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Five Challenges of Designing Disability Income Support for People with Mental Illnesses: A Qualitative Case Study of Australia and Ontario

Publication: Canadian Journal of Community Mental Health
1 June 2018

Abstract

In most disability income support (DIS) programs, mental illnesses is the fastest growing category of illness, but it is unknown how policy designers consider this vulnerable group. Forty-five DIS policy designers in Australia and Ontario explained how they consider mental illnesses when designing policy. Using a grounded theory approach, five challenges emerged: validating duration, proving an illness, (un)differentiating mental illnesses, managing mental illnesses, and separating the person from the illness. Each challenge is described and compared across Australia and Ontario. These challenges provide a framework for other settings to determine how well their DIS policies have considered mental illnesses in policy design.

Résumé

Dans la plupart des programmes de soutien du revenu en cas d’invalidité, les maladies mentales sont la catégorie de maladies qui connaît la croissance la plus rapide; or, on ne sait pas exactement comment les concepteurs de politiques considèrent ou évaluent ces maladies et les personnes qui en souffrent, qui constituent un groupe vulnérable. Dans ce rapport, 45 concepteurs de politiques travaillant en Australie et en Ontario expliquent leur vision de la maladie mentale. Grâce à ces témoignages, et à l’aide d’une méthodologie de théorie à base empirique, j’ai relevé cinq défis qui se posent: la validation de la durée, la preuve d’une maladie, la difficulté de différencier certaines maladies mentales, la gestion des maladies mentales et la séparation de la maladie de l’individu qui en souffre. Je décris chacun de ces défis et je compare la façon dont il se pose et est traité en Australie et en Ontario. L’ensemble forme un cadre qui pourrait être utilisé ailleurs pour permettre d’évaluer la façon dont la maladie mentale est traitée dans la conception de programmes de soutien du revenu en cas d’invalidité.

