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I have witnessed first-hand the transformative impact of neuro-affirming, client-centred OT practice and am so scared and worried about going backwards.

Genuine Early Intervention

Private practices using a neuroaffirming model provide the first truly effective early intervention for mental health in young people that I have witnessed. Well before early warning signs of mental health difficulties", we are building self awareness, assertion and self esteem, so that their stress vulnerability bucket doesn't tip and become symptoms.

This approach is holistic, not limited to a single area of practice, and is genuinely aligned with each client’s unique goals.

Systemic Barriers and the Social Model of Disability

The challenges neurodivergent young people face in schools are systemic, not individual failings. By adopting a social model of disability, we recognise that the environment—not the individual—is often the barrier. Now that these challenges are visible, we have an opportunity to change systems (like schools) to better support these young people. It is the allied health funded currently by NDIS that are highlighting this need and advocating for change.

Misguided Government Narratives

Current government narratives suggest that current NDIS services including OT services are “not helping” because young people continue to struggle in schools.

This overlooks the reality that the system itself has not adapted to meet their needs, despite increased awareness.

Without OT's in there doing the advocacy for understanding and change the change that it is so desperately needed is unlikely to occur. You only have to ask one person with a lived experience of neurodivergence as adults to understand, this is not a new, but a newly seen problem.

Risks of Reducing OT Access

Proposals to replace individualised OT care with short-term, generic interventions (like a 6-week parent course) are inadequate and unrealistic.

Diluting OT models and delegating them to untrained, non-OT staff is disrespectful to the profession and undermines the quality of care.

There is no doubt there will be a lot of money given to the school system as a swap from NDIS money, however this is a big risk for the children, as the eyes observing their behaviour are unlikely to have the understanding of what they are seeing and recommendations on what will help as likely to be non evidence based and dangerous to the young peoples mental health. Rather it's likely we will see more of what we already see, the school will adapt within their current system and capacity (which is not set up or able to genuinely meet the need that we now know exists for many children) and beyond that, the family have no choice but to leave the school. Resulting in more school can't.

Families cannot afford to home school children, do not wish to, but don't feel safe or comfortable sending their child in to a system where they are set up to fail.

Long-Term Consequences

Removing or reducing access to individualised OT support will have significant knock-on effects:

Increased mental health crises in the future.

Reduced ability for neurodivergent young people to contribute meaningfully to society.

Loss of the progress made in recognising and supporting these young people.

OTs feel undervalued and concerned for the future of their clients.

The profession’s unique skills and holistic approach are essential for meaningful, lasting change. I am so tired of being undervalued in this profession. very ready to jump ship, but sadly I care too much about the clients.

Reducing access to OTs for neurodivergent young people risks undoing vital progress in early intervention and mental health. True change requires systemic adaptation, not just short-term or diluted solutions. The expertise of OTs is crucial for supporting young people to thrive, and cutting these services will have far-reaching negative consequences for individuals, families, and society.

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7-year-old making strong OT progress, funding uncertainty ahead

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7-year-old making strong OT progress, funding uncertainty ahead

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A 7-year-old client is currently engaging well in OT and demonstrating steady progress across key developmental and functional areas. With ongoing OT support, he has been able to build important regulation, participation, and skill development foundations.

However, his current funding is soon due to run out. This has left his parents feeling uncertain about what comes next, particularly whether he will be able to maintain the gains he has made or if there is a risk of regression without continued support.

This situation highlights the importance of timely and sustained access to OT services to support functional progress and prevent loss of skills for children with ongoing support needs.

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If someone had told me 13 years ago that being an Occupational Therapist would look and feel the way it does now, I’m not sure I would have believed them. Not because the core OT values or frameworks have changed, but because practicing within the NDIS has become so heavy and complex, and because the scheme feels so disconnected from the people it was originally designed to support.

Part of being an Occupational Therapist is having genuine care and empathy for the humans we support, which is often those who are navigating vulnerability - whether that's physical, mental, psychosocial or intellectual. Like NDIS participants. It's also about the unique skills and knowledge we have, and the way we use these to support people, and show up for them even when the policy frameworks or funding models make that difficult.

Working within the NDIS space is making this harder, to be an OT when our opinion and skills are not valued, we are experiencing empathy fatigue, the administration load feels astronomical, and when the people we support are bearing such a huge impact. The injustices that are occurring, the reduced continuity of care and the fractured service delivery are having very real consequences in people’s everyday lives. It is exhausting. For both clinicians and participants.

The major shortfalls of the NDIS are extremely concerning for participants, but also for the sustainability of the OT support available to participants who rely on it. I am genuinely concerned there will be a gradual exodus of OTs from the NDIS space - not because we don’t care, but because caring and working within this environment is becoming harder to sustain.

Unless there is genuine systemic change, as this campaign highlights there is real risk of losing the practitioners the scheme needs to function. It is scary and I am holding out hope we see the change our participants, OTs, and this country needs.

