Disability Support Pension Research Articles

Substance use by homeless clinic attenders in Sydney.

Describe patterns of substance use and comorbid conditions among clinic attenders in homeless shelters in Sydney. Retrospective cohort study of 2498 people who attended a psychiatric clinic at one of three homeless hostels between February 2008 and May 2020. Multivariable logistic regression was used to identify factors associated with self-reported substance use, psychiatric diagnosis and measures of social function. A total of 2041 of the 2498 (81.7%) reported the harmful use of at least one substance, with alcohol (61.8%), cannabis (50.9%) and stimulant drugs (34.9%) the three most common. Those reporting the regular use of two or more substances (1466, 58.7%) were more likely to have a history of early life and adult trauma, a diagnosis of personality disorder, a criminal conviction, receive the Disability Support Pension, be chronically homeless and sleep in the open. The study found a high rate of polysubstance use among homeless clinic attenders in Sydney, and an increase in the prevalence of substance use compared to previous studies. Substance use is both a cause and a consequence of homelessness, and services to address substance use have to be part of any program to reduce homelessness and sleeping in the open.

The risk of repeated suicidal presentations following residential treatment for substance use disorders: A recurrent event analysis using linked administrative data

BackgroundIndividuals seeking alcohol and other drug (AOD) treatment consistently experience higher rates of suicidal behaviours and death by suicide when compared to the general population. By linking residential AOD treatment data to administrative healthcare and death datasets, we aimed to examine suicide-related behaviours and identify risk and protective factors for these events following discharge from residential treatment. MethodsParticipants included 1056 individuals aged 18–69 (M = 32.06, SD = 9.55, male = 696,65.9 %) admitted to three residential treatment facilities in Queensland, Australia from January 1, 2014 to December 31, 2016. Treatment data was linked to administrative hospital, emergency department (ED), mental health service, and Registry of Deaths data 2-years post-discharge. ICD-10 codes were used to identify and analyse suicide-related events. ResultsWithin 2-years post-discharge, 175 (16.6 %) individuals had a suicide-related event (n = 298 episodes). The highest proportion of episodes (11.1 %) occurred within 1-month of discharge. Higher risk of a recurrent suicide-related event was associated with receiving a Disability Support Pension (aHR = 1.69 (95%CI:1.10,2.59), two or more previous episodes of residential AOD treatment (aHR = 1.49 (95%CI:1.30,2.15). Completing residential treatment was associated with a lower risk of suicide-related events (aHR = 0.54 (95%CI:0.35,0.83). LimitationsThe amalgamation of suicidal ideation, attempts, and death into a single outcome oversimplifies their complex nature and interplay. The exclusive focus on one service provider limits generalisability, and data constraints and missingness preclude many analyses. ConclusionsUnderstanding suicidal behaviours and critical risk periods following discharge from residential treatment is crucial for improving continuing care, developing effective suicide prevention, and implementing targeted interventions among this high-risk population.

Investigating the Critical Period for Alcohol or Other Drug-Related Presentations Following Access to Residential Substance Use Treatment: a Data Linkage Study

AbstractIndividuals who access residential treatment for substance use disorders are at a greater risk of negative health and substance-use outcomes upon exiting treatment. Using linked data, we aimed to identify predictive factors and the critical period for alcohol or other drug (AOD)-related events following discharge. Participants include 1056 individuals admitted to three residential treatment centres in Queensland, Australia from January 1 2014 to December 31 2016. We linked participants’ treatment data with administrative data from hospitals, emergency departments, AOD services, mental health services and the death registry up to December 31 2018. We used survival analysis to examine presentations for AOD-related events within two-years of index discharge. A high proportion of individuals (57%) presented to healthcare services for AOD-related events within 2 year of discharge from residential treatment, with the first 30 days representing a critical period of increased risk. Completing residential treatment (aHR = 0.49 [0.37–0.66], p < .001) and high drug-abstaining self-efficacy (aHR = 0.60 [0.44–0.82], p = .001) were associated with a reduced likelihood of AOD-related events. Individuals with over two previous residential treatment admissions (aHR = 1.31 [1.04–1.64], p = .029), identifying as Indigenous Australian (aHR = 1.34 [1.10–1.63], p < .001), alcohol as a primary substance (aHR = 1.58 [1.30–1.92], p < .001), and receiving a Disability Support Pension (aHR = 1.48 [1.06–2.06], p = 0.022) were at a greater likelihood. The high proportion of individuals that present to health and drug services for AOD-related events, especially in the first 30 days post-discharge, highlights the need for continued support following discharge from substance use treatment.

