Bridging the Gap: Delivering Mental Health First-Aid through Peer Support

Daniel Gao, University of Melbourne Faculty of Business and Economics

Executive Summary:

In the midst of the global mental health crisis, a staggering diversity of solutions have been proposed and trialled by organisations and governing bodies. Despite the steady facilitation of services and interventions alongside increased federal funding, statistics from the national census and NGO surveys have suggested that mental illness rates and distress levels amongst children, teenagers, and young adults have increased (Treasury, 2022). Specifically, 39.6% of Australians aged 16-24 reported experiencing a 12-month mental disorder (Australian Bureau of Statistics, 2021), and three-quarters of voters aged 16-24 believe young people cannot access the specialist care they need (Orygen, 2022). This highlights the critical need for strategies that effectively bridge Australian services with the young populations they aim to support. This policy paper pushes for peer support and mental health first-aid education to become a central asset in overcoming this crisis, serving as a means of early intervention and acting as first responders who can assist in alleviating a degree of emotional trauma and referring those in need to the professional services Australia has to offer. It recommends allocating funding to form a new federal body within the Department of Health and Aged Care, tasked with developing a curriculum to train professionals in peer support and mental health first-aid education. Additionally, it proposes introducing a ‘Mental Health Literacy and Education’ subsection within Australia’s Long Term National Health Plan (ALTNHP) within 5 years to outline a commitment to peer support and mental health first-aid education for all schools in Australia, delivered in partnership with NGOs and charities. The estimated cost is $1.2 million annually for effective implementation in all Australian schools.

Problem Identification

Despite growth in federal funding allocated to the mental health sector, a concerning trend persists in youth mental health statistics, with “39.6% [of Australians] aged 16-24 [reporting] a 12-month mental disorder” (Australian Bureau of Statistics, 2021)  and “three-quarters of voters aged 16-24 believe young people… cannot access the specialist care they need” (Orygen, 2022). Logically, the cause for concern is not the total funding allocated, but the efficacy of the services and resources these funds are designed to provide. 

What must first be foregrounded is the immediacy and urgency of this mental health crisis amongst the Australian youth. With grant offerings reflecting the mandate and key areas specified within both the federal budget and plans from respective departments within the government, changes in these documents can cause significant flow on effects to the impact of organisations and actors (Hartanti et al., 2022). Australia’s Long Term National Health Plan is one such document, whose directives shape the scope of professional services and the mental health safety net in the country more broadly  (Mental Health Commission, 2017). Within ‘Pillar Three: Mental Health and Preventative Health’, the department delegates the responsibility of addressing youth mental health issues to a secondary ‘National Children’s Mental Health and Wellbeing Strategy’ (NCMHWS) despite the next paragraph explicitly recognising “research into the early detection, diagnosis and treatment of eating disorders'' as a priority (Department of Health, 2019). 

The otherwise lack of explicit mention for youth mental health in a plan that outlines the most pressing concerns for Australian health warrants concerns for the future solutions protecting young Australians and risks the struggles of this demographic being overlooked in policymaking and grants.  In 2013, 14.4% of young people reported experiencing a mental disorder and by 2022, 26% of young people aged 15-24 reported experiencing chronic anxiety disorders alone (Australian Institute of Health and Welfare, 2022). As a result, the four year gap between the ALTNHP’s publishing and the release of the NCMHWS in late 2023, diverting attention away from youth mental health solutions becomes a possibility. To ensure a framework is in place to protect the wellbeing of the next generation of Australians, a comprehensive and urgent response is necessary, which would most effectively stem from change within ALTNHP.

Just as early intervention is recognised as a critical element for addressing the eating disorder crisis, its importance as a mechanism of Australia’s mental health safety net should similarly be reflected in policy-making. For young Australians, a successful response hinges on the actions outlined in the new NCMHWS, and while its existence as a separate document to ALTNHP implies more extensive considerations and solutions, an evaluation of its ‘Action’ sections reveal more concerns (National Mental Health Commission, 2023).  The recognition of ‘Early Intervention’ as a critical concern was supplemented by an acknowledgement that “there are barriers such as lack of investment and research into mental health assessment tools… for this population” and a parent’s commentary that “early intervention isn’t made possible around mental health because it’s so focused on disability” (National Mental Health Commission, 2023). However, the only attached solution to this was the Mental Health in Primary Schools Pilot (MHiPS) program, which was an existing initiative. An effective early intervention strategy should involve literacy and education, and action steps for delivering both to children, teenagers and young adults are absent in the document (Sznitman et al., 2011). The latter sections of this policy paper propose mental health first-aid and peer support as unique solutions which seek to address this shortcoming.

