Is sex therapy covered by the NDIS?

Horse riding, puppetry and prosthetic feet for the beach: these are all things that can be claimed under the government’s National Disability Insurance Scheme (NDIS). Recently, one more was added to the list for a woman with multiple sclerosis: sex therapy. 

The ruling was made by the Administrative Appeals Tribunal (AAT) and resulted in both an outpouring of support and cynicism. While the ABC wrote the ruling was a “‘precedent-setting’ case,” The Daily Telegraph tweeted that taxpayers would have to foot the $10,000 bill for “a lesbian woman with a disability” to be provided with “a ‘sexual release’”. 

Orgasms aside, the ruling shows there are a few muddy areas in what is and isn’t covered by the NDIS. Crikey examines what the scheme is for, and some of its common uses. 

How does the NDIS work?

The whole idea of the NDIS is to give people living with disabilities a way to engage with their community, increase their independence, and pursue their goals, objectives and aspirations. 

In 2011, a scathing report was released by the Productivity Commission’s inquiry into disability care, which found the previous support system was “unfair”, giving disabled people “little choice and no certainty of access to appropriate supports”. Along came Julia Gillard who committed to the NDIS, a first-of-its-kind scheme proposed in a year Australia went through three prime ministers. It was, to put it gently, ambitious. After passing parliament in 2013, the NDIS is now expected to have 460,000 participants by 2020. It’s half funded by the federal government from a Medicare levy tax, with the rest provided by each state and territory. 

Those on the NDIS develop a personal plan with the national agency, outlining what support they need and the goals they want to pursue. “The principles are they should be able to determine their own goals and how they go about getting them — they should have control over their own lives,” said Professor Richard Madden, who is on the board of disability service provider House With No Steps.

There are tens of thousands of approved providers across Australia and, according to Madden, it’s pretty easy to get a new provider put on the list. The service is approved if it is considered “reasonable and necessary”, determined on a case-by-case basis for the individual.  

So what does the NDIS cover?

Boring essentials are not covered by the NDIS. Groceries and other necessities are bought using the Disability Support Pension (though not everyone on the NDIS qualifies for the DSP and vice-versa). 

But the NDIS does cover hiring help for household tasks, getting mobility equipment and home modifications installed, or having someone mind the kids while you work on something else.

Travel is sometimes covered, so long as it’s for the right purpose and takes into account help from family. For instance, in one tribunal appeal, a semi-paraplegic man was granted reimbursement to drive his kids to a weekly sporting activity, but not to drive to a fortnightly family dinner. He could claim trips to “away” games at his local lawn bowls club, but not to family holidays at Apollo Bay.

Does it cover education, sport and hobbies?

You can get classes on specialised driving, trips to the gym or learning a new skill. A hobby class on puppetry or organic gardening isn’t out of the question, and it’s pretty common to use NDIS funding to have a support worker drive you to a care centre for weekly activities.

One woman won the right to get funding for a separate prosthetic foot to use solely at the beach or pool instead of her regular day-to-day one — but she lost the right to have a new foot section funded which would allow her to wear high heels. Unless she was planning on sprinting in stilettos, the aesthetic prosthetic wasn’t deemed necessary. 

Are therapies fair game?

The NDIS cracked down on dodgy therapy providers in 2017 after The Daily Telegraph reported companies were offering energy healing, soul counselling and equine-assisted therapy… which involved convincing horses to move without touching them.

Last year, more than 300 providers had their registration revoked following complaints filed to the disability watchdog. 

Alternative therapies are still provided, as well as standard ones. Physiotherapy is pretty common, as is seeing a psychologist. Art, music and equine therapy (the kind where you actually ride a horse) make the list — as well as one provider that offers meditation that “utilises the body’s chakras”, though it’s unclear if this specific service is approved. 

So why isn’t sex therapy covered?

Given all the other forms of therapy, why was getting sex therapy approved such an ordeal? Well, according to clinical psychiatrist Matthew Yua, it’s thanks to stigma and prejudice. 

“People have a kind of a different attitude when it comes to sex. It’s OK to hang out with horses, study insects — but when it comes to something sexual that improves quality of life, making you physically and mentally healthier, there’s a different connotation that puts people off,” he said. 

Importantly, a sex therapist is not a sex worker. Sex therapists offer counselling on relationships, libido and body confidence issues — they don’t touch clients. 

“It’s important not to mix up the two. Therapists have specialised training for people with disabilities, for couples with sexual performance issues. It’s a very professional kind of therapy,” Yua said, adding he is an advocate for sex work to be covered, too. 

“People need to recognise people with a disability need help to achieve sexual release. It’s a professional service for people who have needs.”