The Commission extensively engaged with people to learn of these themes: 

• The system is overwhelmed, unable to keep up with the number of people seeking treatment
• Investment is inadequate and the workforce is under-resourced
• There are clear gaps in the system:
  • Community-based services are lacking
  • There is a ‘missing middle’ – people have needs that are too complex or too severe to be met through seeing a GP or private psychologist/psychiatrist but not severe enough to meet the criteria for entry into specialist mental health services
  • The system is crisis-driven where hospital Emergency Departments are used as entry points.
• Accessing services can be difficult:
  • Wait periods are lengthy and people become more unwell, before they can get help
  • Poverty and disadvantage make access harder
  • Access is worse in regional and rural areas where suicide rates and workforce shortages are higher in these areas
  • There are barriers to care for people from diverse communities and social groups - including Aboriginal people, LGBTIQ+ people, refugees, asylum seekers, people from culturally diverse backgrounds and people living with disabilities 
• The system is out of balance compared with what we know works and is needed:
  • There is an over-reliance on medication, use of restraint, seclusion and compulsory treatment
  • There is a lack of focus on therapeutic strength-based treatments
  • People are not involved in making their own decisions about their treatment, care and support
  • Families, carers and supporters feel left out and are not receiving appropriate support