Context

Mental health is undoubtedly a sector of high priority and an area of concern in Australian policy (Department of Health, 2019). The rise in funding in accordance with ALTNHP in 2020 to “$503 million for youth” affirms the federal government’s commitment to protecting the large quantity of vulnerable Australians that struggle each year (Department of Health, 2019). However, addressing the delivery of mental health aid to the Australian youth requires acknowledging and subsequently resolving the cross-sectional challenges it raises. To identify the area to be resolved, the process in which a child, adolescent, or young adult recognises that they need aid and then seeks it must be examined and reconciled with current interventions. For an individual to take action, the result must justify the risks of possible ostracism and the inconvenience caused (Rickwood et al., 2005). This highlights a struggle experienced by young Australians regarding the social stigma of asking for support that policymakers are tasked with addressing to ensure both access and utility of mental health resources.

Furthermore, those unaffected by the social stigma in seeking help may still be daunted by other more subjective and situational possibilities. For example, amongst young men, a culture of toxic masculinity has fostered a belief in this demographic that seeking assistance implies some form of personal defeat (Smith et al., 2020). For others, this may stem from the concern that it may trouble or inconvenience others (Corrigan & Kleinlein, 2005). Concerns such as these form a major reason why many suffering from mental illnesses remain silent: their attempt not to submit to their emotions while refusing aid with the hope of saving others’ efforts (Smith et al., 2020). With this reasoning, it is unlikely that they may be comfortable enough to reach out to parents, unfamiliar supervisors, or professional service providers. Peer support in mental health is where one’s friends can provide emotional assistance and comfort in times of struggle (Mind Australia, 2019). However, consoling or lending an ear in a time of emotional duress requires an understanding of what to say and what not to say, with even fundamental decisions potentially serving to deepen insecurities and feelings of guilt rather than alleviate them (Hold My Hand Australia, 2021). As a result, peer support must be developed in tandem with mental health first-aid education, equipping youth with the skills and knowledge to offer an immediate source of emotional support, which then becomes a means of referring them to a professional.

In Victoria, Macedon Ranges Shire Council has developed a successful model which allocated funding towards “mental health education and youth suicide prevention” (MHFA Community, 2023). Since 2010, it has aimed to make mental health first-aid training and mental health literacy accessible to all within the community, including youth. By 2023, 2,400 teenagers received essential education by attending workshops introduced directly to local schools, clubs, and families. In determining the approach’s effectiveness, feedback was collected over the past decade and displayed “increased community resilience” and “reduced frequency of crisis” (MHFA Community, 2023).

Another persistent struggle is uncovering the validity of statistics and metrics used to determine the success of these services. Within Headspace’s 2021 report on the accessibility and usage of their ‘Headspace Centres’, they claim “more than 10% of the estimated 950,000 young people in Australia who would have experienced a mental health problem… have accessed a Headspace centre” (Headspace, 2021). However, the organisation employed an outdated national study conducted in 2007 to determine the 950,000 figure (Slade et al., 2009). Furthermore, 405,139 total services were offered but only a quarter of these services were utilised, and this figure has only trended downwards since the COVID-19 pandemic (Headspace, 2021). “Contacts to Kids’ Helpline [rising] by more than 20% in 2020” initially appears as a positive trend that counteracts this (YourTown, 2020); however, its function as a helpline means it is a ‘last-resort’ service, where more contacts translate to an unprecedented increase in the number of Australian youth struggling intensely with mental health (de Jong et al., 2020). Yet, this does not account for a vast community of young Australians yet to be reached or have not voluntarily sought help from professional services (Coralie J Wilson, 2014). Having established the uncertain, yet widespread impact of the youth mental health crisis on young Australians and that no reliable and conclusive figures can attest to the overwhelming success of Australia’s mental health safety net, innovative solutions must be trialled to halt its progression.

An important component of mental health solutions that should be emphasised is effective education. However, education can only amount to tangible benefits with a framework and guidelines to inform teachings and to equip professionals to deliver the material (Yale.edu, 2013). Despite establishing the importance of teaching ‘peer support’ and ‘mental health first-aid,’ these are currently not universally defined, and their bounds in mental health are not yet grounded. According to SANE Australia, peer support regards “support based on shared experiences of dealing with mental health challenges” (SANE Australia, n.d.), whereas Shery Mead, an acclaimed mental health author and the founder of ‘International Peer Support,’ generalises the definition more broadly to “providing knowledge, experience, emotional, social, or practical help to each other” (Mead et al., 2001). As a result, the formulation of a universal curriculum is necessary to combine the efforts of Australian mental health professionals to most optimally assist educators and school students.

