Today MHCSA Executive Director presented once again to the Health Services Committee at Parliament House. Previously we talked to them about the Chief Psychiatrist’s Report on the Unmet Needs on Pyschosocial Supports. This time we brought the committee up to date on our pilot to address the unmet needs.
Following is our full speech;
Thank you once again for the opportunity to speak with the Health Services Committee today. Before I begin I would like to state that the Mental Health Coalition of South Australia recognises and acknowledges that we are living and working on traditional lands of the Kaurna people and recognise their cultural, spiritual, physical, emotional, intellectual and economic connection with this land.
We also recognise the tireless work of lived experience advocates who have shaped the progress we have achieved today and those who contribute towards our vision for the future.
The last time we provided information to the Health Services Committee it was June 2024 and it was our President Paul Creedon who came to present to you the study commissioned by the Office of the Chief Psychiatrist which revealed a troubling reality: over 19,000 South Austrlaians living severe mental ill-health in our state are not receiving the necessary support they need to live well in the community.
That report was well over a year old when we came to talk to you about it, and now we are approaching the second anniversary of its completion – and what can I tell you?
That 19,000 South Australians each year are still living without the support they need to live well in the community, that we know what it looks like nationally – and it is no better, however, in some good news I can say we come here with a solution.
As you all know – psychosocial support services, usually delivered by non-governmental mental health organisations play a pivotal role in making our health system effective for people with more complex issues or needs. These services are essential for helping people with mental ill-health to not only manage symptoms of illness, but to participate socially and economically in our State and improve their overall quality of life and wellbeing.
Our SA unmet needs study showed us that only 25% of these South Australians have access to the services they need, leaving a staggering 75% without adequate support.
The investment required to address this gap stands at an estimated $125 million per year —just 2% of our current health budget. This cost is not only reasonable but necessary if we are going to address our mental health crisis.
We know from evaluations of SA NGO services (and research in other places) that psychosocial support helps individuals to lead better lives and reduces their need for crisis and acute mental health services. Investment in this part of the mental health system will make the other parts of the mental health system more efficient and effective for this group of people.
Addressing this gap will have a positive impact on families, friends and particularly carers. We must take into account the impact on caregivers. Nearly 40% of carers in South Australia are looking after loved ones who are accessing mental health services. These caregivers face heightened psychological distress due to the demands of their roles. It is crucial we recognise this and ensure they receive the support they need in as part of this.
But before I lay out our plan to meet this unmet for mental health support for South Australia let us look at what our national unmet needs study revealed.
The National Unmet Needs report was commissioned by the Federal Government and completed through the Psychosocial Project Group in May last year. That following August the Mental Health Ministers from across Australia were brought together after extensive advocacy from stakeholders, and they released the sobering numbers on the national unmet needs for psychosocial support. The national picture estimates that 285,470 Australians—over a quarter of a million people—are in urgent need of psychosocial support, yet they are not receiving it. These numbers are not just statistics; they represent individuals, families, and communities across the country that are struggling under the weight of lack of effective support from an overburdened system.
Throughout Australia the consequences of this gap are profound and as we see, it is not just here in South Australia people and their families are unable to access the necessary support. Nationally our hospital-based crisis and acute care services are facing unprecedented pressure. Our healthcare system is stretched thin, unable to keep pace with the rising demand for mental health care.
During the National Health and Mental Health Ministers meetings, they resolved to meet regularly to address these issues and we hope that this will lead to significant changes to our national picture.
Meanwhile, the national report highlights the urgent need for focus on specific demographics. However, I must emphasise the concerning absence of a clear rationale for excluding the needs of those over 65 from the summary findings in the paper. This may lead to neglect of an appropriate response to an entire segment of our population that needs – and deserves – psychosocial support specific to their needs.
The report does recommend prioritising work with First Nations peoples, who experience disproportionate levels of unmet need for social and emotional wellbeing support. It is critical that we engage with these communities not just to listen but to implement culturally appropriate and responsive mental health support systems that honor their unique contexts.
Back here in South Australia, while the national work was going on we knew we were ahead of our interstate colleagues. We knew the number of South Australians needing our support but this raised questions of how to engage them in services. That was our next challenge.
We started with looking at where to find people who had unmet needs and went to locations where we knew there was significant mental health need but also where there were strong networks of mental health stakeholders who were passionate about improving mental health in their local area. The areas we chose were the Barossa Valley and Northern metropolitan Adelaide.
In collaboration with government and non-government mental health services, police, general practice, local councils, community services, and individuals with lived experiences in these areas – and more – we sought advice about solutions that would be effective in the local community and service context.
