Delays in initial assessments and service provision
The pathway to services is very different for humanitarian entrants than for the Australian-born population. An Australian living with a disability is typically linked to health and disability support services as they are required from birth, or when disability is first suspected. Diagnosis is available before services are often needed. In contrast, humanitarian entrants arrive needing services, but without a recognised diagnosis.
Diagnosis is required to access almost all disability services in Australia. Without it the person cannot access NDIS services or basic equipment such as mobility aids. Getting a diagnosis requires the person to be put on a waiting list for the service.
However, there is a significant delay for new humanitarian entrants in accessing basic services that may be crucial for the individual’s health, wellbeing and dignity. For a myriad of reasons these processes and referral pathways are either inaccessible or ineffective for newly arrived refugees with disabilities, and their families. As a result, they may have to wait for long periods before accessing vital health or community services, or prior to obtaining even basic equipment such as mobility aids.
Unlike people who are born with or acquire a disability in Australia, people from refugee backgrounds who arrive with pre-existing disabilities have no service history in Australia. Additionally, newly arrived refugees with disabilities have very limited formal or informal support networks, meaning they are not easily linked or moved into service systems, such as the NDIS. The nature of mainstream and disability service systems in Australia is complex, and the delay that follows can have a negative effect on physical and emotional health and wellbeing, making the settlement process more challenging.
Newly arrived people with a disability face significant delays in accessing basic services such as equipment, occupational therapists and specialist doctors. As one service provider from Victoria noted in a consultation held by RCOA in 2015:
The process at the moment is that once they come in you send them to the refugee health GP or you can refer them to the local council occupational therapist. It’s usually three months or so for them to be able to come and make an assessment. And then when they come and make an assessment they put in an application for a wheelchair, that takes approximately a year, sometimes a year and a half … the thing that I think makes it hardest is that there’s no accelerated pathway for those clients who are without equipment.
In a consultation held by RCOA in December 2016 in Tasmania, one service provider noted:
And there’s just a time lag from when they arrive to connect them to services because of all that application process. It’s designed around people who are born like that or have an acquired injury. They get really fed up with having to do all this. And they get quite cynical, “you’re not going to get there”, it deters them from filling out the form.
While settlement services are contracted to provide mobility aids for the first 28 days, after this time the wheelchair may be removed and entrants are required to hire the equipment themselves until state-based equipment providers are in place. The gap is potentially weeks or months. During this time entrants may experience acute financial stress particularly as the DSP may not be in place to compensate for their higher living costs.
In some areas, the waiting list for public providers such as Occupational Therapists can be up to a year, creating a significant delay at the first step towards service provision. Funding for private purchase can be sought from DSS through SIS if the client is moved to SIS, but there is no automatic referral of people with a disability to SIS despite their additional support needs, nor is there any automatic acceptance of the need for purchase. DSS officers are required to decide on the veracity of a request for a health assessment for an NDIS process that they are unfamiliar with.
Again, people living with a disability who are sponsored may be the most vulnerable. They may not have received on-arrival screening from a refugee health provider. If their GP does identify a disability at a routine visit, the GP may not have the understanding of or willingness to assist the person apply for NDIS. Newly arrived refugees with disabilities have very limited formal or informal support networks, meaning they are not able to easily advocate their way through the NDIS process independently. The nature of mainstream and disability service systems in Australia is too complex.
Sponsors themselves are unlikely to understand what is required to apply for NDIS. This creates a real risk that services will be delayed until the person comes to the attention of a school or on admission to a hospital due to declining health or function. Proposers are not provided with specialist information and support to assist them navigate through the NDIS. Nor should they be expected to fund private services to assist that process. For example, one service provider reports that sponsors have been expected by DSS to pay for private health services to diagnose functional ability.
Delays can have a negative effect on physical and emotional health and wellbeing, making the settlement process more challenging, as well as impacting on the quality of social participation of carers and family members.. Feedback from service providers suggests that it can take approximately 3 to 9 months or more for newly arrived refugees with a disability to access an NDIS Plan, only then can services be put in place.
The lack of access to the NDIS leaves people without support to access vital services, and puts pressure back on settlement services who are not specialised disability services. As one service provider noted:
The new NDIS makes it difficult. For instance, it takes two weeks just to get the form.
Early intervention services for children from birth to 7 years of age, have been experiencing significant waiting periods in some areas due to the NDIS transition and provider changes. Services are not required to consider refugee status/ the lack of access to any services prior to arrival at triage. As a result, refugees may not be seen before they are no longer eligible for the program if they are effectively competing with an Australian born child who has been on the waiting list since birth.
Recommendation 3: Give refugees priority access to support
Refugees and humanitarian entrants with a disability should receive priority access to disability support systems and professional medical advice and assessment, including doctors, physical therapists and allied health. This priority access should recognise the lack of disability support many people have received prior to arriving in Australia. This would include:
- State-based equipment providers in each state and territory should include refugee status as a triage priority on waiting lists in recognition that most will have no existing equipment.
- NDIS to require Early Childhood Early Intervention services to consider refugee status in triage.
Where prioritisation is not possible, funding for necessary services should be funded by DSS via SIS.
Recommendation 4: Provide funding for immediate access to disability support aids
The Department of Social Services should extend funding for hiring of disability support aids until people have access to State-wide Equipment Program funding or the NDIS.
Advance Diversity Services, Issues That Refugees with Disabilities Face and Recommendations on Improving Policy and Practice to Better Support This Group, 2.
Refugee Council of Australia, Australia’s Response to a World in Crisis: Community Views on Planning for the 2016-17 Refugee and Humanitarian Program (March 2016), 74.
Karen Soldatic, Kelly Somers, Amma Buckley, and Caroline Fleay, ‘‘Nowhere to be found’: Disabled refugees and asylum seekers within the Australian resettlement landscape’ (2015) 2 Disability and the Global South 501, 508.