For the benefits of the aforementioned changes to reach the Australian youth efficiently and effectively, collaboration between the state/territory and federal governments with charitable and non-for-profit organisations are essential. The Department of Health and Aged Care is a key player whose guidelines outlined in the ALTNHP inform the grants and funding that enable organisations to deliver specific services as outlined in its mandate to the general public. As such, the recommendations below encourage a top-down response, beginning at a federal level in terms of policy change which would enable key actors such as Australian medical professionals within the mental health sector to train volunteers within charitable organisations to ultimately impact youth within schools and universities.

Policy Recommendations

The following proposals are suggested to resolve the aforementioned youth mental health issues the nation faces:

1. Allocate funding towards the formation of a new federal body within the Department of Health and Aged Care, tasked with developing a curriculum to train professionals in peer support and mental health first-aid education.

2. For the Department of Health and Aged Care to introduce a ‘Mental Health Literacy and Education’ subsection within Australia’s Long Term National Health Plan within 5 years.

Policy Recommendation 1: Form a new body within the Department of Health and Aged Care, tasked with developing a curriculum to train professionals in peer support and mental health first-aid education.

This body will devise a unanimous definition of ‘peer support’ and assume the responsibility of developing a centralised curriculum which training providers from Australian medical professionals within the mental health sector and trainees can use to receive practical and consistent information. This would be overseen by the Department of Health and would be made up of professionals such as members of the Australian Psychological Association, volunteers, past mental health patients, and young people. The role of this body would be to oversee the development and proofing of the curriculum. Including members from non-professional backgrounds who may have been the target audience for this curriculum in the past would allow for a more diverse range of solutions to be devised. Decisions on the content to include should be made according to the Delphi Consensus Model, a method that makes decisions utilising the consensus of a diverse group to minimise risk and create a comprehensive solution as trialled by Mental Health First-Aid Australia (Mental Health First-Aid Australia, n.d.). To ensure transparency and alignment with international standards, the curriculum should adhere to the standards outlined in ISO 45003, a set of guidelines to aid organisations in delivering quality psychological support (ISO, 2021).

These resources would be distributed to Australian NGOs and charities for training providers to be contracted and taught as an in-person service or as an online resource licensed to schools and universities to be distributed through their networks. Operational costs would be funded through existing grants proposed as part of the Long-term National Health Plan. A predicted annual budget is provided below for reference:

Category	Description	Estimated Cost (Annual)
Personnel Costs	Salaries and benefits for 10 task force members, including mental health professionals, educational experts, and youth organisation representatives	$500,000
Research and Development	Costs for curriculum development, including research, expert consultations, and pilot testing	$200,000
Training and Implementation	Costs to train trainers for nationwide curriculum delivery, both in-person and online	$300,000
Operational and Administrative Expenses	Office space, equipment, and overheads for the newly formed body	$100,000
Monitoring and Evaluation	Systems for feedback collection effectiveness evaluation and non-compliance checks, using surveys and third-party evaluations	$100,000
Total		$1,200,000

Cost estimations based on Statement 6 of Budget Paper No. 1 (budget.gov.au, 2024).

This new body would additionally adopt the responsibilities of overseeing the roll out of the program and monitoring outcomes. Both internal feedback from the facilitators subject to the training and external feedback measuring the effectiveness of the training would be collected via a survey. This external feedback to the task force would be provided by medical practitioners such as psychiatrists with prior experience providing support, whose feedback could inform future efforts to refine the curriculum. The curriculum would be updated each year in accordance with the suggestions received. 

Policy Recommendation 2: For the Department of Health and Aged Care to introduce a ‘Mental Health Literacy and Education’ subsection within Australia’s Long Term National Health Plan within 5 years.

To improve the preemptive measures currently in ALTNHP, focusing on mental health literacy and mental health education would prove to be a critical first step. This would be facilitated within the Department of Health and Aged Care, the body responsible for the publication of the policy and the allocation associated funding, by adding a subsection within the existing mental health section of the policy. The subsection would need to outline requirements for peer support and mental health first-aid education for all secondary schools (including private, government, and independent schools).  Delivery would then require collaboration between the Department of Health and the education departments of Australian states and territories. Although extensive and inevitably costly, a solution of this scale is necessary to reach the Australian youth in an equitable manner that is still within the policy domain. This proposal is designed to impact enough children, teenagers, and young adults that it fosters dialogue on mental health literacy and awareness within the Australian youth community at large. A social movement could be an effective means of creating a natural preventative measure against the mental health crisis, as more youth are comfortable seeking help and supporting one another (Stuart, 2016).

