Invisible workforce

A system that leaves carers carrying the weight

I am the CEO of Mental Health Carers New South Wales, the peak body representing families and carers of people who experience mental distress. My work is focused on systemic advocacy. I push for a system that recognises and supports carers in their role, and one that is more effective in supporting the recovery of the people they care for.

This is not a narrow issue. It sits at the centre of how we

Design
Fund
Deliver care.

A system that never arrived

The mental health system, as we describe it, is not functioning as it should. The failure is not new. It has been decades in the making.

Around 40 years ago, deinstitutionalisation began following the Richmond Report. Large institutions were deemed inhumane and unnecessary.

People were moved into the community, and the expectation was clear. Community-based mental health services would be built around them.

That did not happen.

Ten years later, the Burdekin Report made the failure explicit. People had been moved out, but the support structures were never developed. That gap has never been meaningfully closed. Since then, there have been countless inquiries, reports, and commissions. The conclusion has remained the same, and the system has not fundamentally changed.

Care rationing

What we have now is a system that responds at the edges. There is some support for people with mild or emerging concerns. Beyond that, access is largely limited to crisis care through emergency departments and acute units. For those living with long-term or severe mental health conditions, consistent community support is still missing.

The result is predictable. Care is rationed to crisis. People deteriorate until they reach breaking point. Families and friends step in to fill the gap, often without support, recognition, or choice.

The invisible workforce

Families and carers now provide more care, in economic terms, than all state and national mental health services combined.

It is largely unplanned and unsupported
It does not account for people’s skills, training, or capacity
It pulls people, often women, out of the workforce.
It creates economic inefficiency and personal strain.

At the same time, the lack of early and sustained support drives people into crisis. Emergency departments are seeing more people, in greater distress, with more complex needs. This feeds stigma. People are perceived as dangerous, when in reality they are individuals whose needs have not been met, until they are desperate.

We are allowing distress to escalate, and then reacting to it.

Advocacy in a fragmented system

Mental Health Carers NSW has existed in some form since 1974. We became a peak advocacy body in 2009. I have been part of that journey, first as a policy officer and since 2012 as CEO.

We have not yet achieved what we set out to do. The community-based system we expected has not yet been built.

In response, we are working differently. We are collaborating more closely across sectors, including disability, domestic violence, and broader health advocacy. The pressures we see in mental health are reflected across human services.

There are lessons in what has been attempted. The NDIS shows that large-scale reform is possible. It also shows the risks of how systems are designed and delivered. What it demonstrates most clearly is that change can happen, but only if it is structured properly.

What needs to change

What we need is a commitment from government to meet unmet need across essential human services in a systematic way that maximises benefit for both the economy and the community. That means identifying need, funding it, and building services to meet it. The economic case is clear. Supporting people earlier and more effectively strengthens workforce participation, reduces long-term costs, and improves outcomes across society, and financially.
We also need governments to collaborate across state, territory, and national levels to fund that unmet need, and to work together in how services are planned and delivered. Without that alignment, fragmentation continues and people fall through the gaps.
People need support to navigate the system. Service navigation and case facilitation are critical, particularly for vulnerable groups dealing with multiple providers across different levels of government.
Early intervention must be prioritised. Minimising harm and disability requires acting sooner, not later, and improving mental health literacy across services so that support is more effective and consistent.

Accountability

There must also be accountability. Clear responsibility and dispute resolution are essential so that people are not left without support while governments argue over who is responsible for delivering it.

Co-design

Across all of this, services must be co-designed with the people who use them, particularly vulnerable groups and First Nations communities. Where possible, they should be delivered by peers, because shared experience builds trust, strengthens engagement, and provides practical support that systems alone cannot replicate.

What we are talking about is the repair of a social safety net. It is about ensuring that people receive the support they need on their worst day, so that those days are fewer and less severe.

Australia is a great place. We should be working together to make it as good as it can be for everyone. I believe we can do that.

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The advocate for New Zealander's mental health