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Writer's pictureAlex Wilson

The 'Missing Middle': Where can I get help?


Orygen youth mental health define the missing middle in the following way:


The ‘missing middle’ is a term used to describe people whose needs are not met by current mental health services.


They are often too unwell for primary care, but not unwell enough for state-based services.


They may have accessed services in the past year, however, these services were not able to deliver either the duration of care, or level of specialist care appropriate for more complex and serious mental ill-health.


There is a huge gap in mental health services for those whose issues are too complex for general psychology services (eg. your local psychology clinics), but are not serious enough for public acute care services (eg. your local emergency department & mental health team).


Many mental health services are not experienced or equipped to work with higher levels of risk &/ or complexity. Those services that are equipped typically experience very high levels of demand, & often turn away those who are not presenting with extremely urgent needs.


Research shows that young people, ages 12-20, are especially affected by this gap in services. Tragically, suicide rates are a stark reflection of this gap in services.


The following are common issues for those in the 'missing middle':


  • History of complex trauma

  • Chronic self harm

  • Chronic suicidality

  • Numerous treatment attempts that have not been successful

  • Those with a diagnosis of a personality disorder

  • Multiple mental health diagnoses

  • Numerous hospital admissions or crisis service episodes

  • Experiences of being stigmatised by health professionals due to complex mental health needs


If you find yourself in the 'missing middle', it's important to know the following:


  • You have not failed- treatment has failed

  • You have not failed- the system has failed you

  • You are not beyond help- you just haven't found the right help yet

  • There is help available- you just have to know where to look


At Mindful Recovery Services, we specialise in the missing middle!!!! Complexity is our speciality:)


Our latest expansion, the Central Coast DBT Centre, provides evidence-based mental health care for people aged 13 & over. DBT is a psychological therapy that was designed to work with complexity & has a strong evidence-base of research supporting its effectiveness.


If you or someone you know feels stuck in the 'missing middle', please reach out to us- we would love to help:)

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