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We keep pumping money into a system we know is at breaking point

In particular there have been calls to address what is being called the “missing middle”, those whose mental health conditions mean they are neither acute enough for emergency intervention, but not mild enough to be tackled with 10 subsidised visits to a psychologist.

Last week the Australian Psychological Society released a white paper calling for greater access to mental health services for people who are too unwell for preventative services but not unwell enough for acute services.


This follows the Australasian College of Emergency Medicine claims that people with acute mental health conditions can wait as long as six days for a bed – in what must seem like an eternity for someone in crisis, and indicative of the waiting times for care that those with less acute situations must face. When emergency department doctors are calling for additional community-based mental health care we know the current system is at breaking point.

These calls from professional organisation for a rebalancing of the mental health system – on the back of what seems like daily reports of someone who has died because they slipped through the cracks – may be the game changer because real reform requires advocacy from all who work in and use the mental health system. Having this sort of advocacy – when mental health is under the spotlight as never before, with the Productivity Commission Inquiry in mental health – is very important.

And, while the Productivity Commission will not report until 2020, the NSW Budget, which will be handed down this week provides an opportunity to implement the change we know will make a difference.

So what needs to change? NSW mental health spending is below the national average per capita and we spend a greater proportion of the mental health budget on acute mental health services than any other state in Australia.

The numbers of people reporting to emergency departments due to mental health issues has grown 76 per cent.

The numbers of people reporting to emergency departments due to mental health issues has grown 76 per cent.Credit:ninevms

Those in power need to listen to the experts on the front line – the psychologists and the emergency doctors who know and want more resources shifted towards early intervention and community-based support. Services must be recovery-oriented, with people with a lived experience of mental health conditions involved in their design and delivery.

There are some great models of how to bridge the gap between acute care and returning to the community. The NSW Housing and Accommodation Support Initiative reduces mental health emergency department presentations by more than half after two years participation.

The Step-Up Step-Down services assists people discharged from hospital to return home in a gradual and supported way and provides a “step up” function where someone who is unwell can self refer to a therapist if needed. This program works and is half the cost of an inpatient bed yet there are only a handful of these networks across the state.

There have been significant improvements in mental health over the last decade – there is greater awareness and understanding in the community about mental health issues and funding and services have increased. We have mental health commissions at both a state and national level and the peer workforce is growing.

Reviews such as the Productivity Commission and the ongoing royal commissions are important. But there are programs that exist that work, that ensure that people with mental health problems and their families are supported and don’t slip between the cracks.

Providing funding for these and other community-based mental health services in the upcoming budget won’t be just a Band-Aid until the loftier recommendations are made, let alone acted upon, they would be a life saver.

Carmel Tebbutt is the chief executive officer at NSW Mental Health Co-ordinating Council.

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