Suicidal thoughts, self harm and depression shadowed Sarah Mintz as a teenager living in regional coastal NSW.
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But distance, a lack of services, long wait times and the fear of being stigmatised threw up "roadblock after roadblock" between her and the support she needed.
"It was really difficult to go and get help because I didn't want people to know about it," she said.
"When you grow up in a small town everybody knows everybody, so you have the issue of confidentiality."
Problems at home in Bellingen on the Mid North Coast combined with bullying at school drove Ms Mintz to seek help. But accessing mental health services meant travelling long distances or going on a lengthy local waiting list.
"It adds extra stress onto what you are already experiencing," the 25-year-old said.
"My GP was really great but it was still a waiting period of getting in to see someone.
"In such a small town there's only so many therapists you can go to ... I ended up with a therapist that was local but it took me a long time to get in to see her."
Ms Mintz, now a community engagement officer at headspace Kempsey, knows her experience is common among regional young people across the state.
40% of young Australians have mental health problems
Australian Bureau of Statistics (ABS) data shows mental health problems affected 39.6 per cent of people aged 16 to 24 in 2020-21, surging from just 26 per cent in 2007.
One in four young people reported seeking mental health support from a professional, but more than a third of those said they did not receive the counselling they needed.
Mission Australia's Annual Youth Survey revealed young people in NSW ranked mental health as the second biggest challenge of 2022 (29.4 per cent) behind school challenges (43.3 per cent).
Suicide is the leading cause of death for people aged 15 to 24.
But it's often harder for regional young people to access services.
In Sydney city and its inner south there were 331 psychologists for every 100,000 people in 2020. In the state's Murray region, which includes Albury, Hay and Deniliquin, there were just 43.
You can't 'put mental health on hold'
Shelby Mitchell, 17, said her local headspace centre, which provides support services and counselling, had changed young people's lives since it opened at Kempsey.
But it wasn't enough and waiting lists were long.
"It's a bit frustrating because we only have one youth headspace here," she said. "Sometimes people could be waiting two or three months to get in and you can't really put mental health on hold."
Shelby, the first person from Kempsey to be appointed to the state government's Youth Advisory Council, said she would like more equality of access between metropolitan and regional areas.
"It would just be great ... to have the same opportunities as what people who live in metro areas do," she said.
Regional NSW deserves slice of funding pie
Shelby's concerns about access to mental health services are backed up by research.
The Mental Health Commission of NSW found 22 per cent of regional and rural residents reported good access to mental health services compared to one third of major city residents in 2021.
Dr Hazel Dalton from Charles Sturt University's Rural Health Research Institute in Orange said securing ongoing funding was hard.
"There is that difficulty in getting serial investment over a long period of time and it has meant that we are not getting a good slice of the pie," she said.
Dr Dalton said recent floods, storms and bushfires in regional areas had amplified the need for mental health services, but the landscape in NSW was not all "doom and gloom".
There had been a steep decline in youth suicides over two years, particularly in regional NSW, for example.
According to the NSW government, there was 60 per cent reduction in regional youth suicide between 2019 and late 2022.
"For rural NSW it's been pretty tough," Dr Dalton said. "We came off a really severe drought into unprecedented fires and flooding as well as a pandemic ... and people are still continuing to feel that impact.
"It's not all doom and gloom. There is a tremendous amount of activity, but there is another side of things where we would be better off investing in more services."
The growing demand for help
NSW Health Minister Brad Hazzard said the number of young people experiencing mental health challenges was a "big issue" in Australia.
"All states are seeing an increase in mental health concerns for young people," he said.
"I know young people personally who have been in that situation and they are getting the services they need now but it will often be a challenge."
Kempsey headspace community engagement officer Sarah Mintz is hoping the issue will be on every candidate's mind at the upcoming state election.
More services like headspace, which offers free support to people aged 12 to 25, were needed in regional areas, she said.
The Kempsey centre only opened its doors in 2022, one of 23 hubs now spread across regional NSW compared to just four a decade ago.
The manager, Annette Toomey, has lived in the area for the past 15 years, working with disadvantaged young people in various roles.
Mrs Toomey said individual counselling and support services had been lacking in the town.
"There is not enough mental health staff out there to meet the needs of young people that we are seeing," she said.
Mrs Toomey raised concerns about the federal government's decision to cut subsidised visits to psychologists in 2023 to the pre-COVID level of 10 per person.
"I don't feel that that's in line with what we're seeing," she said.
"At this time of year we see a lot of school anxiety ... I feel that there's been an increase in that [anxiety] since COVID-19."
Incentives were needed to attract mental health care professionals to the area.
"Whether that's by paying people what they are worth, housing affordability ... all of those things impact on clinicians coming to work for headspace Kempsey," she said.
How the parties compare on mental health
NSW Labor has pledged to tackle mental health by addressing suicide prevention if it wins government on March 25.
It has promised to boost access for mental health services and give $17 million to Kids Helpline over four years to increase its capacity to respond to a rising number of calls.
The Greens want to see "significant" increases in funding for public mental health services, including hospital inpatient services, psychologists, outpatient and outreach services, and case managers.
The party also wants to see more action on mental health and addiction and improve support in schools.
The Coalition, meanwhile, has committed to recruiting 90 school "wellbeing nurses", engaging final year students to work in headspace centres, and to training 275,000 teachers, community leaders and parents to help with suicide prevention.
More young people in politics
Year 12 Kempsey student Shelby Mitchell can't vote in this election because she's not yet 18, but would like to see more young people involved in politics.
"Young people have so many great ideas," she said. "It would just be great to see those ideas being put forward more."
- Lifeline is available 24 hours a day, seven days a week on 13 11 14. Or call Beyond Blue on 1300 224 636, Kids Helpline on 1800 551 800 or headspace on 1800 650 890, or visit headspace.org.au.
My story
Young people are consistently left out of the conversation about politics, but they shouldn't be.
The people who will be elected at the NSW election will be in charge of making decisions that affect our future.
That's why it's so important young people make themselves heard on March 25. We have the numbers to make them care about the issues we face.
- Young & Regional: My Vote Matters is an engaging and non-partisan multimedia ACM series focusing on the new generation of voters in our regional towns and cities as they consider the issues and candidates they will support at the March 25 election. Young people living in regional areas are key to a thriving NSW. They are the farmers, teachers, nurses, small business owners, tradesmen and women and police officers who will ensure the state is fed, healthy and sustainable. Their voice matters and their vote matters.