Art and music therapies can be ‘life changing’ for people with disability

From November, music and art therapists will be able to charge the National Disability Insurance Scheme (NDIS) the same as counsellors, after an independent review found they can be effective and “even life changing” for some people with disability.

The National Disability Insurance Agency commissioned the review, led by health economist Stephen Duckett, after widespread criticism of pricing changes it announced last year.

In November last year, the federal government announced it would slash the maximum therapists could bill per hour from A$193.99 to $67.56, citing insufficient evidence they were effective.

This week, the National Disability Insurance Agency (NDIA) has accepted the Duckett Review’s 19 recommendations, and the finding these therapies are effective and beneficial for people with specific conditions and disabilities.

Here’s what we know, and what will change.

What’s changing

Art and music therapies will be restored to the “therapy supports” funding category, following last year’s unexpected announcement they would be restricted to the “community participation” category.

These NDIS funding categories are different in two important ways.

The first relates to the maximum hourly rate for an individual session. Therapy supports can cost a maximum of $193.99 an hour. In contrast, “community participation” costs are capped at $67.56 an hour.

The review recommended a new hourly rate of $156.16 for individual art and music therapy sessions – the same hourly rate as counselling. However this remains significantly lower than other allied health services with similar levels of training, such as occupational therapy.

The second difference is that therapy services and community participation programs have very different requirements for providing evidence they are beneficial, and for providers’ qualifications levels and training.

The review also recommended a clearer distinction between art and music as a therapeutic support, and art and music as an activity.

And it recommended these therapies should be delivered by a qualified and registered music or art therapist.

So, what’s the difference?

As a music therapy researcher, I am often asked to explain the difference between “music therapy” and “music activity”.

People can be confused because music activities might also make us feel good. For example, music activities such as singing in a community choir can have mental health benefits for adults. Learning to play the ukulele has been shown to build stronger empathic skills in children.

Music activities like these are valuable for many people, but they are not music therapy.

Music therapy practice is informed by research into the benefits of specific methods and techniques for people with disability. These include autistic children, people with profound disabilities, and people recovering from major injury.

For example, if a client is non-speaking, the therapist might use a vocal improvisation technique, creating supportive music to encourage the person to make sounds with their voice. The back-and-forth musical dialogue at first doesn’t rely on words. But the therapist may help the client extend to more expressive vocalisations and even word production.

In Australia, music therapists must complete a two-year master’s degree before they are able to register with the Australian Music Therapy Association, and engage in continuous professional development.

The review said artists or musicians who do not have relevant qualifications to register with their professional bodies should not charge the new hourly rate for therapy.

So, what does the evidence say?

The new review acknowledged that establishing the evidence for therapy and disability is a complex task.

Around one in five Australians live with disability. Each person has unique needs and strengths, and disability occurs across the lifespan, meaning needs can also change. But when studying whether a particular kind of therapy is beneficial, researchers will focus on a particular group of people, such as adults with cerebral palsy.

This means the quantity and quality of evidence available will vary across different age groups and conditions – and there may be gaps. So care needs to be taken when interpreting the research to consider whether findings from one study might be applicable to other people with similar goals, needs, or conditions.

Qualified therapists are trained to interpret this evidence. They may be working with a client whose condition or needs differ from what’s in the existing research literature. So, they will consider whether a study showing benefits for music therapy with one group (such as non-speaking autistic children) could be relevant to another (for example, other people who have limitations in verbal expression).

The Duckett Review acknowledges this challenge of generalising evidence across different therapies. But it also warns of possible discrimination against people with rare conditions that attract limited research funding, and calls for more research.