community mental health NGO sector itself—as well.

The NDIS is an extraordinary national initiative and it provides an extraordinary safety net, but a safety net is not, by itself, something that allows you to easily rise up. It's not a firm foundation upon which to construct and build capacity. If the vision at the end of the 20th century for psychosocial disability was recovery, then the emerging vision for the 21st century should be discovery beyond recovery—discovering the human potential in each person that previous centuries have written off. Independent functional assessments being introduced for all their issues provides a starting benchmark for ongoing functional improvements in outcome measures. But obtaining high outcomes requires staff with high levels of behaviour change competency and other skills—social and practical intelligence—and, as outlined in our submission, the current NDIS level of remuneration does not allow for attracting or retaining many people with such high-level skills. This is a point Tony Stevenson will return to in a moment.

The practical point when you're trying to establish your pathway to a vision is: where are we now? So where are we now? Unfortunately, it's not possible to present the data on the number and distribution of the psychosocial workforce across all types of employers as there is a real lack of data for this workforce. Prior to the NDIS commencing, the NGO community mental health workforce was not included in the mental health national minimum dataset, and, as such, there remains a gap in mental health workforce data. While the NDIS has supported some workforce research, this data is neither detailed nor up to date and sufficient for workforce development and planning. This is something that applies not only to the NDIS but to all community based mental health activities. It is something on the radar of the national workforce development task force but it's also something that needs to be noted and improved, because you cannot clarify where you're going to until you've actually got a clear database on where you are now, and that is not there.

Recommendation 1 in our report is that government should work together with the NDIA and the NGO providers to define the broad-based community mental health workforce, including the NDIS psychosocial disability workforce, and establish ongoing data collection to monitor the required growth for this workforce.

Very quickly, I will note too that the same issue applies to our recommendation 3, which is that we need to ensure access to NDIS psychosocial services in regional, rural and remote Australia through funding measures that realistically account for increased cost of service delivery in these areas, increasing recruitment of workforce from local areas, and considering block-funding and hybrid models.

Thank you. I will now pass over to Tony.

Mr Stevenson : Good afternoon, senators. I'm Tony Stevenson, the Chief Executive Officer of the Mental Illness Fellowship of Australia. MIFA is the federation of seven not-for-profit mental health organisations across Australia. Together we support, per year, around 20,000 people with mental illness and their families and carers. We work very closely with people to assist their journey to recover their mental health, physical health, social connectedness and have equal opportunities in all aspects of their life. Our members build community. We value peer support and lived experience and we support recovery. Over 55 per cent of our workforce have lived experience as consumers or carers. That includes our boards. We know from experience that a better quality of life is possible for everyone affected by mental illness.

We urge the Joint Standing Committee on the NDIS to consider the issues raised in our submission, which go to the viability and quality of the psychosocial disability workforce into the future. People with complex mental health conditions and with additional complexities are highly marginalised and excluded from most opportunities in the community. They experience long periods of unemployment, often periods of homelessness, a lack of friends, dislocation from family and considerable physical health comorbidities.

The NDIS offers the best hope ever to close the loop, following the closure of institutions in the 1980s. People have a right to lifetime support, to enable them to live their life of their choice in their community, and that's what the NDIS offers. We've had great programs in the decades since the closure of institutions. Many of those have been severely disrupted, in order for governments around the country to fund the NDIS, but we do want to acknowledge that the NDIS, if it's properly implemented, will give people that optimism and quality of life that is their right. The crux of our submission really relates to the viability and quality of the workforce that is going to achieve that outcome.

Psychosocial support workers require a very high level of independent judgement and carry a significant responsibility and duty of care to people that they're supporting, far higher than we would expect from an attendant care worker. Yet many of the funding arrangements within the NDIS align that important work of recovery with the rates that are applicable for attendant care workers, for example. Consumers with significant psychosocial disability and functional impairment are frequently reluctant to engage with support systems, so psychosocial support providers must be proactive in the way that they reach out and engage with participants—a long period of time to build and establish trust—and work alongside consumers to assess their needs, set goals, formulate a plan and coordinate supports.

