Archives For Support Services

It can be quite overwhelming to pursue an NDIS package, particularly when you have limited supports (family or services) to assist you with this process. I decided to write a few blog posts on this topic with the hope that it will assist some people who are pursuing an NDIS package with the process. By virtue of working in community mental health, I have the vantage point of knowing what it is like to support individuals with psychosocial* disabilities to access NDIS.

When applying for an NDIS package, there are a few paths that you can walk down i.e. autism, mental health or autism and mental health path. To receive an NDIS package you are required to have a diagnosed disability (physical or psychosocial), and this diagnosis needs to be current and relevant (i.e. less than two years old & based on the DSM-V criteria).

The simpler path to NDIS is with a diagnosis of Autism Level 2 or 3. Having either one of these diagnoses means that you do not need to have Part C of the Evidence of Disability Form completed or provide evidence of the impact that your disability has on your life. You just need to submit a diagnostic report to NDIA which provides evidence of having this Level 2 or 3 diagnosis. Most likely, those with Autism Level 2 or 3 already have supports in place that will assist them to transition across to NDIS.

Access to NDIS becomes a bit more complex for those with a diagnosis of Autism Level 1, as you must provide evidence that illustrates your lack of functionality and what supports are needed to assist you. Similarly, those who are a self-diagnosed Autistic need to provide evidence of another disability to receive supports. Psychosocial Disabilities can include a diagnosis of Schizophrenia, Mood Disorders, Personality Disorders, Anxiety Disorders, or a combination of these issues. If your current clinical psychologist or psychiatrist does not give you an Autism diagnosis, for whatever reason, then use the psychological disorder pathway for NDIS.

Here is a recent example of mine from work: I recently supported someone who had a past diagnosis of Asperger’s Syndrome to get a more current diagnosis.  It is unclear whether this past diagnosis was official since no documented evidence exists. Upon review, the psychiatrist did not include an updated diagnosis of Autism in the diagnostic report. This may be due to the psychiatrists limited understanding of neurodevelopmental disorders; their specialisation was adults and old age. Instead, the psychiatrist listed PTSD, Anxiety, Depression, Eating Disorder-NOS, and Cluster-B Personality Disorder (i.e. Borderline, Narcissistic, Histrionic and Antisocial). In my opinion, it is not worth pursuing an Autism diagnosis via a psychiatrist if you’re time-pressed or have already started the application process and received (or completed via phone) the Access Request Form. Most psychiatrists have wait-lists (sometimes really long wait-lists) and it can also be challenging to find a good one. So, the mental health route is good enough for now, especially if you have a very good documented history of seeing your psychiatrist.

I recently participated in an e-conference for professionals seeking information about working with persons with Autism and Mental Health issues. One person that I interacted with in chat seemed to think that based on one’s current functionality a person with Autism Level 1 could receive supports under the Autism-only path. To me, this doesn’t make sense as the three levels of Autism are based on functionality and how much support the individuals need. There is no official information about this with regard to NDIS. But, one would think that if the functional impact was more severe or became more severe the person would receive an Autism Level 2 diagnosis. So, in my opinion, the only other thing that would increase the severity of Autism Level 1 is co-occurring Mental Health issues.

I would advise that when you’re applying for NDIS that you do not entirely rely on the General Practitioners (GPs) Functionality Assessment which is included in the NDIS Access Request Form that is posted to your mailing address. When I have been supporting clients to see GPs and psychiatrists they often fail to understand how psychosocial disabilities apply to NDIS. The GPs/Psychiatrists that I have interacted with also continue to fail to understand the relationship between psychosocial disabilities and NDIS when you give them examples and provide them with support tools. Your GP doesn’t get to see you in your home or the community, so they can’t properly assess you. They don’t really know you well enough. Perhaps things will improve over time when GPs and Psychiatrists go through their own training processes, and begin to understand what questions to ask people in relation to NDIS and psychosocial disabilities.

A lot of GPs are time poor, so they often want to rush through paperwork. They also do a sloppy job when they take the form to complete it at a later time. So, what ends up happening is that professionals will write “no support needed” or leave things blank under areas of need. I had this happen to a client the other day, her GP wrote no in all areas of functionality even though she has high psychosocial needs. The areas of need being: Mobility and Transport, Communication, Social Interaction, Learning, Self-Management, and Self-Care. Identifying areas of need is essential to getting an NDIS package. So, this sloppiness without additional supporting evidence will probably lead to a rejection letter from NDIA*. You can have your case reviewed, but it’s best to take steps to minimise this eventuality.

