The NDIS at ten years: designing an equitable scheme for the next decade

To the Editor: The perspective by Smith‐Merry and colleagues identifies that people with psychosocial disability (disability attributed to mental ill‐health) have one of the lowest rates of plan utilisation within the National Disability Insurance Scheme (NDIS; about 53%).1 Data from December 2022 show fewer of their claims are made on capacity building (behavioural interventions) and capital (personal care and recreational expense) compared with core support on daily living (ie, transport and other consumables).2 Thus, people with psychosocial disability receive fewer supports in areas with the greatest potential to promote their functional recovery.

The release of suicide statistics by the Australian Institute of Health and Welfare in April 2023 shed further light on the inequities among service users with disability. Between 2013 to 2018, rates of suicide were three times higher among disability service users compared with the general population (34 per 100 000 compared with 11 per 100 000).3 Within the disability groups, one in five suicide deaths occur disproportionately in people with psychosocial disability (20.7%), followed by physical disability (3.2%) and acquired brain injury (3.1%).3

The association between suicide and complex mental illness is well established. However, despite poor rates of plan utilisation, service users with psychosocial disability are not eligible to access $171.3 million in innovative treatments outlined in the 2021 National Mental Health and Suicide Prevention Plan targeting people with psychosocial disability.4 Given the limitations in accessing support through the NDIS, exclusion from national suicide prevention policy represents yet another driver of inequity and system inefficiency.

Progress is being made in some areas of disability. Indeed, the Australian Government has endorsed a national roadmap that includes improved access to mental health services for people with intellectual disability.5 Its implementation is now a focus. However, new safeguarding measures for people with psychosocial disability are needed. At a minimum, these should include the provision of evidence‐based suicide prevention education and training to the disability support workforce. Other opportunities that address the undersupply of specialised supports associated with poor plan utilisation are needed, in addition to engaging people with disability to understand the risk antecedents, to drive effective suicide prevention in this population.