QFHY and National Disability Insurance Agency

The Administrative Appeals Tribunal considered the dispute between QFHY (the applicant) and the National Disability Insurance Agency (the respondent) regarding the provision of reasonable and necessary supports under the National Disability Insurance Scheme (NDIS) Act. The applicant sought funding for a sex worker to be used as part of a therapeutic approach, termed "the Guide," designed by the applicant to address challenges in communicating with and relating to women, stemming from autism and associated cognitive and psychosocial issues. This approach combined cognitive behavioural therapy with in vivo and graded exposure therapy, where the sex worker would simulate interactions with women through role-playing, including a sexual component.

The central legal issue before the Tribunal was whether the proposed support, specifically the engagement of a sex worker for exposure therapy and associated costs for a support worker, constituted a "reasonable and necessary support" under subsection 34(1) of the NDIS Act. To determine this, the Tribunal was required to consider the factors outlined in subsection 34(1), including whether the support would be effective and beneficial for the applicant, aligned with current good practice, and represented value for money. The Tribunal also had to consider relevant rules, including those pertaining to the quality and safety of supports.

The Tribunal's reasoning focused on the evidence presented, including expert reports and the applicant's own detailed explanations of his proposed therapeutic model. While acknowledging the applicant's innovative approach and the potential for psychological benefit, the Tribunal was not satisfied that the proposed support would be effective and beneficial, nor that it met the threshold of "current good practice" as required by the NDIS Act. The Tribunal found that the applicant's proposed exposure therapy, involving a sex worker, had not been sufficiently researched, reviewed, or tested by qualified professionals. Expert opinion, particularly from a consultant forensic psychiatrist, raised concerns about the lack of a therapeutic framework, the potential for harm through unpredictable interactions and rejection, and the absence of established ethical guidelines in the proposed engagement. The Tribunal distinguished the applicant's case from a previous decision (WRMF) where a similar support was considered, noting significant differences in the underlying reasons for seeking the support and the applicant's lack of lived experience with the proposed therapy.

Ultimately, the Tribunal affirmed the respondent's decision, finding that the applicant had not satisfied the requirements of section 34(1) of the NDIS Act. Consequently, the Tribunal was not satisfied that funding for a sex worker to engage in exposure therapy, or the associated support worker costs, constituted a reasonable and necessary support under the NDIS.