Experts say early mental health support could ease pressure on families

Australia’s underfunded mental health system is leaving too many people without the care they need until their illness becomes severe. Experts warn that better support earlier in life could change outcomes for people with psychosocial disability and ease the strain on families already stretched to breaking point.

The “ambulance at the bottom of the cliff”

Professor Patrick McGorry, former Australian of the Year, describes the NDIS as the “ambulance at the bottom of the cliff” for people with psychosocial disability – disability that arises from mental health conditions like schizophrenia.

He says the government is spending too much money helping people only once their illness has become severe and disabling, instead of funding early intervention.

“We’re spending it on stage 4, and we’re not investing enough in stage 1 and 2 to prevent the emerging illness and the emerging disability,” Professor McGorry told the ABC.

What is psychosocial disability?

According to the Australian Institute of Health and Welfare (AIHW), about 10 per cent of NDIS participants live with psychosocial disability. In the year to June 2023, the NDIS spent around $4.25 billion on supports for this group.

The AIHW explains that psychosocial disability can include difficulties with communication, social interaction, self-care, and decision-making. These often result from conditions such as psychosis, severe depression or bipolar disorder.

Families left to struggle

The story of Matthew Templeton shows the gaps in the system. Diagnosed with schizophrenia, he spent years cycling through homelessness and prison because he couldn’t get timely treatment. His mother says he was “let down by the public system” again and again, including being jailed during a severe psychotic episode when he should have been in hospital.

Now on the NDIS, Matthew receives daily support from a worker funded by his package. His family says this has been life-changing – but they believe he might never have needed such intensive disability support if mental health services had been stronger when he was younger.

Experts call for early intervention

Psychiatrists like Dr Pramudie Gunaratne, from the Royal Australian and New Zealand College of Psychiatrists, argue that untreated psychosis quickly becomes harder to manage.

“We have a window of opportunity to get in early and change the trajectory of someone’s life so they don’t fall down the cascade into permanent disability or into homelessness or the prison system,” she says.

But others, such as Muriel Cummins from the Occupational Therapy Society for Invisible and Hidden Disabilities, caution that there’s no clear evidence early intervention will reduce the need for NDIS support. She points out that the NDIS currently plays a crucial role in helping people with serious mental health conditions live independently, stay connected to their community, and maintain their health.

Access challenges remain

Despite these supports, not everyone who applies for the NDIS with a psychosocial disability is successful. Approval rates vary significantly by age. For people aged under 25, only about 19% of applications for a primary psychosocial disability were approved in 2022–23. For those aged 25 and over, the approval rate was higher at around 49%, according to the NDIS Psychosocial Disability Summary – June 2023.

Families and advocates say the process is still too complicated, with long waits for decisions and confusing evidence requirements.

Government reform plans

The federal government has set a target to reduce NDIS growth to 5–6% a year, down from earlier projections of 8% that would have seen the scheme hit $105 billion a year within a decade. To help achieve this, the government and states agreed in 2023 to create a new system of foundational supports – services outside the NDIS for people with disabilities, including psychosocial disability.

These reforms are being tied to a new hospital funding agreement currently being negotiated with the states. All health ministers have said psychosocial support will be a priority in the deal, which the government wants finalised by the end of the year.

The Commonwealth says it is already investing about $7.7 billion this year in mental health and suicide prevention programs, and promises reforms to make sure “everyone can get the mental health care and support they need.”

What this means for people living with disability

For people with psychosocial disability and their families, the debate raises big questions. Will reforms to mental health care reduce the number of people forced to rely on the NDIS? Or will gaps in services leave people even more vulnerable if access to the scheme is tightened?

Experts agree on one thing: without strong, accessible mental health care, families will continue to carry the burden of a system that too often only steps in when it’s already too late.