MHCC Mental Health Rights Manual

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Chapter 13 Section C: Accessing the NDIS

Overview

The National Disability Insurance Scheme (NDIS) has a role in supporting inclusive communities where everyone can create and pursue their personal aspirations and goals. The Scheme is available to make it easier for all Australians to receive information and connections to services in their communities that will assist people in their daily life and help them participate more fully in the community. This section will focus on how all Australian’s who are living with mental health conditions (described as psychosocial disability under the Scheme) can receive assistance from the NDIS as well as other mainstream services.

This section will provide information about:
  • How to access the NDIS
  • Who can support you in accessing the NDIS
  • The eligibility requirements to access the NDIS
  • Do you have to prove that you have a psychosocial disability?
  • The role of GPs in the NDIS
  • How you will find out if you’re eligible for the NDIS
  • What if you don’t meet the eligibility requirements for the NDIS?

5A.1: How to access the NDIS

If you are currently receiving disability supports, the NDIS will contact you by letter or phone when the NDIS is available in your area and it is your time to transition to the NDIS. If the National Disability Insurance Agency (NDIA) believes it necessary, you will then need to complete a Supporting Evidence Form so that they can gain a better understanding of your needs and determine your eligibility.

If you are not currently receiving disability support services and believe you are eligible to become an NDIS participant, you will need to contact the NDIA directly when it is available in your area.

You can call the NDIA on 1800 800 110 between 8am to 8pm, Monday to Friday.

You are then required to complete an NDIS Access Request Form which gathers information about you, your supports and about your disability. You have the opportunity to complete the form over the phone with an NDIA representative or you can alternatively ask to fill out a hard copy of the form and return it to an NDIA office. You will be asked to provide the following information:

  • Your name, age, where you live and whether you have permission to live in Australia permanently
  • Confirmation of your age and address
  • Information about your disability and how it impacts your day-to-day functioning
  • Current and/or relevant reports you already have from medical specialists or allied health professionals
  • Whether you give permission for the NDIA to talk to other people about your disability, including Centrelink, your GP or a person providing support to you.

Once your access request is made, the NDIS will send you a letter requesting any further evidence you need to provide. You can send your evidence to the NDIA via:
Mail: GPO Box 700, Canberra, ACT, 2601
Email: NAT@ndis.gov.au
In person: drop in to your local NDIA office

13C.2: Who can help me access the NDIS?

To assist you in accessing the NDIS and understand the planning process, a number of services have been developed in order to support prospective participants with the initial stages of engaging with the NDIS. 

13C.2.1: Local Area Coordinators (LAC)

Local Area Coordination partners are organisations working with the NDIA to help individuals, their families and carers to navigate and access the NDIS within their local communities. Local Area Coordinators (LACs) employed by Local Area Coordination partners will assist participants to plan and coordinate services in a way that maximises your choice and control over the services you use. This includes supporting you to navigate mainstream services and increase your access to services and more actively participate in your community.

For those who meet Access Requirements, the LACs can assist with supporting you to:

  • Get ready for your plan
  • Develop your plan
  • Get your plan going
  • Keep in touch with you, if you need help with your plan.

For most people aged seven and above, a Local Area Coordinator (LAC) working for one of NDIS’s Partners in the Community will be your main contact point for the NDIS.

For most people aged seven and above, a Local Area Coordinator (LAC) working for one of NDIS’s Partners in the Community will be your main contact point for the NDIS.

In NSW the partners delivering LAC services are:

  • Uniting (external) - covering Nepean Blue Mountains, Northern Sydney, Western Sydney, Southern NSW, Illawarra Shoalhaven
  • St Vincent de Paul Society NSW (external) - covering South Western Sydney, Central Coast, Hunter New England, Sydney and South Eastern Sydney
  • Social Futures (external) - covering Far West, Murrumbidgee, Mid North Coast, Northern NSW and Western NSW

Here is a list of Local Area Coordination partner offices in NSW.

For further information on how your Local Area Coordinator can assist you, visit the NDIS website.

13C.3: Eligibility requirements to access the NDIS

The NDIS has been developed to cater to the day-to-day needs, goals and aspirations of their participants which is why you do not need to have a formal mental health or psychosocial disability diagnosis to be eligible for NDIS funded services.

The National Disability Insurance Scheme Act 2013 determines who can and cannot access the individualised plans created under the NDIS. To receive an NDIS package a person must:

  • Be an Australian citizen, or a permanent resident, or hold a Protected Special Category visa*
  • Be under 65 years old when they apply
  • Live in an area where the NDIS is available; and
  • Meet the disability requirements which are outlined in the NDIS Act 2013

*People are generally considered as a protected SCV holder if they arrived in Australia on a New Zealand passport and were: in Australia on 26 February 2001, in Australia for 12 months in the 2 years immediately before this date, or assessed as a protected SCV holder before 26 February 2004.

You will meet the disability requirements and be eligible to access NDIS services if:

  • Your impairments are likely to be permanent (impairments that vary in intensity, for example chronic episodic symptoms of some mental health conditions may still be classed as permanent)
  • Your disability significantly affects your ability to perform everyday tasks or participate in activities
  • You are likely to require support under the NDIS for your lifetime

 You are likely to be eligible for the NDIS if you usually need support from a person or assistive equipment to:

  • Be independently mobile. For example, getting out of bed, moving around at home, and getting around outside the home;
  • Communicate to others or be understood by other people;
  • Interact socially. For example, creating and maintaining relationships, and managing emotions and feelings;
  • Learn. For example, understanding, remembering and learning new information;
  • Take care of your physical wellbeing. For example, showering, dressing, eating, and taking medication;
  • Manage your life. For example, managing finances, maintaining your home, and making decisions.