So, my advice would be for those with current supports in place to accumulate evidence through support letters from support workers/case managers and reports from psychologists, psychiatrists, and occupational therapists. All of which need to be less than two years old. The more current a document the better it is. For those of you without professional supports, my suggestion would be to not only provide diagnostic reports that outline your disability but to consider pursuing an Occupational Therapy (OT) Assessment. This is advice also advice I give to those who a reticent about getting a mental health diagnosis.

If you meet the eligibility criteria, it is worth pursuing a chronic disease management plan from your GP, as this will enable you to get rebates for seeing an OT. To a total of five sessions. A good OT report will include the following things: background & known medical information, social circumstances & supports, personal presentation at the assessment, cognitive function & mental state, current supports in place, overview of home environment, activities of daily living, and issues and support needs identified, and lastly assessment summary and professional recommendations. The exploration of all of these domains by a professional will assist to support your application for an NDIS package.

In my next post, I’ll go through the application process.

Thanks for reading!

Do you have experiences with NDIS?
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Notes from this blog post.

Psychosocial Disability: Term used to describe the experience of people with impairments and participation restrictions related to mental health.
NDIA: The National Disability Insurance Agency, an independent statutory agency.
NDIS: The National Disability Insurance Scheme, a healthcare program initiated by the Australian Government for Australians with a disability.

Chronic Disease Management Plan:
https://www.humanservices.gov.au/customer/services/medicare/chronic-disease-management-plan

Autism DSM-V:
http://nspt4kids.com/healthtopics-and-conditions-database/autism/
http://raisingchildren.net.au/articles/dsm-5_autism_diagnosis.html
https://www.psychology.org.au/publications/tip_sheets/autism/
https://www.autism.com/news_dsmV

In Australia, gaining affordable supportive services for Autism is dependent on whether or not you qualify for NDIS (that is, if NDIS has rolled out into your area). It also depends on your age! Those aged 18 and above may encounter difficulties obtaining support services. Individuals who have received a late diagnosis or those labelled as ‘borderline’ or ‘mildly’ autistic will also encounter barriers when seeking support.


Employment Help?
There are a few services that can be accessed to receive assistance in finding and maintaining employment. I am not going to be providing recommendations, as I believe that quality is dependent on location and staff, and not just the service provider itself. There is a lack of consistency across services, as some just try to meet their quotas and don’t offer much help at all. For instance, you might have one job service provider that is fantastic, in let’s say, North Sydney but is quite poor in Bankstown. So, my recommendation would be to look at reviews online or just try it out to see if it suits your needs.

Nova Employment – Disability Service.
http://www.novaemployment.com.au/
This service is free (as it is government funded), however, you need to meet their eligibility criteria: To participate in this program, you must have a disability, or a permanent medical condition or significant barriers to employment.

ASPECT – Autism Spectrum Australia
https://www.autismspectrum.org.au/aspectcapable

ASPECT’s employment help  (Aspect Capable) is not a free service. I am not sure what the current rate is per hour, but I think it is somewhere between $60-80. If you are feeling stuck and want a mentoring service with a good understanding of Autism Spectrum Conditions then ASPECT is something you could consider.

My only critique about employment services is that they may box you in, simply for the reason that you have Autism. For example, the misconception that the only work deemed okay for people with Autism are things like factory work, computing, gardening or working in warehousing. It’s true that there may be some things you’re not suited to, however, it shouldn’t be ruled out as impossible (or not worth trying).


Mental Health Support?
I suppose that working in community mental health makes me privy to the various barriers and strengths that exist within the system. I have found that not all workers are fluent in ‘spectrum conditions’ and misunderstandings arise because of this. I presently work with a few individuals diagnosed with an Autism Spectrum Condition, and I liaise with other workers who work with individuals on the spectrum.

In terms of free support, the government provides funding for several programs run through NGOs.  These programs exist to assist those ‘suffering’ from mental illness to work toward their recovery goals. You are partnered with a support worker who will provide practical support, social support, and greater access to community participation among other things. Support is usually relinquished when the participant no longer needs someone to walk alongside them (i.e. they have developed a greater capacity for independence).

Remember, the focus of these programs is for Mental Health Recovery and not Autism Spectrum Conditions. So, if you want to access support that is specifically developed for those on the spectrum you would need to find an organisation that provides this service, and often at your own expense ($$$).

