Written by Prof Kat McFerran, Faculty of Fine Arts and Music, 30 November 2024

In the final week of parliament for 2024, the Minister for the National Disability Insurance Scheme (NDIS) dropped a bombshell for participants in the scheme. “How people access music and art therapy will change”.  This is an unanticipated turnaround since music and art therapy have been included in the scheme since its inception including a close examination of music therapy in trials between 2013-2015, particularly in the Barwon region in Victoria.

Background of the NDIS

The purpose of the NDIS is to provide reasonable and necessary supports for participants to live their life and achieve specific goals including independence, involvement in the community, education, employment, health and wellbeing. This is explained on the NDIS webpage as support that will help participants to:

  • pursue their goals, objectives and aspirations
  • increase their independence
  • increase community and workplace participation, and
  • develop their capacity to actively take part in the community.

The emphasis has always been on choice and for participants to select the types of services that will work for them, rather than being obliged to access programs inside large not-for-profit disability service providers. The establishment of the NDIS marked a move away from the medical model of disability service provision and towards the social model of understanding that disability is caused by barriers in the physical, attitudinal and social environment that fail to accommodate people’s impairments.

The Economic Context

In practical terms, one of the drivers for the innovative change in funding of disability services was a desire to reduce the institutionalisation of people with disabilities and to fund services that enabled full participation in the community. In addition to a repositioning of where the ‘problem’ of disability is located, there had been several investigations highlighting possible harms of institutional and residential settings. This included a Senate Community Affairs Reference Committee in 2015 and other findings that led to the establishment of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability in April 2019.

The economic efficiencies of providing support services through organisational models receiving block funding are important to recognise, however. Lessons had been learned from the deinstitutionalisation of the mental health sector in response to the Richmond Report (1983). That movement began with the closure or many large psychiatric hospitals and institutions beginning in the 1980s and only in the 1990s with a new National Mental Health Strategy to foster the development of community support services.

The NDIS was a more proactive strategy that began by addressing the need for funding in a way that would not leave people without services as policy tried to catch up. The insurance model was modelled on the North American approach to service provision and fostered a more market-driven approach to services. If people wanted it, it could be funded – at least in theory.

The Challenges of Service Selection

The early NDIS trials were illuminating. Planners were provided for each participant in the scheme to negotiate what could be included in their individually tailored plan. Planners were not trained in social justice, counselling or with systemic understandings, as social workers are for example. They were often people from within the sector, whose wages were higher than a disability support worker but lower than an allied health professional. They knew of some services, and not of others, and they came with unexamined pre-assumptions about what was reasonable and necessary for people.  

This led us to partner with the NDIS and the Australian Music Therapy Association in 2015 (funded by a University of Melbourne Engagement Initiative Grant) to

·      Better understand the needs and capacity for contribution of each party involved

·      Generate knowledge for each party regarding requirements and objectives of both the Scheme and music therapy service options

·      Facilitate greater community participation through access to music-based services for people with disability

We interviewed 4 NDIA Plan Support Coordinators, 5 Registered Music Therapists and one parent of a child who participated in music therapy. Analysis confirmed that the greatest barrier to consistent access to music therapy was a lack of understanding by those with the authority to approve its inclusion within NDIS plans. In response, we published resources including a white paper (available on request) that explained when music therapy could be a reasonable and necessary support service for people with disability.

Approval as a NDIS funded support

As the NDIS moved into full scale national delivery, we continued to answer queries from individual planners and meet frequently with representatives of the NDIS. The result was the inclusion of music therapy in the NDIS Practice Standards Verification Module for Capacity Building – Improved Daily Living. Music therapy research was used to demonstrate that it was a reasonable and necessary way for people to address a range of cognitive, behavioural, communication, physical and socio-emotional goals related to mental health and wellbeing; speech, communication and social skills; body movement, coordination and physical function; memory, attention and cognitive function; as well as pain management.

