Aussie Life

Aussie Life

5 February 2022

9:00 AM

5 February 2022

9:00 AM

The elevation of Dylan Alcott to Australian of the Year is a great win for the disability sector, but threatens to entrench disability as another hostile arm of identity politics.

Alcott’s first major statement was to insist on further funding for the NDIS, a program whose costs are approaching thirty billion dollars a year. The Budget will include a further $13.2 billion for the NDIS between 2021 and 2024. Some government estimates fear it has the potential to dwarf Medicare by 2030 at its current rate of growth.

What disability advocates have no answer for is the ever-burgeoning net that the term disability captures, especially where it overlaps with mental health. I assess such applications regularly for those suffering serious mental illnesses like schizophrenia.

Unfortunately, the market for disability is not terribly different to any other. If people get paid to be classified as disabled, demand will only increase.

But the growth in funding is trending away from physical disabilities like Alcott’s, who suffered a surgically induced spinal injury as a baby, towards behavioural disturbance, intellectual retardation and chronic mental illness.

Those diagnosed with autism for example have quadrupled in the last twenty years and represent the fastest growing segment of NDIS applicants.

The breadth of symptoms in autism is large, incorporating everything from people missing social cues, being easily overwhelmed by sensory stimuli such as loud noises to preferring repetition and routine. Many of these symptoms overlap with other disorders such as ADHD, social anxiety or conduct problems that do not readily attract extra support.

This can lead to considerable pressures upon clinicians to place people suffering from an undifferentiated mix of cognitive, mood or behavioural disturbance into the autism category in order to attract funding. There is a broad spectrum of variation in the level of severity and dysfunction among autism sufferers, hence the ever growing label of ‘high-functioning’.

If is often preferable to retain the therapeutic alliance by fitting patients into the already malleable psychiatric categories. Health workers have little incentive to constrain costs when payments are uncapped and not tied to their own departments.

This was touched upon by former minister for disability Linda Reynolds who said the scheme was ‘too reliant on the empathy of public servants’. Reynolds ultimately failed in her attempt to bring greater discipline and objectivity to the process in the form of independent assessments. Meanwhile the cost blowout in uncapped NDIS payments continues unchecked and blends into an expensive synthesis with broader advocacy for mental health funding.

The definition of disability has steadily shifted in recent decades to its current idea of a long-term functional disorder that limits an ability to fulfil social roles. The concept is evolving, combining perspectives from both human rights and medicine. Like other civil rights movements, its aim to give dignity to historically marginalised groups is laudable.

But in line with its parallels to other movements in identity politics, such as race and gender, are accusations of able-ism. The undercurrent of this term is that disabilities like autism are not disorders but differences. Activists like Greta Thunberg referred to her diagnosed autism as a superpower giving her a black and white outlook that her supporters interpreted as moral clarity.

The political implication of the neurodiversity movement is that if only society could be more accommodating, those with disabilities such as autism could live relatively normal lives. There is a significant contradiction in such pronouncements given those with serious illnesses like schizophrenia or brain injury require sophisticated treatments, especially when acutely unwell.

Nobody will question that those with disabilities deserve the necessary support, understanding and accommodations to help live meaningful lives.

But the huge growth in NDIS funding is helping to entrench the notion of disability as an attractive identity, over and above the world of insecure work. This is especially true in a world created by explosive identity politics where the public proclamation of pain helps allow the extraction of privilege.

This is the silent undercurrent of our low unemployment figures, so pronounced during the pandemic where employers cannot find locals to fill jobs. A significant portion of locals who probably could work, have given up doing so. Find me someone delivering food via an algorithm who is an Australian citizen?

Even before the NDIS was enshrined, there had been a steady shift from looking for work to being placed on the disability pension, a tripling in the decade to 2013 when the Gillard government tightened the guidelines. Unfortunately very few people shift back from the disability support pension once approved, less than five per cent. This rise has been dominated by an increase in mental health claims, away from the more common historical reason of bad backs. The changes in disability pension payments are a sensitive indicator of the economy’s shift from manufacturing to services.

While not all recipients of the disability pension receive NDIS, the majority do. One of the supporting claims from the Productivity Commission’s original assessment of the benefits of the NDIS scheme was the potential to shift disabled people into more work. However this has occurred only in rare cases.

I see it in my patients who are long-term unemployed, struggling for confidence and see themselves as too old to retrain in alternative sectors. For those who coined the catchy phrase, ‘don’t dis my ability’, in such groups the ‘dis’ often wins over the ‘ability’, especially when the financial rewards are more immediate.

Recent winners of the Australian of the Year award such as Rosie Batty or Grace Tame became fiercely partisan cultural warriors throughout their term and simplistically cast anyone from the conservative side of politics as a villain.

Alcott can make an especially useful contribution if he can communicate the growing loosening of the term disability. He may then avoid his advocacy for the disabled descending into ever greater demands for further funding the sinkhole the NDIS has become.

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