From this stakeholder engagement and the relevant evidence-base, we identified a critical investment requirement for these regions: $2 million annually for Barossa and $30 million annually for Northern metropolitan Adelaide (NALHN). This vast majority of this investment will deliver the essential psychosocial support services identified as missing in the unmet needs report, but also includes a small but essential investment on workforce development and impact measurement.
A key component of the proposed approach is the integration of lived experience Peer Workers within general practices. These Peer Workers will collaborate with GPs to deliver enhanced physical health outcomes and the concept of ‘social prescribing.’ This means that when a patient presents with mental health concerns, instead of the GP struggling with limited time to understand and find support options for people with complex needs, they can refer to the Peer Worker.
The Peer Worker will then be the gateway to psychosocial support and engage with the patient individually to navigate effective access to other services that they need—whether it be housing support, financial support, work on relationships, employment services, domestic violence assistance, drug and alcohol programs or more. It will also include looking for opportunities within the community for connections to overcome isolation and pursue interests including sport, social, recreational, or volunteering activities.
The enthusiasm of GPs for this approach has been integral to its development. We discovered early on in our work that mental health issues were the number one presentation at their practices.
Our research clearly indicated that this kind of referral system for psychosocial support is severely lacking in our current healthcare landscape, leading to unnecessary strain on both patients and healthcare providers. This strain was communicated to us strongly in our work in the Barossa and the Northern suburbs.
Between 2021 and 2024,a project called Assisting Communities Through Direct Connection (ACDC), was delivered by our peak body Community Mental Health Australia (CMHA). This was a national project but included a focus on the City of Salisbury. The door knocking of 3,000 households across The City of Salisbury revealed a high level of mental health need with a high proportion of people reporting low wellbeing and moderate to high psychological distress.
Householder survey data reveals some of the potential drivers of or associations with poor mental health including unemployment or underemployment, loneliness, physical health issues, housing stress, financial stress, discrimination, alcohol and other drugs issues and food insecurity.
Utilising a small grant, we are currently doing more detailed follow up work in the City of Salisbury on place-based solutions to address the unmet need for psychosocial support amongst priority populations in the area. A key focus of the project is to explore ways to start conversations with priority population groups, in order to offer information through proactive outreach, rather than waiting for people to present to services in crisis to ask for help.
We have developed draft models of care with lived experience representatives from priority population groups in the City of Salisbury, including carers, women aged 65 – 74, First Nations people, migrant communities and workers in the logistics, manufacturing and construction industries.
We have been guided by input from a wide range of organisations and individuals including The City of Salisbury Council, NGO Mental Health Services, GPs, First Nations organisations, local business and other health, social, welfare and community services.
So while the rest of the country grapples with its unmet needs, you can see once again SA is leading the way in developing solutions, but now we need the support of our leaders to invest in these solutions for the benefit of 19000 individuals and their families each year.
As mentioned earlier, the bulk of the investment required is in service delivery but we also need to invest in workforce development. Workforce is an issue everywhere but expanding the psychosocial support workforce is less difficult than other areas of health. Already, there is increased pressure from SA funders on NGOs to increase the number of qualified Lived Experience Workers in the workforce. Our organisation has been proactive in supporting this growth with Health SA funding for our Lived Experience Workforce Program (LEWP).
The Sector is facing an increasingly challenging environment for recruitment of skilled workers and increasing pressure and so we are advocating for investment in workforce development to assist the Sector to compete with other sectors to recruit, train and develop the Mental Health workforce we need, particularly Lived Experience workers. Growing the Peer Workforce is an important national issue and failure to increase our investment will mean that SA’s sector will be left behind.
While we are using local knowledge and evidence-base to design the pilot programs in both regions we recognise that there is a lot that we don’t know.
As an evolving area of service delivery, we are also asking for a modest investment in independent University-based capacity to enable the services, and particularly the pilot elements to be evaluated. The researchers would work with the relevant stakeholders to co-design impact reporting and support quality improvement. This reduces the risk of suboptimal impacts and failure to adapt to changing client needs. The benefits of this will be to optimise outcomes over time through ongoing attention to quality improvement.
In our Budget Submission for the upcoming SA Budget we asked the Government to invest $16.36million to start to meet our state’s psychosocial support needs as quantified in the Unmet Needs Report.
Addressing these unmet needs is not just a matter of economic consideration; it’s our responsibility to ensure we are all able to live well in our communities. We are all aware of the detrimental effects that a lack of access to mental health support can have on South Australians well-being and quality of life.
