A World-Class Mental Health System

Dr Nathan Kesteven

In the 1970s the standard treatment for breast cancer was a complete mastectomy and removal of all the lymph nodes on the same side of the breast. Then the patient may have been treated with high dose chemotherapy and/or radiotherapy. Outcomes were fair and side effects were substantial.

Fast forward to 2025. Treatment is now team based, with the surgeon, oncologist, radiation oncologist, cancer care nurse and patient. Depending on the biopsy and imaging results there may be simply a lumpectomy +/- lymph node removal, possible chemotherapy (generally with low toxicity), perhaps radiotherapy and perhaps hormonal therapy. Patients are also supported by the cancer nurse to adopt a healthy lifestyle – eat a balanced diet, get fit and quit smoking. Outcomes have improved significantly and side effects generally much less traumatic.

While advancements in cancer care have dramatically improved outcomes and reduced treatment side effects, the mental health landscape remains largely unchanged. In the 1970s the standard treatment for those with psychosis was admission to a mental health unit, administration of antipsychotic medications and probable use of coercive interventions. In 2025 the standard treatment in most of Australia for that same cohort is admission to a mental health unit, administration of antipsychotic medication and probable use of coercive interventions.

For many of you who have experience of the present system this is not news. However, a beacon of hope shines through the publication of the World Health Organisation’s (WHO) 2021 Guidance on Community Mental Health. This landmark document outlines a pathway to 21st-century care, emphasising Recovery-Based Health Services and Person-Centred Care, grounded in the Convention on the Rights of Persons with Disabilities.

While the 296-page document is a treasure trove of inspiring examples from around the globe, it’s sobering to note the absence of Australian models. This highlights a critical gap in our national approach. The document describes so many amazing, inspiring and mind-opening examples of hospital and community based mental health services that demonstrate how to offer humanistic, compassionate (for patients, families/carers and staff), safe, cost efficient and most importantly effective RECOVERY based outcomes for those who need it, regardless of diagnosis or severity.

For example, Brazil’s community-based mental health centres (CAPS) follow three guiding principles:

1. Open door policies – a person can simply walk in to the centre to make an initial meeting; people are free to come and go throughout the daily life of the CAPS, participating in the activities offered or simply use it as a place to connect and meet with others, as a place of respite, or to participate in group activities. There are NO locked doors.

2. Community engagement – CAPS are active in the community, working to fully engage with and understand the community they serve and the individuals who live there. They identify and activate community resources and create partnerships to carry out mental health care initiatives.

3. Deinstitutionalisation – CAPS were designed and developed to replace psychiatric hospitals and other institutionalisation structures, all CAPS have the capacity and responsibility to attend to complex, challenging and crisis situations, offering care and support with community-based practices. As a principle, CAPS do not refer individuals to psychiatric hospitals.

The WHO Guidance on Community Mental Health is replete with such inspiring models, all supported by evidence showing improved outcomes. Trieste, perhaps the poster child of how to run a mental health system, has one of Italy’s lowest rates of involuntary hospitalisation for mental health conditions, with 8.1 people per 100 000 population today. The total number of people subjected to involuntary treatment in Trieste dropped from 150 in 1971 to 18 in 2019, in a population of 240,000.

Australia’s involuntary hospitalisation rate was 227 per 100,000 people in 2016.

From someone who both works in this field as a doctor and having family members who have needed mental health support, the WHO Document explains to all who need and wish to know how to set up and run an exemplary mental health system. The Guidance document itself and associated papers, technical and training packages, has information for everyone – patients, carers, medical staff, peer workers and importantly, managers and policy makers. It lists the steps and ingredients that are needed to bring our mental health system into the 21st Century.

What does this mean for Wayahead?

In our recent NSW pre-budget submission, Wayahead highlighted the groundbreaking WHO Guidance on Community Mental Health. The WHO Guidance provides a roadmap for building a truly exceptional mental health system. As Nathan has highlighted, this document showcases inspiring, evidence-based models from around the globe that prioritise person-centered care and recovery.

We strongly believe that many of these innovative service models, such as the community-based mental health centers in Brazil (CAPS) or the peer-led crisis services in New Zealand (Tupu Ake), could be successfully replicated in Australia to significantly improve our mental health system. This would represent a major step towards providing more humane, effective, and accessible mental healthcare for all Australians.

At Wayahead, we’re committed to aligning our services with these principles, creating a supportive community where individuals can thrive. We believe that by learning from global best practices, we can help shape a positive future.

Sharon Grocott (CEO)