Psychiatric Impairments and the Disability Support Pension

Economic Justice Australia

The following selection of case studies from EJA member centres around Australia present the experiences of people whose primary condition is a psychiatric impairment attempting to access the Disability Support Pension and their experiences with trying to meet their mutual obligations on Job Seeker in the meantime. For people whose primary condition is a psychiatric impairment, our member community legal centre experience is that the eligibility criteria and application requirements make it more difficult for them to access the Disability Support Pension. Many people in this situation end up on Jobseeker Payment where they find it difficult to meet the mutual obligation requirements to remain eligible for payment.

Domestic violence survivor refused DSP after difficulty obtaining psychiatrist report

Laura contacted the Centre for advice about her rejected DSP claim. She had been diagnosed with PTSD, major depressive disorder and generalised anxiety disorder by a registered psychologist. She also had a long history of physical, psychological and financial domestic violence perpetrated by her first husband, second husband and her long-term partner. She had been forced into two arranged marriages by her family and faced family and community pressure to stay in abusive situations in order to avoid the cultural stigma of divorce. Laura had tried to seek police assistance for the abuse perpetrated by her long-term partner but he was released without charges being pressed. Laura had experienced a nervous breakdown as a result of the domestic violence and was alienated from her community.

Laura’s conditions were having a severe functional impact on her life. She lived by herself and could not leave the house without anxiety and fatigue setting in straight away. She received help from her adult sons but did not have other social relationships. When she tried to plan her activities or make decisions, she said her brain would go numb and she would become overwhelmed. She had been a housewife all her life and had not been in employment. Laura was receiving Newstart Allowance.

Laura’s claim for the DSP had been rejected because she did not meet the required 20 points impairment rating under the Impairment tables. When she expressed a desire to appeal the rejection, Centrelink told her she should obtain a report from a psychiatrist in addition to the existing report from her registered psychologist, which identified the diagnoses previously made by a psychiatrist and the severe functional impact on her activities. Laura had seen the psychiatrist in the previous year but he was retiring soon and refused to spend time filling in a report for Centrelink.

Obstacles to successful DSP claim

People with long-standing, debilitating mental health conditions can face insurmountable challenges in providing evidence to support DSP claims and appeals unless they are under the ongoing care of doctors who are prepared to support them in the DSP claim and appeal process. Laura had no such support, and was alienated from past social supports.
Laura’s mental health condition had been diagnosed by a psychiatrist and was thereby assessable under Table 5 of the Impairment Tables but the psychiatrist was not prepared to spend time preparing a report for Centrelink.
Laura’s registered psychologist was prepared to provide reports to Centrelink, and did so, but the requirement under the Impairment Tables that mental health diagnoses be either by a psychiatrist or clinical psychologist meant that the report provided by the registered psychologist was given no weight.
Preparation of reports for Centrelink cannot be billed to Medicare. Doctors were previously under a statutory obligation to complete Treating Doctor Reports for DSP claimants but they are no longer under any obligation to complete reports. The onus is now on the claimant to provide an existing report confirming the diagnosis/diagnoses or approach their doctors and persuade them to provide organise new reports addressing relevant Impairment Table criteria. This can prevent vulnerable people with complex psychosocial conditions from pursuing DSP claims and appeals.

Policy implications

Completion of Treating Doctor Reports should be a mandatory requirement, with report pro forma issued to DSP claimants when they claim – as was the case previously, but billable under Medicare.
Centrelink should provide vulnerable clients such as Laura with social worker support, for ongoing assistance and referral to community support services, including for assistance and advocacy regarding social security claims and appeals.

Refugee with severe psychiatric conditions refused re-grant of DSP

Caden had been under clinical care for depression, an anxiety disorder and PTSD since 2012. He also had a number of physical conditions – including a long-standing spinal condition, epilepsy, diabetes, vision problems and asthma. Caden was separated from his family in Afghanistan and experienced short-term memory problems and poor concentration, feelings of hopelessness and helplessness, poor sleeping, intrusive memories and a loss of interest in life. He had been receiving support from the NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors since 2014.

Caden had been receiving DSP for 11 years before he went overseas for medical treatment. He remained overseas for 2-3 weeks longer than the 13 week portability period and his DSP was cancelled. Caden appealed the DSP cancellation but this appeal was rejected.