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I was the only therapist allocated a participant with mental health seemed the highest category of complexity in NDIS. After being on boarded, the LAC had the participant removed from their caseload. There was no warning, no replacement. The participant only had me. It took 16 months for another staff member to get onboard for funding and support. After I did the FCA at the request of NDIS, the NDIS planner told my client that she "should just get mental health support from a care coordinator or friend". I had to then stop the meeting and provide education to the NDIS planner to why this is not recommended, and to NOT give my client unsolicited Mental Health advice. They cut her OT funding after that.

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No OTs, No NDIS: A Frontline Perspective on Reform

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No OTs, No NDIS: A Frontline Perspective on Reform

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I am the Director of Building Blocks Therapy Hub, a paediatric therapy practice established in 2002 that supports hundreds of children and families across New South Wales.

Every week, I see the difference the NDIS can make when it works well—and the consequences when it does not.

I want to be clear from the outset: I support reform of the NDIS.

The Scheme must be sustainable. Funding should be directed towards those who genuinely need it. There must be accountability, consistency, and a strong focus on functional outcomes and participant independence.

What concerns me is not that reform is occurring.

What concerns me is how inconsistently it is currently being experienced by participants, families and providers.

Every day, occupational therapists help children develop the skills needed to participate in everyday life. We help children learn to communicate, regulate emotions, manage self-care, participate at school, engage with their peers, access their community and build independence.

Occupational therapy is not simply about delivering therapy sessions. It is about helping people participate in life.

When access to occupational therapy is reduced, the impacts do not disappear. They are transferred to families, schools, carers and other systems already under pressure.

Over the past twelve months, I have observed increasing confusion and anxiety amongst families attempting to navigate changes within the NDIS.

One family stands out in particular.

Their seven-year-old child was receiving supports due to ongoing social communication and language difficulties. Documentation had been provided recommending a further twelve-month extension of support to monitor developmental progress, particularly given a family history of autism and ongoing functional concerns.

The family had initially been advised that funding would continue until July, yet within 24 hours they were informed that the funding had ceased.

I sat with that parent during a therapy session as they cried.

Their distress was not about losing therapy sessions.

Their distress was about their child’s future.

Who would support their child now?

What would happen if difficulties increased?

How could they afford private intervention if needed?

Had their child simply fallen through the cracks?

These are not questions about funding.

They are questions about a child’s future opportunities, participation and development.

The emotional toll of these decisions is rarely captured in budget papers, but it is being felt by families every day.

What made this situation particularly difficult was that it occurred against a backdrop of significant inconsistency. In the same period that some families are losing access to supports despite ongoing functional concerns, we continue to see other participants entering the Scheme with substantial budgets for comparatively mild difficulties.

This is not an argument against funding those participants.

It is an argument for fairness, transparency and consistency.

Participants, families and providers should be able to understand why decisions are being made and trust that similar circumstances will result in similar outcomes.

We are also seeing a significant increase in requests for Functional Capacity Assessments.

While these assessments can be valuable when genuinely required, they are resource-intensive, expensive and time-consuming. They require many hours of clinician time and often consume thousands of dollars of participant funding.

Many clinicians are questioning whether this represents the best use of limited NDIS resources.

Over many years, occupational therapists have produced detailed reports, recommendations and evidence regarding participant needs. Yet many clinicians have experienced situations where detailed recommendations, supported by evidence and professional judgement, have not been reflected in funding decisions.

If reforms result in increasing amounts of participant funding being spent on repeated assessments, repeated evidence gathering and repeated reviews rather than direct supports and capacity building, we risk shifting resources away from the very outcomes the NDIS was designed to achieve.

Occupational therapy already represents one of the largest areas of allied health expenditure within the NDIS because of the central role OTs play in assessment, capacity building, assistive technology, home modifications, functional participation and independence.

If increasing proportions of occupational therapy funding are redirected towards repeated assessment and justification activities rather than intervention and capacity building, we risk spending more money proving need than addressing it.

As a provider, I am also concerned about workforce sustainability.

Our practice employs occupational therapists, speech pathologists, physiotherapists, allied health assistants, administration staff and support personnel. Like many providers, we invest heavily in supervision, professional development, governance and quality improvement to ensure families receive safe and effective services.

However, increasing uncertainty makes it more difficult to recruit, retain and support experienced clinicians within the NDIS sector.

This concern is not unique to our practice. Occupational Therapy Australia’s 2025 survey of NDIS occupational therapy businesses found that 55% failed to make a profit in the previous financial year, 14% were planning to close, and a further 50% were considering exiting the NDIS sector within three years.

These are not simply business statistics.

They represent future waitlists.

They represent fewer therapists available to support participants.

They represent reduced service availability in regional and growing communities.

Most importantly, they represent participants who may be allocated funding but be unable to find an occupational therapist to deliver the support they have been approved to receive.

Without a stable and sustainable workforce, participant choice becomes an illusion.

You cannot choose a provider that does not exist.

You cannot access services that are unavailable.

And you cannot achieve functional outcomes without the workforce needed to deliver them.

The future of the NDIS should not involve shifting increasing administrative burden onto participants, families and providers.

It should involve building a fair, transparent and evidence-informed system that directs resources towards meaningful functional outcomes.

Participants deserve consistency.

Families deserve clarity.

Providers deserve a system that is workable, sustainable and focused on delivering outcomes rather than navigating bureaucracy.