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References

Andrews, K. (2014). Commonwealth doctors to assess new DSP claims [Press release]. Canberra: Retrieved Jan 8, 2014 from http://kevinandrews.com.au/latest-news/2014/12/12/commonwealth-doctors-assess-new-dsp-claims/
Australian Government. (2013). Senate Estimates—Hansard Transcripts. Retrieved Dec 5, 2012 from http://www.aph.gov.au/parliamentary_business/senate_estimates
Australian Government. (2015). Job capacity assessment (JCA). Guide to Social Security Law. Retrieved Aug 18, 2015 from http://guides.dss.gov.au/guide-social-security-law/1/1/j/10.
Bank of Canada. (2015). Year average of exchange rates. Retrieved May 5, 2016 from http://www.bankofcanada.ca/stats/assets/pdf/nraa-2015-en.pdf
Barr B., Taylor-Robinson D., Stuckler D., Loopstra R., Reeves A., and Whitehead M. 2015 ‘First, do no harm’: Are disability assessments associated with adverse trends in mental health? A longitudinal ecological study Journal of Epidemiology and Community Health
Bartram M. and Chodos H. 2013 Changing Directions, Changing Lives: The Mental Health Strategy for Canada Canadian Journal of Community Mental Health 32 4
Baumberg, B., Warren, J., Garthwaite, K.,& Bambra, C. (2015). Rethinking the work capability assessment. London, England: Demos.
Birks, M., & Mills, J. (2010). Essentials of grounded theory. Thousand Oaks, CA: Sage .
Brucker D. L. 2009 Social construction of disability and substance abuse within public disability benefit systems International Journal of Drug Policy 20 5 418 -23
Bryant, A., & Charmaz, K. (2007). The SAGE handbook of grounded theory. London, England: Sage.
Canadian Mental Health Association: Ontario. (2016). Improving the medical review process for ODSP clients. Toronto, ON: Canadian Mental Health Association, Ontario Office. Retrieved February 20, 2017 from http://ontario.cmha.ca/news/improving-the-medical-review-process-for-odsp-clients/#.WLQf6tUrKot
Carney T. 1991 Disability Support Pension: Towards workforce opportunities or social control? University of NSW Law Journal 14 2 220 -246
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage.
Copes, T., & Bisgould, L. (2010). Respondents’ factum: Director, Ontario Disability Support Program and Tranchemontagne and Werbeski. Toronto, ON: Sudbury Community Legal Clinic and Legal Aid Ontario.
Corbin, J., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, CA: Sage.
Currie S. R., Fiest K., and Guyn L. 2013 Using community-level mental health surveillance data to examine the relationship of depression prevalence to social determinants of health and access to mental health services Canadian Journal of Community Mental Health 32 1 43 -57
Deber R. B. 2005 Slaves to economists? A Canadian’s view of the Australian health care system Australian Health Review 29 4 386 -391
Department of Health and Ageing (2010). National mental health report 2010: Summary of 15 years of reform in Australia’s mental health services under the National Mental Health Strategy 1993–2008. Canberra: Commonwealth of Australia.
[DHS] Department of Human Services. (2016a). Disability Support Pension: Eligibility basics. Retrieved May 25, 2016 from http://www.humanservices.gov.au/customer/services/centrelink/disability-support-pension
DHS. (2016b). Medical evidence and assessment. Retrieved July 6, 2016 from http://www.humanservices.gov.au/customer/enablers/medical-evidence-and-assessment
[DSS] Department of Social Services. (1991). Social Security Act, 1991. Canberra, ACT: Australian Department of Social Services.
DSS. (2012). Social Security (Tables for the assessment of work-related impairment for Disability Support Pension) Determination 2011. Canberra, ACT: Australian Department of Social Services.
DSS. (2013). Characteristics of Disability Support Pension recipients: June 2013. Canberra, ACT: Australian Department of Social Services. Retrieved July 6, 2016 from http://www.dss.gov.au/sites/default/files/documents/01_2014/dsp_characteristics_report_2013_final.pdf
DSS. (2014). A new system for better employment and social outcomes: Interim report of the Reference Group on Welfare Reform to the Minister for Social Services. Canberra, ACT: Australian Department of Social Services. Retrieved July 6, 2016 from https://www.dss.gov.au/sites/default/files/documents/02_2015/dss001_14_final_report_access_2.pdf
Dolowitz D. P. and Marsh D. 2000 Learning from abroad: The role of policy transfer in contemporary policy‐making Governance 13 1 5 -23
Dunlop M. 1983 Australia looks to Canada’s Medicare Canadian Medical Association Journal 129 10 1140.
Fryers T., Melzer D., and Jenkins R. 2003 Social inequalities and the common mental disorders Social Psychiatry and Psychiatric Epidemiology 38 5 229 -237
Fryers T., Melzer D., Jenkins R., and Brugha T. 2005 The distribution of the common mental disorders: Social inequalities in Europe Clinical Practice and Epidemiology in Mental Health 1 14
