NSW Health engaged David McGrath Consulting to undertake a technical analysis to identify unmet need for psychosocial supports in NSW for people with mental health conditions. The project aimed to:
An Advisory Group with sector representatives was established to oversee the project (see Terms of Reference, Full Report - Appendix 1).
This document is a short summary of the NSW Psychosocial Research Project, including high-level findings. It should be read in conjunction with the Full Report, which provides a detailed explanation of the methodology, including assumptions and limitations.
The project used the National Mental Health Services Planning Framework (NMHSPF) to determine what services/programs were in scope and to identify demand for psychosocial supports. The NMHSPF was used as it is the only nationally agreed reference point in Australia for planning purposes in mental health. The NMHSPF was also used to undertake a similar unmet need analysis by the Productivity Commission in 2020.
The NMHSPF is a technical and complex tool and the consultant was required to make assumptions when conducting the analysis. A detailed overview of the methodology used (including assumptions and limitations) is in the Full Report.
The project involved a technical analysis. It did not include consultation with people with lived experience and their families and carers about what their psychosocial support needs are or whether these are being met.
The advisory group identified several limitations with the analysis and the NMHSPF tool, including:
NSW Health acknowledges the limitations of this project. The findings are intended to be a starting point to build a more comprehensive understanding of community-based mental health supports in NSW. The findings will be considered in conjunction with other gap analyses and reviews that are occurring both nationally and in NSW, including the national Analysis of unmet need for psychosocial supports outside of the National Disability Insurance Scheme – Final Report.
The project defined psychosocial supports as non-clinical and recovery-oriented services, delivered in the community and tailored to individual needs, that support people experiencing moderate to complex mental health challenges to live independently and participate in the community.
To be included in the psychosocial service mapping, a program had to be assessed as meeting the Specialised Mental Health Community Support Services description in the NMHSPF taxonomy. Refer to the Full Report for a detailed explanation of this process.
Services and programs funded by the following agencies were considered in the mapping:
Each service/program was reviewed by the consultant and NSW Health to determine if it met the definition of psychosocial supports for the project, noting there is no nationally agreed funding and performance definitions for psychosocial support. It is acknowledged that there may be omissions from the data set despite best endeavours to capture activity across government portfolios (refer to the ‘In and Out of Scope Program List’ for a full list of the programs considered).
The target group for the project was people with complex mental health conditions aged 12 years and over who require psychosocial supports and their carers.
The consultant identified the number of people who require psychosocial support in NSW by identifying people who had a demand for Specialised Mental Health Community Support Services using the NMHSPF tool. This is a complicated and technical process that requires a range of assumptions to be made. Details on the methodology and assumptions used by the consultant can be found in the Full Report.
The analysis identified that there were approximately 125,000 people in NSW who required a psychosocial support but did not receive it in 2022-23. This was determined by comparing the number of people who required a service with the number of people who received a service to determine the gap.
The analysis identified that there were approximately 95,000 carers in NSW of people with a mental health condition who required a psychosocial support but did not receive it in 2022-23.
The consultant used the NMHSPF tool to estimate that the total required expenditure on psychosocial support in NSW in 2022-23 was $907 million.
However, the overall expenditure on psychosocial support services in NSW in 2022-23 was $1,631 million, which is approximately $723 million (80%) higher than what the NMHSPF estimates was required. This is despite the analysis identifying high numbers of unmet need.
Chart 1 shows that NDIS expenditure accounted for almost 90% of total expenditure in NSW but only supported approximately 50% of consumers (with average annual funding of $83,000 per person, compared to NSW Health expenditure of $21,000 per person).
The NDIS is spending around 11.5 times the average estimated expenditure per consumer modelled by the NMHSPF, and around 4 times the NSW Health average expenditure. This may be appropriate for some people due to their complexity being at the extreme of the population distribution curve. However, given that total expenditure on the NDIS exceeds total modelled need, it is unlikely to be appropriate for all of the NDIS participants. Co-existing conditions and secondary non-mental health-related diagnoses may also contribute to this expenditure.
The report identifies a clear unmet need for psychosocial supports for people with mental health conditions in NSW. Caution should be used when quoting the exact numbers from the report, noting the different ways the NMHSPF tool can be interpreted/ used, the limitations of the NMHSPF, and potential data inaccuracies.
The Terms of Reference for this project did not require any recommendations in response to the findings, nor did it preclude them. As such, the following are couched as suggested approaches within the context of the Terms of Reference:
