When Edward contacted SSRV, he had been struggling with anxiety, depression and PTSD for over 10 years. His application for the Disability Support Pension (DSP) had been rejected, and he was seeking help appealing that decision.
Five years ago, Edward was assessed and diagnosed by a psychiatrist, who then referred him back to his GP for ongoing monitoring and management. Edward previously attended sessions with a psychologist. He has regularly seen his GP and taken medication prescribed to him.
While the medication stops him from feeling suicidal, he has never been able to return to work. Six months before applying for DSP, Edward saw a psychiatrist for a review. The psychiatrist recommended he try further counselling. Centrelink then rejected his claim for DSP on the basis that the psychiatrist recommended further counselling, so Edward contacted SSRV for assistance.
Accessing DSP should be straight forward for vulnerable members of our community. However, we commonly hear stories like Edward’s. The medical eligibility criteria for DSP is technical, complex and can difficult to understand. Further, applying for DSP based on a mental health condition has specific requirements.
Diagnosis
From April 1 2023, the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 has been updated.
One of the most significant changes relates to diagnosis of a mental health condition.
A diagnosis can now be made by a psychiatrist, or a GP and registered psychologist (prior to 1 April 2023 they had to be a clinical psychologist). It is hoped this change will assist vulnerable members of our community to meet the diagnosis requirement where previously they may not have been able to.
Reasonably treated and stabilised
Another key change within the impairment tables relates to a condition (not just a mental health condition) needing to be reasonably treated and stabilised, instead of fully treated and fully stabilised.
Even so, the test applied to assess whether a condition is reasonably treated and stabilised hasn’t changed significantly. A mental health condition does not have to be cured to be reasonably treated. Rather, it involves assessing what treatment has occurred, what treatment hasn’t occurred and why (such as cost, risk, accessibility, success rate) and whether over the next two years any further treatment is likely to result in significant functional improvement.
Meanwhile, the impairment tables define ‘stabilised’ as ‘…the person has undertaken reasonable treatment for the condition and any further reasonable treatment is unlikely to result in a significant functional improvement’. Reasonable treatment means treatment that is accessible, has a reasonable cost, is regularly used for the condition, has a high success rate, will likely result in significant functional improvement and is low risk.
The impairment tables also note, however, that a condition can still be stabilised even if someone has not undertaken reasonable treatment in circumstances where there is unlikely to be significant functional improvement even if they were to undergo reasonable treatment.
Additionally, if they have a medical or other compelling reason for not having undertaken reasonable treatment then they can be considered stabilised. Centrelink recognises that for mental health this may be particularly relevant when someone is so unwell that they can’t make beneficial decisions about treatment recommendations. We have seen the medical or other compelling reason provision applied for a client suffering schizophrenia where the symptoms of his illness caused him to fear treatment as he believed it was intended to harm him.
At what point Centrelink will accept someone is reasonably treated and stabilised for a mental health condition isn’t black and white and it can be difficult for clients who have not received ongoing treatment from a psychiatrist. However, while the impairment tables are prescriptive about diagnosis, they do not require that treatment and medical evidence be provided by a psychiatrist. A GP can provide treatment and medical evidence outlining the diagnosis, history and compliance with prescribed treatment or recommendations.
The likelihood of obtaining DSP without supporting evidence or ongoing treatment from a psychiatrist increases if they have regularly engaged with their GP over an extended period, attempted some kind of psychological therapy (unless deemed unsuitable by their treating practitioner) and complied consistently with any prescribed medication and changes recommended.
This is reflected in the case of ZSYJ and Secretary, Department of Social Services (Social services second review) [2018] AATA 3969 (22 October 2018) where the Tribunal determined that Ms ZSYJ’s mental health conditions were treated and stabilised despite not having received ongoing treatment from a psychiatrist.
Key points in the Tribunal’s assessment included that she had attended regular appointments with her GP, and followed their treatment recommendations including complying with her prescribed medication and attempted counselling. The Tribunal accepted that further treatment wasn’t going to result in a significant functional improvement given how long she had struggled with her conditions.
In Edward’s case, SSRV assisted him to successfully appeal the decision to reject his DSP application. Similar to the case of ZSYJ, key to Edward’s success was the longstanding nature of his mental health condition, the lack of significant improvement over the years, his regular engagement with his GP and compliance with their treatment recommendations and his attempt at counselling.
As such, while the recent changes to the impairment tables have the potential to help vulnerable members of our community access DSP, whether a mental health condition meets the definition of diagnosed, reasonably treated and stabilised will still be assessed on a case-by-case basis and the quality of the medical evidence remains critical.
If you would like more information about the DSP eligibility criteria, visit our DSP Help website: dsphelp.org.au