‘Fully Diagnosed, Fully Stabilised and Fully Treated’: Succeeding in a Claim for a Disability Support Pension in Australia for Endometriosis and Chronic Pelvic Pain

In 2019, Ms Natasha Thomson won an application for a disability support pension (DSP) under the Social Security Act 1991 (Cth) before the Australian Administrative Appeals Tribunal (AAT). Ms Thomson was taken to the AAT by the Department of Social Security when it appealed a decision of the AAT’s Social Services and Child Support Division. Ms Thomson is the only applicant with chronic pelvic pain and likely endometriosis that has succeeded in her claim for a DSP before the Tribunal since 2005. Endometriosis is an inflammatory condition characterised by endometrial-like tissue growing outside the uterus, which can result in pain and adhesions. It commonly grows on the pelvic organs and peritoneum but has been found in other parts of the body, such as the lungs, diaphragm, kidney and navel. There is no cure at present. Long-term management is required using medical and/or surgical treatment, both of which focus on alleviating symptoms. In this article, I consider the AAT’s determinations and set out what applicants, their legal representatives and their treating doctors can learn from the cases on applicants for a DSP with endometriosis and chronic pelvic pain.

News media representations of people receiving income support and the production of stigma power: An empirical analysis of reporting on two Australian welfare payments

People receiving working-age income support payments are often stigmatised as morally and/or behaviourally deficient. We consider the role of the media, as a potential source of structural stigma, in perpetuating negative characterisations of people in receipt of either the Disability Support Pension (DSP) or unemployment benefits (Newstart) during a major period of welfare reform in Australia. Newspaper articles (N = 8290) that appeared in Australia’s five largest newspapers between 2001 and 2016, and referenced either payment were analysed. We found an increased use of fraud language associated with the DSP, which coincides with increased political and policy focus on this payment. We conclude that in a period of increasing political concern with welfare reform, media coverage of welfare recipients is a form of stigma power, acting discursively as symbolic violence.

The challenges of inadequate financial support for Australians with cancer

The publicly funded Medicare system in Australia has been recognised as a leading universal health-care model. However, its equitability has been under increased scrutiny. The COVID-19 pandemic has widened care disparities between socioeconomic groups. In particular, patients with cancer are facing unprecedented challenges in accessing income support. The Australian Disability Support Pension (DSP) aims to provide financial assistance to those with a permanent medical condition. However, the majority of Australians with cancer do not meet its eligibility requirements, leaving them with financial and psychological distress while confronting a life-changing diagnosis.

The learning, compliance, and psychological costs of applying for the Disability Support Pension

AbstractThe Disability Support Pension (DSP) provides financial support to more than 750,000 Australians with permanent physical, intellectual or psychiatric impairments that prevent them from engaging in employment. We sought to characterise the information, compliance and psychological costs of applying for the DSP. A cohort of 518 DSP applicants and recipients completed a questionnaire capturing medical, disability, benefit and demographic data. The questionnaire also included an Administrative Burden (AB) scale that was co‐developed with disability advocates and people with lived experience of DSP processes. Most respondents reported high or very high scores on three sub‐scales assessing information, compliance and psychological costs. In logistic regression models, DSP applicants reported greater costs than DSP recipients across all three scales. People with poorer health‐related quality of life, younger age and less education reported higher costs, consistent with the observation of an inequitable distribution of administrative burden in AB theory. All three scales had acceptable reliability. Study findings suggest that DSP applicants find the application process challenging and stressful. These effects are more pronounced in people who have applied for the DSP than those currently receiving the DSP, and in those with lower human capital.

