Mental health
Priority Area
Health Needs Assessment 2025 - 2028
Mental health is an essential component of the overall health and wellbeing of individuals and communities. Mental health has emerged as one of the most pressing concerns for community members and service providers on the North Coast. Limited access to suitable services, long wait times and a shortage of adequately trained mental health professionals has led to significant challenges for those seeking support. These issues, compounded by rising rates of psychological distress, suicide and self-harm, has resulted in people struggling to access appropriate support for mental health.
There are considerable gaps in data regarding mental health on the North Coast. Much of the available data relies on self-reporting or comes from individuals already engaged in treatment. This reliance limits a comprehensive understanding of the extent of needs and challenges on the North Coast region. Mental health service providers and Healthy North Coast subject matter experts highlighted that the lack of detailed and diverse data hinders the ability to form a full picture of the situation. To improve this, further collaboration is required with service providers and community organisations, as well as additional data from frontline service providers, community groups and individuals with lived experience.
Mental health on the North Coast
More people have died by suicide on the North Coast than in Australia every year since 2012. The number of people dying by suicide on the North Coast peaked in 2021. Between 2018 and 2022, 469 people died by suicide in the region. In this period, all North Coast statistical areas level 3 (SA3s) had more people dying by suicide per population than NSW and Australia. Clarence Valley SA3 had the highest number of people die by suicide (22 per 100,000 people). Notably, Port Macquarie experienced a 30% increase compared to 3 years prior, with 17 people dying by suicide per 100,000 residents in 2018-2022.
Consultations have identified 2 critical concerns: the high suicide rates in regional and remote areas and a lack of capacity in schools to address severe mental health issues in children (AIHW, 2024).
In response to some of these challenges, Healthy North Coast has implemented the Targeted Regional Initiatives for Suicide Prevention (TRISP). This multi-sectoral approach focuses on 4 key strategies from the Lifespan Model, including promoting help-seeking and resilience in schools, training the community to respond to suicide risk, improving emergency care for suicidal crises and engaging the community in change efforts. These targeted activities aim to address the specific needs of the North Coast population.
Intentional self-harm refers to deliberately causing physical harm to oneself but not necessarily with the intention of dying. It is often used when individuals are experiencing overwhelming and distressing thoughts or feelings (AIHW, 2025; Mental Health Foundation, 2025). In 2022-23, for every 100,000 residents on the North Coast there were 72 hospitalisations due to intentional self-harm. Whilst this was lower than the national average, it was higher than the NSW rate. Intentional self-harm hospitalisations on the North Coast vary depending on age and across the geography of the region:
- Port Macquarie and Clarence Valley SA3s had the highest rates of intentional self-harm hospitalisations
- More people aged 65 years and older on the North Coast experienced intentional self-harm hospitalisations than NSW and Australian rates.
This highlights the need for further research and support for mental health in the ageing population of the North Coast (AIHW, 2023).
Healthy North Coast is committed to supporting people to live and age well and stay connected to community and country. Social prescribing continues to gather momentum in Australia as a contemporary approach to health care and is already widely adopted in countries such as the United Kingdom. From April 2025, Healthy North Coast will be engaging with towns across the footprint to develop the next phase of Healthy Towns – where people can live and age well, with ongoing opportunities to contribute and stay connected to community and country.
The Kessel Psychological Distress scale (K10) is a questionnaire used to yield a global measure of psychological distress based on anxiety and depressive symptoms. Population level data from the K10 questionnaire is used as a key indicator of mental health and wellbeing within a population. In 2021-23 on the North Coast region, 25% of adults reported experiencing moderate levels of psychological distress, 13% high distress and 7% very high distress. The proportion of people experiencing high and very high levels of psychological distress on the North Coast region has steadily increased since 2009-2011 (NSW Government, 2023).
General practitioners (GPs) play a crucial role in providing mental health services, often serving as the first point of contact for people seeking mental health support and referrals. On the North Coast, the number of people using GP mental health services in 2021-22 was higher than the national average, with 11% of the population accessing these services compared to 9% nationally. The number of people using GP mental health services varied across SA3s, ranging from 9% of the population in Kempsey-Nambucca and Clarence Valley to 12% of the population in Richmond Valley-Coastal.
The prevalence of mental health conditions among general practice patients on the North Coast region varied by condition and location:
- Anxiety was the most common condition, affecting 12% of patients and showing an increasing trend, with the highest rates in the local government areas (LGAs) of Lismore (16%), Ballina (14%) and Kempsey (14%).
- Depression affected 8% of patients and was decreasing, with the highest rates in Richmond Valley (10%) and over 9% in Nambucca Valley and Lismore.
- Other conditions such as attention deficit/hyperactivity disorder (ADHD), bipolar disorder and schizophrenia affected smaller percentages of the population but showed increasing trends, with varying prevalence across different LGAs (PATCAT, 2024).
In 2023-24, post-traumatic stress disorder (PTSD) was the most commonly recorded diagnosis for people using primary mental health care commissioned services. This was followed by mixed anxiety and depressive symptoms, major depressive disorder and generalised anxiety disorder. Of note, attention deficit hyperactivity disorder (ADHD), which accounts for 3% of the care provided, experienced a three-fold increase between 2020-21 and 2023-24 rising from 59 to 168 people (PMHC MDS, 2024).
The impact of the 2022 floods on the mental health of people on the North Coast has likely contributed to the increase of the number of people being diagnosed with PTSD. To support the lives of people affected, researchers from Southern Cross University are conducting a world-first clinical trial which combines group-based arts programs and Methylenedioxymethamphetamine (MDMA)-assisted therapy to support more than 200 flood survivors suffering from PTSD. The 4-year study, funded by the Australian Government’s Medical Research Future Fund (MRFF), aims to provide alternative treatment options for those affected by the disaster (Ministers Department of Health and Aged Care, 2024; Southern Cross University, 2024).