Programs include:-
RichmondRPA (NSW and QLD only):
Provides a range of services, including support for women and children, youth, and adults.
https://www.richmondpra.org.au/our-services

Compeer (through St Vincent de Paul Society):
An international program to support individuals faced with social isolation by matching you with a volunteer.
https://www.vinnies.org.au/findhelp/view/113

Personal Helpers and Mentor Service (PHaMs): –

You can self-refer to this program. However, you need to be aware that some areas aren’t taking referrals at this time or may have a wait list due largely to demand.
https://www.dss.gov.au/our-responsibilities/mental-health/programs-services/personal-helpers-and-mentors-phams

Neami National:-
Offers several services, including community outreach and peer-led programs. It’s probably best to check your location on their site to see what services are available.
http://www.neaminational.org.au/our-services/community-outreach-support

Headspace:-
For those aged 12-25. Again, be aware that depending on what area you live in there could be a long wait-list for psychological support! They’re also a little adverse to those considered ‘too complex’, as it challenges their current capacities. They’re not able to offer long-term subsidised assistance and generally, young people who attend this service have more straightforward depression and anxiety. They will receive 10 sessions, as per better access scheme with the potential to extend (it’s up to the practitioner’s discretion). http://headspace.org.au/

Mindspot:-
Free national telephone and online service, for anxiety and depression
https://mindspot.org.au/

Support for day to day living program:-
Another government initiative which focuses on providing structured and social-based activities. Again, you need to check the website to see what is available in your location.
http://www.health.gov.au/internet/main/publishing.nsf/content/mental-d2dl

Lastly, another alternative is asking your GP to refer you to one of those rare psychologists who bulk-bills.  You can also access private services if you have private health insurance.


Service Coordination.
In Australia, federal and state governments fund programs that facilitate the coordination of supports. This means that these organisations build a picture from your story and link you into the appropriate supportive services (a holistic approach).

New South Wales ONLY- Abilitylinks (Disability):-https://www.adhc.nsw.gov.au/individuals/inclusion_and_participation/ability_links_nsw
You will need to visit the site to see which organisation is the lead in your area.

All States and Territories – Partners in Recovery (Mental Health):-
http://www.pirinitiative.com.au/index_public.php


Social Support?
In terms of social supports, there are mainstream supports and peer-led groups.

ASPECT facilitates social networks and social groups.
https://www.autismspectrum.org.au/content/adult-social-networks
https://www.autismspectrum.org.au/adultsocialgroups

Autism Community Network
http://www.autismcommunity.org.au/acn-services.html

Meetup.com
This site has a number of Autism/Asperger groups. You’d need to search for what is in your area. Alternatively, you can look up groups along a similar vein, for example, shy and socially anxious. You can also join groups that align with your personal interests.

ASPIA – Group for partners of individuals with Asperger’s
http://www.aspia.org.au/groups.html

New South Wales
Diverse minds, located in Erskineville (Sydney), runs an adult female group (18-35) and an adult group (for those aged between 20-30).
http://www.diverseminds.com.au/services/groups/

Queensland
Asperger Centre –
Has links to several groups for individuals with Asperger’s
http://www.asperger.asn.au/

Victoria
Asperger Victoria – Adult monthly meetings and social events
http://www.aspergersvic.org.au/as-adults/

South Australia
Nothing at this time

Western Australia
Autism West – Chat time
http://www.autismwest.org.au/index.php/18-and-over/

Tasmania
Nothing at this time

Australian Capital Territory
Autism Asperger ACT – Discussion Group
http://www.autismaspergeract.com.au/our-services/autism-asperger-discussion-group/

Northern Territory
Nothing at this time


Assessments and Private Psychological Support!
Personally, if I were to go for an assessment or pay for psychological services I would find a place that specialises in autism. If you are female, a clinic that is familiar with female presentations would be best. Sessions can be quite expensive if you pay from your own pocket, anywhere from $200-$350. You might be able to get discounts if you have a concession, are experiencing financial hardship or if they have a student (registrar) psychologist at the clinic.

Regarding seeking support through more generalist clinics. I am not saying this is the case for everyone (some people might have had a good experience), however, I have heard quite a decent amount of people retell experiences of grief at having gone through generic psychological services i.e. depression, anxiety, schizophrenia and bipolar disorder among other things. This is due largely to professionals lacking an awareness and understanding regarding Autism Spectrum Conditions.


Psychiatrists
Finding a good psychiatrist can be challenging. Your General Practitioner (GP) may have a list, but it is usually a good idea to do your own research. And to ring a psychiatrist’s practice inquiring after wait lists before you see your GP for a referral. Unfortunately, some psychiatrists have a wait list that lasts months.