The impact of antineutrophil cytoplasmic antibody-associated vasculitis on employment and work disability in an Australian population.

Although antineutrophil cytoplasmic antibody-associated vasculitis (AAV) most commonly affects older individuals, many patients develop the disease during their most productive working years. The aim of this study was to examine the effects of AAV on employment and work disability in a cohort of Australian patients of working age. Patients attending a vasculitis clinic located in Melbourne, Australia, completed an employment questionnaire in addition to the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem. The average age of the 47 respondents was 47.8±11.9years (range 22-63years), with a median disease duration of 60months (range 10.2-318.5months). There were 68.1% who were currently employed, but 20.6% of respondents employed at the time of diagnosis were no longer working and 10.6% had experienced a significant reduction in work hours since their diagnosis. There were 12.7% who were dependent on the disability support pension. The rate of work disability was 23.4%. Many participants considered themselves work impaired (41.9%), with 10.1% having missed work in the previous week. Furthermore, 44.7% of respondents reported that their financial stability had been negatively impacted by their vasculitis diagnosis. Fatigue was commonly reported. Work disabled patients were significantly more likely to be obese and less likely to have completed a tertiary education. Work disabled patients tended to be older, myeloperoxidase-antineutrophil cytoplasmic antibody positive, and have renal involvement and lung involvement. A proportion of people living with AAV in Australia experience a decline in employment and an increase in work disability when living with this condition.

Health service use of Australian unemployment and disability benefit recipients: a national, cross-sectional study

BackgroundHealthcare is funded and delivered separately from income support programs such as unemployment and disability benefits. Greater understanding of the health service use (HSU) of benefit recipients would support more effective design and delivery of health and income support programs. This study aimed to characterise the HSU of disability and unemployment benefit recipients relative to people earning wages, while controlling for personal, household and health-related factors associated with HSU in benefit recipients.MethodsA cross-sectional national survey of 9110 working age Australian adults in three groups: (1) 566 receiving the disability support pension (DSP); (2) 410 receiving unemployment benefits; and (3) 8134 earning wages. Outcomes included prevalence and frequency of health professional consultations, hospital attendance and admission in the past 12 months, as well as medication and supplement use in the past 2 weeks. Analyses compared DSP and unemployment benefit recipients to wage earners using prevalence ratios and incident rate ratios, adjusted for predisposing, enabling and need factors that may affect HSU.ResultsIn adjusted regression models, both DSP and unemployment benefit recipients were significantly more likely than wage earners to have consulted psychologists and social workers. DSP recipients also reported a significantly higher prevalence of consultations with General Practitioners (GPs), specialist physicians and podiatrists.. Both groups reported significantly more frequent consultations with GPs and DSP recipients with specialists. No differences were observed between groups for hospital attendance or admission, or supplement use in fully adjusted models, though the DSP group reported more prevalent medication use than wage earners. Inclusion of confounders including self-assessed health, disability severity, health insurance status, and financial resources attenuated the relationship between benefit receipt and HSU, however significant associations were still observed.ConclusionsPeople receiving unemployment and disability insurance benefits use significantly more health services than wage earners. A range of personal and clinical characteristics explained much, but not all, of the association between greater HSU and benefit receipt. Greater coordination between health and income support systems may improve health, reduce HSU and improve work ability in unemployed and working age people.