Gartrell, A. (2017) ‘More people need to get in’: Allan Fels calls for radical rethink of NDIS on mental illness. The Sydney Morning Herald 25 July 2017. Retrieved August 8, 2017 from: http://www.smh.com.au/federal-politics/political-news/more-people-need-to-get-in-allan-fels-calls-for-radical-rethink-of-ndis-on-mental-illness-20170725-gxiaqs.html
Gray v. Director of the Ontario Disability Support Program. (2002). 59 O.R. (3d) 364 [Court of Appeal for Ontario]. Retrieved Sept 20, 2015 from http://www.canlii.org/en/on/onca/doc/2002/2002canlii7805/2002canlii7805.html?autocompleteStr=59%20O.R.%20(3d)%20364%20&autocompletePos=1
Hales-Ricalis C. 2010 Lessons to be learned: The decision of the Social Benefits Tribunal in Tranchemontagne v. Ontario (Director, Disability Support Program Critical Disability Discourse 2 2 1 -16
Heim C. and Nemeroff C. B. 2001 The role of childhood trauma in the neurobiology of mood and anxiety disorders: Preclinical and clinical studies Biological Psychiatry 49 12 1023 -1039
Hurley, J., Vaithianathan, R., Crossley, T., & Cobb-Clark, D. (2002). Parallel private health insurance in Australia: A cautionary tale and lessons for Canada. Canberra, ACT: Centre for Economic Policy Research.
Income Security Advocacy Centre. (2015). OW and ODSP rates and OCB amounts—2015. Toronto, ON: Income Security Advocacy Centre.
Judd F. K. and Humphreys J. S. 2001 Mental health issues for rural and remote Australia Australian Journal of Rural Health 9 5 254 -258
Karolinska Institutet. (2017) Läkarprogrammet—Hälsa I samhälle och miljö. Stockholm: Karolinska Institutet.
Kessler R. C. and Foster C. L. 1995 Social consequences of psychiatric disorders, I: Educational attainment American Journal of Psychiatry 152 2 1026 -1032
Mulvale G. and Bartram M. 2015 No More “Us” and “Them”: Integrating Recovery and Well-Being into a Conceptual Model for Mental Health Policy Canadian Journal of Community Mental Health 34 4 1 -37
Mulvale G. and Bourgeault I. L. 2007 Finding the right mix: How do contextual factors affect collaborative mental health care in Ontario? Canadian Public Policy 33 S1 S49 -S64
Muntaner C., Eaton W., Miech R., and O’Campo P. 2004 Socioeconomic position and major mental disorders Epidemiologic Reviews 26 1 53 -62
O’Reilly R., Bishop J., Maddox K., Hutchinson L., Fisman M., and Takhar J. 2007 Is telepsychiatry equivalent to face-to-face psychiatry? Results from a randomized controlled equivalence trial Psychiatric Services 58 6 836 -843
[OECD] Organisation for Economic Co-operation and Development. (2012). Sick on the job? Myths and realities about mental health and work. Mental health and work. Paris: OECD Publication Services.
Parliament of Australia. (2017). The provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition. Retrieved on August 8, 2017 from http://www.aph.gov.au/Parliamentary_Business/Committees/Joint/ National_Disability_Insurance_Scheme/MentalHealth
Penrod J., Preston D. B., Cain R. E., and Starks M. T. 2003 A discussion of chain referral as a method of sampling hard-to-reach populations Journal of Transcultural Nursing 14 2 100 -107
Prince M., Patel V., Saxena S., Maj M., Maselko J., Phillips M. R., and Rahman A. 2007 No health without mental health The Lancet 370 9590 859 -877
Sbaraini A., Carter S., Evans R., and Blinkhorn A. 2011 How to do a grounded theory study: A worked example of a study of dental practices BMC Medical Research Methodology 11
Stone, D. A. (1984), The disabled state. Philadelphia, PA: Temple University Press.
Tansey O. 2007 Process tracing and elite interviewing: A case for non-probability sampling PS: Political Science & Politics 40 4 765 -772
Tempier R., Meadows G. N., Vasiliadis H.-M., Mosier K. E., Lesage A., Stiller A., and Lepnurm M. 2009 Mental disorders and mental health care in Canada and Australia: Comparative epidemiological findings Social Psychiatry and Psychiatric Epidemiology 44 1 63 -72
Trainor, J., Pomeroy, E., & Pape, B. (2004). A framework for support (3rd ed.). Toronto, ON: Canadian Mental Health Association, National Office. Retrieved March 6, 2018 from https://cmha.bc.ca/wp-content/uploads/2015/11/Framework_for_Support.pdf
Walker S. P., Wachs T. D., Grantham-McGregor S., Black M. M., Nelson C. A., Huffman S. L., and Lozoff B. 2011 Inequality in early childhood: Risk and protective factors for early child development The Lancet 378 9799 1325 -1338
Whiteford H. A., Buckingham W. J., Harris M. G., Burgess P. M., Pirkis J. E., Barendregt J. J., and Hall W. D. 2014 Estimating treatment rates for mental disorders in Australia Australian Health Review 38 1 80 -85

Information & Authors

Information

Published In

cover image Canadian Journal of Community Mental Health
Canadian Journal of Community Mental Health
Volume 36Number 4December 2017
Pages: 109 - 126

History

Version of record online: 1 June 2018

Key Words

  1. Australia
  2. Ontario
  3. mental illness
  4. disability income support
  5. grounded theory

Mots-clés

  1. Australie
  2. Ontario
  3. maladie mentale
  4. soutien du revenu en cas d’invalidité
  5. méthodologie de théorie à base empirique

Authors

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Ashley McAllister [email protected]

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