“… when I asked for help, it felt like there was nothing there … it’s so heartbreaking when you finally work up the courage to voice the horrible things that you’re experiencing, but there’s nothing there to help you.” – Amelia Morris, Royal Commission into Victoria’s Mental Health System
Experiences like Amelia’s are common, indicating the gap in mental health services between those who are too unwell for general practice and primary care but not unwell enough for more specialised, tertiary services. Consequently, a large, growing group of people with ‘moderate-severe’ mental illness — ‘the missing middle’ — are falling through the gaps in the system of care.
According to the Australian Institute of Health and Welfare’s 2019 report into state and territory community mental health services, despite 3.1 per cent of Australians experiencing severe mental ill-health, only 1.8 per cent of the population received state or territory funded community mental health care in 2017-18, resulting in a gap in community specialist public mental health care provision for approximately 328,700 people. [1]
A further 1.2 million Australians with moderate mental ill-health are largely underserved by both Medicare-subsidised mental health supports and may require secondary or tertiary care.[2]
The ‘missing middle’ may or may not have accessed services before, but due to cost, exhaustion of rationed sessions, specialised care requirement, lack of transport and many more reasons, they are left without and potentially deteriorating.
Addressing gaps in the system of care
State, Territory and Commonwealth governments have now agreed to share responsibility for addressing gaps in the system of mental health care for the ‘missing middle’ through the National Mental Health and Suicide Prevention Agreement 2022.
This agreement outlines their commitment to work together to improve all Australians’ mental health, reduce the suicide rate towards zero, and to enhance and ensure sustainability of the Australian mental health and suicide prevention system.
Primary Health Networks (PHNs) and others will be funded to commission accessible, responsive services designed to address the complexity and severity of the ‘missing middle.’ PHNs will explore new or reformed models of care and commission and contract services which provide innovative, more integrated service delivery for people with needs that are currently unmet.
According to the Agreement, the models of care should prioritise:
- interventions across the spectrum of presentations appropriate to need
- services which offer whole of person, prevention, and early intervention care
- a more seamless experience across primary, community, specialist, and acute care settings.
Improved integration is required across the service system, starting from state/Commonwealth co-commissioning and including the development of more partnerships, collaboration and information sharing. Improved integration needs to occur across disciplines, services and the broader system, through:
- vertical integration between tertiary, community, and primary care services within geographical regions
- secondary consultation and review by tertiary services to those presenting to local or community mental health and suicide prevention services
- centring primary care: engagement and coordination by primary care services
Service development, commissioning and review with Larter
Larter consultants have been working with flexibility and depth of experience with both funders and consumers with lived experience for 14 years.
Our multidisciplinary team knows funders’ requirements and service gaps for consumers vary nationwide. What’s more, designing and commissioning local needs-based responses requires a deep analysis of each individual set of circumstances. There’s no cookie-cutter approach.
With our deep insight into mental health services, co-design, outcomes frameworks and evaluation, we consider all the issues involved. That includes accessibility and barriers for priority cohorts, such as Aboriginal and Torres Strait Islander peoples, LGBTQIA+SB people, those experiencing homelessness or housing instability, people at risk of or experiencing abuse and violence, to name a few.
“We know the issues and recommendations that have emerged from the Mental Health Royal Commission, and the National Mental Health and Suicide Prevention Agreement 2022. Our experience with both Commonwealth and State governments stands us in good stead for responding to need resulting from changes to the mental health and suicide prevention system.
“We’re sensitive to the issues surrounding the integrating of services across funding complexity but we’re ready for the challenge. We work with consumers and people with lived experience and understand the gaps from a person-centred perspective, and we’re determined to contribute to improving the experience for ‘the missing middle’ — people who are currently falling through the gaps in the system of care,” says Jo Grzelinska, Principal Consultant at Larter.
How we can help you
If you’d like to discover how working with us will help you develop, co-design and review new, improved mental health services in your area, please contact Jo on 1800 527 837.
[1] Orygen, Defining the Missing Middle
[2] Orygen, Defining the Missing Middle