It's essential that the psychosocial workforce has the relevant experience and that they bring a high degree of sensitivity and empathy to the task. In this regard, peer workers are an essential component of the NDIS workforce. We must support the expansion of the peer workforce. We must develop that workforce and support that workforce, because they are absolutely critical in bridging that gap with people who are reluctant to engage with the NDIS. Governments must recognise that the investment in competency in a psychosocial disability workforce is an investment in recovery and the aims of the NDIS. NDIS psychosocial support workers have the highest proportion of clients with complex behaviour needs compared to other service providers—that's 34.4 per cent compared to 16.7 per cent.

As has been mentioned by the other speakers, transitioning from the previous Commonwealth programs—Partners in Recovery, Personal Helpers and Mentors et cetera—has been very difficult for organisations, with the unrealistic cost pressures under the NDIS. This has resulted in many redundancies and resignations and, consequently, a major loss of institutional memory, organisational stability and an increase in human resources and recruitment costs. The high turnover of staff is damaging for continuity and quality of care, where a trusted relationship between a consumer and staff is fundamental to engagement and recovery. So we've seen a move from full-time permanent staff, staff with appropriate qualifications and experience and appropriate remuneration under the previous Commonwealth supported programs. We now have only about 33 per cent of support workers who are full time. The rest are part-time and, largely, casual. We know the disruption that causes to a workforce but also to individual people in that workforce.

In order to address that question of viability and quality, we must investigate thoroughly the assumptions around the pricing for the psychosocial disability workforce. The hourly rate must be enough to attract and retain people with the required skills, experience and qualifications. We must have sufficient supervision and professional development opportunities for psychosocial support workers under the NDIS. We have to reduce the amount of billable face-to-face hours that are required to make the funding work viable. Psychosocial support workers need time to reflect, to plan, to debrief, to be in a position to provide the quality that's required, and organisations also need the capacity to invest in ongoing quality and to meet those very high standards of financial and human resources support that is expected.

CHAIR: Thank you very much. I'll lead off with some questions and then go to Senator Brown. In your submission you note that investment in community managed mental health services mostly ceased with the transition to the NDIS. Can you just explain why you believe this has occurred? Has it been that states and territories have lowered or ceased investment owing to a perception that this support is now provided by the Commonwealth through the NDIS or are there other reasons?

Mr Stevenson : Of course, we had a range of programs which were developed over a decade or so based on very strong evidence. The Commonwealth and the states and territories invested in recovery support programs. The Commonwealth's programs were the Day to Day Living program, the Personal Helpers and Mentors program and the Partners in Recovery program. Both Labor and coalition governments supported and nurtured those programs over many years, and they were targeted at a cohort of people—around 350,000 people in Australia—with severe and complex mental illness. They were rationed; there was a particular amount of funding available and that funding had spread across those programs. But, for those who were eligible and connected in, those programs were meeting their needs. The average funding available to people was around $5,000 to $10,000 a year.

The NDIS replaced those programs. The Commonwealth and the states and territories disinvested in those programs and transferred those funds into their NDIS contributions, so we had a reduction in programs. They were actually supporting around 100,000 people at any one time out of that 350,000 cohort, and they were replaced by the NDIS, which has, under the model, a maximum of 65,000, but only actually about 30,000 to 35,000 are currently getting support. So we've had a huge reduction in the number of people getting support. I must say that the NDIS contribution is higher for those who are eligible, but many people are not eligible, and most of the programs that were there have been shut down.

Those programs were very well funded such that we had a very strong and stable workforce on good remuneration and with stability of employment. Now, for less people we have a workforce that is largely casualised and where the NDIS pricing has forced down the levels of remuneration and conditions for those staff.

CHAIR: If I can summarise, you're saying that, for people who transition to the NDIS, there is still funding of programs; but, for those who don't qualify for the NDIS, the previous funding from states and territories has largely ceased.

Mr Stevenson : It has, largely. There were some measures introduced after that occurred. There is some continuity of support for people who were previously supported through those programs and now are not eligible. There was a new psychosocial program jointly funded by the Commonwealth and the states, but the supply of services is far less than what existed previously.