Changes in Access to Australian Disability Support Benefits During a Period of Social Welfare Reform

AbstractThe Disability Support Pension (DSP) is the major Australian government financial benefit program for people of working age with medical conditions and disabilities that restrict work capacity. Between 2012 and 2018 a series of policy reforms sought to restrict the growth in DSP payments and encourage more people with some work capacity to seek employment. We characterise changes in three markers of access to disability financial support over the reform period (1) DSP recipient rates (2) DSP grant (approval) rates and (3) the rate of unemployment benefit receipt in people with impaired work capacity. Results demonstrate a significant reduction in DSP receipt and grant rates, and significant increase in the rate of unemployment benefit receipt in working-age Australians with work disabling medical conditions and disability. These changes were not distributed uniformly. People whose primary medical condition was a musculoskeletal or circulatory system disorder demonstrated greater declines in DSP receipt and grant rates, while there was a more rapid increase in unemployment benefit receipt among people with primary mental health conditions. Some trend changes occur in periods during which new disability assessment and pension eligibility policies were introduced, though our ability to attribute changes to specific policy changes is limited.

The impact of the disability support pension on mental health: evidence from 14 years of an Australian cohort

Objective:To assess the effect of the Australian Disability Support Pension (DSP) on the symptomology of depression and anxiety over and above the effects of reporting a disability itself. Methods:We used the Household Income Labour Dynamics in Australia (HILDA) survey from 2004 to 2017. We used fixed effects regression to understand mental health differences (using the Mental Health Inventory‐5 [MHI‐5]) when a person reported: i) a disability; or ii) a disability and receiving the DSP) compared to when they reported no disability. The models controlled for time‐varying changes in the severity of the disability and other time‐related confounders. Results:There was a 2.97‐point decline (95%CI −3.26 to −2.68) in the MHI‐5 when a person reported a disability compared to waves in which they reported no disability and 4.48‐point decline (95%CI −5.75 to −3.22) when a person reported both a disability and being on the DSP compared to waves in which they reported neither. Conclusions:Results suggest that accessing and being in receipt of the DSP can impact the mental health of people with disabilities. Implications for public health:Government income support policies should address the unintended adverse consequences in already vulnerable populations.

Comparison of homeless clinic attenders with and without psychotic illness.

To compare the characteristics of clinic attenders in inner city homeless hostels with and without a diagnosed psychotic illness. A cross-sectional study of homeless people attending psychiatric clinics in three inner city homeless hostels over a period of 8 years. The demographic characteristics, comorbid conditions, pathway to homelessness and pattern of homelessness of clinic attenders with a diagnosis of psychosis were compared with those who were not known to have psychotic illness. 2389 homeless people attended one or more of the clinics in the 8 years of the study, of whom 1222 (51.2%) had a diagnosed psychotic illness, mostly schizophrenia. Those with psychosis were less likely to have been married (23.2% vs 45.5%), were less likely to have worked for more than a year (47.4% vs 74%) and were more likely to have been discharged from hospital to homelessness, to receive the Disability Support Pension (72.2% vs 38.3%), or be under financial management orders (12.0% vs 2.6%). Homeless people with psychosis were also more likely to have been homeless for more than a year, sleep in the open, and were less likely to have a current substance use disorder, problem gambling or a history of early life or recent trauma. A high proportion of those with psychosis (29.5%) had been released from prison to homelessness and a surprising number (22%) reported the loss of public housing tenancy. The results demonstrate the homeless with psychotic illness are particularly disabled and disadvantaged, often have multiple comorbid conditions, and many have been unable to maintain public housing tenancy. The inability of many of the homeless mentally ill to maintain public housing tenancy suggests the need for more supported housing to help the chronically homeless with psychotic illness maintain tenancy.

