Author: Muriel Cummins, member of TAMHSS
Why the ICF Should Underpin Functional Capacity and Support Needs Assessments for Psychosocial Disability—Across NDIS and Broader Mental Health Systems
The International Classification of Functioning, Disability and Health (ICF), developed by the World Health Organization (WHO, 2001), offers a globally endorsed biopsychosocial framework for understanding disability. It recognises that disability arises not only from medical conditions, but also from the interaction between impairments, personal factors, and environmental barriers. This framework is particularly important for people with psychosocial disability, whose impairments may be episodic, fluctuating, or not immediately visible (Hamilton et al., 2020; Byrne et al., 2021).
Reflecting the Nature of Psychosocial Disability.
Psychosocial disability often includes symptoms such as cognitive difficulties, emotional dysregulation, social withdrawal, and motivational fluctuations. These issues rarely present uniformly and often vary by day, context, or support environment (Muir et al., 2020; Salzer & Baron, 2016). Unlike many static physical disabilities, psychosocial disability is characterised by periods of stability and acute distress, making its functional impact difficult to capture using standardised diagnostic or deficit-based tools alone.
The ICF provides a structured way to assess how such impairments affect participation in everyday life. It enables clinicians to document how symptoms interfere with communication, self-care, community access, and other domains of functioning—key criteria under Section 24 of the NDIS Act (NDIS, 2024a). This is especially valuable for psychosocial disability, where people often fall through eligibility gaps due to the lack of tailored, contextualised assessment tools (Joint Standing Committee on the NDIS, 2017).
Supporting Equity in Access and Planning
People with psychosocial disability remain under-represented in the NDIS and are more likely to experience rejection at access (AIHW, 2020; Smith-Merry et al., 2018). A key driver of this inequity is misalignment between standard evidence requirements and the lived realities of fluctuating mental health. The ICF can help bridge this gap by offering a personalised, participation-focused framework that supports consistent and transparent assessment processes.
The ICF allows assessors to explore:
Capacity: What a person can do in an optimal or community setting;
Environmental supports or barriers: Which factors restrict or enable participation.
This enables both diagnostic-independent access decisions and more accurate identification of supports that are reasonable and necessary under Section 34 of the NDIS Act (NDIS, 2024a).
Foundation for Dual Assessment Pathways Under the 2024 NDIS Reforms
The NDIS Amendment Act 2024 introduces two formalised assessment pathways:
Functional Capacity Assessments (for eligibility determination)
Support Needs Assessments (for planning) (DSS, 2024)
The ICF can underpin both pathways, ensuring that assessments are person-centred, rights-based, and consistent across providers and jurisdictions. It supports:
Functional evidence of substantially reduced capacity in relevant domains (eligibility);
A clear, contextualised understanding of environmental modifications, capacity-building, and community access needs (planning).
As national assessment reforms progress, embedding the ICF will help reduce variability, increase transparency, and align with international human rights obligations (UNCRPD, 2006).
Broader System Integration: Mental Health Beyond the NDIS
Importantly, the ICF is not limited to the NDIS. It is already used in Australian rehabilitation, aged care, and mental health settings (Madden et al., 2014; Hancock et al., 2018). Embedding ICF in psychosocial assessment allows for continuity of evidence between NDIS and non-NDIS supports—including PHN-commissioned programs, clinical mental health services, and community-managed organisations.
This unified approach also strengthens outcome measurement. ICF-based tools such as WHODAS 2.0 and the LSP-16 have been validated in Australian psychosocial contexts and are compatible with existing clinical, functional, and quality of life metrics (O’Brien et al., 2022). When used in combination, they provide reliable data to inform service access, planning, and review.
Best Practice and Workforce Alignment
Occupational therapists are among the most frequent professionals contributing to NDIS access reports and support planning evidence for people with psychosocial disability. The ICF aligns with OT core values, focusing on function, participation, and meaningful occupation (OT Australia, 2022). The use of ICF also promotes consistency across multidisciplinary teams, including peer workers, mental health nurses, and psychologists, supporting shared language and goals.
Embedding the ICF into national assessment and planning approaches provides a solid foundation for:
Equity of access to supports;
Coherent communication across systems and services;
Evidence-informed decision-making aligned with Australia’s obligations under the UNCRPD.
Conclusion
For people with psychosocial disability, the ICF enables meaningful, contextualised assessment that reflects the complexity of mental health-related functional impairments. It should be embedded in functional capacity and support needs assessments across NDIS and broader mental health systems. This will ensure fairer access, more accurate planning, and a system grounded in participation, recovery, and rights.
References
AIHW (Australian Institute of Health and Welfare). (2020). People with Disability in Australia. Canberra: AIHW.
Byrne, L., Stratford, A., & Davidson, L. (2021). The centrality of choice: How shared decision making impacts recovery. Psychiatric Rehabilitation Journal, 44(1), 85–91.
Department of Social Services (DSS). (2024). NDIS Amendment Act 2024 – Implementation Guidance. Canberra: Commonwealth of Australia.
Hamilton, M. P., Dickinson, H., & Brophy, L. (2020). From entitlements to outcomes: The emerging role of functional impact assessment in the Australian NDIS. Disability & Society, 35(1), 68–92.
Hancock, N., Smith-Merry, J., & Gillespie, J. (2018). Understanding the role of mental health psychosocial support in the context of the NDIS. Australian Health Review, 42(6), 707–710.
Hopper, K. (2007). Rethinking social recovery in schizophrenia: What a capabilities approach might offer. Social Science & Medicine, 65(5), 868–879.
Joint Standing Committee on the NDIS. (2017). Provision of services under the NDIS for people with psychosocial disabilities. Canberra: Parliament of Australia.
