Stop Defining Life's Struggles as Mental Illness
Instead of rewarding psychological fragility, our government must stop incentivising young Australians to medicalise everyday struggles and anxieties and encourage resilience.
This article was first published on the 17th April 2026 in the Australian Financial Review. A selection of Josh’s columns will be published here on Substack a few weeks after they appear in print.
At the time, the government had just backflipped on its promise not to rein in the cost of Australia’s most out-of-control program, the NDIS, which provides money and services to anyone with a disability. This got Josh thinking... is there a deeper problem with paying people to be sick?
So the National Disability Insurance Scheme is not untouchable, after all. After years of insisting it’s just peachy (perfectly sustainable, nothing to see here!), the prime minister has made a stunning discovery. The most out-of-control government program in Australian history, he has deduced, may need a few minor tweaks.
Why has the NDIS, specifically, of all government programs, ballooned like no other? There are two insights here. One involves rethinking wellness and flourishing. The other is how incentives change behaviour, not just in policy, but in society, in our lives.
If you pay people to have disabilities, it’s unsurprising that more people will have disabilities. Not because they’re lying, but because life is genuinely challenging. And interpreting your challenges as a disability is what the NDIS is designed, unintentionally, to incentivise.
Many of the three-quarters-of-a-million people on the NDIS desperately need it. But because the scheme includes mental health conditions as well as physical ones, its scope is slipperier than most government programs. If you can get help by coding life’s struggles as a pathology, you’d be silly not to.
Governments are usually shrewder about targeting carrots and sticks. Pigouvian taxes, or “sin taxes”, discourage smoking, gambling and drinking. Subsidies incentivise rooftop solar, early childhood education, vaccination (by tying the Family Tax Benefit to vaccination status) – even, for a while, having babies.
Those programs are, by definition, contained. The baby bonus can only apply to fertile would-be parents. The Child Care Subsidy can only apply to families with pre-school-aged children. The number of potential recipients is knowable in advance. But what is the precise number of people who could use some help navigating life – and who might meet a diagnostic threshold? Sign me up to infinity and beyond, doc.
The cost of the NDIS is nearly quadruple what its founders projected, and it’s growing at double digits. In 2023, the scheme already cost more than all of Medicare, more than all federal aged care funding. I put this to Bill Shorten, then the minister for the NDIS, on my ABC Radio show at the time. He dismissed my concerns as “disaster media”, saying: “Any media coverage which says that the scheme’s not sustainable – I just don’t accept the start of that proposition.” I replied: “I don’t want to tell you how to do your job, but if I was living with a disability, I would also want to know that the minister was taking seriously the worries about the expansion of the system.” He bristled. “Disability,” he schooled me, “could be any of us, at any time.”
“Shoehorning psychological wellness into a negative model of relieving disability, rather than a positive model of promoting resilience, is distorting.”
Well, he was right about that. Now it’s all of us, all the time.
