Addressing the gap: The challenge of the ‘forgotten middle’ in mental health care

| May 06, 2024

Across Australia, a significant gap persists in mental health care, leaving approximately two million individuals stranded in what experts term the “forgotten middle.” These are individuals who require more comprehensive support than what is typically provided by primary care but fall short of meeting the criteria for emergency care or hospitalisation.

One of the key issues exacerbating this gap is the imbalance in government funding. Notably, individuals enrolled in the National Disability Insurance Scheme (NDIS) for psychosocial disabilities stemming from mental illness receive nearly twenty times more financial assistance per person compared to those who are unable to access the scheme.

Katie Barton, a 20-year-old who found herself caught in this forgotten middle, experienced firsthand the challenges of navigating a fragmented mental health system. After enduring a twelve-month wait to see a specialist psychologist, she ultimately sought help from a hospital emergency department when her condition became critical.

Barton’s story underscores a pressing need for comprehensive reforms within the mental health sector. Advocates argue that addressing the forgotten middle requires substantial investment in community-based care, including social support, employment assistance, and stable housing, alongside access to multidisciplinary teams of healthcare professionals.

Professor Sebastian Rosenberg from the University of Sydney’s Brain and Mind Centre emphasises the glaring absence of secondary care within the current system. While acute hospitalisation and primary care services exist, there remains a significant void in intermediate support tailored to individuals with moderate to severe mental health needs.

The disparity in funding between those covered by the NDIS and those outside the scheme further exacerbates this issue. Despite the NDIS allocating substantial resources to support individuals with psychosocial disabilities, a vast portion of the population lacks adequate access to essential mental health services.

Youth mental health expert Patrick McGorry stresses the importance of adopting a holistic approach that goes beyond individual therapy sessions. He advocates for the implementation of team-based care involving psychiatrists, case managers, and social therapists to provide comprehensive support to those in need.

While the government has taken steps to address gaps in mental health care, challenges persist. Rachel Green, CEO of SANE, highlights the need for a paradigm shift towards a more inclusive and community-focused approach. By investing in early intervention and holistic support services, policymakers can mitigate the long-term impacts of untreated mental illness and promote overall well-being. 

In conclusion, closing the gap in mental health care requires a concerted effort from policymakers, healthcare providers, and community stakeholders. By prioritising investment in comprehensive and accessible services, we can ensure that individuals like Katie Barton receive the support they need at every stage of their mental health journey. 


Chrysanthos, N., ‘Why Katie and two million others living with mental illnesses are the missing middle’, The Sydney Morning Herald (Sydney, April 22, 2023).