Madden, R. H., Glozier, N., & Mpofu, E. (2014). The utility of the ICF framework in disability policy, service planning and research in Australia. Disability and Rehabilitation, 36(6), 527–534.
Muir, K., Powell, A., McDermott, S., & Flaxman, S. (2020). Review of psychosocial disability and the NDIS: A research summary. UNSW Social Policy Research Centre.
National Disability Insurance Scheme (NDIS). (2024a). Operational Guidelines: Access and Planning Criteria.
O’Brien, M., Thomas, J., & Hickey, C. (2022). Evaluating the WHODAS 2.0 in a community mental health population: Validity and practice relevance. Australasian Psychiatry, 30(5), 593–597.
Occupational Therapy Australia. (2022). Position Statement: Occupational Therapy and the ICF Framework.
Salzer, M. S., & Baron, R. C. (2016). Promoting Community Integration for People with Psychiatric Disabilities: Evidence, Practices, and Future Directions. Psychiatric Services, 67(5), 507–515.
Smith-Merry, J., Hancock, N., Bresnan, A., Yen, I., & Gilroy, J. (2018). Mind the Gap: The National Disability Insurance Scheme and psychosocial disability. University of Sydney.
UNCRPD (United Nations Convention on the Rights of Persons with Disabilities). (2006). Convention on the Rights of Persons with Disabilities. United Nations.
WHO (World Health Organization). (2001). International Classification of Functioning, Disability and Health (ICF). Geneva: WHO.
List of Recommended Assessment Tools Aligned with the ICF for Psychosocial Disability
Assessment of functional capacity and support needs for people with psychosocial disability should draw on validated tools that align with the International Classification of Functioning, Disability and Health (ICF). These tools allow for comprehensive, contextualised evaluation across eligibility, planning, and broader service systems—beyond diagnosis.
Key Assessment Principles
Use a combination of clinician-administered and self-report tools.
Incorporate carer, family, and support worker perspectives.
Choose tools that map directly to ICF domains and reflect functioning in real-life environments.
1. WHODAS 2.0 – World Health Organization Disability Assessment Schedule
ICF Basis: Developed by WHO to reflect ICF domains.
Domains: Cognition, mobility, self-care, getting along, life activities, and participation.
Formats: Available in 36-item self- and proxy-report version.
Use: Widely used in NDIS functional assessments and mental health contexts.
Strengths: Validated globally; suitable for both eligibility and planning assessments.
2. ICF Core Sets
Description: Selected subsets of ICF categories relevant to specific health conditions.
Relevant Sets: Schizophrenia and Depression Core Sets.
Use: Guide structured assessments across functioning, environment, and support needs.
Strengths: Offer condition-specific insights while remaining aligned to the broader ICF framework.
3. Canadian Occupational Performance Measure (COPM)
ICF Alignment: Captures individual goals within activity and participation domains.
Use: Identifies and rates performance and satisfaction in self-care, productivity, and leisure.
Strengths: Highly individualised; suitable for goal setting, review, and outcome measurement.
4. Life Skills Profile – 39 Item (LSP-39)
Purpose: A comprehensive tool assessing psychosocial functioning in people with serious mental illness.
Domains: Self-care, non-turbulence, social contact, communication, responsibility, and family harmony.
ICF Mapping: Strong alignment to ICF domains of self-care, social interaction, interpersonal relationships, and self-management.
Use: Widely used in Australian community mental health settings and in psychosocial disability assessment.
Strengths:
Offers a detailed picture of daily functional abilities across diverse domains.
Can be completed by clinicians or close informants such as carers or support workers.
Supports tracking of functional change over time and informs support needs planning.
5. Model of Human Occupation Screening Tool (MOHOST)
ICF Compatibility: Assesses volition, habituation, skills, and environment—mapping closely to ICF participation and activity domains.
Use: Especially useful for individuals with complex, fluctuating or non-visible disability.
Strengths: Supports contextual and strengths-based understanding of occupational functioning.
6. I-CAN (Instrument for the Classification and Assessment of Support Needs)
Design: Australian-developed tool based on ICF and used widely in NDIS contexts.
Domains: 12 life areas, including self-care, mobility, emotional wellbeing, interpersonal relationships, and communication.
Use: Supports both eligibility and support planning for psychosocial and cognitive disability.
Strengths:
Generates “I CAN” statements for personalised documentation.
Validated across diverse disability cohorts.
Integrates support needs and functional limitations into one structured tool.
Conclusion
These tools collectively enable comprehensive, ICF-consistent functional assessments for psychosocial disability. They can be used across service sectors, including the NDIS, to support access decisions, support needs planning, and outcome evaluation. Each tool brings distinct strengths, and using a combination allows clinicians to provide accurate, contextualised, and person-centred evidence of need.
References
Australian Institute of Health and Welfare (AIHW). (2020). People with Disability in Australia. https://www.aihw.gov.au
Centre for Disability Studies. (2020). I-CAN Instrument Overview. https://www.cds.org.au
Hamilton, M. P., Dickinson, H., & Brophy, L. (2020). From entitlements to outcomes in the NDIS. Disability & Society, 35(1), 68–92.
Hancock, N., Smith-Merry, J., & Gillespie, J. (2018). Psychosocial support and the NDIS. Australian Health Review, 42(6), 707–710.
Madden, R. H., Glozier, N., & Mpofu, E. (2014). The ICF in Australian disability policy and research. Disability and Rehabilitation, 36(6), 527–534.
Parker, S., & Rosen, A. (1994). The Life Skills Profile: A measure assessing function and disability in schizophrenia. Australian and New Zealand Journal of Psychiatry, 28(2), 265–276.
Resnik, L., Plow, M., & Ciechanowski, K. (2009). Measuring patient-centered care: A systematic review of tools. Medical Care Research and Review, 66(6), 660–690.
World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Geneva: WHO.