Mr Gye : Yes, and I might complement that answer Tony's just given. At the state level, many of the services that were there also went into scope, and states varied in their response. Victoria, ambitiously, closed down all their community sponsored mental health programs on the presumption that the NDIS would solve all problems, and it has not, and thus it has given birth to the need for the royal commission and the recommendations that, in essence, many of those services should return. There are various different stories for each one of the states, and I could happily provide all the details of the before-and-after picture from 2015 to 2020.

The replacement programs at the Commonwealth level, the ones that Tony Stevenson just mentioned, are funded and commissioned through the Primary Health Networks. The total funding for those programs is a little bit less than 20 per cent of the previous funding that was available through the Commonwealth programs that ceased and faded out between 2016 and 2019. So the picture is much less, and the general financial circumstance in which almost the entire NGO sector finds itself in is adapting to the NDIS pricing. The way that's largely happened—and, again, there is not sufficient data on this, although there was a report commissioned by the NDIS from a company called AbleInsight which is certainly worth reading. But, as Tony pointed out, in order not to go broke, most organisations restructured, there were many mergers, a number of organisations closed. Through the restructuring, they changed job descriptions and lowered the average salary by sometimes several levels on the appropriate development awards and increased significantly the casualisation of the workforce, thus lowering the attractiveness of this as a career to new people and lowering the organisation's capacity to put in place compliance to best manage quality and safety. The issues of quality and safety are now at the forefront of NDIS, and the remuneration that organisations are receiving is insufficient, we propose, in order to be able to provide the necessary level of quality and safety and, particularly, capacity building to get the recovery outcomes that we want to see.

CHAIR: Just one more question from me before I go to Senator Brown. In your first recommendation, where you propose governments work together with providers to define the necessary workforce, you talk about establishing ongoing data collection. What data in particular have you got in mind?

Mr Gye : First, we need a clear, publicly available set of data of organisations that are contracted either as providers in the NDIS or through the PHN services, and also through the state government mental health services. The NDIS has a data collection process, but the publicly available data, even to those on the committees, is very poor. You cannot easily find the number of NGO organisations providing NDIS services. You definitely can't find the number of workers and/or the qualifications that they've got, so you've got no benchmark for before-and-after workforce capacity building. Over the last week, I have attempted to get that data by filling out the requisite forms. I have so far been unsuccessful because you're required to fill out a 20-page form with possible ethics approval in order to get that data, even de-identified. Ditto at the state level: there's been a long story of sad failure why the minimum data set was not collected to again provide that data for the state funded community mental health services.

While there is a data set in the Primary Health Networks, we've been singularly unsuccessful in being able to access that data set in order to get that same data: the providers, the number of providers, where they are, the number of staff they have and the qualifications of those staff. Beyond that, it would also, of course, be good to know the locations of centres, occasions of service and, ultimately, outcome measures achieved. That would be the broad envelope of the data requirements, but this needs some specific detail. I'm happy to provide that, if that was requested.

Senator CAROL BROWN: Thank you for the evidence you're giving here today. Have your organisations been consulted or involved in the development of the National NDIS Workforce Plan?

Mr Lovelock : No, I'm not aware of any invitation to be involved in that planning.

Mr Stevenson : No, we haven't been involved.

Mr Gye : No. Similarly, we've not been involved with the NDIS mental health workforce planning process. We are involved through the National Mental Health Sector Reference Group, which is overseen by strategic adviser Gerry Naughtin in the NDIS. I think, indirectly, we make some contribution to that, but we're not directly involved or engaged with that process or the relevant task force.

Senator CAROL BROWN: Do you have an understanding of who's actually involved with the department in putting together or developing a national workforce plan?

Mr Lovelock : No, I'm not.

Mr Gye : No, I also am not.

Mr Stevenson : The same for me.

Senator CAROL BROWN: Do you find that unusual? Do you want to be involved or do you think that your organisations should be consulted?

Mr Lovelock : Absolutely. We'd certainly be happy to support and be involved in that, if that opportunity was provided. Psychosocial disability has, unfortunately, had a history of being an add-on in relation to the NDIA and the work it's undertaken and has resulted in it quite often falling off the radar in terms of consultation.

