Mental health services in Australia are facing significant challenges, pushing many individuals with mental illness onto the National Disability Insurance Scheme (NDIS) for extended periods. Prominent psychiatrist Patrick McGorry has emphasized that increased investment in early intervention could save the NDIS billions of dollars.

As the Albanese government aims to control NDIS costs, projected to reach $52 billion this financial year, McGorry described the scheme as the "ambulance at the bottom of the cliff" for those with psychosocial disabilities. He argued that the federal government could reduce the number of Australians relying on the NDIS by enhancing mental health support in public hospitals.

"What we're spending money on is pretty much palliative care. We're spending it on stage 4 and we're not investing enough in stage 1 and 2 to prevent the emerging illness and the emerging disability," McGorry stated. Psychosocial disability, which includes conditions like schizophrenia, accounts for approximately 10 percent of NDIS participants, according to the Australian Institute of Health and Welfare (AIHW). The AIHW reported that $4.25 billion was allocated to NDIS participants with psychosocial disabilities in the financial year ending June 2023.

Debate continues over the effectiveness of early intervention in altering the course of psychotic illnesses. However, Pramudie Gunaratne, NSW Chair of the Royal Australian and New Zealand College of Psychiatrists, supports the notion that early intervention can prevent some individuals from needing the NDIS. "When someone has psychosis, it's like the clock starts ticking, and we know the longer psychosis is left untreated, the harder it is to treat," she explained. Gunaratne highlighted the importance of early intervention to change the trajectory of a person's life, preventing them from falling into permanent disability, homelessness, or incarceration.

Matthew Templeton, a 27-year-old from Coffs Harbour, was diagnosed with schizophrenia in 2017 and became an NDIS participant this year. He has faced homelessness and incarceration since he was 14. His mother, Maree Templeton, expressed her frustration with the public mental health system, stating, "People really and truly do not know what the mental health system is like. It's really so sad. I'm not just talking for my son. There are a lot of people that do have psychosis that need help … but they get turned away."

Maree Templeton noted that her son had been under Professor McGorry's care since he was 12, but struggled to receive adequate support during acute episodes. "He didn't even know where he was or what's happening or anything, that's how bad he was. He needed to be in the mental health unit instead of being put back into jail," she said. Matthew's NDIS package provides for a support worker six hours a day, seven days a week. While the Templetons and McGorry acknowledge the NDIS's role in assisting Matthew, McGorry believes he would have benefited more from earlier mental health support.

McGorry also pointed out that individuals who end up on the NDIS with psychosocial disabilities often remain on the scheme due to a lack of alternative support. "It's a one-way trip and it's a trip that you probably don't want to take unless you really have to," he said.

Ian Hickie, co-director of Health and Policy at Sydney University's Brain and Mind Centre, echoed McGorry's concerns but expressed doubt about the mental health system's ability to adapt to better serve those with psychosocial disabilities. "At the moment there's a split between our federal systems, which are hands-off, and our public health system, which has retreated largely from early intervention to simply manning emergency departments and providing long-term care to those who are already significantly disabled," Hickie said.

Muriel Cummins from the Occupational Therapy Society for Invisible and Hidden Disabilities argued that there is insufficient evidence to prove that investing in early intervention would reduce the need for psychosocial support through the NDIS. She emphasized the importance of the NDIS in providing essential support for individuals with psychosocial disabilities.

Last month, Health and NDIS Minister Mark Butler announced plans to reduce the NDIS growth rate to 5 to 6 percent, down from an interim target of 8 percent. This change aims to prevent the scheme from reaching $105 billion annually over the next decade. To facilitate this reduction, the national cabinet agreed to establish foundational supports as a new tier of services outside the NDIS for disabilities like psychosocial disability.

NSW Premier Chris Minns recently cautioned the federal government about potential backlash if states are expected to agree to NDIS changes without a broader public hospital funding agreement. A spokesperson for Butler stated that all health ministers recognized psychosocial care as a national priority in future agreements. The government is investing approximately $7.7 billion this financial year in mental health and suicide prevention, with a commitment to reforming the mental health system to ensure everyone receives the necessary care and support.