In theory, the NDIS is a publicly funded scheme for anyone living with a disability that significantly impacts their day-to-day life. However, in practice, people with psychosocial disabilities (that is, disabilities stemming from chronic mental health conditions) only get onto the NDIS if they have enough money to pay for the costly psychiatric assessments that are required to prove the reality of their disability. This creates a perverse scenario where the less money you have, the harder it is to access the NDIS’s supposedly universal support scheme.
The NDIS Eligibility Criteria
This inequality is a result of the NDIS’s eligibility criteria. To receive an NDIS psychosocial disability package, an individual must demonstrate that they have a mental health condition that creates a ‘functional impairment’ (i.e., it interferes with their capacity to carry out daily activities)1. The second eligibility criterion is that an individual’s functional impairment is, or is likely to be, permanent. This is the NDIS’s way of restricting access for people with short-term or ‘curable’ mental health conditions who can therefore be treated within the clinical mental health system.
However, to prove that your mental health-related impairments are permanent, you need to show that you have tried a wide variety of mainstream treatments for your mental health condition, that these treatments have not significantly reduced your impairment, and that you therefore require ongoing direct support to manage your day-to-day life.
Yet, to exhaust all the mainstream psychotherapeutic and psychopharmacological treatments (and thereby prove the permanency of your condition), you would generally have to attend, and pay for, countless psychology and psychiatry appointments. You would need to undertake courses in multiple types of therapy (generally, far more than the ten subsidised sessions per year covered by Medicare). You would also need to try a wide range of pharmaceutical interventions, which means attending multiple consultations with a psychiatrist. While public and bulk-billed mental health services do exist, they offer limited care that is generally insufficient to complete the exhaustive range of treatments required by the NDIS to prove that you have a permanent impairment. In addition to having tried countless treatments, you need an in-depth supporting letter from a psychiatrist (for which they will often bill). It is no surprise, then, that a University of Sydney survey of people living with psychosocial disabilities found 66.1% of participants viewed the cost of assessments as a major barrier to applying for the NDIS2.
The clinical mental health system remains largely a pay-to-play system. Therefore, by making access to the NDIS contingent on exhausting all available clinical treatment options, the access inequalities inherent in the clinical mental health system are effectively transmitted into the NDIS—leaving people with limited income and chronic mental health conditions to fend for themselves. It is perverse that we have a system that effectively prices people out of accessing publicly funded support, and unless the NDIS addresses this structural inequality in their mental health eligibility criteria, it runs the risk of turning into yet another mechanism by which public resources are funnelled into a kind of middle-class welfare.
The Ideological Function of ‘Mental Illness’
Receiving a psychosocial NDIS package is often life-changing for people who have been battling alone through day-to-day life for years on end, and I wrote this article because I want to outline and highlight the way poor people are barred from accessing these life-changing supports. However, even if everyone had equal access to mental health supports, it would in no way adequately address the deeper causes of our ‘mental health crisis’. In many ways, the whole discourse of ‘mental illness’ and ‘psychosocial disability’—which exist within a psychiatric discourse that rarely takes stock of the historical, economic, and cultural causes of mental distress—ultimately functions to mystify these deeper causes. As clinical psychologist David Smail puts it,
‘Margaret Thatcher’s much cited view that, “There is no such thing as society, only individuals and their families,” finds unacknowledged echo in almost all approaches to therapy’.
Just as Thatcher used ‘there is no such thing as society’ to individualise the societal pathologies being unleashed through the neoliberal restructuring of the economy, such a sentiment is (unintentionally) deployed in psychological discourses to a similar effect by locating the cause of mental distress in some pathological disorder within the patient.
This is strange when even within the positivistic, diagnosis-focused terrain of psychological research, it has been clearly proven that poverty, sexual abuse, forced displacement, among many other socially determined phenomena, are key ‘risk factors’ for falling into a diagnostic category.3 Yet in many of these papers, you will find few allusions to the need for political change, but rather, to quote one paper, exhortations that the government provide ‘targeted’ mental health services to ‘marginalised groups’ to promote ‘social functioning and workforce participation’.
