If a group of leaders cannot define a man or a woman, how confident are we in their ability to oversee a health framework that defines concepts such as ‘permanent disability’ or even ‘mental health’?

You may sympathise with my doubts.

A political machine philosophically hamstrung by an inability to explain essential aspects of who we are as humans and how we live together in civil society is going to struggle coordinating health.

It is my view that ideological confusion has added to the problems we see in the NDIS. Despite the NDIS appearing to start with a consensus to care for people who needed more support than the old system offered, its implementation has been a shambles.

To use a sporting analogy, how can people play a good game if the rules are confusing?

And how can the leaders define the rules when they forget the basis of the game?

Imagine if a referee failed to blow their whistle when mistakes occur? It would be chaos. Which is what we have in the NDIS.

For the romantic socialist, such fundamental problems do not matter. A well-defined core question, ‘Care for whom, with what medical condition, diagnosed by whom, living under what circumstances, and with what accountabilities?’ sits beyond sentimentalist ways of looking at social life.

Consider this provocative quote from a psychiatrist almost 60 years ago. I believe it throws a testing light on the assumptions underpinning an important part of this NDIS mess:

‘Mental illness is a metaphor. Minds can be “sick” only in the sense that jokes are “sick” or economies are “sick” …. mental illness is not something a person has, but is something he does or is.’

Given the apparent low accountability coursing through the veins of the NDIS, how can we have confidence the system is not causing damage of various kinds through programs, such as those in the contested ‘gender affirming care’ area?

Then there is the question of what appears to be slackness in the loose way NDIS providers can provide all kinds of services that are not clinically prescribed (e.g. partial funding support for holiday care). Physical causes of ill health can usually be treated with validated physical interventions. But the concept creep in the ‘mental health’ field has been so significant that much of what is distress of the soul now seems to far too quickly attract a label, medication, and imaginative but not ‘proven’ support activities.

Remember – the scientific method only works well in physical aspects of our reality. Issues beyond the brain (the purist realm of psychiatry) become entangled in our murky discussions about the nature of human self-consciousness, human agency, decision making, and moral responsibility. When leaders have displayed a dubious grasp of biological and scientific norms, I personally find it concerning that they then oversee billions of dollars in public money assigned to mental health conditions that may not always be carefully defined, properly diagnosed, or responded to with clinically verifiable and replicable interventions.

Clarifying what can and cannot be defined for inclusion in the NDIS could certainly use some work.

Similarly, the NDIS money trail is, in my opinion, so loose it would make any decent accountant shudder.

Which begs the question, why can’t NDIS monies be similarly subject to the procedures used to oversee Medicare?

One of the largest problems facing NDIS is the classification of autism. The condition has experienced exponential growth with complaints made that the expanded definitions are too broad and that many mild cases should not be included in the NDIS. Some of these are said to include what used to be considered personality traits and reasonably normal human behaviour such as social awkwardness and sensitivity to some environments.

One professor has suggested that the autism spectrum be replaced by subcategories that separate the conditions into the more clearly defined clinical childhood autism, hypersensitivity, and Asperger’s.

How and if these are included in the NDIS could then be properly considered.

It is reasonable for the public to ask how many of those with Asperger’s and hypersensitivity would still qualify for the NDIS if they were not included on the autism spectrum? Not many, perhaps.

What are we left with?

Leaders disinclined to pursue reform and taxpayers funding sentimentalist ideals that could cause greater distress to more people if allowed to go unchecked in major conceptual and practical ways.