The delivery would be the responsibility of NGOs and charities such as Headspace, facilitated by the grants created by the Department of Health, and state and territory mental health departments as a result of the new Mental Health Literacy and Education subsection. The funding made available would incentivise these organisations to expand their outreach, educating and sharing their services with more communities of youth (Treasury, 2022). Charities and NGOs seeking to offer mental health literacy and education services would train their staff based on the guidelines in the first policy recommendation, with the new body of the Department of Health responsible for overseeing the quality of implementation. 

To determine a budget for these grants, estimates were based on the services offered by ‘Mental Health First-Aid Australia’, which produced a round estimate of $10,000 per school (Mental Health First-Aid Australia, 2023). Delivering this to Australia’s 2861 schools would total $28.61 million annually, reaching over 1.6 million Australian youth (Statista Research Department, 2023). Success would be monitored through student feedback collected by NGOs and charities after service delivery. Positive outcomes of this policy should also be visible in the National Study of Mental Health and Wellbeing published by the Australian Bureau of Statistics (Australian Bureau of Statistics, 2021). The taskforce would also monitor data to watch for consistent increases in the percentage of youth who saw a health professional for their mental health and reductions in 16-24-year-olds who experienced a mental illness in the past 12 months which would attest to the success of the policy.  

Together, the two policy recommendations can ensure more services are, therefore, more visible and directly accessible to Australian youth.

Limitations/Barriers

Effective implementation of the proposed policy changes necessitates close collaboration with state and territory mental health departments. The risk of non-compliance can be mitigated through the establishment of ongoing intergovernmental workshops and formal agreements, ensuring alignment and commitment across jurisdictions. Financial constraints pose a significant challenge due to the substantial funding requirements of the initiatives outlined. Addressing this concern requires a phased approach to funding and exploring possibilities for additional allocations from the federal budget to ensure sustainable resource distribution. The collaborative nature of designing these mental health programs invites potential bias, which could impact the objectivity and effectiveness of the educational content. To minimise this risk, a robust peer review process should be implemented, involving a diverse group of stakeholders to provide a balanced perspective in the development phases. 

Another notable challenge is the variability in educational delivery, which depends on the approval and cooperation of state/territory education departments. Adapting services to meet the distinct needs of various healthcare structures across Australia is crucial. This can be achieved through regular state-level engagement and developing flexible policy frameworks that allow for regional customization of mental health education programs. By proactively addressing these barriers through strategic planning and collaborative efforts, the policy aims to establish a comprehensive and responsive mental health educational framework that is adaptable across different state systems and capable of meeting the diverse needs of Australian youth.

Another barrier is the implementation process's large-scale funding, resource and labour requirements. It is suggested this amount is allocated from the funding dedicated to youth mental health in the current ALTNP. However, it would inevitably form a major component of the budget, which may then require additional funding from this federal budget. Third-party providers must also be contracted to monitor and evaluate its effectiveness, which would incur further costs. Additional resourcing challenges are posed for charities and NGOs due to the necessity of widespread recruitment efforts and for distribution in regional areas.   

Conclusion

Confronting the youth mental health challenges that have continued to plague the populace today requires novel solutions created not just for those with diagnosed mental health issues, but for all young Australians. Despite the significant budget allocation for mental health prevention and treatment, a vast community of youth still remain unable to or uncomfortable seeking professional help. To reach these vulnerable children, teenagers and young adults, it is proposed that a requirement for peer support and mental health first-aid education is constructed to bridge this gap. 

This, supplemented by a universal curriculum to ensure equity and ease of delivery, would create a mental health safety net for all Australian youth and future citizens and would lay the groundwork for a more harmonious system. By responding to the mental health crisis in a manner that challenges the current victim and respondent framework, it becomes an all-encompassing societal movement towards wellness that serves the needs of today’s youth. After all, mental health is something every Australian shares, and these policies would ensure that future generations can reach their aspirations supported by a more well-adjusted and health-conscious community.

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The views and opinions expressed by Global Voices Fellows do not necessarily reflect those of the organisation or its staff.