However, while mental distress is disproportionately distributed in racialised, class-based and gendered ways, it is also baked into the very mechanism of a capitalist economy in ways that affect people irrespective of their identity. We only need to consider our relationship with work to see how this is true. We know, for example, that unemployment (a structural byproduct of capitalism) is a key driver of mental distress. But the nature of work itself under capitalism is also an enduring source of distress for the gainfully employed; by squeezing employed workers towards higher levels of productivity, we are seeing an epidemic of psychological ‘burnout’. Moreover, by creating an increasing number of jobs that have no apparent socially useful function, capitalism generates a great deal of mental distress by forcing many people to spend most of their waking hours in meaningless or even socially destructive work. People who work in jobs with no clear social value report high levels of dissatisfaction.
Combine these insights about work with the research into the impacts of the ‘loneliness epidemic’ and research about urban environments where there is a lack of access to natural green spaces is profoundly affecting people’s mental health. Psychological research is slowly arriving at the same conclusion Karl Marx arrived at 170 years ago with his thesis on alienation: capitalism alienates us from our labour (meaningless and/or exploitative work), it alienates us from one another through the erosion of community bonds (loneliness epidemic), it alienates us from the earth itself (urbanisation), and as a consequence of all this, it alienates us from ourselves and leaves us feeling empty and unhappy. Indeed, the psychologist Carl Rogers suggests that mental wellbeing amounts to an ‘acceptance of the is-ness of [oneself]’. Trauma psychiatrist Judith Hermans similarly describes it as a matter of ‘gaining possession of oneself’, and a similar notion of mental wellbeing is expressed in Buddhist teachings under the rubric of non-judgemental self-awareness. If these definitions of mental health are correct, then the consequences of self-alienation are indeed psychologically catastrophic.
But at the end of the day, psychology and psychiatry do not aim to change the conditions of social reality. In fact, except for psychoanalytic and humanistic psychologists who lead a marginalised existence on the fringe of mainstream psychology (both of which largely reject clinical mental health diagnosis in favour of an approach that attempts to understand the deeper meaning of psychological distress), these disciplines aren’t even really interested in leading patients to an understanding of themselves and the reason for their suffering. Rather, psychological supports largely attempt to provide short-term interventions that assist people in adapting to the prevailing conditions of social life. This is evidenced by the fact that the governments only fund a maximum of ten psychology sessions a year, and even free public mental health programs like the government’s Commonwealth Psychosocial Support program are only for ‘people living with severe mental health challenges who need short-term help to function day to day’. Even the NDIS itself is about promoting a person’s capacity to adapt, rather than supporting them towards a deeper understanding of the roots of their difficulties. Beneath the crust of clinical language, the positive objective of most mental health interventions is subject who is ‘happy’ to operate as an atomised and self-sufficient subject, a subject who is content to lead a deracinated consumer existence and get by selling themselves into work that is often meaningless and exhausting.
Indeed, workplace performance—or the lack thereof—has become an increasingly important signifier of ‘mental illnesses’. The first issue of the Diagnostic and Statistical Manual of Mental Disorders (the DSM), published in 1952, contained only ten references to employment, productivity, and work. The current edition of the DSM, published in 2013, contains 387 references to these themes, with a decline in workplace performance—and the presence of traits that hinder one’s ability to ‘perform’ in the workplace, like timidity, shyness and lack of self-assertion—regarded as legitimate indicators of mental illness. The NDIS’s psychosocial disability program is similarly involved in promoting an adaptationist approach to distress; it lists ‘greater independence’, ‘access to new skills’, ‘more time with family and friends’ and access to ‘jobs or volunteering in their community’ as four of the five objectives of NDIS support. Just as the clinical mental health system transmits its access inequalities to the NDIS, so too does it infuse the latter with its project of creating productive, socially active and compliant citizens. Indeed, having worked at multiple NDIS providers myself, I can attest to the way services rarely invest time in creating a deep understanding of someone’s distress, but rather obsess over ‘capacity building’ and ushering a person towards more ‘independent’ and ‘productive’ forms of existence.
That is not to say that people do not benefit from psychotherapy, disability services and psychopharmacology. Indeed, drugs, therapy, psychosocial support, and taking time to ‘look within’ can be extremely beneficial. Nor is it to deny that people experience trauma because of things that happened to them in their personal life, things which would still arguably occur under the most utopian of economic arrangements. Likewise, I do not want to demonise the thousands of mental health professionals who put their heart and soul into both helping people and changing social structures. Indeed, many of the radical critiques of mental health cited in this article have come from psychologists and psychiatrists themselves. But we can acknowledge the benefits people reap from the mental health system—benefits which, as we have seen, are much less accessible to lower-class people—while also acknowledging that psychological discourses function to manufacture consent to the status quo by translating feelings of distress into individuated disorders.
