Content warning: This article discusses mental health issues, suicide, and cyberbullying, which may be distressing for some readers. If you need support, please see the resources at the end of this article.
Australia’s mental health system is at breaking point. If you or someone you love has ever struggled to access timely, compassionate, and effective mental health care, you’re not alone. In fact, you’re part of a growing majority.
The cracks in our mental health system are now so wide that even those with private health insurance, supportive families, and the will to seek help can find themselves falling through. So, how did we get here? And, more importantly, what can be done to fix it?
Dr Ashwini Padhi, a psychiatrist with decades of experience in the United Kingdom and Australia, did not mince words: ‘The system is in crisis.’
He’s seen the best and worst of mental health care, but says he’s never witnessed the level of strain and dysfunction that exists today.
The reasons are complex, but at their core are skyrocketing demand, chronic underfunding, and a workforce stretched to its limits.
The COVID-19 pandemic turbocharged an already growing mental health crisis, especially among young people.
Anxiety, depression, and other mental health conditions are on the rise, with young women particularly affected.
According to the Australian Institute of Health and Welfare, more than 43 per cent of Australians aged 16 to 85 have experienced a mental illness at some point, and 22 per cent experienced mental ill-health in just the past year. That’s over 8.5 million people.
Yet, as Dr Mark Cross, another leading psychiatrist, puts it: ‘The system is broken, not fit for purpose. We simply can’t keep going in the same business-as-usual manner.’
Behind these statistics are real people and families. Katerina Kouselas’s husband died by suicide just three days after being discharged from the hospital.
She told the Victorian Royal Commission, ‘I believe the mental health system failed him. And it might be failing lots of other people we don’t know about.’
Sadly, stories like this are all too common. In January, more than 200 New South Wales (NSW) psychiatrists threatened to resign over poor wages and working conditions, with many following through.
One of those who left, Dr Prachi Brahmbhatt, said, ‘I could no longer be complicit in a system that was actively harming my patients and colleagues.’
Why is this happening?
The reasons are many, but a few stand out:
- Underfunding: Mental health accounts for 13 per cent of Australia’s total disease burden, but receives only 7 per cent of healthcare funding. As Dr Padhi points out, ‘There’s more publicity in opening a swanky cardiology unit than a mental health ward for the homeless and disadvantaged.’
- Workforce shortages: Exhausted, underpaid staff are leaving in droves. Even if every top high school graduate chose psychiatry today, filling the gaps would take a decade.
- Fragmentation: The system is a patchwork of federal and state programs, private providers, and community groups, with little coordination. Patients often fall through the cracks.
- Access inequality: In inner-city Perth, there are 107 psychiatrists per 100,000 people. In regional NSW, there’s less than one. Even in the cities, waitlists are long, and costs are high—$200–$350 per psychologist session and $350–$500 for a psychiatrist, even after Medicare rebates.
For many, the only option in a crisis is the hospital emergency department (ED). But EDs are chaotic, overstretched, and ill-equipped for mental health care.
Emergency presentations for mental health have more than doubled since 2011. The average wait is seven hours; 10 per cent of patients wait more than 23 hours for a bed.
Monique (name changed), a Melbourne woman with a long history of depression, found herself waiting 13 hours in the ED after a medication overdose.
She was told she wasn’t ‘sick enough’ to be admitted, and sent home with a family member and a phone check-in every two days.
‘How many people like me are just sent back out the door?’ she wondered.
Hospital staff are under constant pressure to free up beds. Dr Padhi describes daily ‘Executive Huddles’ where managers push for more discharges, sometimes before it’s safe.
Home Treatment Teams, meant to support people after discharge, are overloaded. They often have three times as many cases as they can handle.
Recent inquiries have called for thousands more mental health beds, but there simply aren’t enough psychiatrists to staff them. Also, attracting professionals to rural and regional areas is a significant challenge.
Innovations and silver linings
It’s not all doom and gloom. There are glimmers of hope and innovation:
- Medicare mental health centres: Free, strategically located services offering up to three months of care and help navigating the system. But there aren’t nearly enough of them.
- Telehealth and online support: Services like Headspace and Beyond Blue are making a difference, especially in remote areas.
- Peer navigators and lived experience practitioners: People who’ve been through the system can offer unique support and understanding. Dr Padhi’s introduction of peer navigators and mental health nurses in EDs has been a game-changer for many.
- Specialised support: Susan Boden’s story is a rare example of what’s possible when the proper support is available. After a severe postnatal mental health crisis, she was able to stay in the hospital with her baby and husband. She later became a mental health practitioner, helping others navigate the system.
What needs to change?
Experts agree: we need a long-term, bipartisan plan for mental health in Australia that goes beyond election cycles and is designed with input from the community. This plan should:
- Increase funding to match the true burden of mental illness.
- Address workforce shortages with better pay, training, and incentives to work in underserved areas.
- Expand access to free and affordable care, especially in regional and remote communities.
- Invest in prevention, early intervention, and social connection—because mental health support often happens outside clinics, in our communities, families, and social groups.
- Reduce stigma and address the unique needs of vulnerable groups, including culturally and linguistically diverse people, Aboriginal and Torres Strait Islander people, those living in poverty, people with disabilities, and LGBTQI+ Australians.
As Georgie Harman, chief executive officer of Beyond Blue, said, ‘We actually need a long-term vision and plan of where we want to get to as a country in terms of mental health. What we have is a loose confederation of confetti.’
Where to Find Help
If you or someone you know needs support, please reach out:
- Lifeline: 13 11 14
- Beyond Blue: 1300 22 4636
- Headspace
- Kids’ Helpline: 1800 55 1800
- 13YARN (for Aboriginal and Torres Strait Islander people): 13 92 76
Have you or someone you know struggled to access mental health care in Australia? What changes would you like to see? Share your story or thoughts in the comments below—your experiences can help shine a light on what’s working, what’s not, and what needs to change.