When Caden re-applied for DSP, he was rejected on the basis of not meeting the 20 point impairment rating requirement. Caden lodged another application for DSP but this was also rejected. Caden’s appeal of the rejection to the AAT1 was unsuccessful – he was not assigned any points for his spinal condition, diabetes, vision problems or asthma, the AAT member citing potential further treatment options indicating that the conditions were not “fully treated, diagnosed and stabilised”. Five points were assigned for Caden’s epilepsy. The member did not assign any points for Caden’s mental health conditions. In assessing the functional impact of these conditions, the member referred to a report by a neurologist which stated that Caden had mild behavioural difficulties. On the basis of this report, the member concluded that Caden did not experience significant functional difficulties.

Caden appealed to the AAT2 and his appeal was again rejected. The member did not assign points for any of Caden’s physical conditions, including his epilepsy. He cited the fact that Caden had suffered a seizure due to taking only half of his prescribed dose of medication as evidence that the condition was not fully treated and stabilized. In assessing Caden’s mental health conditions, the member considered a new report prepared by Caden’s clinical psychologist. The report provided limited detail about Caden’s functional capacity beyond describing the symptoms of his conditions. The member referred to the fact that Caden was able to live alone, travel overseas on four occasions from 2013 to 2018 and participate in the Tribunal hearing on his own for three hours by telephone as evidence that the conditions only had a mild functional impact. He therefore assigned 5 points to the conditions. The AAT2 decision did not refer to the full scope of Caden’s evidence.

Caden did not speak or read English, which exacerbated his problems navigating the claims system due to his mental health conditions. He had difficulty understanding what evidence was required by Centrelink and the Tribunal. He had a lot of medical evidence which was not properly collated and contained gaps. He had been receiving some support from a social worker but they had limited capacity to assist with his DSP claims and appeals.

Obstacles to successful DSP claim

Centrelink originally granted Caden DSP accepting that he was a young man with severe psychiatric conditions resulting from his traumatic past, and also had multiple physical impairments.
When Caden lodged the new claim for DSP on his return to Australia, Centrelink was in a position to review the evidence on file and take into account the fact that he had been paid DSP for 11 years; his DSP had been cancelled only weeks before – solely because it had ceased to be payable under the portability provisions. Instead, a vulnerable young man was treated as a fresh claimant, with the onus on him to obtain evidence to re-establish his DSP eligibility. The result was that Caden ended up at the AAT with inadequate evidence to demonstrate his ongoing psychosocial disability and physical impairments.

Mutual obligation implications

Caden will inevitably face substantial challenges complying with JobSeeker Payment mutual obligation requirements. It is also likely that if he reclaims DSP, Centrelink will be reluctant to grant, however strong his evidence may be – in deference to the AAT’s decision regarding his previous claim.

Survivor of childhood domestic violence struggles with mutual obligation activity requirements and obtaining evidence for DSP claim

Peter had applied for DSP unsuccessfully several times when he contacted the Centre. He had spinal and knee conditions as well as depression and anxiety. His mental health conditions stemmed from domestic violence he had experienced as a child. He struggled with comprehension, short term memory loss and concentration issues, and had difficulty completing daily tasks such as making breakfast. He had had four falls recently which had exacerbated these symptoms. He had few social interactions and had difficulty focussing for long enough to understand new information and pick up new tasks.

When Peter appealed his latest DSP rejection, the Authorised Review Officer (ARO) awarded him 15 points on the impairment tables for his physical and mental conditions. Peter wanted to collect further evidence about his conditions from his GP, but the GP who could provide a report regarding the relevant 13 week period had moved to a country town 4-5 hours away and Peter had not been able to contact him. Peter was not seeing a psychiatrist or psychologist at the time of submitting his DSP claim as the last psychiatrist he saw told Peter that no further psychiatric help would be of benefit.

Peter was on Newstart and subject to mutual obligations. His mental health had been deteriorating and he was having difficulty engaging with his employment services provider. Peter had a conflictual relationship with his employment services provider. The provider was asking him to sign a participation agreement which included 15 hours of activity a week but he was not capable of completing this many hours. When Peter tried to review his activity agreement on the MyGov website it was blank, and he only had 48 hours to complete it. He had had a medical exemption previously, but his new GP would not provide a medical certificate so he had to continue fulfilling mutual obligations. Centrelink had offered to move him to a disability employment service provider but this had not been actioned.

