A different front door

I'm an occupational therapist by training, and I’ve worked in and around mental health, disability, refugee services, inpatient care, outpatient care, and Aboriginal communities for more than 30 years. I’m currently the Senior Manager of Operations at the Urgent Mental Health Care Centre in Adelaide.

A system that struggles

What I’ve seen over those three decades is a system that has always tried to provide care, but often struggles to provide the right care, in the right place, at the right time.

For a long time, people in mental health crisis have had very few places to go.

Community drop-in spaces that once existed have gradually disappeared.
Access to mental health teams has become increasingly narrow and criteria-driven.

Unless someone is extremely unwell or presents significant safety concerns, they can struggle to get immediate support.

Default to ED

That vacuum pushes people somewhere else. More and more, people end up in emergency departments because there is nowhere else to walk into. When people present to the Urgent Mental Health Care Centre, we ask people directly where they would have gone if they had not come to our service. A large number tell us they would have gone to an emergency department.

Growing need

At the same time, demand keeps growing. We have :

An increasing population
An ageing population
The impacts of social media on younger people, and more people coming forward for support.

For all that the level of funding and community service development has not matched that growth.

Inequity is an issue

Over the years there have been excellent programmes and initiatives, but inequity remains a real issue. I previously worked in an Early Psychosis programme through Headspace, and it was an outstanding service if you lived inside the catchment. You could access a full two-year programme with comprehensive support with first episode psychosis. But if you lived one street outside the catchment, you did not get the same service. That sort of inconsistency exists throughout the system.

Creating Something Different

Around seven or eight years ago, the Australian Federal Government recognised the need for greater investment in mental health support and created a national funding initiative called Head to Health. The intention was to support the development of low barrier access mental health care centres across Australia. The Head to Health Brand was changed with urgent mental health care centres now branded under the banner of Medicare Mental Health Centres.

At the same time, the Chief Psychiatrist in South Australia was becoming increasingly concerned about emergency departments filling up with people seeking mental health support. He had been looking closely at 24-hour crisis care models operating in the United States and wanted to explore whether South Australia could create something similar. The South Australian Government ultimately partnered with the Federal Government to establish a 24-hour mental health crisis centre for Adelaide. A co-design process followed, involving the Lived Experience Leadership and Advocacy Network and the Australian Centre for Social Innovation. People with lived experience heavily shaped the philosophy of care from the beginning.

Neami National, the NGO I work for, responded to the tender process because this work sits directly within our core business. During that process we also formed a partnership with an American organisation called Recovery Innovations, which had extensive experience operating similar services in the United States.

That partnership became an important part of establishing the centre. Recovery Innovations supported us through implementation, reviews, and operational guidance as the service developed.

Side by side

From the outset, we wanted a model where lived experience workers and clinical staff worked side by side in a genuinely collaborative structure. Not a tokenistic model. Not an add-on. A true partnership.

Building a Fusion Model

Our service began operating five years ago. Initially, we opened for 12 hours a day and only accepted referrals from emergency services such as police and ambulance teams. That gave us time to establish relationships, build governance structures, and integrate with other services across the community.

The term “Fusion Model” is borrowed from our US partners and it means a fusion of lived experience and clinical support with each guest being involved in what that looks like, so as to get the best outcome for each person.

The long-term goal, however, was always a fully open-access 24-hour service. That transition happened relatively quickly.

One of a kind

Today, people can walk in at any time, day or night. They do not need a referral. They do not need an appointment. They do not need a Medicare card. There is no cost. The principle is low-barrier access.

As far as we are aware, this is the only 24-hour service of its kind in Australia operating with this level of lived experience and clinical integration for people in mental health crisis.

The building itself sits in Adelaide’s CBD and used to be a Holden car dealership. It has now been completely repurposed into a lounge-style environment designed around comfort, connection, and safety.

Care not treatment

When people walk through the door, they enter a calm, welcoming space with quiet areas, breakout rooms, food, showers, spare clothing, and support.Those things matter.

When someone is in crisis, they may not have eaten in 24 hours. They may need somewhere safe to sit. They may need clean clothes. Sometimes the first thing they need is care, not treatment.

That distinction is central to our philosophy. We can provide medication if needed, and we do have the capacity to use the Mental Health Act, but we use restrictive interventions minimally.

Numbers tell the story

Last month, out of more than 500 referrals, only five people required transfer under the Mental Health Act and only one person was placed on an inpatient treatment order.Our model is built around relational engagement.

If someone spends four hours in an emergency department, they may only receive 15 minutes of direct face-to-face interaction. If someone spends four hours in our service, they are likely to spend most of that time actively engaged with another human being.

Peer first, peer last

One of the strongest parts of the model is our lived experience workforce.

We aim operate with a 50-50 split between lived experience workers and clinicians. Across the service we employ mental health nurses, social workers, occupational therapists, psychologists, and Lived Experience workers working together in what we call a fusion model. We also employ Senior Medical Practitioners and Nurse Practitioners who can prescribe medication and provide some physical health support, along with two consultant psychiatrists who provide governance support, supervision, research support and training.

Our approach changes conversations

It means a lived experience worker may challenge a doctor about placing someone on a treatment order because they understand, from direct experience, the impact that decision can have on someone’s life. It creates a very different dynamic.

Our guests' needs vary

We work from the principle that the guest defines the crisis. That means we do not decide whether someone’s distress is valid enough to deserve support. If someone walks through the door needing help, we engage with them. We refer to people who use the service as guests, which reflects the trauma-informed philosophy underpinning the centre.

Most guests are between 20 and 39 years old. We see slightly more women than men, although it stays relatively close to an even split.We are also proud that the service engages groups who are often underrepresented in mainstream mental health services.Around 15 percent of referrals identify as Aboriginal, which is significantly higher than many mainstream services. We also see a high proportion of people with gender-diverse identities.

That tells us people feel safe walking through the door.

Promoting the Service

One thing we have learned is that you cannot stop promoting a service like this.We promote constantly because we want people to remember that this place exists when they or someone they know needs help.

That includes

Social media campaigns
Radio interviews
Podcasts, print advertising
Conference presentations
Stakeholder engagement, tours, and information sessions.

At least once a week we host tours for services and organisations wanting to understand the model because there is strong interest in how the centre operates.Even now, years after opening, we continue seeing large numbers of first-time guests every month.

What we know is working

We know this model is working because people tell us directly. Many guests say they would not have sought help at all if this service did not exist. We have also seen people who previously attended emergency departments daily, sometimes multiple times a day, gradually shift away from that pattern through sustained relational support and connection with other services. For many people, this becomes a safer and more approachable entry point into the mental health system.We also know success is not always about long-term engagement. Sometimes success is seeing someone once. A person comes in distressed, overwhelmed, and isolated. They are listened to. They are validated. They leave calmer, safer, and with new ideas or supports in place.

What's next for us

There is still more we would like to build. One priority would be re-establishing a dedicated aftercare team. We would also like greater investment in promotion and more overnight leadership support across the 24-hour operation.

Peer power

But what gives me the greatest sense of pride is the way lived experience workers have become central to this model. Their contribution is not symbolic. It is fundamental. Again and again, guests describe how meaningful it was to speak with someone who understood what they were going through because they had walked a similar path themselves.

That level of connection changes the experience of seeking help. It changes what mental health care can feel like.

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