Everyday is a struggle for Andrew Gibbard. For 25 of his 44 years, he has lived with severe schizophrenia. The voices in his head never stop.
- Community mental health services in Victoria will soon be run by the NDIS
- There are concerns the majority of people currently receiving support will not be eligible
- Advocates fear the changes will see a reduction in expertise and experience in the mental health workforce
"I have to deal with schizophrenia all day, every day. Which is a lot of voices I have to talk to, argue with, debate things with," he says.
Living on his own in a simple one-room townhouse in Melbourne's outer east, virtually his only visitor is his community mental health support worker, Robyn Stringer.
"She's great at helping me with all the professional things, the appointments," he says.
It's not easy for Mr Gibbard to talk like this. He pauses often, looking down to gather his thoughts.
"She breaks up my isolation as well, very much so, to have Robyn come over. Because at times I am very isolated."
Over the last five years, Ms Stringer has been visiting regularly.
She is the one he asks for when he needs support. And she is the one who ensures he is looking after himself.
"I've got a good overview of what Andrew's doing with his health," she says.
"It's difficult for Andrew to get out of the door sometimes. Having an outreach service with someone experienced with mental health issues in the home is really essential."
But for Mr Gibbard, that essential service is changing with the transition to the National Disability Insurance Scheme (NDIS).
Ms Stringer's visits will end by December.
She works for the not-for-profit social and health agency EACH, which is funded through Victoria's Mental Health Community Support Service (MHCSS).
As the NDIS rolls out in areas of Victoria, the MHCSS is being wrapped up.
Right now, there are more than 900 full and part-time workers in Victoria doing mental health outreach paid for by the MHCSS.
By July next year — when the NDIS fully rolls out across the state — there will be none.
"It's a shame because we're going to be losing a lot of workers who are really skilled in mental health," Ms Stringer says.
"There will be quite a lot of us who just go into other fields, I suppose."
Those who live with mental illness and are already cared for under the MHCSS, like Mr Gibbard, will be automatically enrolled in the NDIS.
The Victorian Government says it is working to diminish the impact on the mental health workforce.
It also says those living with mental illness who join the NDIS will be better off.
"The average NDIS package value is nearly three times the average level of funding clients currently receive through the Mental Health Community Support Services program," Martin Foley, Victoria's Minister for Housing, Disability, and Ageing, said in a statement.
Fears specialised community care will disappear
But mental health advocates say the vast majority of those who live with mental illness in Victoria will not be covered by the scheme.
Mental Health Victoria estimates more than 90 per cent of those living with mental illness in the state — nearly 135,000 people — will not be eligible.
"We don't know what is going to happen to those people," Lisa Darmanin of the Australian Services Union, which represents many mental health support workers, says.
"They are going to fall through the cracks."
She says Victoria cannot afford to lose an entire community mental health workforce that took decades to develop.
"Once they're gone, they're gone," she says.
"The highly specialised community-based mental health workforce capacity will disappear."
Nicci Wall knows all too well what can happen when community mental health outreach stops.
The 52-year old first attempted suicide at age seven. She was finally diagnosed with bi-polar disorder when she was 35.
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Her suburb near Geelong was one of the first in Victoria to transition to the NDIS in 2014.
She applied to the scheme and was rejected, and the mental health support she received from federal and state funded programs ended.
"It's gone from being a proactive … set of services to reactive. You can now only get services when you're in crisis," she says.
Ms Wall still struggles with suicidal thoughts, and now relies on the 10 visits to a psychologist a year she is allowed under Medicare.
She also pays for additional mental health support out of pocket.
Appointments with a psychologist can cost more than $280 an hour.
"Those who aren't in a position like myself that can pay … they're left isolated, alone, and flailing," she says.
'Hopefully I'll keep it all together'
Ms Stringer is concerned about what will happen to the thousands of others living with mental illness who will go without support through home visits and drop-in centres in the community.
"I guess I'm worried about more risk to people with homelessness, hospital admissions, just a worse quality of life," she says.
Mr Gibbard is also worried. In the NDIS, he will have some home support, but advocates fear workers will not have any experience dealing with mental illness.
And they won't be Robyn.
"I hope it's not too rocky a road. She's a good person. I guess I'll miss Robyn," he says.
"I'll send the best to her and continue on my way. Hopefully keep it all together upstairs, with the schizophrenia."