Obstacles to successful DSP claim, and mutual obligations implications

Peter’s mental health conditions and cognitive impairments make it impossible for him to engage with the requirements of the DSP claim process, and also affect his engagement with his employment services provider.
Peter would in all likelihood be able to establish eligibility for DSP with comprehensive evidence but he faces multiple barriers that prevent him from gathering this evidence and pursuing a claim. Instead, Peter’s disabilities mean that he is likely to remain on JobSeeker Payment but continue to have great difficulty complying with mutual obligations associated with Newstart Allowance/JobSeeker payment unless he can be connected with a supportive provider. Without such support he faces periods of non-payment and ongoing poverty.

Risk of homelessness after DSP cancellation

Stuart contacted the Centre after having had no income for over a year. He had previously received DSP but it was cancelled following a review and began receiving Newstart Allowance. Stuart has mental health conditions and drug addiction problems which manifest in anger management issues, and make it difficult for him to engage with Centrelink and his employment service provider.

At an appointment with his employment service provider over a year previously his conversation with the provider staff member escalated and Stuart walked out. His Newstart Allowance was cancelled immediately and Stuart had received no payment since then. He was living with his parents who were themselves dysfunctional and prone to conflict. Stuart’s living situation was not sustainable due to these pressures and he faced the risk of homelessness. Stuart was being assisted by his sister, who was worried that if he did begin receiving Newstart Allowance again he would be breached due to his behavioural issues and lose payment once more.

Mutual obligations implications

It is clear that due to his long-term, well established mental health conditions, Stuart was unable to appeal the cancellation of his DSP and is unable to comply with ongoing mutual obligation requirements. In the absence of stable income support he is at ongoing risk of destitution.

Suicide attempt after DSP rejection

Alana suffered from chronic pain, carpal tunnel syndrome and panic disorder with severe agoraphobic features. Her symptoms included episodes of depression and anxiety, lack of motivation, social isolation, avoidance of going outdoors and socializing, reduced memory, concentration issues and inability to plan ahead. She had been hospitalized for this condition twice, the last time a year previously, and had been seeing a psychologist for over 5 years. Her symptoms had significantly worsened over the last 2 years, with a prognosis of ongoing symptoms for at least another 24 months. Alana’s psychologist and GP had provided evidence to Centrelink that Alana was not fit for any work for 12 months.

Alana had previously worked in aged care but was required to cease work in 2015 and again in 2017 due to her mental health status. Centrelink’s Job Capacity Assessor had assessed Alana’s work as 8-14 hours a week, with the potential to increase to 15-22 hours per week with specific intervention services.

Alana had been rejected from the DSP. Her appeal to the Administrative Appeals Tribunal Social Services Division was unsuccessful due to evidence that her condition had changed after the 13 week relevant period following her DSP application. Alana did not want to appeal the decision.

Alana was receiving Newstart Allowance and had to complete mutual obligations to keep her payment. Her employment services provider had told her that she could not be placed with a disability-specific employment services provider because Centrelink did not recognise her as having a disability. Due to the pressure of completing mutual obligations, Alana’s mental health had deteriorated and she attempted suicide. After this, she was given a medical exemption for 6 months. Alana applied for a further medical exemption, but this was rejected by Centrelink as the medical certificate characterized Alana’s symptoms as a temporary exacerbation of an existing condition and the JCA had assessed her as being able to work 15-22 hours a week.

Alana’s psychologist expressed concern that having to participate in mutual obligations would make Alana vulnerable to another suicide attempt. Alana’s psychologist also filed complaints against the Job Capacity Assessors to the Health Care Complaints Commission and the Ombudsman.