Mr Gye : Certainly, we would be very interested in being involved. We are engaged with the NDIS in several ways. I would not wish this to seem like a criticism of the NDIS in their attempts to consult with the field on a number of different areas, but certainly in this area there's a gap, and we'd be very pleased to be involved.

Senator CAROL BROWN: My understanding is that the Department of Social Services are currently developing the NDIS national workforce plan.

Mr Lovelock : Thank you for that advice. We'll follow-up with DSS and talk to them about potential participation.

Senator CAROL BROWN: You talked about the casualisation of the psychosocial workforce. Could you please expand on the direct impact this casualisation is having on the psychosocial workforce?

Mr Stevenson : Yes. It's very important to build the rapport and the trust with the people we're supporting, considering that people with severe mental illness and significant psychosocial impairment are actually reluctant to reach out and seek support to understand what is available and what is possible. That's why the peer workforce is so important. So we do need to value the workforce, in that sense.

It's not just a matter of waiting for people to indicate their preferred support arrangement, week to week, to then reach out to your workforce and see who's available at those times. We need the stability with that workforce so that they're able to respond and engage with people as needed, that they're able to focus on their own skills development, professional development, that they have the opportunity to debrief with their co-workers and so on. For the quality of support and safety for consumers, we need people to be a part of a stable workforce.

For the individual workers that's very important as well, because we know what the negative impacts are of being a part of a casual workforce. We've seen, in the aged-care sector, how staff have to work across two or three or even more organisations in order to get the hours they need in their employment each week. That level of fragmentation of people who are not in a position to develop that stability and underpin their practice with those quality safeguards, I think, is going to be extremely detrimental to people being supported.

Mr Gye : If I might add to that answer, the casualisation of the workforce also means that, over time, people are not accruing funds to be able to take four weeks paid holiday a year. Over time, you've got people who are working 52 weeks a year in order to make ends meet and, over time, you'll get an impact on workers from that. Also too, without the commitment to an organisation—because the organisation is unable to make that commitment to you—while I can't present any data on this I'm sure that there would be a body of data on employee engagement and casualisation that would be relevant here.

We do need the time to invest in not just employees as a fee-for-service resource, that's used for hourly charging, but to take a person as a human resource in an organisation and to train and develop that person. I've recently been having conversations with organisations, where I've been reaching out to find organisations that are finding the NDIS viable for them, so that I can balance the criticisms that I often hear with the need to hear positive stories there. But even in those organisations I've spoken to, the ones that have adapted have done just that: they've restructured. They've casualised. They've reduced their training for staff to about three days a year—three to four days a year was the average, and that includes induction training. They've increased the number of part-time employees as well in order to adjust to the pricing model of the NDIS.

I think there's certainly evidence out there that casualisation is detrimental to quality and safety, but, again, it's without the appropriate data. Data's what's lacking here, to say that with certainty. We have to give probabilistic arguments.

Senator CAROL BROWN: In the submissions that you've put forward, and you've talked about it a bit in your responses, on the difficulty in recruitment, with workers moving out because of working conditions and remuneration, will the recovery coach support item adequately address this issue around remuneration? Do you know why it's been delayed and when it's expected to be introduced?

Mr Stevenson : The recovery coach model has actually been introduced. It was introduced on 1 July. I would say yes and no to your question. It is an opportunity to review the assumptions around pricing for that role because it is a new role being introduced. However, it is a slightly different role to the general support worker workforce but it is part of the recovery workforce. So what we do have an opportunity to do at the moment is work together with the NDIA around the other part of the recovery coach initiative, which is the broader recovery framework that the NDIA has committed to introduce.

We have been very active in our support for a recovery framework to be the overarching set of principles, if you like, for people with psychosocial disability in the NDIS. The NDIA have agreed to implement a recovery framework and, as part of that, they have already started the new role of recovery coach. But through that broader development recovery framework, we have got an excellent opportunity to delve into the characteristics of a psychosocial disability support worker to bring in the aspects of recovery that we believe are critical in that role, which we have discussed, and to look at the appropriate remuneration for all of the roles within a recovery approach to the NDIS. It includes the support workers and it includes the recovery coach.