The increase in the number of people living with mental health concerns, particularly anxiety, PTSD and ADHD, highlight a growing demand for mental health services to meet the needs of people living with these conditions. Without increased accessibility, the mental health challenges faced by people in the region may continue to escalate, placing greater strain on existing services.
Youth mental health remains a significant challenge across the North Coast region. The rates of young people experiencing self-harm, suicide attempts and mental health conditions including depression and anxiety are higher than the NSW average (AIHW, 2024). Concerns about access to appropriate and timely mental health services for children and young people, particularly but not limited to the more regional areas, were raised extensively in consultations with community members, service providers and subject matter experts within Healthy North Coast.
Younger girls are increasingly experiencing high rates of anxiety and school refusal and the number of older girls dying by suicide has increased. Participants in consultations raised concerns and highlighted the continued gap in access to clinical and non-clinical services for young people to support mental health and indicated that where creative therapies exist, there is high uptake.
As part of the Targeted Regional Initiatives for Suicide Prevention (TRISP) Healthy North Coast conducted consultations in Port Macquarie, Grafton, Coffs Harbour, Lismore, Tweed Heads and online in August 2024. One of the 4 lifespan strategies explored was: Promoting help-seeking, mental health and resilience in schools. The TRISP participants reported that limitations in technology influence access to support and fear around help-seeking as barriers for young people to access support. They raised concerns that factors affecting students’ psychological health require recognition, and that more mental health education in the school curriculum is needed. These were identified in the service provider and subject matter expert consultations as part of this needs assessment.
Early intervention is critical to manage the early symptoms of ill mental health, to minimise deterioration and progression to more severe or acute illness. The TRISP participants highlighted that many mental health challenges are exacerbated by a lack of emotional coping strategies, contributing to issues like substance use and suicidality. Since emotional regulation difficulties are linked to self-harm, substance abuse and suicidal behaviour, incorporating programs to teach these skills in schools and in communities could provide vital early intervention before mental health issues become more severe.
Service use and availability
In 2021-22, people on the North Coast presented to emergency departments for mental-health related concerns more than the NSW and Australian averages. For every 10,000 people, there were 145 mental health-related presentations on the North Coast, compared to 105 in NSW and 109 in Australia. While there was a 10% decline these presentations in the 3-year period since 2018-19, this was less than the 19% reduction observed in NSW.
Although there is variation across SA3s on the North Coast, all of them have higher rates of mental health-related presentations to emergency department than NSW and Australia. For every 10,000 residents in Kempsey-Nambucca SA3 there were 200 presentations for mental health concerns, the highest on the North Coast. These high rates may be attributed to gaps in primary health care services, with community members reporting challenges in accessing timely and appropriate mental health services. Both community members and service providers emphasised the need for enhanced early intervention services to address the growing severity of mental health issues in the region (AIHW, 2022).
In 2023-24, nearly 6,500 people accessed Healthy North Coast commissioned mental health services, with almost 44,000 sessions delivered. These numbers represent only a portion of the population using mental health care services, as non-commissioned services and unreported demand are not included. Many people struggle to access mental health services, especially in under-serviced areas.
In 2023-24, the most common type of care people accessed through commissioned mental health services was psychological therapy, which accounted for 67% of all care provided. This was followed by low-intensity psychological interventions (11%) and clinical care coordination (9%). Notably, the number of psychological therapy sessions delivered increased by 59% over the past 3 years since 2020-21, while both low-intensity psychological interventions and clinical care coordination saw declines of 13% and 27%, respectively. These shifts are likely influenced by targeted referrals from general practitioners and local health districts for specific treatment types (PMHC MDS, 2024).
Despite the increase in primary mental health commissioned services and access to those in Lismore LGA, 1 in 2 of the 124 respondents from Lismore to the Better Health Community Survey who reported requiring mental health services stated a lack of services in their area as a challenge for access. Cost (55%) and difficulty to organise (33%) were other major barriers identified in by people from Lismore. This was consistent with the region overall, where cost (56%), lack of services (45%) and difficulty to organise (30%) were the top 3 barriers reported by people across the region to accessing mental health services.
A total of 34% of care provided was for individuals experiencing subsyndromal conditions, which do not meet the criteria for formal diagnoses but still present significant mental health challenges. This signals a need for more preventive and early intervention services to address emerging issues before they escalate (PMHC MDS, 2024).
Despite the range of mental health services delivered, consultations with community members, service providers and subject matter experts identified significant gaps in service availability and accessibility, particularly for neurodivergent individuals and those living in remote areas. The unmet demand for mental health care remains a critical concern across the North Coast.
Survey results further highlighted these concerns, with 41% of individuals who needed mental health services reporting that they could not access them. Mental health was identified as a primary health concern by 49% of survey respondents across the region, which was up to 62% in Lismore and 60% in Byron LGAs. Community participants expressed frustration with the excessive burden placed on individuals when trying to access care, which only worsened their mental health challenges.
Consultation participants pointed out concerns around the suitability of services, particularly regarding age appropriateness, cultural sensitivity and gender considerations. There is a need for a more skilled and resourced workforce across the North Coast, particularly mental health professionals who are experienced in working with neurodivergent individuals and young people.
Throughout this document ‘survey’ refers to the 2024 Better Health Community survey undertaken as part of the Health Needs Assessment 2025-28 consultation process