Most importantly, people with disability deserve a system that supports participation, independence, choice and opportunity.

The question is not whether the NDIS should change.

It must.

The question is whether we can create a system that remains focused on function, participation and independence while also being sustainable for future generations.

Occupational therapists want to be part of that solution.

We are not asking for the NDIS to remain unchanged.

We are asking for reforms that are fair, transparent, clinically informed and consistently applied.

We see every day what works.

We see every day what does not.

We see the real-world consequences when supports are available, and when they are not.

Listen to participants.

Listen to families.

Listen to the clinicians working on the frontline.

Because the success of NDIS reform will not ultimately be measured by budget savings.

It will be measured by whether people with disability have greater opportunities to participate, belong, thrive and live meaningful lives.

That is the outcome we should all be working towards.

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I am an Occupational Therapist working with severely physically disabled NDIS participants. Many of my clients are totally dependent on a range of AT items plus 1:1 daily supports for their personal care, mobility, transfers and community access. When funding for Occupational Therapy intervention is restricted or capped this immediately impacts the functioning and reliability of my clients' essential AT items.

For example to name a few; breakages happen to ceiling hoist handsets, manual wheelchair parts/accessories, shower commode parts, hi-lo bed handsets, etc, from the wear and tear of daily use.

Also, due to the frequency of daily use, AT items require regular servicing. For example to name only a few; ceiling hoist tracks, ceiling hoist motors, wheelchair bearings/axles/brakes, hi-lo adjustable bed mechanisms, power wheelchair motors/axles/wheels, etc, all require regular servicing to maintain optimal reliability and functioning.

For many reasons my clients cannot manage these issues themselves. Maybe they don't have the cognitive capacity or maybe they are being cared for by elderly parents who can't cope with the complexities. Sometimes my clients are being supported in SIL homes where the staff don't organise the AT issues.

When an AT item breaks down it is stressful for my clients and can place them at risk of injury. They require my intervention and expertise with reviewing damage/breakages, arranging AT technicians to service and/or repair, ensuring the repairs are completed satisfactorily, and ensuring the AT items continue to support my clients' functional limitations.

This type of Occupational Therapy intervention cannot be scheduled or predicted as it depends on when the AT incidents/breakdowns occur. But it is still vital Occupational Therapy intervention and requires adequate funding to enable prompt responses and swift resolution of issues. When my clients depend on hoists for all transfers, they cannot be left without a safely functioning hoist. When my clients depend on power wheelchairs for their mobility; they cannot be left without a reliably functioning PWC.

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As an Occupational Therapist working with NDIS participants, I have seen firsthand how delays in accessing services can significantly impact people with disability and their families.

Many participants are already experiencing challenges with independence, self-care, mobility, emotional regulation, communication, or participation in daily life. When access to occupational therapy is delayed, these difficulties often increase, placing additional pressure on families and carers who are trying to manage without the supports they need.

I have worked with participants whose functional difficulties became more significant while waiting for services, resulting in increased stress for families and missed opportunities for early intervention. For children, delays can affect participation at home, school, and in the community. For adults, delays can impact independence, safety, and overall quality of life.

Occupational therapy plays a critical role in helping participants build skills, maintain independence, access assistive technology, and reduce long-term support needs. Timely access to OT services is essential, and any reduction in access can have real consequences for participants and their families.

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This page is part of Occupational Therapy Australia’s No OTs, No NDIS campaign. We welcome contributions from OTs and NDIS participants accessing OT services (including their families and carers) who have experienced challenges under the current NDIS reforms.

If you would like to contribute, select 'post' to share your story. We are focused on the challenges people are experiencing under the current NDIS reforms. For OTs, this might include workforce shortages or reduced travel or outreach capacity in regional and remote areas. For people with disability accessing OTs services, this could include delays in accessing treatment, cancelled services or overall negative impacts on your daily life, independence or safety.

By posting, you agree to the following:

You may post anonymously. You are not required to post any identifiable information in sharing your story. Please only share what you are comfortable making public.

If you are comfortable identifying, please include your State/Territory.

This board is moderated. All submissions are reviewed by OTA before being published.

Be respectful. Posts must be constructive and free from offensive, defamatory or discriminatory language.

Stay on topic. This space is for experiences relevant to the No OTs, No NDIS campaign. We are focused on collecting stories related to challenges under the current NDIS reforms.

No identifying details about others. Please avoid naming individuals, providers or organisations. OTA may make small edits to your post to meet our community standards.

Content may be used to support the campaign. Stories may be incorporated into OTA’s advocacy materials to help demonstrate the real‑world impact of a system under pressure. They will not be used outside this purpose.

By contributing, you are helping to strengthen our collective voice in calling for a sustainable future for OTs and the people they support. For questions or concerns, please contact policy@otaus.com.au

If you need support or if you are in crisis, you can contact 000, LifeLine (13 11 14) or 1300 YARN for culturally safe support for Aboriginal and Torres Strait Islander people.

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No OTs, No NDIS is a OTA campaign responding to NDIS reforms that are limiting access to essential occupational therapy supports and impacting participants, families and communities.