Our Submission to the Independent review of music therapy by Dr Duckett

For transparency, I have released the submission JAM music therapy made to the review, for your information. As one of 600 submissions received by Dr Duckett, this triggered an extension of the date from March 14th to April 17th. It takes time to read that much! With the Australian Federal election expected in May, the outcome of the review is likely some time away, after the election.

Until then music therapy continues to be funded under Capacity Building, Therapy Supports, with no changes as reiterated and confirmed by the CEO of the NDIS, Rebecca Falkingham.

 Feb 7th, 2025

I’m writing to you in relation to the announced independent review of NDIS funded music therapy commissioned by the NDIA on 13 December 2024, led by Dr Stephen Duckett AM. I understand the review will be undertaken until mid-March 2025 and I wanted to share my personal experiences and the benefits of music therapy for participants to ensure it remains as a NDIS supported therapy. 

I understand the review comes after sustained advocacy by the peak body, the Australian Music Therapy Association (AMTA), music therapy professionals and participants, opposing a leaked decision by the NDIA in late November 2024 to remove music therapy as a NDIS support in the absence of any consultation. Thousands of participants and their families across the country will be impacted by this decision.

Therapy supports provide NDIS participants with critical, often life-changing results, through goal-directed, individualised therapy. Music therapy is one of the many allied health professions providing therapy supports in the NDIS, along with occupational therapy and speech therapy.

Music therapy is supported by a strong evidence-base and delivers significant functional outcomes for participants. Music therapy professionals registered by the AMTA are Masters-qualified and meet the necessary accreditation requirements.

I acknowledge the importance of ensuring the sustainability of the NDIS for future generations. The NDIA has stated for evidence-based therapy to be funded through the Scheme, there needs to be evidence that the therapy helps participants improve or maintain their functional capacity in areas such as language and communication, personal care, mobility, interpersonal interactions and community living.

I am a fully qualified, registered music therapist with AMTA and have been since 1985. I have always aimed to deliver a quality, tailored music therapy program to my participants. I have worked in several work environments prior to the advent of the NDIS, and the promise of the NDIS to deliver meaningful lifestyles for the most vulnerable people in our society was, and is the motivator to be a registered NDIS provider. My life’s work has been to provide music therapy to people with severe and profound intellectual disability, including people with autism, cerebral palsy, Down syndrome and multiple disabilities and so on. To be actively involved in live music making is known to increase neuronal connections and promote brain plasticity. Affording my participants the opportunity to benefit from a non- speaking therapy, where connections and communication can occur in real time without words is a vital service to people who cannot and will never speak. Please refer to the beautiful example of this in the literature by Felicity North[1].

As a music therapist, the approach detailed in the Journal above echoes my approach, of meeting the child or person where they are, to create connections and provide avenues of communication, with the resulting benefits of emotional regulation. Live music affects everyone in all areas of functioning, socially, emotionally, physically, cognitively, spiritually and intellectually. On brain scans, music is shown to activate many areas of the brain[2].

For me, the power of music therapy is also the relationship developed with the participant through the music. I established my group music therapy program in 1998 with the intention to provide music therapy sessions to people with disabilities in the community, in line with the prevailing approach of the time - Social Role Valorisation (SRV) of Wolfensberger[3]. SRV (and the precursor, the Principle of Normalisation) instigated the deinstitutionalisation of people with disabilities across the world and promoted access to the regular rhythms of life which were denied in institutional settings. For me, I wanted to provide the opportunity for people with severe disabilities to go out in the evening and experience making live music, like other people in the community may choose to do[4]. My group participants attend for an average of ten years – with 2 participants attending from the very first session until now (26 years and counting!). The relationship I have with my participants is long and enduring and (I trust) life enhancing. The significance of being involved in a music therapy program designed with the needs of the participants first and foremost, where they experience belonging, cannot be understated. To paraphrase the social scientist, Dr Brene Brown[5], when you belong you reveal your authentic self.

Finally, I wish to share a couple of recent vignettes of my work with individuals. One of my participants is a young man with multiple disabilities. He has cerebral palsy, a wheelchair user, is completely nonverbal, and vision impaired. We have weekly music therapy. He often can be heard vocalising in excitement as he approaches the clinic door, knowing that he will have 45 minutes of music tailored just to him. He does not like to play instruments, preferring to vocalise/sing. I promote and support his vocalisations, singing interactively and improvisationally with him. He also loves particular pop songs so I am working to reinforce gestural communication so that he can clearly indicate his musical choices - and he now shakes his head from side to side rather than not responding. He has learned to nod his head as well in music therapy, but sometimes he just wants to put his head back and sing along too. Thus, a significant functional outcome for communicating choice has been achieved for this participant in music therapy- gestural communication which is understood in the community, but also a regular dose of vital personal nonverbal communication through live improvisational music therapy.

Another participant has Autism (level 3) with some disordered verbal capacity. They are highly musical, with the capacity to play numerous instruments at a young age.  On assessment, their mother stated to me that 'Music is their language' and it is evident that they connect more readily and regulate in the music therapy session. On assessment the goals established were to promote flexibility, maintain regulation and address social skills of sharing and turn taking.  Development of a rapport has been rapid and our connection through music has allowed me to address their emotional regulation challenges and insistence on sameness. In any one session we play the music of Debussy together, play an original song composed by the participant, sing a reggae, rock or jazz song. Progress is evident with turn taking of song choices developing, sharing of musical instruments and musically adapting and interacting through structured musical activities and songs. There is still much to do as they continue to require support with emotional regulation and social communication.