Obstacles to successful DSP claim and mutual obligations implications

Alana’s case points to the complexity of the interplay of the DSP work test (requiring inability to work at least 15 hours per week for at least 2 years due to permanent impairment), compared to the criteria for granting a temporary exemption for mutual obligations (temporary inability to work at least 8 hours a week).
Alana was advised to reclaim DSP and also appeal the rejection of her medical certificate for Newstart Allowance to an Authorised Review Officer – meaning that she would need to ask her doctor for superficially contradictory reports attesting to her inability to work at least 15 hours a week for at least 2 years, and her temporary inability to work at least 8 hours a week. This a significant ask of anyone let alone a person with severe psychiatric conditions, a recent suicide attempt and ongoing suicidal ideation.

Policy implications

Alana’s case highlights the systemic barriers that can preclude vulnerable people with severe psychiatric conditions from accessing DSP. The complexity of qualification requirements, especially for assessment of psychiatric conditions, is such that treating doctors are confused regarding what needs to be addressed in reports – especially where their patient is both seeking relief from mutual obligations and claiming DSP. Treating doctors need to be provided with standard proforma for relevant Impairment Tables.
Centrelink should provide vulnerable clients such as Alana with social worker support, for ongoing assistance and referral to community support services, including for assistance and advocacy regarding social security claims and appeals.

At risk of destitution – mental health and constant pain preventing compliance with mutual obligations

Sam had a number of physical and psychiatric conditions. He suffered from constant pain due to shoulder injuries and crushed vertebrae in his neck. He had seen several psychologists and psychiatrists for his mental health issues, but did not agree with the diagnosis given to him by his psychiatrist. Sam had applied for the DSP 3 or 4 times and was waiting for the outcome of the most recent application. Sam had been receiving Newstart for 2 or 3 years. He had problems engaging with his employment service provider and had had medical exemptions from mutual obligations in the past.

Sam’s mental health issues made it difficult for him to engage with Centrelink. His payments had been suspended many times. Sam contacted the Centre a few months after his payment was cancelled due to not reporting his income. Sam did not appeal or respond to the letter informing him of the cancellation of his Newstart because he was severely distressed, depressed and unable to deal with Centrelink. He was reluctant to claim a Centrelink payment again due to the adverse impact engaging with Centrelink and employment services had on his mental health.

Sam had been without income for several months. He survived with help from his friends and the assistance of community service caseworkers.

Sam was advised to re-apply for Newstart Allowance and he successfully did so. The centre contacted Centrelink to obtain personalised service for Sam due to his support needs.

Obstacles to successful DSP claim and mutual obligations implications

Sam’s Newstart Allowance was restored but only due to the intervention of an advocate and a receptive Centrelink officer.
Given his severe mental health issues, Sam remains highly vulnerable, and at ongoing risk of destitution while on JobSeeker Payment. He is likely eligible for DSP but unable to pursue the rigours of claiming due to his fragile mental health.

Policy implications

Centrelink should provide vulnerable clients such as Sam with social worker support, for ongoing assistance and referral to community support services, including for assistance and advocacy regarding social security claims and appeals.

Medical exemptions

“Catch 22” when claiming DSP

Sarah was applying for the DSP on the basis of her heart condition, anxiety and depression. While waiting for the outcome of her application, she was receiving Newstart Allowance. Her health conditions made it difficult for her to engage with mutual obligations, including attending provider appointments and applying for jobs. Sarah supplied Centrelink with a medical certificate to receive a medical exemption from mutual obligations. Centrelink denied the exemption because the medical certificate stated that Sarah’s conditions were permanent, explaining that exemptions can only be granted for temporary conditions. Centrelink advised Sarah to get a new medical certificate which described her conditions as temporary.

Mutual obligations implications

This case demonstrates the ‘catch-22’ situation for many people on Newstart who are applying for DSP. When they seek an exemption from mutual obligation requirements, they must describe their condition as a temporary flare-up of a permanent condition or associated symptoms – but if they do so, Centrelink regards this as evidence that the condition is not ‘fully treated and stabilised’, as is required for DSP. As a result, many clients with psychiatric conditions who want to claim DSP risk suspension or cancellation of payments due to non-compliance.

