Warning: this story contains a discussion on mental illness and suicide.

Riley* began seeing a psychologist when he was just 13 years old, but his mental health really deteriorated in 2020, when he was in Year 12.

“I had presented to the emergency department in North Melbourne, probably four times before I was finally admitted,” Riley told triple j Hack.

Each time, Riley was told he had appropriate support systems at home, and he was released into his parents’ care.

“My parents would have to sleep in the same room as me. I was on close watch.”

By the end of the same year, Riley had been sectioned, or detained in hospital under the state mental health laws, after self-harming and attempting suicide.

He said he was discharged from hospital a week later with some information on personality disorders, a contact number for a community outreach team, and no other follow-up information.

“I went to headspace and I had my one-hour session with them as an intake session, and they listened to my story,” Riley said.

Riley said headspace, which is designed for people with mild to moderate mental health conditions, told him its service didn’t have the right supports for him.

Riley said he thinks headspace is a “good service overall,” and that he was disappointed by the lack of follow-up care in the public health system after his hospitalisation.

“It was this period where I needed acute follow up care and I had none and I think that impacted my recovery.”

Riley’s story is reflective of what health professionals have coined ‘the missing middle’, the group of people who are most likely to fall through the gaps of the existing system.

“The missing middle is where you’ve got at one end the severe and complex cases. They are people who will require hospitalisation for their mental health issues, and medication and often psychiatric intervention,” Dr Zena Burgess from the Australian Psychological Society told Hack.

“At the other end, you’ve got people who have transient short-term anxiety or depression, or social issues that need a bit of coaching and a bit of support to get through a particular circumstance,” she said.

Dr Burgess said our current system caters for both ends of the spectrum, but often lets people in the middle down.

Getting the right support would stop their conditions from becoming chronic, Dr Burgess said.

‘The system is broken’

Around one in five adult Australians have experienced a mental health condition in the last year, and mental health remains the number one reason people visit their GPs.

A 2020 report by the Productivity Commission recommended a funding injection of $2.4 billion a year was needed to meet the needs of the community, which would in turn generate billions in return via economic participation and quality of life.

The COVID-era doubling of Medicare-subsidised psychology and mental health social worker sessions from 10 to 20 under the Better Access Scheme was broadly welcomed by both healthcare professionals and patients.

But Labor decided against extending the extra sessions when the doubling of the scheme expired in December 2022, pointing to research saying the extra sessions were more likely to be used by people on higher incomes.

This year’s budget contained a $590 million initiative to create an early intervention online platform over the next eight years.

“Australia’s current mental health care system is broken and in need of urgent reform,” Professor Samuel Harvey from the Black Dog Institute said.

“The funding announced in the budget does not come close to the amount required to fix Australia’s mental health care system.”

“There are millions of these people across Australia that are falling in between the gap that exists between primary care and hospital care,” Professor Harvey said.

University student Juliette told Hack she was disappointed the extra sessions weren’t reinstated in the last federal budget.

“Ten sessions isn’t even enough for me to go [to a psychologist] monthly, which means it’s barely worth me going at all. I’m kind of just stuck until things get to crisis point.”

“Is it even worth me trying to focus on getting better when, if I’m in this state that I’m currently in, I’m not going to get help? Or I could just wait for it to get worse,” Juliette said.

Juliette said her mental health had improved when the extra 10 subsidised sessions were on offer, and that she can’t afford to pay out of pocket for the sessions.

“I was doing a lot better when I had that constant support, even though I was still dealing with a lot of issues. Just knowing that every two to three weeks, I was going to be able to go and talk to my therapist about it,” Juliette explained.

“It was such a relief, knowing that I wasn’t having to do this alone.”

Dr Burgess said cost and lack of access outside major cities were a major barrier to access.

“[In the budget] we were wanting to see psychological services made really affordable for young people, and particularly for young people working in rural and living in rural and regional areas. We also wanted to see a really big investment in crisis services for young people,” Dr Burgess said.

Shortage of experts

Access issues are made worse by nationwide shortages of both psychologists and psychiatrists.

Last year’s National Health Workforce Strategy found that we need to nearly double the number of psychiatrists available to meet community need.

“It all boils down to workforce,” Dr Astha Tomar from the Royal Australian and New Zealand College of Psychiatrists told Hack.

“Are we supporting that existing workforce? And are we creating future workforces,” she asked.

Dr Tomar welcomed the early intervention program launched in the budget, but said fixing the system comes down to cold, hard cash.

“It’s costing our economy in Australia $220 billion every year because of mental ill health and mental illnesses. Small initiatives which are investing $500 million over five years or eight years will make a difference. But would that be enough?”

Accessing care ‘exponentially harder’ without family support

Riley is managing his mental health conditions with a range of supports, including a psychiatrist, a mental health social worker, a therapy skills program and medication.

And, he says, his parents have been behind him since Day One.

“I had people supporting me to access care, when getting up to brush my teeth was difficult.”

He said his life would have been “exponentially harder” without the financial and emotional support he gets from his parents and acknowledged that not everyone has that kind of help.

“I’m one of the lucky ones,” Riley said.