For my participants, the prospect of music therapy being removed is a serious concern for their health, wellbeing and overall development. As a therapeutic medium, music therapy is unique in their lives, offering an effective and efficient means to achieve their goals and to live satisfying and meaningful lives.

 It is not sensible or possible to compare music therapy to music activities, any more than it is not sensible to compare talking to speech therapy, or walking to physiotherapy.

 To deny my participants, who are some of the most vulnerable people in the community, access to music therapy, risks damaging their health and wellbeing. It will cost the NDIS far more to replace music therapy, one therapy that can address emotional, communication and social, physical and intellectual benefits in each session.  It is safe, effective, efficient and supported by extensive literature as evidence.

 It saddens me as an experienced and qualified music therapist, the profession is so misunderstood by the NDIS, despite being included from the outset, and with its own line item. I trust that this process of review has enlightened the NDIS to the significant benefits of music therapy to NDIS participants and the stringent requirements to enter and remain in the profession. I trust this review will support the return of Music Therapy, when delivered by qualified music therapists, registered with AMTA to therapy supports alongside our Allied health colleagues in the NDIS

 Finally, I wish to add a note regarding pricing, as this is part of the review. I run a small private practice and there has been no price increase for over 5 years. This is unsustainable in the current economic conditions, where the costs of every aspect of running a business is rising. Music therapy requires the use of many high-quality musical instruments and technologies to ensure the best service is provided. The purchase, maintenance and replacement of instruments is additional to all the other necessary inputs that a business requires.

Additionally, and unlike many of the other Allied Health professions, we are required to include GST in the price of our support when registered for GST. It is subject to exclusions which create extra administration to deliver and appear contrary to the spirit of the NDIS. When a person receives music therapy in their Government funded residence we are not required to charge GST. However, if that same person attends a session in the community (i.e. comes to the studio for a session, or to the groups in the community centre) GST is applied. So accessing music therapy in the community environment is penalised.

With the inclusion of GST in the price cap the cost of one hour of music therapy is less than the price for NDIS therapy services in 2018. Despite extensive advocacy by AMTA to Federal and State Treasurers and to the then NDIS minister, Bill Shorten to address the GST issue, no change has occurred and music therapy continues to be excluded from the ATO GST free list.

 To countenance a price reduction will likely cause most providers of music therapy to close their doors. Additionally, the price per hour is the price per session, not each hour of operation. The average utilisation rate is 50% but also now much lower with the damage that has been inflicted due to the NDIS threatening our exclusion - referrals have been seriously impacted. Additionally planners are continuing to deny inclusion of music therapy in plans despite information from the NDIS stating that there are to be no changes until the review is delivered. Without music therapy in participant’s plans that are being reviewed in this period will mean that they will lose access to a therapy for a year if not more, seriously affecting development especially for children.

The impacts of the NDIS’s poor communication regarding the status of music therapy has been devastating for our participants and has limited their rightful access to an effective and efficient therapy. The flow on effect from low referrals and music therapy denied in plans and any price reduction will be that private practices will close and our participants will bear the brunt of these closures. Participants will need to seek alternatives with other allied health providers in an already thin market with long waitlists. The impacts and flow on effects are already being felt and are wide ranging and serious for participants and their families and carers.

Finally, I know that AMTA will be providing an extensive submission to support the review, alongside other industry stakeholders. I also hope that Dr Duckett, as part of the review, meets with participants, their families and music therapy professionals to hear first-hand the importance of music therapy supports in the NDIS.

 I trust that Dr Duckett will appreciate that while we are a small profession we are passionate, educated, prepared and able to demonstrate that music, when delivered by trained, qualified and registered music therapists is effective, efficient, safe and necessary for our participants.

Yours sincerely,

Helen Cameron,

RMT; MMT

[1] North, F. (2014). Music, communication, relationship: A dual practitioner perspective from music therapy/speech and language therapy. Psychology of Music, 42(6), 776-790. https://doi.org/10.1177/0305735614552720

[2] Martins, M., Reis, A. M., Gaser, C., & Castro, S. L. (2023). Individual differences in rhythm perception modulate music-related motor learning: a neurobehavioral training study with children. Scientific Reports, 13(1), 1–12. https://doi.org/10.1038/s41598-023-48132-2

[3] Flynn, R. J., & Lemay, R. A. (1999). Normalization and Social Role Valorisation at a Quarter Century: Evolution,Impact and Renewal. In R. J. Flynn & R. A. Lemay (Eds.), Normalization and Social Role Valorisation at a Quarter Century: Evolution,Impact. Universtiy of Ottowa Press. http://www.uopress.uottawa.ca 

[4]  Cameron, H. J. (2017). Long term music therapy for people with intellectual disabilities and the National Disability Insurance Scheme (NDIS). Australian Journal of Music Therapy, 28, 1–15.

[5] Brown, B. (2010). The Gifts of Imperfection (10th anniversary edition ed.). Hazelden. https:/lccn.loc.gov/2021055703