Where we have some challenge in that is that there are a number of different assumptions around how we should do that. I think where the opportunity is and where we would appreciate this role is to be able to work with the NDIA to fully understand what the different role is for a psychosocial support worker, to then work through the assumptions that would arrive at an appropriate price. We know there are differences perhaps in philosophy, different approaches and different understandings about all of this, but the best opportunity we have is if we can work collaboratively to really unpack a lot of that, with the aim of developing an appropriate role description and appropriate price and remuneration, where we can actually demonstrate that the benefits of investing in that way will actually enhance the outcomes of the NDIS.

Mr Gye : If I might just add to Tony's answer, agreeing that the recovery coach is a positive but a qualified positive at the same time. It is a positive in that it provides an opportunity for organisations to employ people at a slightly higher level than they do for their primary core supports. But organisations have historically been depending upon a proportion of support coordination pricing, which is a level II at about $102 an hour. The recovery coach comes in at about $80 an hour, which is certainly better than the $60 to $65 an hour for the core supports there. The problem is that the recovery coach is now being seen as a replacement for the support coordination level 2 role which means that the advantage that used to present in terms of the daily rate being offset by the fact that the recovery coach at $80 an hour is lower. The offset of the offset is that there may be more hours that are contracted for the recovery coach.

The other criticism I'd make as a recovery coach is, in the consultations, the award level appropriate that was put into the pricing level formula was—our award primarily is the SCHADS Award, which senators may be aware of. It was put into the formula as a SCHADS level 4. Our view at Community Mental Health Australia is that the competencies required for that role to get the recovery outcomes that are needed to really move people forward in their recovery journey—that is, increased independence and ultimately less need for the NDIS—mean it should be at a higher level. We've been suggesting publicly that it should have been at least a SCHADS level 6, not a SCHADS level 4.

At this point I will put on the table that we've also proposed in another context that an initiative of the NDIS should be undertaken through a series of pilot projects to demonstrate the proof of concept that if you can gather the right team with the right competencies you can and will achieve those functional outcomes. And the budget for those pilot projects can, of course, be defined as a broad envelope, possibly equivalent to the annual package of a person or persons involved, but with the full freedom to expend within an envelope, with the test showing us those improved functional recovery outcomes so that we can see that people will move forward in the NDIS. The underlying presumption here I believe is that essentially the focus of those auditors involved in the scheme is on maintaining and supporting people with disabilities in a lifelong fashion. The proposition that we're bringing here, which the recovery movement has championed for the last 20 years, is that people can move forward and develop a contributing life given the right supports, and that's the vision and that's the goal that we need to invest in.

Dr MARTIN: Thank you very much for your submission. In your submission you talk about the specialised psychosocial support workforce as the core workforce and that currently the psychosocial support staff are employed by three groups. You defined one as specialised mental health psychosocial service providers. The second group is general disability service providers, and the third group is other arrangements, such as soul traders not formally part of any other organisational structure. Could you spell out what percentage of psychosocial support staff fall into those categories?

Mr Stevenson : I'll do the best I can to answer your question, but I'll refer back to Bill Gye's earlier comments that we don't have the data. We would certainly appreciate any data that was available from the NDIA concerning that breakdown, because I would assume that there would be some capacity for that. But, broadly speaking, the majority would be through the specialist mental health organisations.

Dr MARTIN: When you say [inaudible], is that people that are registered health professionals with AHPRA, like speech pathologists and occupational therapists and psychologists and, perhaps, paediatricians as well?

Mr Stevenson : It includes all of those, but it also includes the general disability support workers under the NDIS. For people with a psychosocial disability, it would include a mental health support worker. They're people normally—

Dr MARTIN: When you say mental health support worker, what do you mean? A registered health professional?

Mr Stevenson : No. I mean a person with, say, up to a Certificate IV in Mental Health study but a range of qualifications and experience. I suppose, broadly speaking, it's a professional group outside of those professional disciplines that you mentioned, such as the allied health professionals et cetera. This is a group of people that have a range of qualifications and experience. The most common would be a certificate level in mental health through a TAFE college or private provider.

