Back to News

Long-term Support, Flexible Delivery and Step-up Step-down Services in Demand

This opinion piece by MHCC CEO, Carmel Tebbutt, ran in Sydney Morning Herald on November 10, 2020:

Women can get a meal, wash their clothes or just have a chat at Lou’s Place, a busy day refuge in inner Sydney. It also connects women to services in the community: crisis support, housing and mental health.

When I asked its manager what needed to be done to make the mental health system work better, she said most of the women visiting Lou’s Place have experienced abuse, which often underlies homelessness and mental health issues.

But Lou’s Place struggles to connect those women with longer-term mental health support to address their trauma.

Good initiatives are stretched to the max and there are simply not enough places, particularly those linked to accommodation that many people living with severe mental health issues require. New approaches are urgently needed.A few kilometres down the road, one such service is opening its doors. The Bondi Prevention and Recovery Centre (PARC) is a rambling house, converted to provide intensive community support to help people with mental illness avoid hospital admission (known as step-up services), as well as residential places for people who have been in hospital, meaning they can be discharged sooner (step-down).

Operated by Independent Community Living Australia in partnership with the local health district, its eight bedrooms are modest but comfortable, individually decorated to create a home-like environment in which people can continue to receive clinical support while also focusing on self-care and recovery.

The step-up step-down model is widely operated across Australia, with other states investing heavily in this approach. It is not hard to understand why; these services have demonstrated they can reduce unplanned mental health-related hospital admissions and they are half the cost of an in-patient bed. Research by KPMG shows step-up step-down services pay for themselves through savings in other parts of the health system.

Yet there are only a handful of these services across NSW, and the emergency department is still far too often the first option for people experiencing a mental health crisis. According to a recent report by the Australian College of Emergency Medicine (ACEM), the number of mental health-related emergency department visits nationally has risen by almost 50,000 a year between 2013–14 and 2017–18, putting extra pressure on hospitals.

Data collected by the ACEM shows people who attend emergency departments for help with mental health needs wait longer than other patients for assessment and treatment, potentially exacerbating their distress. And we know that the COVID-19 pandemic has further increased demand for mental health services.

Next week’s NSW state budget provides an opportunity for a serious injection of funds into a comprehensive network of step-up step-down services, delivered, like Bondi PARC, through partnerships between community mental health organisations and the NSW government’s local health districts. This should be accompanied by an expansion of community mental health hubs that offer co-located digital and peer support services, providing a soft entry point into the mental health service system for adults, similar to what the well-known Headspace centres do for youth.

Some of this is already beginning. The NSW government’s LikeMind pilot includes four centres providing integrated support to adults with moderate to severe mental illness, and the Commonwealth Government has invested in HeadtoHelp adult mental health clinics. But so far, the Commonwealth has only funded one such clinic in NSW, and that is not enough.

Community-based mental health support needs to operate consistently across the state, not as one-off initiatives dropped into a sea of need.

Nearly every week we see new polls showing the impact of COVID-19 on mental health. An IPSOS poll in late October showed 45 per cent believed their mental health had been affected “a great deal” or “fair amount” by the pandemic and the lockdown, and the impact is higher still for younger people. Governments have responded quickly and creatively, with new funding for innovative services or delivery modes, such as tele-psychology.

We have shown we can make mental health services available flexibly, according to people’s needs. Now we need to apply that commitment to the community mental health system, to make sure Lou’s Place, and all the other services like it, can always find long-term support for people whose needs are greatest.