The National Disability Insurance Agency has an NDIS Access Checklist that is helpful in understanding what is needed to meet the access requirement.

13C.4: Do I have to prove that I have a psychosocial disability?

While no diagnosis of a mental health condition is required to be eligible for NDIS funding, you will need to provide evidence of how your psychosocial disability effects your day-to-day living. This means that you are a person living with a mental health condition that affects or reduces your ability to function, think clearly, experience full physical health and need support with social and emotional aspects of life (permanently or on an episodic basis).


The information supporting your application to the NDIS should include details describing your disability, the treatments you’ve received, the daily impacts of it on your life, and how long it is expected to last. Supporting evidence must be less than 12 months old and can be demonstrated as:

  • A letter from a health professional, support person, or family member
  • A completed assessment from a health professional who is relevant to your primary disability such as a general practitioner (GP), occupational therapist, psychologist, psychiatrist or social worker; or
  • Other substantial reports from your treating health professional, support service, or family member.

It is favourable for the treating health professional who provides the evidence of your disability to be the most appropriate person to provide evidence of your primary disability, and has treated you for a significant period of time (e.g. at least six months). This health professional will not be able to tell you if you meet the NDIS requirements, only the NDIA can make this decision.

The assessments which are considered ‘best practice’ in evidence for psychosocial disability are:

  • Health of the Nation Survey (HoNOS)
  • Life Skills Profile – 16 item (LSP – 16)
  • World Health Organisation Disability Assessment Schedule (WHODAS) 2.0 (17 years and over) or,
  • PEDI-CAT (16 years and under)

If you do not have any recent evidence, or your evidence doesn’t provide enough detail, you may be asked to complete a Supporting Evidence Form which asks information about you, and has a section to be completed by a health professional about your impairments and the supports you need. An example of a completed Supporting Evidence Form has been provided on the reimagine.today website.

If you would like help in collecting your supporting evidence, Local Area Coordinators are available to assist with this.

13C.5: The role of GPs in the NDIS

GPs are often the first point of contact for people living with disabilities and their families. They have an important role in supporting people access the NDIS.

Responsibilities of GPs include:

  • Helping their patients to understand the NDIS, particularly for people who have limited community connections and support outside of their GP, particularly people living in rural and remote areas or people from diverse cultural backgrounds.
  • Setting expectations for patients about the likelihood of funding (Note: GPs cannot tell you for certain whether you will meet the eligibility requirements or not)
  • The responsibilities of the NDIS compared to the mainstream health sector
  • Supporting a patient’s NDIS access request by:
    • Completing the supporting evidence section of the Access Request Form
    • Documenting that they have or are likely to have a permanent disability
    • Providing copies of reports or assessments relevant to the diagnosis/condition that outlines the extent of the functional impact of the disability

GPs will not automatically receive your NDIS plan so it is useful to provide it to your regular GP so that they are aware of what supports you’re receiving and so they can also gain a better understanding of what supports NDIS participants can receive.

If you are a GP or allied health profession the following are useful preliminary resources:

13C.6: How will I know if I am eligible for the NDIS?

 The NDIA will contact you to inform you of their decision within 21 days of receiving your application and supporting evidence. The NDIA will send a letter informing you of their decision that you are either eligible or ineligible for an NDIS package. This is called an ‘access decision’. If the NDIA has found you to be ineligible, they will provide information explaining their decision.

If you believe the NDIA has made an incorrect decision, click here for more information about how to request a review of an NDIA decision.

13C.7: Am I eligible for the NDIS if I have received financial compensation for my disability?

A potential participant may have received or is currently receiving a compensation payment from an insurance company, statutory scheme, or an individual/organisation due to an accident or injury which resulted in significant functional impairment.

If your acquired impairment is likely to be lifelong and significantly impact your daily functioning, you are still eligible for an NDIS package. However, the value of the reasonable and necessary supports in your NDIS package may be reduced by the Compensation Reduction Amount as calculated by the NDIA if your compensation payment is used to cover the cost of support needs. If you disagree with the Compensation Reduction Amount, you are entitled to request a review of the decision.

Follow this link for more information in this manual about review of NDIA rulings.

If you have received a lump sum compensation payment from a commercial insurer to pay damages for pain and suffering, loss of income, medical costs, or a Victim of Crime payment, your NDIS plan will not be affected.

When applying for the NDIS, you will need to fill out a Compensation Information Form which provides the NDIA with information regarding the compensation payment, supporting documents for the compensation payment, and information concerning spending compensation payments on services and supports which the NDIS could potentially fund in a support package.

For more information about compensation payments and the NDIS, follow this link.

13C.7: What if I don’t meet the eligibility requirements?

You do not have to be an NDIS participant to receive support for your disability. If you are not eligible to participate in the NDIS, NDIS Local Area Coordinators (LACs) are available to help provide short-term assistance to those who do not have an NDIS plan. LAC’s offer all people information about what supports are available to you and offer suggestions of relevant supports and services which will best meet your needs, goals and aspirations.

Additionally, Ability Links NSW work with all people with disability, their families and carers to provide no-cost, short-term support to assist in connecting people to services in the community to help achieve their goals.

Chapter 8 of our manual also provides information about a range of different supports available for persons with psychosocial disability, as well as other forms of mental health conditions and disabilities. It also provides information about access to services for older people with disabilities and mental health conditions here.

If the impact of your disability deteriorates over time and is significantly impacting your day-to-day living, or you develop a new impairment, you can make a new access request with the NDIA as they make their decisions based on the current impact of your disability.

Alternatively, if you disagree with the decision that you are ineligible to access the NDIS, you can seek a formal review, outlined here.