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Spotlight: Health, safety and wellbeing under the NDIS

A deeper look into health, safety and wellbeing of the disability workforce.

In 2020, focus groups and in-depth interviews explored the workforce’s experience of health, safety, and wellbeing under the NDIS, as well as the workforce’s understanding of current health and safety protections both at a workplace and legislative level.

The COVID-19 pandemic, which was reaching its peak in Victoria when the research was conducted, also meant that health, safety, and wellbeing were front of mind for workers in 2020. Considering the potential impacts of COVID-19 on the disability workforce, it is noteworthy that there was an increase in the proportion of survey participants who said that their job “never” put their health and safety at risk between 2018 and 2020 (24% in 2020 vs 21% in 2019 and 19% in 2018).

  • Mental health was overwhelmingly the first thing that came to mind when workers were asked about health, safety, and wellbeing. In the qualitative research, most workers reported experiencing health and safety risks as part of their job, of particular concern were mental health and stress. The pressures of workload (clients and administration), risky work conditions, often combined with unsupportive management systems and cultures of workplace bullying were immensely stressful. Feelings of being isolated and that their roles were increasingly devalued also contributed to worker’s psychological burden, particularly in direct support contexts. Stress was also commonly attributed to isolation, a high workload due to increasing administrative requirements coupled with limited time for this additional work.

    Most workers felt that an Employee Assistance Program (EAP) was insufficient in meeting their mental health needs, and many wanted to see greater emotional support provided from within their organisation, delivered by people who understood the nature of their work.

    “Mental health: There’s a lot of stress, have been with psychologist four times, I have been on work cover, stress leave. It’s management that makes it stressful, when they don’t listen, you feel frustrated”

    “I probably got more out of being able to debrief with colleagues and team managers, that they know what I’m talking about, I don’t have to explain the whole situation before getting to the debriefing part”

  • Research findings suggest that experiences of occupational violence were common. Many workers felt that this wasn’t taken seriously enough in the industry. The qualitative research participants reported that there were not adequate processes in place to reduce the risk of violence (such as risk assessments or provision of security equipment for home visits); and when incident reports were lodged, follow up was lacking. This was often attributed to a culture that puts the safety of clients well ahead of the rights of staff.

    Exclusion of the direct support workforce from information about clients (including their NDIS plans) often put workers at risk, particularly when working in a casual capacity with unfamiliar clients. In 2020 18% of survey participants indicated that they work in a casual capacity, which is a significant increase compared to 2018 findings (13%).

  • The theme of isolation has been identified in this research as a prevalent issue in the disability sector. This has been largely attributed to the introduction of the NDIS, which has meant an increase in casualised, one-on-one work, and a billable-hours structure which limited the ability for NDIS providers to hold team meetings and provide group training and networking.

    These themes continued into 2020. Many workers reflected it is the ability to debrief with colleagues and team management who understand the nuances of issues faced was most beneficial for stress management and overall wellbeing. An increased sense of isolation under the NDIS was leaving workers feeling bereft of this opportunity and feeling more isolated than ever. Isolation also presented barriers to the exchange of ideas and experiences, such as behavioural de-escalation strategies, which were not as easily shared as in the past.

    COVID-19 may have amplified existing feelings of isolation. While isolation was a common experience across the workforce, the manifestation of this differed for those remaining on-site, (such as residential support workers) compared to those who transitioned to working from home (often those in management positions, support coordinators or allied health professionals).

    Many direct support workers who continued to work on-site or in clients’ homes felt abandoned by management in a potentially highly risky situation. It was often observed that there was a lack of recognition of the risks and challenges of work for those working face-to-face with clients.

    This coupled with the challenges of managing client’s frustrations about living under lockdown conditions, and often taking on additional management responsibilities, escalated feelings of isolation.

    “This year (during COVID) has been the most mental draining for me… management that were here, pretty much walked out and worked from home, but the centre was still open for high behaviours, so I was in position of managing the centre and the staff plus clients. ”
  • There was a lack of awareness of the protections in place for workers. Research participants commonly cited OH&S representatives and their unions as their key avenues to raise safety concerns. Reporting was often felt to be a “tick box” exercise with no feedback or action ever received.

    Signifying a lack of standardised information about health and safety across the sector, qualitative findings suggest that workers across the study had very little understanding of what health, safety or wellbeing protections are in place legislatively for those who work in the disability sector. None mentioned the Occupational Health and Safety Act 2004 and there was also very low awareness of their rights. Generally, workers agreed that there was a lack of genuine focus on health and safety across the sector.

    This was attributed to a culture that didn’t adequately prioritise safety, a lack of training, and lack of time to do adequate risk assessments before issues occur. Instead, workers described a highly reactive system. It was also commonly observed that even when proper processes were followed and incidents reported, there was rarely any response to the issue.

    Workers articulated the need for an organisational culture that is committed to safety, is responsive, open to feedback, transparent about processes and prioritises the safety of staff alongside clients.

    “To be honest I’m severely disappointed in the recognition of staff. We had a client who was an NDIS client who was extremely abusive towards staff. I wasn’t fully aware of the full extent of it… it was happening prior to my arrival. There is a culture in disability that you just suck it up. I don’t just suck it up, I went to WorkSafe and it has been elevated up the organisation.”
    “A safety culture is responsive. If someone raises an issue, physical, psychological [or] other, is there a response?” (Residential support worker)

    When asked to imagine a workplace in the disability sector that is truly committed to the health, safety, and wellbeing of staff, some of the most commonly raised characteristics of the workplace were:

    • Staff feel comfortable reporting health, safety and wellbeing issues and ideas for process improvement without fear of blame or other negative repercussions
    • Incidents and issues are taken seriously, and the organisation’s response visible
    • Management recognise and acknowledge the challenges of disability work, listen to, and provide support and advice to staff
    • Training on safety procedures is regularly provided for new and existing staff, including promotion of the NDIS quality and safeguards orientation training
    • Correct equipment is provided, and infrastructure is safe and regularly tested

Reviewed 02 September 2021

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