Dr MARTIN: Are you saying that they fall under the same category as the registered health professionals in that group that you define?

Mr Stevenson : We were talking about the way in which mental health support workers are employed. They are employed in specialist mental health organisations. They're employed in other disability organisations because people that they may support with physical or cognitive disability may have a secondary psychosocial disability, or they may be expanding their target group to include, now, people with a psychosocial disability. So those organisations would also employ this workforce. And of course, under the NDIS, people can practise as a sole trader and provide support. We're focusing on the support worker category, but certainly all of those allied health professionals are also providing support to people with a psychosocial disability as well, and they are all working across those three organisational structures also.

Dr MARTIN: Do you have information on how many people have completed certificate IV mental health support worker qualifications?

Mr Stevenson : No, because there is no national register, there's no national accreditation and the Australian Institute of Health and Welfare doesn't adequately collect information on that workforce. So we don't have that data, and that is a very big gap in how we understand these issues and how we can plan for this workforce.

Mr Gye : To add to Tony's answer, I'm just looking up the data that we do have, which is provided to us as part of membership of the national Mental Health Sector Reference Group, and the proportion of sole traders to other organisations—that's the only differentiation that's made—is 33 per cent of organisations; 1,848 are sole traders providing primary psychosocial support, disability; and other organisations—and that would be a combination of private and NGO—is 3,791. That's based upon the funding that's made available annually—the annual active plan expenditure—divided by the average cost per hour for core supports. That seems to suggest that about 30,000 staff are involved, both as sole traders and other organisations, in providing core supports, and about 5,680 staff are providing capacity-building supports. That's the sum total of the data that we have available.

As Tony said, there is a long and sad story as to the failure of data collection. The Australian Institute of Health and Welfare have wished to do this, but they need state governments to come on board to provide the state data. Western Australia came to the party; the Western Australian Mental Health Commission provided the minimum dataset. Queensland started to do that in 2018-19. But the Australian Institute of Health and Welfare require a minimum of three states before they publicly report that data, and all the other states, despite our continuous ankle-biting, have failed to do it up till now, so we don't have the state data. The NDIS data is probably there, but it would need high-level access and the capacity to query it to find that data. Similarly, it's the same story with the PHN psychosocial services across the country—the data is there, to some extent, but needs high-level access and permission to access it. It is not easy, when you are trying to do planning, if data is hidden behind these protective walls. It would be a great outcome if the recommendations from these hearings could be that the data is more publicly provided—within the limits of confidentiality, of course.

Dr MARTIN: I've just one other question in relation to the mental health support worker cert IV qualification: how many—and are you able to find out if it's possible, through the organisations that you represent—of the mental health support workers are working independently with patients with psychosocial disability, without input from a registered mental health professional such as a psychiatrist or a clinical psychologist?

Mr Stevenson : The connection with those other professionals is with the individual participant. There's no structural supervision by qualified professional mental health staff for support workers. They get their supervision within their organisational structure. Participants would generally have clinical support as well as the community support provided by the support worker, so they may well see a psychiatrist or attend a public hospital for psychiatric care and medication or a GP or other allied health professionals. But the support worker role is largely independent. It's focusing on the person's recovery, in a community sense, in terms of their capacity to live well and live independently and connect with family and friends and community, and to have housing and those sorts of supports.

Dr MARTIN: Sorry to interrupt. Is there any structure or system in place to ensure collaboration between other mental health professionals who are working with the patient or the individual participant with the psychosocial disability and the mental health support worker? Is there anything in place to ensure collaboration?

Mr Stevenson : The collaboration is not provided systemically. It's achieved in the way in which all of those professionals and organisations find ways to work together, collaboratively. But the system itself is quite fragmented in how those various roles are funded, how they're organised and how they interact with people. There are certainly models around stepped care and person centred care that the PHNs are developing, where they endeavour to get those parts of the systems to collaborate more and to work together more. Certainly the Productivity Commission, in their draft report, identified that that was a gap and that the system is incredibly fragmented in that way.

