Dr Vash Singh, Psychiatrist, Subiaco
During the Federal election campaign, promises to expand mental health services were front and centre, yet many proposed initiatives are not firmly anchored in evidence, nor have they demonstrated real value in improving long-term patient outcomes.
In a system already strained, it is critical that new investments prioritise models of care that are innovative, integrated, and genuinely value based. Without such focus, we risk perpetuating the very cycle we seek to escape.
There is currently a gap in mental health care. Demand for mental health services has surged in recent years, exacerbated by the pandemic, economic pressures, and social isolation. Yet, traditional inpatient admissions often function as short-term crisis interventions rather than part of a broader therapeutic continuum.
Inpatient teams frequently disengage after discharge, leaving GPs to manage patients who are still at high risk and require significant support. This abrupt handover – often described by GPs as the hospital having “washed their hands” of the patient – places enormous pressure on primary care without the necessary backup.
RELATED: Emergency departments facing mental health tsunami
Moreover, many patients require more intensive intervention than standard outpatient models can offer, but not the full containment of a hospital bed.
This is where current services fall short – there is a large and growing gap between acute inpatient care and outpatient community management.
Intensive day programs: a vital bridge
Innovative, integrated day hospital models provide a critical bridge across this divide. These programs deliver daily, multidisciplinary care for several weeks, allowing patients to stabilise without severing ties to their families, jobs, and communities.
Once acute symptoms improve, patients can transition to lower-intensity outpatient therapy within the same service, offering a seamless step-down pathway.
In effect, a single service can offer multiple tiers of care – from intensive to maintenance – tailored to patient needs at different stages of recovery.
Evidence supports the effectiveness of such models. A randomised controlled trial published in The Lancet Psychiatry (2020) found that day hospital care for adolescents with eating disorders was as effective as inpatient treatment in reducing symptom severity, while enabling patients to maintain crucial social and familial connections.
A review in Psychiatric Services (2019) further highlighted that step-down day hospital programs significantly reduced hospital readmissions and improved continuity of care.
Applying value-based healthcare
The concept of value-based healthcare – providing care that achieves the best outcomes at the lowest possible cost – has become central to discussions about the future of health service delivery.
Applying this framework to mental health care demands that we:
- Prioritise services that deliver measurable, patient-centred outcomes, not just activity or throughput
- Invest in models that reduce reliance on acute crisis admissions by providing early, intensive intervention
- Integrate tiers of care under one service umbrella, allowing for flexibility, continuity, and personalised step-down care.
Day hospital programs embody this value-based approach. They are less costly than prolonged inpatient stays, reduce burden on emergency services, and offer outcomes that match or exceed traditional models.
Yet, despite their strong evidence base, these programs remain underfunded and under-recognised in policy discussions.
RELATED: Navigating PTSD for kids
With any new funding pledges, policymakers must look beyond short-term political wins and invest in models of care that are truly innovative and sustainable.
Integrated intensive day programs should be scaled up and incorporated as a core part of Australia’s mental health service landscape.
Failing to do so risks continuing a reactive, fragmented system that leaves vulnerable patients – and their GPs – without the support they need.
If we are serious about changing mental health outcomes in Australia, it is time to build bridges, not just hospital beds.
Key messages
- There is a gap in mental health care between hospitals and primary care
- Innovative, integrated day hospital models can bridge this divide
- Future mental health reform must be value-based and evidence-informed.
Author competing interests – nil
This clinical update is CPD verified. Complete your self-reflection and claim your CPD time here.
Want more news, clinicals, features and guest columns delivered straight to you? Subscribe for free to WA’s only independent magazine for medical practitioners.
Want to submit an article? Email editor@mforum.com.au