‘My family is suffering a terrible loss because of cracks in the mental health system’

A grieving mother whose daughter died in last month’s Bondi Junction attack says more must be done to support the state’s vulnerable, after a new review estimated 58,000 people with severe mental health needs are missing out on care.

The NSW Community Mental Health Services Priority Issues Paper, a state government-led gaps analysis of the mental health sector, found the stretched system needed more money, more workers and better processes for dealing with people in crisis.

Elizabeth Young holding a photo of her daughter Jade, who was killed in the Bondi Junction attack.

Among its revelations was modelling that suggested tens of thousands of people with severe and complex mental health needs are not seen by the system, which is struggling under long wait times, crowded services and a lack of early intervention driving emergency department presentations.

Comparing National Mental Health Planning Services Framework estimates with patients actually attending NSW community mental health services in 2020-21, the report found there was a 29 per cent shortfall in service capacity for the 207,000 people estimated to have severe and complex mental health needs, leaving about 58,000 without care each year.

Elizabeth Young, whose daughter Jade Young was one of six people killed by 40-year-old Joel Cauchi at Bondi Junction Westfield last month, said the tragedy was a consequence of inadequate mental health supports for the vulnerable.

“My family is suffering a terrible loss because of one man who slipped through the cracks in our mental health system,” she said.

Cauchi had received treatment for schizophrenia after being diagnosed as a teenager. In the days after the attack, his Queensland-based parents said he had stopped taking his medication. They spoke openly about their struggle to care for their son, with whom they had recently lost contact.

Describing herself as hollowed out with grief, Young said she had spent the weeks after her daughter’s death researching the state of the mental health system, and that she was frustrated by a lack of action after several inquiries and reviews.

“Always, the need for more funding is revealed. More trained healthcare workers, more hospital beds, more community health centres, mobile facilities: nothing changes,” she said.

“To learn that 58,000 have missed out on appropriate treatment or care is hard to comprehend.”

NSW Mental Health Minister Rose Jackson said the gaps analysis, which was distributed to stakeholders last week, showed the system was experiencing significant challenges in meeting increasing service demand.

In the 12 months to November 2023, the number of people arriving at NSW emergency departments due to a mental health concern increased by 5 per cent to 96,120.

Presentations for self-harm and suicidal thoughts also increased by 5 per cent and comprised more than half of these emergency patients.

“We know we need to do more when it comes to protecting the mental health of our people in NSW,” Jackson said.

“That’s why we’re looking at various ways to adequately meet the mental health needs of our vulnerable communities.”

An election promise in response to concerns about underfunding and staff shortages, the gaps analysis was conducted by representatives from the sector, the government and advocates with experience with mental health issues.

It identified four priority areas for reform: enhanced funding for community mental health services, workforce and training, improving emergency mental health care, as well as the expansion of psychosocial supports, such as homelessness services and recovery programs.

A second report, providing more detail on service demand and proposing solutions through staffing, infrastructure and investment, will be completed by the end of the year.

Professor Samuel Harvey, executive director of the Black Dog Institute and a spokesman for sector representative group the NSW Mental Health Alliance, said the report was significant as the first time NSW had attempted to quantify those going without care.

NSW’s percentage of people with severe and complex mental health services cared for was the second-lowest of any state, behind only Victoria (which throughout its lockdown-heavy 2020-21 financial year is estimated to have met only 48 per cent of demand).

The 2020-21 year was chosen due to the availability of nationally comparable Australian Institute of Health and Welfare hospital data.

“NSW mental health services are in crisis and investment in the state’s mental health can no longer be delayed,” Harvey said, adding the paper substantiated what the sector saw daily.

“We regularly get phone calls from people who are desperate because they can’t find a single psychiatrist or psychologist accepting new referrals,” he said.

“Every night our emergency departments are full of people who couldn’t get help anywhere else. Similarly, we hear from GPs that mental health is the No.1 problem they are seeing, but they can’t access the support and help they need to manage their patients,” he said.

In discussing emergency mental health care, the analysis criticised the unnecessary involvement of police in mental health episodes. It says 43 per cent of police critical incidents – incidents causing death or serious injury to a person, including another police officer – involve a person in mental health crisis.

“Police alone are not the most appropriate responders to all emergency mental health situations,” the report says, noting this was a repeat concern raised in consultations with the sector, which has called for consistent “co-responder” models, programs where a person in crisis is seen by a mental health clinician, which have been trialled in several areas, across the state.

The NSW Health-led Police, Ambulance, Clinical Early Response (PACER) program operates in some of the state’s police districts but its budget to 2025 is fully allocated.

The analysis also raised concerns about the sustainability of the psychiatry workforce, particularly those shunning public hospital work for more lucrative private roles or to become locum doctors.

“Staff specialist positions, which have a lower hourly rate but afford the opportunity for significant contribution to leadership, safety and quality and education work have been particularly difficult to fill,” it noted.

About one in four staff specialist roles at NSW hospitals is currently vacant, and the analysis acknowledged consultant psychiatrist vacancies continue to rise statewide.

”The result is that, even in inner metropolitan Sydney, services are dependent on the most expensive model (locum coverage) to allow for services to remain open. This comes at the expense not only of premium labour, but continuity of care,” the analysis says.

The gaps analysis has occurred in parallel with a state upper house inquiry into the delivery of outpatient and community mental health care, which will deliver its report on June 4.

Inquiry chair, Greens MLC Dr Amanda Cohn, said both investigations had shown NSW’s mental health system had become reactive and crisis-driven, and that desperate patients were ending up in emergency departments because the system was not resourced to provide preventative care.

She was critical of the timing of the release of the first gaps analysis, which was completed at the end of last year.

“One is left to wonder why this report, dated December 2023, was released five months later during the chaotic news week of the federal budget release,” she said.

“It’s also curious that it comes out mere days after I drafted the final report for the NSW mental health inquiry, which could have benefited significantly from the addition of its data.”

If you or anyone you know needs support, call Lifeline on 131 114 or Beyond Blue on 1300 224 636.

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