The National Disability Insurance Scheme (NDIS)

The National Disability Insurance Scheme (NDIS) has significant potential to provide equitable opportunity of access to health and disability services but continues to face particular challenges when it comes to people impacted by brain injury and Aboriginal and/or Torres Strait Islander peoples.

People living with brain injury, who are often confronted with distinctly different functional impairments than people with similar impairments arising from other causes, constitute a highly marginalised and under-serviced group within the Australian health and disability sector. Often misunderstood and overlooked, people with brain injury frequently fall victim to the criminal justice system.

While there is little data on incidence of brain injury within Aboriginal and/or Torres Strait Islander populations, the prevalence of risk factors for brain injury is high. For example, head trauma accounts for 30% of injuries requiring hospitalisation in Indigenous Australians, compared to 18% in non-Indigenous Australians.[i] These challenges compound a host of existing barriers to obtaining quality care and effective interventions.

For Indigenous Australians with brain injury, gaining access to the NDIS relies on demonstrations of cognitive impairment, which typically require a cognitive assessment. While relatively straightforward in the non-Indigenous population, this is problematic for Indigenous Australians, due to the lack of scientifically validated instruments for assessing cognition in adult Indigenous Australians.

Brain Injury needs to be recognised as a distinct condition, and those providing assessments and support services need to receive the appropriate levels of education and training in brain injury.

In order to work effectively with people with brain injury, it is essential that service providers – across all inter-related disciplines – develop a broad understanding of the physical processes of injury and recovery, the possible impact on brain functions, and the outcomes that may result. It is our experience that support providers with skills and experience in brain injury are few and far between, leading to highly variable experiences and outcomes for people impacted by brain injury.

Furthermore, greater effort and resources must be focused on ensuring that Indigenous Australians with a brain injury can access accurate and culturally acceptable cognitive assessment of a similar standard to that available for non-Indigenous Australians.

More broadly speaking, for the NDIS to provide services to Aboriginal and Torres Strait Islander peoples with a disability requires an understanding of the cultural considerations of the communities where the services are delivered. These services need to be culturally appropriate for participants, the local community, Elders and families, and must consider:

• Perceptions and attitudes towards people with disability and older people, as well as beliefs about health and mental health (an approach to social and emotional wellbeing that is holistic and inherent in culture).
• Expectations of family providing care and gender roles
• Beliefs, practices, behaviours, and preferences which can affect the choice to use formal care services.
• Language proficiencies and usability of systems, which can affect access to information and services, as well as ability to communicate needs and preferences.