QCQY and National Disability Insurance Agency

This matter concerned an application by QCQY to the Administrative Appeals Tribunal (AAT) challenging a decision by the National Disability Insurance Agency (NDIA) to refuse funding for sexual therapy services. QCQY, who has schizophrenia, sought funding for fortnightly visits to a sex worker, asserting that this support was crucial for managing his symptoms, improving his mood, and enabling him to cope with life's challenges. He argued that such interactions provided him with happiness, confidence, and clearer thinking, and that alternative social interactions were too overwhelming due to his condition.

The central legal issue before the Tribunal was whether the requested support, specifically funding for sexual therapy services provided by a sex worker, constituted a "reasonable and necessary" support under the National Disability Insurance Scheme (NDIS) Act 2013 (Cth). This required the Tribunal to consider the criteria outlined in the Supports Rules, including whether the support was likely to be effective and beneficial, represented value for money, and was related to QCQY's disability. The Tribunal also had to assess whether comparable supports existed that could achieve the same outcome at a lower cost.

The Tribunal considered medical evidence, including statements from QCQY and expert opinions. While QCQY provided evidence of the perceived benefits of engaging with a sex worker, the Tribunal found that this support lacked a credible clinical basis for managing schizophrenia symptoms. Expert evidence suggested that alternative supports, such as psychiatric treatment, psychotherapy, social skills training, and occupational therapy, were more efficacious in alleviating psychotic symptoms and offered long-term benefits. The Tribunal noted that QCQY had not provided evidence to discount the effectiveness of these alternative supports or to demonstrate that sex toys or aides would be insufficient for sexual release.

Ultimately, the Tribunal was not satisfied that funding for sexual therapy services provided by a sex worker met the criteria of being effective and beneficial in accordance with current good practice. Consequently, the Tribunal found that the requested support did not meet the requirements of subsection 34(1)(d) of the NDIS Act. The Tribunal affirmed the NDIA's decision, meaning QCQY's NDIS plan would not include funding for these services.