1 Introduction

Australia's mental health system is under continuing and unprecedented strain, with growing demand threatening to overwhelm public services. Mental health care is inherently multidisciplinary, requiring strong collaboration among nursing, medicine, and allied health professionals, alongside meaningful and authentic engagement with consumers and carers, to ensure comprehensive and effective support for patients and communities. However, for many years now, mental health services have been under resourced, and there have not been adequate services to meet demand (Roche et al. 2018). In 2023, Mental Health Carers NSW Inc., produced a report that said, “The work of past inquiries has made a convincing case that a significant increase in mental health funding is a prerequisite to achieving meaningful change. This key recommendation has been largely ignored and mental health funding as a proportion of overall health funding has remained stagnant for the past two decades.” (p.24).

The consequences of this prolonged under-resourcing are becoming starkly evident. Frontline healthcare workers characterise the mental health system as overly complicated, difficult to access, occasionally ineffective, and increasingly inequitable. They highlight a system that is poorly funded, disjointed, and not serving its intended purpose (NSW Branch of the Royal Australian New Zealand College of Psychiatrists 2023). There are significant workforce shortages across the mental health sector, including acute and chronic shortages of mental health nurses. There is an urgent need to address the critical shortage of mental health nurses, as highlighted by the Productivity Commission, with immediate action required to support and expand the nursing workforce to ensure effective, multidisciplinary mental health care (Commonwealth of Australia (Department of Health and Aged Care) 2022). This may mitigate the very real issue of substituting other disciplines, which is occurring across the sector, with limited if any evaluation of such role substitution (Looi et al. 2024). General practitioners (GPs) have raised concerns about limited access to equitable and affordable mental health care (The Royal Australian College of General Practitioners 2024). Most recently, New South Wales (NSW) has seen a mass resignation of psychiatrists (Gillespie 2025; Dias and Donaldson 2025). Together, these issues have created a crisis in mental health care. In this editorial, we emphasise the need for health professionals to collaborate in advocating for adequate resourcing of mental health services.

2 A System Under Strain: The Impact of Chronic Under Resourcing

For decades, mental health services in Australia have been chronically underfunded despite multiple inquiries and reforms. In New South Wales (NSW) the Richmond Report of 1983 proposed closing psychiatric hospitals in favour of well-resourced community health centres, aiming to provide community-based care for people with chronic mental illness rather than simply placing people in institutions. A decade later, the Report of the National Inquiry into the Human Rights of People with Mental Illness was released, which detailed widespread systemic human rights abuses of people affected by mental illness and identified the need for a more concerted action by government (Human Rights and Equal Opportunity Commission [HREORC] 1993). Many of the issues highlighted in this Report remain current for people living with mental illness, their carers, and family (Mental Health Carers NSW Inc. 2019). Although these initiatives helped shape services, drive cultural change, and spark improvements, successive governments have failed to fully implement this vision (Crews 2024). Instead, deinstitutionalization was used as a cost-cutting measure, leaving many individuals with serious mental illness without sufficient support. As a result, rather than receiving proper care, many people with serious mental illness ended up in prisons, homeless, or cycling in and out of underfunded and overstretched services (Crews 2024). The failure to invest in adequate community-based care has placed enormous strain on the mental health system, leaving vulnerable individuals and families to navigate complex illnesses with little or no support.

Mental distress in the community has continued to rise, with resourcing for mental health services not keeping pace with need, resulting in considerable disparities in access to mental health services. In Australia, First Nations communities experience high levels of mental health distress, and this distress is compounded by experiencing racism and discrimination in day-to-day life (AIHW undated). Experiences of unfair treatment have been reported in 34% of First Nations People living with an identified mental health issue, compared to < 20% who did not have such a diagnosis (AIHW undated). A recent study reported that 29% of working-age adults in Australia's lowest-income households experience significant mental distress, compared to approximately 11% in the highest-income households (Dawadi et al. 2024). In addition, the study highlighted that individuals residing in the most disadvantaged areas receive six times fewer Medicare-subsidised mental health services than those living in wealthier regions, despite being in greater need of access to services (Dawadi et al. 2024). What this means is that Australians residing in the most disadvantaged regions experience the greatest mental health challenges but have limited access to mental health care services (Dawadi et al. 2024).

3 The Mental Health Nursing Shortage: A Workforce in Crisis

Mental health nurses (MHN) numbers are not high enough currently to meet workforce demand, with identified shortfalls predicted by up to 60%, including maldistribution of MHN further burdening a strained system and staff (Looi et al. 2024). Further complicating this situation is that Australia, compared to other OECD nations, has a heavy reliance on overseas-trained health professionals including mental health nurses (Looi et al. 2024). To tackle these challenges, various programmes and funding initiatives have been introduced. However, surprisingly, few, if any, have acknowledged the psychotherapeutic capabilities of mental health nurses or actively included them in the collaborative solution (Hurley et al. 2022).

