The Hidden Backbone of Mental Health Care

By Irene Clelland, CEO, Arafmi Queensland

Every day across Australia, families, friends and neighbours quietly hold up our mental health system.

They are unpaid mental health carers, and together they contribute around 13.4 billion AUD in unpaid care each year. It’s a number so large it’s hard to picture, yet most of the people doing that work would never think of themselves as part of an economic system. They see themselves simply as someone who loves another person and wants to help.

I’ve worked alongside carers for years, and what always strikes me is how invisible they are. Unpaid carers can be anyone: mums, dads, brothers, sisters, grandparents, friends, even next-door neighbours. They step into a caring role because someone close to them is living with mental health challenges and there’s no one else. They don’t get paid, they don’t clock off, and they don’t often get thanked. Many don’t even realise they’re carers until they burn out.

People care because they want to

Most caring relationships are loving and mutual. People care because they want to, not because someone told them to. But the reality is that love doesn’t replace training, resources or support. When the system can’t meet people’s needs, families fill the gap, and that can be exhausting. Many carers are caring for someone while trying to keep jobs, homes and families together. Without proper support, stress and anxiety creep in. I’ve seen many carers reach the point where they themselves need mental health help.

At Arafmi we see both sides of the equation: the person living with mental health challenges and the person who loves them. Both need support. We remind carers that their wellbeing matters too. I often hear, “As long as the person I care for gets help, I’ll be fine.” But when the person they support starts receiving care, that’s when the cracks show. Fatigue, worry and loneliness catch up fast.

That’s why we’ve built services shaped directly by carers themselves.

Our 24-hour support line is staffed by people with lived experience of caring. It’s not a crisis line; it’s a lifeline for people who need to talk to someone who gets it. We also offer respite accommodation.
One of our homes was co-designed by carers; they told us what they needed: a real break, a place that feels calm and human. I remember a father who cares for his two sons. When he arrived, we’d left a fresh loaf of bread on the table. He cried. It was the first time he’d had his own loaf of bread in years. That moment stays with me because it shows what real respite means. It’s not luxury. It’s relief.

Peer support, a vital role

Peer support and education are equally vital. We run workshops that help carers build skills and confidence: things like setting boundaries, managing medication support, and recognising their own warning signs of burnout. We also bring carers together in forums to share what works. Every time they connect, something shifts. People realise they’re not alone, and that connection often does more good than any formal service.

Measurable wellbeing

When carers first come to us, we do a simple wellbeing check. Most score between one and three out of ten. After some time with us, that often rises to eight, nine or ten. They feel more balanced, more prepared to continue caring, and sometimes, ready to stop. Some choose to step back from caring altogether because it has damaged their own health. That decision takes courage, and we support it. Caring shouldn’t mean sacrificing yourself.

So what would make the biggest difference?

Funding always matters, but money alone won’t fix the system.
What’s needed is mental health literacy: a society that understands what mental health is, knows the early warning signs, and acts with empathy. When communities know how to talk about mental health without stigma, they prevent crises before they start.
Carers also need better access to education and training so they can recognise when someone needs help and how to get it.
Peer support is another key piece. People with lived experience offer a kind of understanding that professionals can’t always give.

Clinical care saves lives, but it’s peer support that often helps people stay well. We need both, working together, not in silos.

Cultural and community context matters too.

Through our Culture Care programme we work with multicultural mental health groups to support carers from diverse backgrounds. Many don’t identify with the word “carer” at all; they just see themselves as family.

In some cultures, mental health isn’t discussed openly, which means people are less likely to seek help. We also partner with First Nations researchers to understand what support looks like in their communities. True inclusion means listening, not assuming.

Every year we support more than four thousand carers across Queensland, and that number keeps growing. The need is huge, but so is the strength within these families and communities. They show up day after day, often with no recognition, holding things together because they care.

What needs to change

For me, the most important message is that carers aren’t just part of the mental health system; they are the system. Without them, it would collapse. Yet too often they’re left out of policy, funding and planning. That has to change. Recognising carers as essential partners in recovery is the first step. The next is making sure they have what they need to stay well themselves.

Mental health carers are everywhere: in every suburb, every town, every street. Some are visible, but many are hidden.

Behind every person living with mental health challenges there’s often someone else quietly holding the line. We need to see them, value them, and make sure they’re not left to do it alone.

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