Under the Better Access Initiative, Medicare subsidies are available for any patient referred by a doctor for 50 sessions each year (compared with 10 sessions for a psychologist). However, you will need to have a severe and persistent mental illness to be eligible for this scheme.


More on the Better Access Initiative:
The Better Access initiative was introduced to address low treatment rates for common mental disorders such as depression and anxiety, particularly presentations of mild to moderate severity, where short-term evidence-based interventions are most likely to be useful. The number of treatment sessions required for mental disorders depends on the diagnosis, duration and severity of the particular disorder. Under this initiative, patients can access Medicare rebates for up to 10 individual allied mental health services per calendar year and/or up to 10 group therapy services.

To access Medicare services under the Better Access initiative, you will need to visit your GP who will assess whether you have a mental disorder and whether the preparation of a GP Mental Health Treatment Plan (MHTP) is appropriate for you, given your health care needs and circumstances. If you are diagnosed as having a mental disorder, your GP may either prepare a GP MHTP, or refer you to a psychiatrist who may prepare a psychiatrist assessment and management plan. Alternatively, your GP may refer you to a psychiatrist who, once an assessment and diagnosis is in place, can directly refer you to allied mental health services. Further information on the Better Access Initiative is available at:http://health.gov.au/mentalhealth-betteraccess.


Thanks for Reading!

I’ll probably create another post at a future time to reflect the implementation of NDIS, so stay tuned!

What services do you have or what services have you found?
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Looking for diagnostic services in Australia? Finding support can sometimes be like navigating a labyrinth. Here is a list of ones that I am aware of. I will focus more on youth and adults, as there are a tonne of services available to children. A simple google search will reveal a whole host of services for children.

Like all lists, this will need to be reviewed in 12 months time to keep it current. If a website is down, it might be a good idea to search for phone numbers or a contact email via Google.


New South Wales
Diverse Minds. Erskineville, Sydney.
This clinic will see children, youth and adults.
Comprehensive Psychology. Various locations, Sydney.
This clinic provides assessment services for children.
Sydney Cognitive Development Centre. Bondi Junction, Sydney.
This clinic will see both children and adults for assessment.
Embracing the other half.  Pymble.
This clinic sees children, youth and adults.
Sydney Cognitive Psychology. Various locations, Sydney.
Provides assessment and support for adults.
Educational Case Management. Newcastle.
Works with children, youth and adults.
Autism Understanding. Mayfield, Newcastle.
This service assesses and works with children, youth and adults.


Queensland
Mind and Hearts. Brisbane City.
Tony Attwoods clinic. They see children, youth and adults.
Stepping Stones for Life. Bulimba.
Assessment and support for children, youth and adults.


Victoria
The ASD Clinic. Malvern and Kew East, Melbourne. 
This clinic assesses children, youth and adults.
Unique U Psychology. East Melbourne.
Specialises in diagnosing girls and women with Autism.
The Social Learning Studio. Ascot Vale, Melbourne.
Provides adult assessments.
Outside the Square Psychology. Burwood, Melbourne.
Children, youth and adult assessments and support.
Kaye Frankcom and Associates. Williamstown. 
Offers adult assessments.


Tasmania
Psych Health Australia. Hobart.
Works with adults.
Tasmanian Autism Diagnostic Service. Hobart.
Diagnostic services for children and young adults.


South Australia
Autism South Australia. Undisclosed location.
Diagnostic services for children, youth and adults.
Connect Psychology. Hyde Park.
Website is under construction, however, they offer adult assessments.
StopThinkDo. North Adelaide.
Provides assessments for adults and children.
Rose Park Psychology. Adelaide.
Provides assessments for adults.
Headstart. Various locations across South Australia.
Provides assessments for children, youth and adults.


Western Australia
ISADD. Perth.
Provides support for children, youth and adults.


Northern Territory
Perth Psychology Services. Darwin Office.
Provides assessments for adults.


Australian Capital Territory
Autism Asperger ACT. Canberra.
Contact the website administrator for names of services found within the ACT.


National OR Skype services.
ASPECT.
They primarily diagnose children.
Tania Marshall. Tania works from Queensland but does do skype assessments. She assesses children and adults.
Dr Kieran Forster. Psychiatrist, based in Queensland, that offers Skype sessions.
Works with adults.


Thanks for Reading!

If you know of any other services not listed here let me know in the comments!
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