Time to address the ‘missing middle’ in mental health


New research has revealed too many people are falling through the gaps of Australia’s mental health system.

Lived Experience Australia (LEA) surveyed 535 people across the nation with lived experience as consumers of mental health services, to find out why they disconnected from services and what was preventing them from re-engaging with mental health care.

LEA’s executive director, Janne McMahon, said the patients falling through the gaps of services were known as “the missing middle”.

“Affordability is still an issue for many people – some respondents said their parents were paying for their private health; or if they were in the public system, they’d love to be seen by the private sector but simply couldn’t afford it,” she said.

“There was also a lack of communication. People felt they had to retell their stories over and over.”

The research findings revealed:

  • More than 50 percent of people said when they disengaged from services they deteriorated into crisis, some attempting suicide.
  • 48 percent of people, after presenting in crisis to emergency departments, were discharged with no follow-up or referrals.
  • 41 percent of consumers and 47 percent of carers said they could not access mental health services when needed.
  • General Practitioners were the primary source of mental health support, despite their generalist nature.

In good news for the private health sector, Ms McMahon said services and patient outcomes there were better.

“In the private system there is a greater range of services, it’s a more welcoming environment, and  people feel able to self-direct their own care. The quality of staff was excellent there and the accessibility to services when they needed it.

“Meeting the eligibility criteria for services is a big issue, particularly in private health, but wait times in private hospitals were not as bad and people feel it’s a better, more trusting environment,” she said.

“The private hospital system is there when needed and for the length of time that people needed – they don’t feel rushed to get out.

“I do feel for psychologists in the public hospital system. Someone presents to the emergency department and they have to assess, ‘Are they as bad off as patients we already have? Can someone go home to make room for them?' It’s really awful.”

Ms McMahon said in the absence of professional care, families were taking more responsibility for their loved ones dealing with mental health problems.

“It’s a hidden statistic, people are caring for their partners or children and there is no-one caring for them. Our report shows some confronting statistics but behind every statistic is a face, a person,” she said.

“The Missing Middle Report shows that at the extreme ends of the mental health system, people are able to access the support they need. However, at the other, far too many people are still slipping though the gaps.”

Up to 50 percent of people surveyed were unable to access care when they needed it in a crisis situation, but Ms McMahon said that didn’t seem to be as big a problem in the private sector.

“There were a lot of positives for the private sector but the main problem remains health insurance – people are experiencing hardship to hang on to their private health, because they’re terrified of having to go into the public system,” she said.

“The private sector is actually in a great position to support the whole system and we’ve got to do something.

“And also there needs to be a greater understanding between health insurers and private hospitals as to what are the gaps for patients, and we need to help carers more.”

The report was not all bad news, with some respondents reporting they had been supported and recovered enough to no longer need mental health services.

One respondent said the “best thing” was regular visits from a social worker with lived experience.

“They understood how difficult getting help could be and acted as a dependable rock I could rely on for support,” they said. “Patients who have disengaged need an empathetic, understanding, single point of contact. Someone the buck stops at.”

Ms McMahon said Australia had come a long way in the conversation surrounding mental health, but more concrete action was needed.

“More recently, there has been a great deal of discussion around people knowing it’s okay to say ‘I need to take two weeks off for my mental health’ and that’s great.

“But what we really need to be looking at is these people dealing with a complex, lifelong, diagnosable mental illness and they’re living with it and just doing the best they can – sometimes they have a flare-up or a crisis, and more needs to be done,” she said.

“I really feel a real sense of responsibility – these 535 people who entered the survey, it was long, it was confronting, but they persevered and they really bared their soul to tell us their lived experience.”

The Missing Middle Report has been presented to every level of government, as well as a number of healthcare and mental health organisations.

“Our mental health system is made of many parts – public, private, practitioners, nurses, staff, consumers and carers,” Ms McMahon said.

“Delivering the world’s best mental health system that our government is aiming for means everyone taking responsibility for their part in the change. Taking the time to listen to those who have lived experience, to include them in discussions and get the process happening.

“We can’t, in this day and age, have people with serious mental ill health not being supported and cared for.”

A copy of the report can be found here at the LEA website.

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