Supporting the ‘missing middle’

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Intro by Samaritans CEO, Brad Webb

For those who work in mental health sector, there is a frustrating place called the ‘missing middle’. The ‘missing middle’ exists between primary care, which can assist with mental health conditions like anxiety and depression, and acute care needs associated with hospitalisation. And it is a place that those with moderate to severe mental health conditions can be trapped in.  

Last year, Samaritans was funded by the Hunter New England Central Coast Primary Health Network to provide services in the ‘missing middle’, and the Rural Young Minds (RYM)program was born.

Twelve months on, I thought we should check in with Felicity Scott at headspace Maitland to see what impact the program has made. Here is her response. 

Who does the RYM program support?

Based on somewhat typical themes in the lives of young people involved in the RYM program, we’ve put together this profile to give you an idea of who is taking part:

Sample profile of program participant:

  • Alex
  • 22 years old
  • Alex has been living with depression and anxiety for approximately two years and has suicidal thoughts
  • Initial steps:Visits local GP who refers to the RYM team
    Attends fortnightly for therapeutic interventions with Samaritans worker.
    Samaritans worker also assists with housing supports, employment assistance and social interactions
  • After three months: Visibly consistent increase in wellness
  • After five months: Plans to discharge Alex into lower level services such as headspace (if in the area), or other counselling services to continue therapeutic work
This is a Samaritans stock image and is not a photograph of the young person profiled.

Update on the RYM program

The Rural Young Minds (RYM) Program is a youth complex mental health service that was commissioned by The Hunter New England Central Coast Primary Health Network in 2018 and is currently celebrating 12 months of service to young people across regional New South Wales. 

The original objective of the RYM service was to address the ‘missing middle’ of mental health service provision. This was intended to be those with severe and/or complex mental health issues but not yet meeting the requirements for admission to The Child and Adolescent Mental Health Service (CAMHS) through Hunter New England Area Health. The RYM service also captures those with a persistent mental health issue such as border line personality disorder or bipolar.

“Over the first twelve months of operation, the team have been working hard to address this ‘missing middle’ and have provided a welcoming service for young people who were previously under serviced to access appropriate mental health services,” Service Manager, Felicity Scott, said.

The service is funded across the Upper Hunter and Liverpool Plains area, with the Gunnedah/Liverpool Plains areas experiencing higher service demand than what was originally anticipated. Young people referred to the service are offered flexible appointment locations including Muswellbrook, Merriwa, Quirindi and Gunnedah and digital/online appointments to include areas such as Scone, Murrurrundi and other outlying areas.

“It has been difficult to recruit for specialist staff in the Upper Hunter but we know that there is demand for increased servicing in the area; we are currently working to address this,” Felicity said.

The service accepts referrals from a range of people and services in the community for young people experiencing ongoing anxiety and/or depression that is not improving despite therapeutic interventions. The young person might be experiencing suicidal thoughts or ideation, mental health that is at risk of developing into an acute presentation or impacting on a young person’s ability to engage with social situations and appropriate everyday self-care and functioning.

“The Rural Young Minds team are still welcoming new referrals and clients. Since the opening of the service, we’ve been receiving a mix of referrals from Schools, GPs, headspace, Corrections and Juvenile Justice and self referrals. We’ve seen that demand is there and it’s still growing- mental health services clearly need ongoing funding commitment and support from the community,” Felicity said.

Felicity explained that one particular success of the service has been the reduction of service needs for young people who have interacted with the Rural Young Minds program.

“This is a great thing for young people, but it further demonstrates the need for investment in outreach services in the area such as headspace who are experiencing a longer waitlist with the needs of these young people now able to be met by the primary care system.

The Rural Young Minds service delivers a stepped care model, with a young person’s journey will be determined by the severity of their mental illness.

“Stepped care is an evidence-based, staged system comprising a hierarchy of interventions, from the least to the most intensive, matched to the individual’s needs. In a stepped care approach, a person presenting to the mental health system is matched to the intervention level that most suits their current need,” Felicity said.

A stepped care approach promotes person-centred care which targets the needs of the individual. Rather than offering a one size fits all approach to care, individuals will be more likely to receive a service which more optimally matches their needs.

“Youth friendly services that can address the needs of mental health in the community in a way that is accessible and targeted will continue to be a priority in regional and remote areas with youth suicide rates an ongoing tragedy. It’s important we continue to build the capacity of services that meet the needs of young people from mild to severe crisis experiences,” Felicity said.

“Improving access to quality care for young people with, or at risk of developing severe mental illness is a key priority of Samaritans. We want young people to get the right care at the right time, in the right place and we believe we have the skills and support networks to deliver,” she said.

Young people do not need to have a mental health care plan for referral or engagement but appointments with a GP are encouraged and greatly assist the improvement and long-term management of mental health and wellbeing.

The service can be accessed by calling 1800 270 738. More information is also on the Samaritans website here: https://www.samaritans.org.au/service/rural-young-minds/