Dr MARTIN: I think in your response you're reiterating an important point: that, without any systemic process to ensure collaboration, people with psychosocial disability, potentially, could be missing out on ensuring that there is collaboration between the registered health professional and the mental health support worker. Yes, that's an important point. Thank you very much. That's all I have to ask at this point.

Ms COKER: I'd just like to thank everyone for sharing your expertise with us today. You mentioned in your presentation that there are unrealistic cost pressures in the NDIS which are leading to a high turnover of staff and, at the same time, a shift to a casualised workforce, with only 30 per cent of the workforce being full time. You also suggest, particularly with regard to the psychosocial workforce, that there needs to be improvements in supervision, training and accreditation; time for workers to reflect, plan and debrief; better pricing and salaries; and less casualisation. You mentioned how a national centre for mental health workforce development could help achieve some of those improvements. Could you explain that?

Mr Lovelock : At the moment there isn't actually any coordination mechanism nationally that works with the different professions in bringing them together—even within the mental health space but also in the psychosocial disability space. There is a lot of cross over in the work, and sometimes in the clients, across mental health and the NDIS. There are also opportunities to build in greater capability with joint training and development of competencies that go across different professions and different professional groups. At the moment, there is no leadership in that space. State governments do their own workforce planning, primarily focused on state based service delivery, which sometimes doesn't include the broader community mental health sector, where a lot of these people live and work. So our plan was to promote the idea of a national workforce, similar to Te Pou in New Zealand, that would take on this broader leadership role in providing education and training and bring all those pieces together.

Ms COKER: I think it is a concept worth considering. In relation to our experience of COVID-19, the UNSW's social policy research centre has released a report with key findings that there is an urgent lack of personal protective equipment being supplied, there is a widespread perception that the disability workforce is being dangerously overlooked in the pandemic response, and that workers are worried about the continuity of and disruption to support for clients, particularly with respect to day programs, community access activities and group homes. I am wondering if you would comment on those findings. Do you agree with them? What could be done to address these concerns?

Mr Gye : Yes, we would concur with those findings from the evidence. They are primarily anecdotal, but we have done some of our own internal surveys. This situation has improved somewhat, and the NDIS has responded in a number of ways to the current crisis, particularly in making personal protective equipment purchasable through an individual's support package but not for the organisations themselves—that would be an extra cost to them that they would have to extract out of the fee-for-service bill that is allowed in the NDIS.

As we've explained previously, it is already an extremely tight business. Therefore, the capacity for organisations to do that has lessened. Substitute support over the telephone and online has been significant and there is both good and bad in that. One of the bads is the ongoing lack of resources and/or competency and/or habits on behalf of a number of disadvantaged people and families to have access and to be able to adequately use that equipment and that channel of support. So yes, we would concur broadly with the findings that there has been some adaption but not sufficient and that it is still an ongoing issue.

Ms COKER: Would you suggest that, because of COVID, there needs to be an adjustment by the people with disabilities to their plans to enable for protections to be provided?

Mr Lovelock : We have been talking to the Department of Health about best practice guidance around supporting people with a psychosocial disability through pandemics. It is something we had already gathered a lot of evidence around—what works and what doesn't—and we need now to make sure we don't lose that but include it into documentation that we can call upon in the future. It will help drive and address the issues that arose during the first wave of the pandemic and that obviously are still occurring in some cases in Victoria through its second wave.

Mr Gye : I would argue this is another area, again, where we should have the data to be able to determine what proportion of people who were getting in face-to-face support, either individually or in groups or through supported accommodation, have now been moved to other more indirect forms of support or not. Those reporting requirements require people to collect and report the data. That is a compliance cost and that compliance cost is not allowed for in the competency nor is it contractually required, as far as I am aware, by the NDIS. In order to manage a scheme of this complexity, ultimately we do need the data, so I do return to the data requirement that I began my presentation with.

CHAIR: I think that's exhausted our questions. I thank you for your submission to these inquiries and thank you for coming online and discussing them with us today. We greatly appreciate that.