Three Year Longitudinal Study of Graduate Employment Outcomes for Australian Apprentices and Trainees with and without Disabilities

ABSTRACT People with disabilities in Australia face significant employment barriers. Research and policy initiatives over the past fifteen years have consistently emphasised the benefits of vocational education and training generally, and apprenticeship and traineeships specifically, as leading to positive vocational pathways and employment outcomes for people with disabilities. However, there is a dearth of evidence of graduate outcomes for apprentices and trainees with disabilities. This paper presents the employment outcomes including hours of work and salaries for a cohort of apprenticeship and traineeship graduates with and without disabilities across a three-year longitudinal Australian study. Overall, there are positive employment outcomes for the research participants although graduates without a disability achieved better outcomes than graduates with disabilities and participants in receipt of the disability support pension had significantly lower wages than other participants with disabilities. There are indications that the gap in outcomes between graduates with and without disabilities has reduced over time, although generalisability of the findings may be limited by the observational study design. Nevertheless, the study has confirmed positive employment and related outcomes for apprenticeship and traineeship graduates with disabilities, which were sustained, or arguably improved, over the three-year period covered by the study.

Why Extended Time on Newstart is Unsuitable for Aboriginal and Torres Strait Islander Australians Living with a Disability

ABSTRACTMany Australians living with a disability find themselves recipients of Newstart Allowance when applying for the Disability Support Pension (DSP). Newstart Allowance is designed as a short-term payment for people looking for work, with a lower fortnightly payment and limited medical and transport subsidies compared to the DSP. This paper describes the financial challenges of living with a disability while on Newstart Allowance. With a focus on the experiences of Aboriginal and Torres Strait Islander (Indigenous) Australians from two regional towns, qualitative semistructured interviews and focus groups documented experiences of 39 community members and 21 medical and nonmedical service providers supporting clients living with a disability on Newstart Allowance. Four themes were identified: (i) living with severe financial hardship, (ii) challenges complying with the DSP application, (iii) being financially penalised for not complying with Newstart Allowance conditions, and (iv) supporting community members to manage severe financial stress. Although people living with a disability on Newstart were experiencing severe hardship and poverty, there was limited participation of Centrelink-employed social workers within their described experiences with Centrelink. We argue that social workers can work to humanise human service settings and potentially help to mitigate these financial challenges.IMPLICATIONSIndigenous Australians living with a disability experience severe disadvantage and poverty while living on Newstart Allowance.Social workers must be easily accessible at Centrelink customer service centres and to Newstart Allowance recipients to help coordinate service engagement.Newstart Allowance should be increased to ensure recipients can respond to cost of living pressures.

Sorting yourself out of the system: everyday processes of elusive social sorting in Australia’s disability social security regime for Indigenous Australians

The Disability Support Pension (DSP), the primary social security payment for Australians living with disability, has undergone considerable reform since the early 2000s. Limited research has examined the impact of such reforms on Aboriginal and Torres Strait Islander (Indigenous) Australians living with disability. This article pays particular attention to the experiences of Indigenous Australians applying for the DSP, with a strong focus on reforms since 2015 as these modifications have been arguably the most rigorous changes to the assessment process and eligibility criteria. The article illustrates the challenges that Indigenous Australians with disability experience in applying for the disability pension under the new process and the supports they require in submitting their application. The article draws on sociological theories of social sorting identified for the disability category by Grover and Piggott and examines the application and implications within the Australian context of such processes for Indigenous Australians living with disability.

The Cashless Debit Card and rights of persons with disabilities

The Cashless Debit Card ( CDC) was triggered by a recommendation in the 2014 Forrest Review, ostensibly to address substance abuse and gambling issues. The CDC applies to a broad range of social security payments, defined as ‘trigger’ payments, including a Disability Support Pension ( DSP). This article contends that people with disabilities are likely to encounter a range of specific issues with the CDC, and that the scheme squares poorly with Australia's international human rights obligations to persons with disabilities. We argue that the CDC has pernicious effects in terms of deprivation of autonomy, subjection to stigma and denial of dignity.