Too distraught and suicidal to appeal DSP rejection or deal with Centrelink

Ed had been diagnosed with depression, PTSD, osteoarthritis, cardiac issues and respiratory issues. His mental health had seriously deteriorated and he was suicidal. Ed’s claim for DSP had been rejected and he was awaiting a decision from the Authorised Review Officer while receiving Newstart Allowance. Ed contacted the Centre when his Newstart Allowance was suspended after he missed a provider appointment due to attending an appointment with his cardiologist. Ed’s payment was suspended on the same day. The next day he gave his provider proof of the cardiologist appointment, but his provider told him to get a medical certificate from his GP, which Ed did. However, this medical certificate was subsequently rejected by Centrelink who told Ed that he could not get another exemption as he had had a 2 week exemption earlier in the year. Ed was too distraught to appeal the decision or ask Centrelink what he needed to do to get back on payment.

Mutual obligations implications

Ed was advised to appeal the DSP rejection but then faced the ‘catch-22’ situation regarding medical exemptions for temporary conditions and the DSP requirement that conditions be ‘fully stabilised’.
Ed was in a fragile mental state, and at ongoing risk of suicide. He was in need of community referrals – and assistance claiming DSP and gathering evidence.

Policy implications

Centrelink should provide vulnerable clients such as Ed with social worker support, for ongoing assistance and referral to community support services, including for assistance and advocacy regarding social security claims and appeals.

No access to support services to help with DSP claim for Aboriginal woman in remote community

Kirra is an Aboriginal woman living in regional NSW, over 50 kilometres from the nearest town. She is a single parent of two children, 8 and 10 years old, one of whom is developmentally delayed.

Kirra had been diagnosed with PTSD and social anxiety and had recently attempted suicide. Kirra had previously been rejected for DSP and appealed the rejection but did not know the result. She was not sure whether they had received an outcome letter, as she is illiterate.

Kirra had recently made a new claim for DSP with a new psychiatrist report as evidence. Kirra contacted the Centre after this claim was rejected and she had put in a request for review by an Authorised Review Officer and been given more time to submit medical evidence. Kirra had no electronic access and was struggling with the cost of petrol travelling to medical facilities and Centrelink, so her treating medical professionals had offered to send evidence to Centrelink directly.

Kirra had been receiving Newstart Allowance and Parenting Payment and had a medical exemption from mutual obligations. She contacted the Centre because her Newstart Allowance had been suspended twice recently, due to failure to attend appointments. Kirra was very distressed by the pressure of dealing with Centrelink .

Kirra was advised to appeal the DSP rejection, and submit a new medical certificate for Newstart Allowance, describing her symptoms as a temporary flare-up of a permanent condition. Her DSP appeal to the ARO was unsuccessful, and Kirra is still on JobSeeker Payment.

Obstacles to successful DSP claim

Kirra’s case demonstrates the systemic barriers for highly vulnerable people with severe mental illness in navigating the social system – especially for people in rural and remote areas, with no access to support services.
Aboriginal people in regional and remote areas have disproportionately high rates of suspensions and penalties for mutual obligation non-compliance; disproportionately low rates of DSP grants; and disproportionately low appeal rates. Kirra’s case demonstrates the issues at play.

#10

Longstanding mental health issues lead to exemptions from mutual obligations but no advice to claim DSP

Alicia had suffered from panic attacks and agoraphobia for the last 10 years. She had attempted suicide and been admitted to a psychiatric hospital. She had not applied for DSP and was receiving Newstart Allowance. She had an exemption from her mutual obligations from February to May 2019. When her exemption expired at the end of May 2019, she was required to re-engage with her provider by attending an appointment, which she did not do. Her Newstart Allowance was suspended on the same day. Alicia’s nominee contacted Centrelink and provided a medical certificate requesting a medical exemption for Alicia on 21 June. However, on 28 June Alicia’s payment was cancelled. Centrelink did not upload the medical certificate to their database and Alicia’s payments were suspended and later cancelled when she did not attend appointments with her employment service provider. Alicia’s appeal of the cancellation to an ARO was not successful. Centrelink told Alicia that her payments would be restored if she made an appointment to see a specialist psychologist from Centrelink. Alicia did so and the Centrelink psychologist recommended she be given an exemption until early 2020. Following this recommendation, Alicia was granted Newstart Allowance again in September 2019 with no mutual obligations until March 2020. When she contacted the Centre, Alicia was in the process of appealing the cancellation of her payment to the AAT1.