A critical re-evaluation of psychosocial disability
The foregoing critique helps us reframe the meaning of a term like ‘psychosocial disability’. If the distress that results from being in, and being unable to conform to, our present social milieu, is coded within the clinical mental health system as ‘mental illness’, then being diagnosed with a ‘psychosocial disability’ (whereby one’s mental illness is deemed permanent) can be understood as the system passing a final verdict that a person will never be able to independently comport themselves into the kind of subject that capital needs them to be. Of course, the NDIS doesn’t frame itself as an enforcer of capitalist subjectivity, but effectively admits as much by describing people with psychosocially disabilities as requiring ‘support to increase [their] social and economic participation’.
For many people, it can be immensely relieving to have their internal experience, their inner knowledge that they cannot function as independently as they ‘should’, validated by a label like ‘psychosocial disability’. However, the supposedly non-judgemental and clinically neutral feeling of terms like ‘mental illness’ and ‘psychosocial disability’ occludes the fact that, functionally speaking, these are moral labels applied to people who offend against the cultural value of atomised self-sufficiency by requiring a robust network of care and support in order to survive. Rather than calling these people ‘bad’, they are called ‘sick’ or ‘disabled’ and required to jump through countless, and often prohibitively expensive, administrative exercises simply to get the care that they need.
The sad irony is, however, that it is precisely the people who are least able to fit the values of capital—i.e. poor people who cannot ‘succeed’ in the labour market, nor afford to pay for clinical mental health services—who the NDIS is least likely to regard as psychosocially disabled and grant support. Paradoxically, it is wealthy people who can pay to get proof they are psychosocially disabled who are most likely to gain the exemption, the partial exemption from being a productive independent citizen afforded by the NDIS. Meanwhile, poorer people remain ensconced in social services like Centrelink and community mental health, which continue to ‘support’ them towards a ‘cure’ for their mental health, and persist in shimmying them back into the position of the isolated, self-sufficient and productive subject of capital.
- For an outline of NDIS eligibility guidelines, see: Psychosocial Disability Access Factsheet 2: Impairment and Psychosocial Disability in the NDIS (2024). ↩︎
- Hancock, N., Scanlan, J.N., Mellifont, D., & Hamilton, D. (2022). Examination of NDIS Access Barriers for People Living with Psychosocial Disability: Final Report. The University of Sydney, Australia. ↩︎
- “The Social Determinants of Mental Health and Disorder: Evidence, Prevention and Recommendations.” World Psychiatry : Official Journal of the World Psychiatric Association (WPA), vol. 23, no. 1, 2024, pp. 58–90, pmc.ncbi.nlm.nih.gov/articles/PMC10786006/, https://doi.org/10.1002/wps.21160. ↩︎
Comments
Excellent article Nick, such a great run down of the neoliberal undergirding of the NDIS. It has always boggled my mind there are less hoops to jump through to access the DSP (for all its major failings, at least actual cash in hand to disabled people, rather than a cottage industry masquerading as welfare service) than the NDIS. The former asks only that all ‘reasonable’ and ‘accessible’ interventions have been attempted, and so have granted applications for clients of mine that have not been able to afford any ‘evidence-based’ therapy for their difficulties.
The NDIS is a dehumanising and infantilising system, obsessed with “goals” that disabled people are asked to reduce their inner worlds to in order to justify their existence and right to support. It is a poisoned chalice that has given my disabled clients a lifeline, the only means by which they can leave the house somedays or access the care they need, but which also abuses them, rips the rug out from underneath them at a moments notice when completely unqualified people who haven’t read any of the documentation in support of their funding decide that they no longer require psychology funding.
Loved, loved this:
‘Beneath the crust of clinical language, the positive objective of most mental health interventions is subject who is “happy” to operate as an atomised and self-sufficient subject, a subject who is content to lead a deracinated consumer existence and get by selling themselves into work that is often meaningless and exhausting.’
Great stuff!