This significant mental health nursing workforce issue extends to those with specialist mental health post-graduate qualifications. An undergraduate degree provides only the basic requirement to practice as a registered nurse, teaching broad content, theory and with limited opportunities for real-world clinical mental health placements across hospital and community settings. Post-graduate mental health qualifications are pursued by nurses who seek a pathway to specialise or advance their mental health practice (Cleary et al. 2024). Nurses who complete specialist post-graduate qualifications are likely to be equipped with the skills and knowledge to engage in evidence-based practice, display higher order capabilities, have the capacity for critical thinking, clinical judgement, problem solving, and research capabilities (Cleary et al. 2024). However, challenges to accessing postgraduate MHN education include costs, access, and time commitments, given that this cohort of potential students often works full-time.

Adequately qualified and experienced mental health staff working in academia are also needed to ensure the delivery of high-quality undergraduate mental health units and postgraduate mental health courses that mitigate the stigma associated with mental health nursing. Recruitment of mental health nurse academics across the education sector remains challenging, with recent research highlighting the need for reform in mental health nurse education (Lakeman et al. 2024).

4 Psychiatrist Resignations in NSW: A Breaking Point for Care

The Royal Australian & New Zealand College of Psychiatrists (RANZCP) announced that over 200 psychiatrists resigned from NSW Health in January 2025, due to concerns about patient safety, and this was following the departure of approximately 140 psychiatrists from the public health system in 2024 (Gillespie 2025). One of Australia's leading psychiatrists has urged the NSW government to take immediate action to rebuild the state's struggling mental health system, describing the situation as the worst it has ever been. Professor Pat McGorry, a former Australian of the Year, met with the NSW premier after the resignations of psychiatrists and the resulting hospital bed closures, warning that the conditions resemble those of an under-resourced healthcare system, where severely ill patients are routinely turned away (Dias and Donaldson 2025). GPs have warned that this mass resignation could push the mental health sector into crisis—a sector that has been described as critically understaffed, meaning that patient care is endangered, and staff that are in the sector are under enormous strain (Gillespie 2025).

5 General Practitioners and Mental Health: Concerns About Access and Equity

6 The Human Cost: Impact on People With Mental Illness, Families and Carers

In 2019, approximately 2.8 million Australians provided practical and emotional support for a person they cared about, with about 240 000, or 8.6% informal carers identified as caring for a person living with a mental illness (Skehan and Fitzpatrick 2019). These informal carers save the government over $13 billion annually; however, this cohort is mostly unsupported, with only some paid a carer allowance, despite the practical, physical, financial and emotional demands of their role (Skehan and Fitzpatrick 2019). As Skehan and Fitzpatrick (2019) rightly highlight, people caring for someone with a mental illness also need timely and equitable access to interventions for their own mental well-being, and there is a need for an agenda that identifies carers' rights, including the right to not have their own mental health and well-being compromised due to their important caring role.

The exclusion of people from accessing timely mental health care, combined with deficiencies in support services for people with mental illness, significantly impacts their quality of life and that of their families and carers (Mental Health Carers NSW Inc. 2019). Families meeting this unmet need do so often at great personal cost, including financial, physical and/or mental and this disadvantage is a determinant of mental ill health, as is discrimination and stigma. As flagged in the sections above, there are also burdens upon mental health staff and frontline mental health nurses due to resourcing and workforce issues (Mental Health Carers NSW Inc. 2019).

7 The Urgent Need for Action

The current state of mental health care represents both a crisis and a critical opportunity for reform. Expanding the role of specialist mental health nurse practitioners in community settings could significantly improve access to care, particularly by embedding them within general practice to provide direct, accessible support to patients, families, and support the work of general practice. Strengthening Medicare funding for mental health services is essential, ensuring that those in lower socio-economic areas—who disproportionately experience mental health distress and health disparities—receive the care they need. Without targeted investment and systemic change, inequities in mental health care will continue to widen, leaving vulnerable populations without adequate support. Urgent policy action is required to transform the system into one that is equitable, sustainable, and capable of meeting the growing demand for mental health services.

In 2024, philanthropist and humanitarian Reverend Bill Crews said that neglecting one vulnerable group ultimately affects society as a whole. People living with mental illness have the right to effective healthcare, regardless of their social situation, their postcode or their household income. The time to act is now, and we must work together with other disciplines and with service users and their carers to advocate for proper resourcing for mental health care. The need for joint advocacy, for a united front for mental health services to be appropriately resourced, has never been greater. The growing mental health crisis demands a collective response, with nursing, general practice, psychiatry, allied health, policymakers, consumers, carers, and third sector services all advocating strongly for change. Policymakers must recognise the critical contributions of all healthcare professionals and provide the necessary resources to support safe and effective patient care and workforce sustainability. Real change requires not just investment in services, but a commitment to supporting everyone involved in delivering them. Australia's mental health workforce is ready to meet the challenge and needs the support of government to make it happen.

Conflicts of Interest

The authors declare no conflicts of interest.