Alicia was advised regarding the evidence she would need to present to the AAT1 about her application for an exemption. She was also advised to reclaim DSP.

Obstacles to successful DSP claim

Given Alicia’s circumstances and Centrelink’s active assistance to avoid the need to lodge medical certificates, it is surprising that Centrelink did not encourage her to claim DSP.
Alicia’s case demonstrates the systemic barriers in the social security system for people with serious, long-standing mental health conditions.

#11

Confusion about whether GP can provide the necessary evidence to show mental health condition has been fully diagnosed, treated and stabilised after initial psychiatrist’s diagnosis

John was diagnosed with generalized anxiety disorder, OCD and major depression. In his DSP claim John provided evidence of his conditions from a mental health support worker, GP and clinical psychologist. He also provided evidence of ongoing and long-lasting psychiatric interventions, including previous episodes of hospitalisation. When Centrelink contacted John’s clinical psychologist about his evidence, he stated that he had last seen John a year before his DSP claim and therefore retracted his previous statement about whether John’s condition was fully diagnosed, treated and stabilied at the time of his claim. Centrelink rejected John’s DSP claim citing a lack of evidence.

John appealed the rejection to an ARO and Centrelink allowed him more time to collect medical evidence. John was asked to seek out a new clinical psychologist for the ARO review and was unsure about whether they would have time to fill out a long report. He wanted to ask his GP to fill out the report instead, as his GP was more familiar with John’s condition.

Obstacles to successful DSP claim

The requirement that a condition has been “fully diagnosed, treated and stabilised” to be assessed under the Impairment Tables is particularly problematic for serious mental health conditions, given that they are often episodic by nature and/or treatment-resistant and/or the patient is non-compliant regarding treatment.

Policy implications

Claimants, their doctors, Centrelink decision-makers, advocates – and Tribunal members – find this requirement confusing, especially in respect of mental health conditions. What should be required by way of evidence where a condition has been diagnosed by a psychiatrist some time ago but clearly persists, is ongoing treatment by a GP who can attest to the fact that the condition is ongoing, treatment is ongoing and stabilised to the extent possible. The fact that there is so much confusion regarding the interpretation and application of this provision points to the fact that it cannot be administered fairly.

#12

Condition found to not be fully diagnosed, treated and stabilised because diagnosis changed from major depressive disorder to bipolar disorder

Lee had a mental health condition which had a severe impact on his ability to function. Lee contacted the Centre when he received an ARO decision affirming the rejection of his claim for DSP. The ARO found that Lee’s condition was not “fully diagnosed, treated and stabilised” because his diagnosis had recently changed. Lee had received a diagnosis of major depressive disorder and anxiety diagnosis in 2016 but in 2019 his new psychiatrist diagnosed him with bipolar disorder, which carried the same symptoms and treatment. Lee had recently started seeing a different psychiatrist.

Lee was receiving Newstart and had to complete mutual obligations per a Job Capacity Assessment which assessed him as having capacity to work, despite Lee being unable to leave the house due to his condition. He had been able to obtain medical exemptions from mutual obligations but exemption at the time was due to expire and he was anxious about whether his new medical certificate, which stated that he would be unable to work for 3-12 months, would not be accepted.

Lee was advised about his appeal rights and it was explained unless he was given 20 points under the a single impairment table, he would need to meet the ‘program of support requirement’ – i.e., he would need to have completed a program of support for at least 18 months of the previous three years. Lee had been enrolled in a TAFE course but was unable to complete it due to the impact of his condition. Lee was unsure about whether this would be counted as participation in a program of support for the purposes of his DSP application.

Obstacles to successful DSP claim

Lee has been suffering from debilitating mental illness since 2016. He was initially diagnosed with one disorder but then diagnosed with a different disorder by a second psychiatrist. Whatever the precise diagnosis, it is patently clear that Lee has not only been unable to work at least 15 hours a week since 2016, he has also been unable to meet the program of support requirement.

Policy implications

The system’s complexity should not be such that a person with a debilitating and long-standing psychiatric should be left to struggle long-term with mutual obligation requirements, and impossibly challenging DSP claim requirements. The system is setting people like Lee up to fail.

