F E AT U R E
Best practice functional capacity assessment for people living with psychosocial disability Muriel Cummins and Malitha Perera
The vision for Australia’s social model of disability The vision for Australia’s social model of disability – the National Disability Insurance Scheme (NDIS) – promised equitable opportunities for people with psychosocial disabilities to live “ordinary” and meaningful lives through the provision of tailored, individualised support. Psychosocial disability is an internationally recognised term under the UNCRPD, used to describe the experience of people with impairments and participation restrictions related to mental health conditions1 . The dawn of the NDIS represented a welcome paradigm shift for cohorts whose care was previously dominated by medical models. Mental health occupational therapists aim every day to honour the original vision of the NDIS by working with participants towards their goals, drawing on a substantive toolbox of evidence-based approaches. Occupational therapists engage in policy advocacy and are committed to building an equitable NDIS.
Functional capacity – a core NDIS construct As defined within the NDIS Act (2013), to be eligible for the NDIS a person must demonstrate “substantially reduced functional capacity” in at least one functional area or domain2. The assessment of functional capacity is therefore a critical aspect of both testing eligibility for the NDIS and ensuring support packages correlate with functional needs identified. Evidence suggests that people with psychosocial disabilities are more than twice as likely to have their initial NDIS applications rejected relative to other disability types3. A recent change to the NDIS Act (2013), titled the National Disability Insurance Scheme Amendment (Participant Service Guarantee and Other Measures) Bill 2021, means there will be clearer eligibility for cohorts who experience episodic conditions where functional capacity fluctuates4. Occupational therapy enables everyday life participation5, and assessment approaches
… people with psychosocial disabilities are more than twice as likely to have their initial NDIS applications rejected relative to other disability types 16 otaus.com.au
identify barriers to full participation and supports needed. The assessment of functional capacity is a core focus of the work of occupational therapists.
2021 parliamentary inquiry into independent assessments The Joint Standing Committee (JSC) on the NDIS is a multi-partisan parliamentary committee appointed to oversee and conduct inquiries into specific aspects of the NDIS. During 2021, the JSC undertook a detailed inquiry into independent assessments – of a person’s functional capacity – used to inform decisions about NDIS eligibility and funding in a participant’s plan. The JSC inquiry sparked a national debate on functional assessment, receiving almost 400 written submissions from people with disabilities and their carer representatives, peak bodies, legal professionals and many more6. It culminated in a report7 which, together with the OTA Submission to the Inquiry8, are essential reading for anyone aiming to understand the current public policy debate on functional assessment and the NDIS. The JSC inquiry report issued a clear set of recommendations for functional capacity assessment within the NDIS, including recommending that functional assessment be completed by allied health professionals with appropriate credentials, and that functional assessment be co-designed in collaboration with
