For too long, NSW's mental health system has been dominated by crisis-driven, hospital-based care, leaving many people without access to the supports they need before reaching breaking point.
Mental Health Coordinating Council is calling for a fundamental shift towards community-based services grounded in human-rights principles and practices. It's time to focus on prevention, recovery and social inclusion – proven strategies that reduce reliance on psychiatric services.
Community-based mental health programs have shown that when people with severe mental health challenges are supported to appropriate community-based living environments, hospital admissions due to mental ill-health is reduced by 74% and length of stays in hospital decreases by 74.8% over two years .
The recent Parliamentary Inquiry into the equity, accessibility and appropriate delivery of outpatient and community mental health care in NSW, recommended the State Government increase investment in these support services. Not only are community-based programs delivering life-changing outcomes for individuals, they also offer significant net cost-savings of up to $86,000 per person over a five-year period.
Amidst the intense focus on hospital-based services, these community-based models of care have been largely overlooked. The voices of those living with mental health challenges, along with their family and carers, hold crucial insights into what truly works and what doesn't—yet they have been left out of the conversation.
Jianna's* experience is a powerful testament to the positive impact these services can have. Since accessing the community-based service, the Prevention and Recovery Centre (PARC) in 2021, it has been life-changing. "My clinician from community mental health suggested PARC to me, and it has made a huge difference in my life," she says.
The PARC model is designed to provide an effective alternative to hospital and inpatient care, in a safe, least restrictive, home-like environment that focuses on building individual autonomy, personal recovery and early intervention. Guests can participate in social and group activities, build their confidence, self-acceptance and daily life and social skills. Led by people with lived experience, with integrated mental health care like mental health support staff and clinical staff, everyone participates in group activities like preparing meals together and morning and evening routines.
It's a model that focuses on personal agency and dignity for people living with mental health challenges, providing support for when people need to step-down into the community from hospital or an extra step-up at times to avert crises.
Before engaging with PARC's support services, Jianna says her mental health severely affected her life. "I struggled with daily tasks, social events, having a job and studying – all the normal things people do. I didn't have the concentration, energy and motivation to engage." She recalls feeling lonely and trapped, leading to depression and feeling a sense of hopelessness.
Jianna's experience with public psychiatrists in hospitals has been far less positive. "Overall, it has been pretty awful because I was misdiagnosed - along with the stigma around certain diagnoses - and just a general lack of care. The high turnover in the public system also means inconsistent psychiatric support, which affected my treatment – each psychiatrist I saw seemed to have a different idea of what is the best ongoing treatment."
"Knowing I have a place like PARC available if I need it provides comfort. There's a full team of people who care and are ready to support me, which increases my sense of safety," Jianna shares.
The Bondi PARC program run by member Independent Community Living Australia (ICLA) released an evaluation last month that showed the cost to run PARC is one third of the cost compared to inpatient support. People's use of hospital emergency and inpatient mental health services also decreased by 33-44%, learning to make early decisions about stepping up into PARC instead of requiring hospital care, when they feel unwell. There are currently only two step-up step-down service locations in NSW.
Dr Evelyne Tadros, CEO of Mental Health Coordinating Council, says, "The future of mental health care must be built around people, and their networks, not just hospitals. We need a system that recognises the power of lived experience in recovery, the peer workforce and community-led models that keep people well and out of crisis."
*name changed
