Last week NSW Health released the long-awaited mental health service gap analysis, Review and Planning for Mental Health Services, providing a clearer picture of where those gaps exist across the system and where greater investment is needed.
NSW Health’s gap analysis brings together a statewide picture of how the mental health care currently being delivered compares with the level of care estimated to be needed, using the National Mental Health Service Planning Framework (NMHSPF).
Mental Health Coordinating Council (MHCC) has previously raised concerns about the limitations of this framework, which is itself under review. While these limitations need to be acknowledged, the findings provide important insight into where gaps exist across the mental health system.
Mental health services across Australia are not keeping up with demand
Researchers compared the mental health services people actually received with the level of service that experts estimate is needed using the National Mental Health Service Planning Framework model.
Key findings suggest:
- Almost every state and territory, including NSW, was providing less mental health care than people are estimated to need.
- This shortage existed across:
o Hospital mental health beds
o Community mental health services
o Community psychosocial support services - No state consistently met the recommended level of care.
This suggests two things:
- Australia probably needs more investment and resources in mental health services.
- The national targets may be very ambitious and may need to be achieved gradually rather than all at once.
How NSW compares with the rest of Australia
If someone needed admission to a mental health unit, NSW generally performed better than the Australian average.
Compared with other states, NSW was better at meeting demand for:
- Short-stay mental health beds
- Longer-stay mental health beds
- Hospital mental health beds overall
However, performing better than other states does not necessarily mean NSW is meeting the level of need in the community.
MHCC has previously raised concerns about relying on relative comparisons of ‘met need’ between jurisdictions. Comparing NSW with states and territories that may themselves have significant service gaps does not tell us the full scale of unmet need in NSW, including the ‘missing middle’ of people who are not receiving the level or type of support they need.
As MHCC has previously noted, calculating the total level of unmet need as a baseline would provide a stronger foundation for measuring service gaps, tracking progress and planning the investment required to build a more effective and less fragmented mental health system.
NSW does less well in community mental health services
Public community mental health services are things like:
- Mental health clinics
- Community treatment teams
- Outreach support
The report found that:
- Fewer NSW residents received these services than would be expected.
- However, those who did receive services tended to be seen more frequently than the national average.
NSW appears to provide more intensive support to people already in the system, but fewer people are getting access in the first place.
The same pattern occurs in psychosocial support services
Psychosocial services help people with:
- Housing
- Daily living skills
- Social participation
- Recovery support
The report found:
- Fewer people in NSW accessed these services than expected.
- But people who did access them received more hours of support than average.
Again, this suggests that NSW tends to provide deeper support to those already receiving services, but access is limited for many others.
Which groups need more support?
One of the strongest findings in the report is that young adults (18-24 years) are not receiving the support they need. Young adults are falling through the cracks, especially during the transition from child/adolescent services to adult services.
People aged 18-24 had:
- More unmet need than the average NSW resident
- Gaps in both hospital and community services
The report suggests:
- More youth-focused services
- Better engagement with young adults
- Better coordination between adolescent and adult mental health services
Children aged 5-11 and older people (65+)
Children aged 5-11 years were identified as needing more community mental health services, as there are not enough services reaching children in this age range.
NSW does not have enough specialist mental health beds for older people. Older adults were found to need more mental health hospital beds than any other age group, particularly acute beds (for severe mental ill-health), sub-acute beds (for people who are recovering but still need support before discharge).
Aboriginal and Torres Strait Islander people
The report found that Aboriginal and Torres Strait Islander people are often getting help only when they become unwell enough to require hospital care, rather than receiving enough support in the community beforehand.
The report recommends improving:
- Community services
- Access pathways
- Engagement with Aboriginal and Torres Strait Islander communities
People living with moderate mental health challenges
The report found psychosocial services mostly focused on people with the most severe needs. While that is important, it means people with moderate mental health challenges may not be getting enough support until their challenges become more serious.
Regional versus metropolitan NSW
Access to inpatient mental health care was strongly influenced by where beds were physically located. Metropolitan residents generally had better access to mental health beds, while some regional Local Health Districts had among the lowest levels of demand being met in NSW. For children and adolescents, areas with dedicated mental health units generally had much better access to inpatient care.
The picture was different for community mental health services, where regional areas often performed better than metropolitan areas. Regional residents generally received a higher proportion of the community mental health services estimated to be needed, while metropolitan districts showed larger service gaps.
This suggests that some of the greatest shortages in community mental health services may be in metropolitan areas, highlighting the importance of looking beyond broad statewide figures when planning future investment.
The report also identified one Local Health District with low levels of demand being met across multiple parts of the system, including:
- hospital services
- community mental health services
- psychosocial services.
This points to a particularly significant service gap, where shortages are evident across the continuum of mental health care rather than within a single type of service.
Taken together, the report paints a clear picture: demand for mental health services exceeds current capacity across NSW and Australia. Substantial gaps remain in community mental health and psychosocial services. Unmet need is particularly evident among young adults aged 18–24, children aged 5–11, older people aged 65 and over, Aboriginal and Torres Strait Islander communities, and people with moderate mental health support needs. Importantly, while people who do access services in NSW often receive relatively intensive support, too many people are not accessing care in the first place. The findings point to the need for greater investment in community-based services, stronger pathways for children and young people, improved access and engagement for Aboriginal and Torres Strait Islander communities, and targeted investment where demand is least well met.
Read the full gap analysis report and associated notes from NSW Health here.
