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We Need to Talk About Mental Health: Fixing a Sick System

Charishma Kaliyanda

As Mental Health Month approached, not a day went by where we didn’t see another media report on the ongoing impacts of the pandemic on our collective worsening mental health.

They highlighted the people stuck on endless waiting lists as wait times to see mental health professionals blow out. They pointed out the looming mental health crisis in young people as they suffer loss of freedom, extended social isolation, lack of connection with peers from remote learning, increased screen use and a denial of celebrating milestones. They warned of the shortage of qualified professionals and the risk of burnout in the healthcare sector due to unsustainable workforce demands.

However, as Professor Ian Hickie from Sydney University’s Brain and Mind Centre has noted, these problems have been building for decades. Pre-pandemic, a quarter of Australians would experience a mental health challenge in their lives, up from an estimated one in ten about a decade ago. This has obviously placed pressure on mental health services, which have struggled to keep up with the demand, often without commensurate resourcing.

The pandemic has shone a light on existing inequities in our system. Mental health presentations are the fastest growing of any hospital admission. Once there, people stay up to twice as long as those with heart conditions – a clear sign of limited treatment and care pathways elsewhere in the system.

Issues around availability of high-quality mental health professionals and waiting times are reflected across many parts of Australia, especially rural and regional areas. The result of historical underfunding and fragmentation of the mental health system.

At the heart of this problem is the divide of funding and resourcing between the levels of government. Hospitals and some community-based services are funded through state governments, early intervention/preventative services and planning and resourcing the mental health workforce are generally a Federal responsibility. To complicate the mix, many services on the ground are delivered by non-government and not-for-profit organisations.

The question becomes – who is responsible for people that are too unwell for early intervention services, but not unwell enough to access acute, inpatient or community based support?

These questions are not easily answered and require a considered approach as the demands on our mental health system increase. The transition out of lockdown will be challenging for many. What is undeniable, especially for people in New South Wales and Victoria, is that levels of psychological distress have increased and our mental health has worsened. Last year, paramedics around the nation were called out 22,400 times to Australians who had attempted, or were seriously considering, ending their lives – an average of 61 calls per day. Lifeline’s three busiest days on record were all in August this year. More than half the call-outs for self-harm were in New South Wales.

What we do know is that exposure to cumulative disasters such as floods, bushfires, and cyclones, and chronic stress events like the pandemic, can disproportionately impact people already experiencing disadvantage. We can build resilience by improving emotional and material supportive strategies.

Emotional supportive strategies focus on reducing stress and transforming maladaptive behaviours to reduce emotional, social, and health problems. Material supportive strategies include policies providing easy and timely access to appropriate resources, such as drug and alcohol and domestic violence support services. We also need mental health policies, plans, and legislation that ensure the care and support of the most vulnerable and marginalised.

That includes rethinking the nation’s approach to treating mental health emergencies. An example of such a strategy is Safe Spaces, a pilot program in Blacktown, New South Wales, giving people in crisis an alternative to waiting in Emergency. Its focus on a soothing sensory environment and peer workers is in stark contrast to competing for attention in trauma wards and waiting rooms.

The importance of early intervention in preventing or delaying the onset of mental illness is crucial. Currently, many clinicians are not able to help clients with such strategies due to wait times, putting more pressure on the system downstream. This requires an urgent conversation around investment in and planning of the clinical workforce. The 2020-21 Budget included significant investment into new digital mental health assessment and referral platforms. A digital platform can’t replace face-to-face attention from clinical professionals, and it will be tech-savvy young people who are in danger of falling through the cracks if used without clinical oversight.

Psychiatrists are particularly in short supply, especially in rural areas and public hospitals, but demand for their care will continue long after the pandemic has passed. As Dr Omar Khorshid, President of the Australian Medical Association, identifies, the allocation of $11m for 30 new psychiatry training places by 2023 is woefully inadequate. It means waiting two years for places to be created and that’s before the training – which can take four to nine years – even begins.

That’s a serious generational lag to delivering what we need right now.

Charishma Kaliyanda is a Councillor on Liverpool Council and a youth mental health educator/worker in Southwest Sydney.


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