Fitting in or fitting up?: individual and policy implications of the framing of mental health and disability in the NDIS

Abstract

With the introduction of the National Disability Insurance Scheme (NDIS), disability policy and mental health policy in Australia collided into one another. During its inquiry into disability care and support which led to the NDIS, the Productivity Commission (2011) determined that some people who had what they termed significant and enduring psychiatric disabilities had similar lifelong support needs to people with an intellectual disability or acquired brain injury. The Productivity Commission proposed that they be included in a mooted insurance scheme for people with disabilities. The term 'primary psychosocial disability' was later used to denote an eligibility category within the NDIS which was distinguishable from the larger group of people with mental health diagnoses. Psychosocial disability is not consistently defined in policy either in Australia or globally, but policy decisions are being made based on the assumption that everyone involved knows what they are talking about, and that they are all talking about the same thing. Identifying, or being identified, as having psychosocial disability can have significant personal and policy consequences, both in terms of eligibility for health and social support and in terms of how people see themselves, and are seen by others, particularly when the term means different things to different groups and in different contexts. This thesis presents a critical analysis of the causes and effects of the introduction of the psychosocial disability category in Australian policy from a lived experience lens. Using Carol Bacchi's WPR ('What's the problem represented to be?') approach, it examines the effect of complex policy problems on how people see themselves, and how people reconcile their ways of understanding their experiences with the policy categories their needs place them in. The thesis draws on interviews with 30 people - carers and consumers with a mental health condition, and those who work with them - and a case study of a mental health advocacy organisation. Policy decisions draw on, and decision-making processes reproduce, mechanisms that disqualify certain individuals and groups as knowers. One such mechanism for people with a mental health diagnosis has been the development of policy categories that align with psy discourses about madness and distress, predicating eligibility for health and social care programs on the agreement that these experiences are best understood in a certain way, by certain types of experts. I show how a decision intended to determine NDIS eligibility has caught people up, willingly and unwillingly, in a battle over knowledge production that has deep historical and philosophical roots, and has produced effects far beyond the initial policy implications. The results reveal the ongoing tension between concepts underpinning the NDIS as disability, social and mental health policy, and contribute to debates about how best to meet the access and support needs of marginalised people