Being listed as a verified practice did not remove all barriers to access, however. There were still frequent challenges from planners who had not heard of music therapy themselves and assumed people could or should see another allied health professional instead, who could just insert music. At times, participants were tenacious enough to challenge these obstacles, sometimes resolved through internal review, and other times proceeding to the Administrative Appeals Tribunal. When the research basis of the profession was challenged in an objective process, the result was frequently positive. There is good evidence to demonstrate that music therapy can be helpful for people with disabilities in addressing goals.

Understanding the Finances

In the recent decision to remove music therapy from this list, there has been no review of evidence. There has been no consultation. There have been no specific challenges. Instead, there has been a broad a statement that more evidence is needed. But confusingly Minister Shorten has stated that “if you have stated in your plan, and because it's reasonable and necessary and based on evidence, in the specific circumstances that it's helping you maintain or improve your functional capacity, you'll continue to access your supports at the high rate of $193 an hour.” And again, “Music and art therapy can help at different levels. Now, I'm aware that for, say, young children with autism, there's some pretty good evidence which shows that the music therapy really does help create quite significant impact. So, that's great. And so, where it's related to a therapy, then it stays at the $193 rate.” But “Where it is a social activity which people get enjoyment, where they get activity, where they get social interaction, it'll be charged at the community rate of $68 an hour.”

The argument has become that people can access more music therapy services by using the lower rate and therefore being able to afford more of it. If it were not for the financial impossibility of this scenario, it might sound reasonable. It sounds as though participants of the scheme have more choice. That would be good.

But the truth is that $68 is not a feasible rate for people to offer service in private practice - a small business model. By comparison, the entry level rate for new graduates working fulltime as an allied health professional in the Victorian hospital system (the lowest paying system for allied health) is approximately $35 an hour, increasing to around $55 for senior clinicians and beyond $60 p/h for management roles. This includes superannuation, insurances, holiday and sick pay, supervision and support, referrals, equipment, no requirements for invoicing or providing individual reports on service beyond progress notes, and is based on face-to-face service expectations of approximately 50% of paid hours. There is no private practice model where $68 would cover costs and yet this is what the funding landscape of the NDIS has encouraged. So it does not enable choices for participants. It reduces them significantly because services will not be available. This is not good.

A Matter of Choice

There has been a community groundswell of support for music and art therapy in the past week. People have spoken up and shared about the value and benefits of their participation in the creative arts therapies. However, anecdotal report tells us that planners have immediately started saying ‘no’ to music therapy, influenced by the nebulous discourse of ‘not enough evidence’ that has pervaded the media in the past week. We live in a time of misinformation and disinformation and the snippets of information that add up to music therapy being cut due to lack of evidence have already overtaken the more detailed, although still non-consultative process of the moment.

The 2019 Tune Review recommended that the NDIS establish a new Independent Evidence Committee to provide expert advice and make recommendations to the NDIS on best practice approaches to collecting and using evidence to inform policy and operational decisions. This is said to include evidence from lived experience of people with disability and is slated to commence from July 2025.

In the meantime, participants of the scheme are once again facing barriers to accessing their choice of services. The medical model is once again dominating the lives of people who might choose creative approaches to achieving their goals, objectives and aspirations. And as always, artists are expected to live in poverty for the services they provide by comparison to other equivalent professionals.

The singling out of music and art therapy in the final days of national parliament for 2024 is lacking justification. Where is the evidence that music and art therapy are less helpful than other allied health interventions? As a researcher, I am aware of the challenges of the evidence-based approach to medical, educational and community service provision. It is a model that works best in controlled laboratory conditions, such as those where medicines can be tested. In the real world, there are many conditions at play that influence the degree of benefit experienced by individuals. But that is well known in the disability sector and the NDIS was set-up to avoid such challenges by allowing people to choose and requiring them to explain what outcomes they, personally, are expecting to see from music therapy.

If the proposed outcomes are not achieved, then music therapy should not be funded again. But that is not the proposal on the table. This move is designed to remove music and art therapy as choices for participants in the scheme, no matter whether they can point to a research-basis or personal lived experience. That is wrong.

Images by Kaboompics.com and Centre for Ageing Better