#13

Too hard for person with psychiatric condition and acquired brain injury to gather evidence

Zara was diagnosed with a lung condition, major depressive disorder and a brain injury which led to memory loss. Zara’s conditions had a significant impact on her functioning, and she required a service dog to be able to leave the house. She had been trying to claim DSP for three years, unsuccessfully. Her latest claim for DSP was rejected on the basis of her condition not being fully diagnosed, treated and stabilised. The decision referred to Zara not pursuing anti-depressants as a treatment option. Zara did not want to take anti-depressants because using them in the past had contributed to her attempting suicide.

Zara had previously participated in program of support activities but was unable to complete them due to her mental health conditions. Zara had obtained a new report from her psychiatrist characterising her condition as fully diagnosed, treated and stabilised, but had not lodged this with Centrelink yet as she had not lodged a request for review.

Zara’s GP had prepared a report on her major depressive disorder, which referenced the effects of the COVID-19 pandemic. It seemed that this might have led Centrelink to characterise her condition as temporary. Zara was advised that unless she was given 20 points on at least one impairment table she would need to meet the program of support requirement to eligible for DSP, unless she could obtain a report from a program manager stating that the program of support was discontinued due to her medical conditions.

Obstacles to successful DSP claim

It is unreasonable to expect a person with a psychiatric condition and acquired brain injury to gather the evidence needed for assessment under the DSP Impairment Tables, as well as regarding exemption from the program of support requirement.

Policy implications

Zara’s case exemplifies the need for legislative reform to address the barriers in place for people with severe mental illness and/or cognitive impairment from accessing DSP.

#14

Treating doctor discouraged patient from claiming DSP

Sarah had been diagnosed with Dissociative Identity Disorder and Post Traumatic Stress Disorder many years previously due to serious childhood trauma. She had a long treatment and management history, ongoing support from a psychiatrist and a regular GP, as well as recent serious and life threatening physical health issues that were still undergoing diagnosis and treatment. When she contacted the Centre, she had stopped work due to her ongoing physical and mental health issues. Sarah had no source of income at the time and was not receiving any Centrelink payments.

Sarah was advised that she was eligible for Newstart Allowance and to also claim DSP. Sarah said that her psychiatrist had advised her to claim Disability Support Pension and had offered to write a report for her. However, Sarah said that she had not claimed the payment because her GP had told her not to bother as ‘no one gets DSP any more’.

Sarah was given detailed written information about how to claim, as well as advice about the interaction between Centrelink payments and other income sources including superannuation and income protection. Sarah told us she would think about claiming and get back to us. When the centre did not hear from Sarah for several months, they contacted her to see if she had claimed Newstart Allowance or Disability Support Pension. Sarah said that she had not yet managed to finish her application as she disassociates every time she attempts the application. She found the application process very challenging. She said that her GP was still discouraging her from applying, but her psychiatrist was continuing to support her in the application process. The centre encouraged Sarah to continue with the claim and to accept the support of her psychiatrist, and to contact us immediately if her claim was rejected by Centrelink. Sarah said that she would and that she would persevere with the claim.

A few months later, Sarah received a letter saying her most recent medical exemption application was rejected and she has to comply with mutual obligations. Two months before getting the letter, Centrelink had told Sarah that they would grant her medical exemptions for the next 12 months. Sarah thought their position might have changed because her most recent medical evidence provide to Centrelink contained a new condition that is permanent following a recent diagnosis.

Obstacles to successful DSP claim

It is not uncommon for treating doctors to discourage patients from applying for DSP, even where they are aware that the person’s impairment limits work capacity or precludes work completely – as for Sarah.

Policy implications

There is a need for mandatory treating doctor reports to be reintroduced as part of the DSP claim process, with a Medicare item number introduced for report completion.

#15

PTSD from childhood trauma but lost medical records made it difficult to show condition was fully diagnosed and treated

Michelle was on Newstart Allowance and living in her car. She suffered from chronic mental health problems which made it difficult for her to sustain rental accommodation and employment. She felt unsafe living in share accommodation and could not afford to rent on her own.

Centrelink had rejected three previous applications for the disability pension on the grounds that they had determined that her mental health conditions were not fully diagnosed and treated. Michelle (now in her late 40’s) was first diagnosed as suffering from anxiety and depression more than 20 years ago, and had more recently been diagnosed with PTSD arising from childhood trauma. A psychiatrist had confirmed the diagnosis of each of these conditions in the past, although Michelle had lost most of her medical records.