How Australian welfare reforms shape low-income single mothers’ food provisioning practices and their children’s nutritional health

ABSTRACTThis paper examines the food provisioning practices of low-income single mothers affected by market-driven welfare reforms in Australia. We explore the tensions between women’s care responsibilities and the government’s welfare-to-work reform, and the effects of these tensions on the nutritional health and wellbeing of women and their children. Conducting a thematic analysis of 20 interviews with single mothers receiving either Parenting Payment Single, Newstart Allowance (NSA), or the Disability Support Pension, we found that when women’s income and time were significantly compromised, especially when women were transferred onto the less generous unemployment benefit NSA, that food provisioning became more psychologically taxing and nutritional health decreased. The findings suggest that public health researchers must focus on challenging the structural antecedents of women’s food work and hunger to alleviate the responsibilities of single mothers in countries facing similar circumstances.

Social Assistance Payments and Food Insecurity inAustralia: Evidence from the HouseholdExpenditure Survey.

It is widely understood that households with low economic resources and poor labour market attachment are at considerable risk of food insecurity in Australia. However, little is known about variations in food insecurity by receipt of specific classes of social assistance payments that are made through the social security system. Using newly released data from the 2016 Household Expenditure Survey, this paper reports on variations in food insecurity prevalence across a range of payment types. We further investigated measures of financial wellbeing reported by food-insecure households in receipt of social assistance payments. Results showed that individuals in receipt of Newstart allowance (11%), Austudy/Abstudy (14%), the Disability Support Pension (12%), the Carer Payment (11%) and the Parenting Payment (9%) were at significantly higher risk of food insecurity compared to those in receipt of the Age Pension (<1%) or no payment at all (1.3%). Results further indicated that food-insecure households in receipt of social assistance payments endured significant financial stress, with a large proportion co-currently experiencing “fuel” or “energy” poverty. Our results support calls by a range of Australian non-government organisations, politicians, and academics for a comprehensive review of the Australian social security system.

PCN110 - COSTS ASSOCIATED WITH TRACHEA, BRONCHUS AND LUNG CANCER IN RUSSIA IN 2016 YEAR

to estimate annual cost of trachea, bronchus and lung (TBL) cancer in Russia in 2016 year. It was a prevalence-based cost of illness study from state perspective. Direct medical costs included inpatient and outpatient diagnostics and treatment, outpatient pharmacotherapy reimbursed by state, palliative care and post-treatment follow-up. Non-medical direct costs included disability pension and temporary social disability payments. The indirect costs were calculated using the human-capital and friction-costs approach. Data was obtained from the national state and healthcare statistics surveillance system, cancer registry, expert survey and literature sources. All costs except outpatient pharmacotherapy were calculated by the bottom-up costing approach. There were 185,631 patients with TBL cancer in Russia with 51,768 incident cases. 22,649 became disabled and 51,476 died. About 60% of incident patients had III or IV stage of cancer. First-year mortality rate for TBL cancer patients was 50.6%. Total economic burden of TBL cancer in 2016 in Russia was equivalent to US$ 0.22 billion (with indirect costs measured by friction cost method) or US$ 1.62 (human capital approach). Direct medical costs were US$ 101.85 million. Main direct medical cost drivers were inpatient treatment (US$ 61.07 million, US$ 2170.84 per patient), outpatient pharmacotherapy (US$ 22.17 million, US$ 119.45 per patient) and treatment in a day hospital department (US$ 14.91 million, US$ 530,00 per patient), which accounted for 60,0%, 21,8% and 14,6% of medical costs respectively. Direct non-medical costs were about US$ 85.94 million. Disability support pension payments were about US$ 77.07 million, while temporary social disability payments were about US$ 8.87 million. The indirect costs were estimated at US$ 0.032 billion or US$ 1.43 billion with friction-cost or human-capital method respectively. TBL cancer imposes significant burden on economic system of Russian Federation.

Understanding the Australian approach to assessing capacity: A detailed case study of the Disability Support Pension

Understanding the Australian approach to assessing capacity: A detailed case study of the Disability Support Pension