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Implementing Sub-Acute Residential Mental Health Services in Australia

Overview

This implementation brief from The ALIVE National Centre for Mental Health Research Translation examines sub-acute residential mental health services — also known as Prevention and Recovery Care (PARC) services or Step-Up/Step-Down (SU/SD) facilities — as a growing and evidence-based component of Australia's mental health system. It summarises Australian and international research evidence on service effectiveness, consumer and carer experiences, scalability modelling, and implementation challenges across Victoria, NSW, Queensland, and Western Australia. Practical implementation guidelines are provided across system, service, and individual levels, with recommendations drawn from an NHMRC-funded PARC study in Victoria.

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Key insights

This implementation brief presents evidence on sub-acute residential mental health services — including PARC and Step-Up/Step-Down facilities — as effective, cost-efficient, and positively regarded community-based alternatives or complements to inpatient care. Drawing on evaluations from across Australia, it highlights strong consumer satisfaction, meaningful recovery outcomes, and the critical importance of peer support and lived experience integration. It also identifies significant implementation challenges, including workforce shortages, service variability, and inequitable access, and calls for coordinated action across policy, funding, and service delivery to scale these services sustainably.

<p>PARC and Step-Up/Step-Down services have been shown to produce meaningful improvements in recovery, wellbeing, and mental health at substantially lower cost than inpatient care. The Bondi PARC evaluation reported improvements in recovery and wellbeing, reduced hospital use, and significant cost efficiency, with a daily cost of approximately $400 compared to $1,438 for inpatient care. Longitudinal research by Brophy et al. found that improvements in personal recovery, mental health, and quality of life were generally maintained at six and twelve months post-discharge, though long-term recovery depends on continued support through community inclusion and continuity of care.</p>

<p>Consumers across multiple states have reported high levels of satisfaction with sub-acute residential services, consistently valuing peer support, community connection, and opportunities to work toward individual recovery goals. Research by Waks et al. across 19 Victorian PARC sites found high satisfaction and significant improvements in personal recovery, with key themes of connection, meaning, purpose, and self-empowerment. In Western Australia, Queensland, and NSW, national evaluations similarly found consistent reductions in psychological distress between entry and exit, and consumers valued having a voice in service delivery. Gender-diverse and younger participants noted particularly strong benefits despite entering with higher levels of distress.</p>

<p>The integration of peer support workers and family and carer peer support workers is identified as essential to effective PARC service delivery. The implementation guidelines recommend that all PARC services have dedicated funding for the Lived Experience workforce, employing at least one peer worker and a family and carer peer support worker. Consumer feedback consistently identifies peer support as one of the most valued aspects of these services. Co-design in day-to-day care, treatment, and support is also identified as a key mechanism for ensuring lived experience is embedded in all aspects of service innovation and delivery.</p>

<p>Significant variation in how sub-acute residential services operate across states and regions is both an adaptive strength and a source of inconsistency in service quality. The Queensland evaluation identified variations across services in staffing profiles, clinical coverage hours, length of stay, group intervention availability, and medication management. Fletcher et al. similarly identified substantial variation in Victoria's PARC services across infrastructure, staffing models, and program delivery, leading to inconsistencies in service quality and gaps in recovery-oriented care, particularly for regional services. Maintaining core service features while allowing local adaptation is identified as a key implementation challenge.</p>

<p>Certain population groups — including males, young people under 20, and those with higher acuity needs — are significantly less likely to access adult PARC services, indicating inequities that must be addressed in future planning. Analysis of over 78,000 admissions by Farhall et al. found that PARC service consumers tended to have lower symptom severity scores, with individuals presenting with aggression, self-harm, or acute psychiatric symptoms less likely to be admitted. The brief notes that PARC services often support a distinct consumer group from inpatient units, and calls for future implementation strategies to ensure equitable access and appropriate targeting.</p>

<p>Modelling indicates that expanding Step-Up/Step-Down bed capacity would increase hospital discharge rates, reduce pressure on community mental health services, and generate substantial cost savings. The MhIND-T model found that scaling up by 600–800 additional beds over 15 years in NSW would increase hospital discharge rates, free up acute care capacity, reduce demand on community mental health services, and generate significant cost savings through reduced inpatient stays and emergency department presentations. The model estimated diminishing returns beyond 800 beds, suggesting this range represents the optimal investment. Despite Victoria's comparatively stronger service coverage, NSW currently has only one SUSD service per 1.63 million people compared to one per 260,000 in Victoria.</p>

Did this resource draw on transformative evidence?

<p>Yes — The brief incorporates a dedicated Lived Experience Perspective section drawing on consumer feedback from evaluations across Victoria, NSW, Queensland, and Western Australia. A first-person quote from a NSW consumer (Jianna) is included, and the lived experiences of consumers across 19 Victorian PARC sites are discussed through the Waks et al. study.</p>
<p>Yes — The implementation guidelines draw directly on practitioner and organisational experience, including the NHMRC-funded PARC study in Victoria. Recommendations address staffing education, co-design, communities of practice, and cross-sector coordination, reflecting accumulated service-level knowledge.</p>
<p>Yes — The brief is grounded in nine referenced sources including peer-reviewed studies, state-level service evaluations, and modelling reports. Key sources include Waks et al. (2024), Farhall et al. (2020), Brophy et al. via Fletcher et al. (2019), the Queensland Adult SUSD Evaluation (2024), the Bondi PARC Final Evaluation (2025), and the MhIND-T modelling report (2024).</p>

How can this resource help me as a...?

Toggle audience types below to explore.

The brief directly addresses system-level recommendations for government policy makers, funding bodies, and housing and mental health authorities, including calls for policy and funding stability and cross-sector integration.

Service managers and organisational leaders are a primary audience, with detailed recommendations on staffing models, lived experience workforce funding, communities of practice, and evaluation and monitoring frameworks.

Frontline workers across clinical and psychosocial support roles will find guidance on recovery-oriented practice, co-design, joint learning, and the integration of peer support in sub-acute residential settings.

The brief synthesises a substantial evidence base and identifies gaps in the research, including around long-term outcomes, equitable access, and optimal length of stay, making it relevant to researchers in mental health services and implementation science.

While not written directly for consumers, the brief centres consumer experience throughout, making it relevant to consumer advocates and those engaged in service co-design and lived experience leadership roles.

Carers are explicitly referenced across the brief in relation to service engagement, peer support roles, and experience of care, making this resource relevant to carer advocates and family and carer lived experience workers.

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Categories

Resource type

Evidence Summary

Practice Guideline

Target audiences

Consumers

Carers

Practitioners

Researchers

Policymakers

Service Leaders

Translational research priority theme

Community-based models of care

Alternatives to compulsory treatment, seclusion and restraint

Workforce capability

Working with diverse consumers, families and communities

Embedding responsible, safe and ethical practice

Understanding and responding to trauma

Understanding and responding to mental health crisis and suicide

Working effectively with families, carers and supporters

Delivering holistic and collaborative assessment and care planning

Delivering compassionate care, support and treatment

Promoting prevention, early intervention and help-seeking

Supporting system navigation, partnerships and collaborative care

Enabling reflective and supportive ways of working

Embedding evidence-informed continuous improvement

Population cohort

Adults

First Nations People & Communities

Collaborative Centre core function

Lived Experience Participation

Service delivery

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