Michelle was under the supervision of her GP and had a mental health care plan. She was also undergoing cognitive therapy with a psychologist provided through a local community organisation. This centre wrote to the psychologist and requested that they provide a report that addressed the specific requirements of Table 5 of the Impairment Tables. The centre also wrote to the clients GP and requested that they provide copies of any previous reports from psychologists and psychiatrists which they may hold.

Both the GP and psychologist cooperated and we were able to establish that Michelle’s mental health conditions had been diagnosed by both a clinical psychologist and psychiatrist. The psychologist provided a report which expressed a clear opinion as to severity of Michelle’s mental health condition. We represented the client at the AAT at tier 1, but the member disagreed with the findings of the psychologist based on the client’s answers to certain questions and a narrow interpretation of particular comments in the psychologists report. We appealed the matter to the General Division of the AAT with the matter settling after we were able to provide further medical evidence clarifying remarks within the earlier report as well as the client’s capacity.

Obstacles to successful DSP claim

Most doctors and psychologists do not understand the need to provide reports that expressly address the requirements of the impairment tables, and this is a particular issue for mental health conditions.

Policy implications

There is a need for mandatory treating doctor reports to be reintroduced as part of the DSP claim process, with a Medicare item number introduced for report completion.

#16

Rare grant of DSP where severe mental health or neurological condition was undiagnosed and untreated

Mark initially approached the centre because his Newstart Allowance had been cut off due to non-compliance with activity testing, and he had had no means of support for some time. It was immediately apparent that Mark had either a severe psychiatric or neurological condition. Mark advised that he had never been diagnosed with any such condition.

In assisting Mark with appeals against the decision to cancel his Newstart Allowance, it came to light that he been on Newstart Allowance since the 1990s, and exempted from participation activities throughout that time. Mark presents as severely disabled to everyone he meets. Both his employment service and Centrelink recognised the extent of his disability and excused him from activity testing for many years; however, it seems no attempts were made to help him apply for DSP.

Issues arose when Mark was shifted to a new employment services provider in 2019, which imposed activity requirements that Mark could not comply with – eventually resulting in the cancellation of his Newstart Allowance.

While assisting Mark to appeal to the AAT regarding the cancellation of his Newstart Allowance, the centre solicitor and social worker spent much time connecting Mark with mental health services and assisting him to apply for DSP. Mark originally intended to claim DSP on the basis of shoulder injury but on the centre’s advice, he agreed to claim DSP on the basis of an underlying mental health or neurological condition.

The DSP application was initially unsuccessful due to lack of medical evidence. The centre lodged an appeal to ARO at the same time as providing Mark with ongoing assistance regarding his Newstart Allowance appeal.

Mark’s DSP appeal did not make it to the ARO. His case went to a Centrelink “subject matter expert” and after sustained advocacy from the centre, Centrelink agreed to grant Mark DSP – despite the fact that he did not have a formal diagnosis of his underlying psychiatric/neurological condition from a clinical psychologist, psychiatrist or other specialist.

This was a remarkable and very rare outcome.

Obstacles to successful DSP claim

Mark’s case demonstrates the systemic barriers in the social security system for people with serious, long-standing mental health conditions.
As Mark’s case demonstrates, people with such conditions are vulnerable to destitution while on Newstart Allowance (now JobSeeker Payment), given the risk of non-payment penalties or cancellation for inevitable breaches of activity testing and mutual obligation requirements. Centrelink responded to Mark’s vulnerability by continuously exempting him from mutual obligations (at least until 2019), but these exemptions ultimately came to an end and Mark was left without means of support. It would have been preferable for Centrelink decision-makers to have felt confident in transferring Mark to DSP many years ago – preventing the distress caused to Mark by the cancellation of his payments, and a costly series of appeals.

Policy implications

Policy guidelines for the grant of DSP in cases where it is manifestly evident that the person is qualified – ‘manifest’ claims – need to be reviewed to ensure that people with severe psychiatric disability and/or cognitive impairment may be determined to be eligible for DSP despite minimal evidence.