The role of occupational therapy in achieving greater participation for people living with psychosocial disability

Since inception, the National Disability Insurance Scheme (NDIS) has been acknowledged as making a real difference to the lives of over 530,000 participants in Australia. In 2023, the NDIS will undergo a broad review of effectiveness (NDIS Review, 2023). This article highlights the role of occupational therapy in improving the effectiveness of the NDIS for people with psychosocial disability, across three priority areas. Increased effectiveness in these areas focuses on targeting and tailoring of existing supported funding as part of the NDIS.

Participation-focused outcomes as the measure of effectiveness

The NDIS recognises psychosocial disability as per the UNCRPD definition, the experience of people with impairments and participation restrictions related to mental health conditions (United Nations General Assembly, 2007). The intended outcomes of the NDIS include better social and economic participation for people with disabilities. Consistent with a social model of disability, this marks a paradigm shift from previous mental health treatment models, where the intended outcomes focus on treatment engagement and symptom reduction. The NDIS has meant a reorientation in service provision towards working with people towards their goals, while improving participation. This reorientation has been embraced by occupational therapists, as it offers greater alignment with professional values and recovery-oriented practice.

What does the data tell us?

The latest NDIS data insights from the psychosocial disability dashboard highlight that 76% of NDIS participants with psychosocial disability believe that the NDIS has brought them greater choice and control in their lives (NDIS, 2022). However, data insights also highlight current challenges facing NDIS participants in the following three areas:

1. Social and community participation

The NDIS measures engagement in a community, cultural or religious group over the past year, as an indicator of social and community participation. Data insights revealed by the disability dashboard (September 2022) highlight that only 32% of participants with psychosocial disability engaged in a community, cultural or religious group or event over the past year, compared to 43% for the Scheme as a whole (NDIS, 2022). This percentage is even lower for the cohort younger than 45 years old, dropping to 25% for young people aged 15-24.

The barriers to social and community participation are a complex interaction of broader factors including social, historic and environmental; and individual factors. Exploring these from a tailored, capacity building perspective has potential to bring better outcomes. Frequently, compensatory supports are funded by the NDIS, generally increased support worker hours, to the detriment of capacity building supports. This can be costly and means the participant may not achieve the level of social and community participation as identified by the participant. Evidence-based occupational therapy interventions focused on tailored approaches to building motivation, such as re-motivation (De las Heras et al, 2003), and interventions focused on building habits and routines, such as the Action to Inertia intervention (Rees et al, 2021) and the re-designing daily occupations ‘Re-Do’ program (Erlandsson, 2013) (Scanlan, 2019), can provide helpful strategies to support social and community participation. Strategies and training for the NDIS workforce by occupational therapists can ensure a team approach to understanding and overcoming individual challenges associated with a dynamic disability. Interventions that place the participant in the driving seat of their support team can also assist with achieving meaningful outcomes (for example, by using evidence-based participant-led videos (Douglas et al, 2022)).

Occupational therapists also work with people within their natural environments, which frequently includes advising and collaborating with community clubs, venues and spaces, on principles of accessibility and universal design. These are critical environmental considerations that are frequently overlooked and make a difference to community participation options for people with psychosocial disability.

2. Employment participation

The dashboard dataset highlights that only 12% of participants with psychosocial disability were in a paid job, compared to 23% for the Scheme as a whole. Carer employment is also low at 34%, compared to 50% for the Scheme as a whole (NDIS, 2022).

There are significant gaps in available disability employment programs, with disability advocates highlighting that employment rates have not changed in 28 years (Shine, 2022). For many people with a psychosocial disability, there is a need to focus on employmentrelated skills to enable the person to find and maintain employment. This can include a tailored approach to building skills that includes a deep understanding of dynamic aspects of functional capacity, including motivation, self-care abilities, planning and sustaining a routine (Erlandsson, 2013). A 2019 systematic review of occupational therapy interventions confirmed the evidence-base for these interventions as part of a consumer-led journey to the return to, or commencement of, paid work (Kirsh et al, 2019).

3. Reducing restrictive practice to enhance participation

There has been a concerning rise in rates of both authorised and non-authorised restrictive practice with people with disabilities, including psychosocial disability, in recent years (Henriques Gomes, 2021). Occupational therapists can provide interventions that prevent or reduce restrictive practices to enable participants engagement in daily living, and social and economic participation. There is a strong evidence-base and policy case for using sensory modulation strategies to reduce restrictive practice (Allied, 2023). However, there are barriers to people with psychosocial disabilities gaining access to funded sensory modulation strategies, including unclear guidelines (NDIS – Sensory equipment, 2023); and knowledge and understanding of NDIS planning workforce. Sensory contributors to behaviours of concern could be addressed through meeting participants’ sensory needs. A reduction of behaviours of concern would mean the participant has greater capacity to autonomously participate in daily living.

Do you have a client with a vision condition?

We can partner with you to enhance their everyday independence through our products and technology.

Towards a more effective NDIS for people with psychosocial disability

There are many further areas where occupational therapists currently enhance the effectiveness of the NDIS, including in the provision of functional capacity assessment and supportneeds identification and working towards better housing outcomes.

In addition, there are areas where the NDIS requires policy change to ensure the needs of people with psychosocial disability are optimally met. 49% of applicants with psychosocial disability are approved to join the Scheme, compared to 77% for the Scheme as a whole (NDIS, 2022). The Productivity Commission (2011) predicted that people with psychosocial disability would represent 14% of total participants at Scheme maturity, and this current proportion sits at 10% (NDIS, 2022).

Occupational therapy is an under-utilised resource that can improve outcomes for psychosocial disability in the NDIS. The development of training opportunities, alongside focused research, will further enhance the evidence-base and practical delivery of occupational therapy interventions. Let’s hope the 2023 NDIS Review can recognise the potential of mental health occupational therapy, enabling the profession to contribute the enhancement of the effectiveness of the Scheme for people with psychosocial disability.

About the authors:

Muriel Cummins is an occupational therapist and holds a Master of Public Health. She graduated in Dublin in 2001 and has worked in mental health and disability in Australia since 2003. She was granted the Australian Allied Health Awards’ 2022 Occupational Therapist of the Year title. Muriel’s previous roles span the clinical, not-for-profit, peak body and private practice sectors.

Malitha Perera is an occupational therapist who has worked in various operational, clinical and strategic leadership roles in mental health. He is passionate about addressing inequities that impact on our collective health and wellbeing. He holds a Bachelor of Occupational Therapy, Bachelor of Psychological Science and Master of Public Health.

References can be viewed by scanning the QR code