Shining a light, but missing the mark: Four Corners’ latest mental health reporting
On June 2, Australians watched the Four Corners episode, ‘Emergency: The Long Wait For Help’. The program highlighted a known issue: the mental health system is failing its users. This coverage, however, may not solve the problems because it inadequately defined them. Modern mental health systems have consistently failed people with lived experience for centuries, with early approaches based on a custodial framework blending ‘care’ and ‘control’. These elements persist in policies, practices, and reporting in 2025, worsened but not originating from under-investment.
2025 now sees the latest iteration of this long-standing ideological practice, though now starved of resources. As the Four Corners program highlighted, there has been a long-standing dispute between psychiatrists and the NSW Government around negotiated pay. A lack of comparatively competitive wages led psychiatrists to walk off the job earlier this year, while they also cited under-investment in the system as a driver.
People with lived experience and their families are not served by the NSW mental health system. People are not provided a diversity of supports and services that meet their need at the time they need it, the system is heavily reliant on the use of biomedical responses to distress, and there are high rates of coercion and resulting trauma from the system. Families are left in a perpetual state of hypervigilance worrying about someone they care about who is not receiving care during their darkest times. Underfunding is a contributing factor to these experiences, but it is not the primary structural cause.
Four Corners faced several challenges: defining the problem by differentiating systemic symptoms from causes, adopting a structural lens considering systems, policies, and environmental factors, and providing fair, balanced reporting that addresses conflicts of interest and elevates the expertise of people with lived experience. To analyse whether they achieved this, I'll use Carol Bacchi’s ‘What’s the Problem Represented to Be’ framework [1].
From a course I collaboratively developed “Consumer Perspectives and Mental Health Policy”: https://cmhl.org.au/training/mental-health-policy-consumer-perspectives
Defining problems is crucial for finding solutions. As Professor Dennis Grube notes in Why Governments Get it Wrong (And How They Can Get It Right), "problem definition" is the first step.
What is the actual problem that this policy is trying to solve? It sounds like a pretty straightforward question, but the answer comes preloaded with all kinds of difficulties. Problem definition is a combination of ideological worldview mixed with imperfect evidence, and then served up as urgent political action. It is subjective choice masquerading as objective analysis. Problem definition provides the frame of action for all that follows. What makes it difficult is that problem definition is a contest between competing views of that problem. Those views don’t stand still, and neither does the problem. What begins as one issue can morph into another.
Ineffective problem definition leads to unworkable or even compounding solutions. Bacchi’s framework helps ask simple yet profound questions for a better understanding of the problem.
The framework uses six questions:
What’s the ‘problem’ represented to be in a specific policy or proposal?
What presuppositions or assumptions underpin this representation?
How has this representation come about?
What is left unproblematic? What are the silences? Can the ‘problem’ be thought about differently?
What effects are produced by this representation?
How/where has this representation been produced, disseminated, and defended?
How has it been (or could it be) questioned, disrupted, and replaced?
I will briefly explore the Four Corners episode using these questions. At best, the episode lacks adequate problem framing for solutions. At worst, it reproduces unexamined systemic problems.
What’s the ‘problem’ represented to be?
The Four Corners episode effectively defines and illustrates a problem. It primarily uses views from psychiatrists and nurses, with people with lived experience corroborating the clinicians’ narrative. I summarise Four Corners’ core problem definition as:
‘NSW’s public mental health system is broken by underfunding, staff shortages, leading to unsafe consumer care, tragic outcomes and violence from consumers’.
The episode describes the system as ‘broken’ and unable to meet demand, focusing on bed pressure. A workforce crisis, centred on psychiatrists’ resignations due to pay disputes, is highlighted. This is linked to compromised care, with people not receiving needed treatment. Resulting safety risks to consumers, staff, and the community from consumers are mentioned, with multiple references to violence by consumers. Gaps in community-based care are discussed using the ‘missing middle’ heuristic, arguing people are ‘too unwell’ for primary care but ‘not unwell enough’ for hospital services. The primary cause behind this issue is presented as government underfunding.
What presuppositions or assumptions underpin this representation of the ‘problem’?
This problem definition carries significant presuppositions and assumptions. The first is that the purpose of the system is primarily to ‘treat mental illness’, when others have argued for more holistic accounts of the system as being about ‘supporting a good life’ as defined by the person - of which ‘treatment’ is one small component. Connected is that upon adequate funding, an ‘ideal’ system would exist, when there are arguably core fundamental problems in the nature of how mental health care is conceptualised and delivered. Another assumption is that the treatments being proposed will work and therefore be the right primary solution to these problems, when other clinical perspectives are critical of this approach. Indeed, the National Mental Health Commission concluded in 2023 that:
‘little data is available on the impact and efficacy of the billions of dollars invested by governments across the system each year, or the experiences and outcomes of people who receive support through the system, and their families, carers and kin.’
Assumptions about the nature of violence as arising from mental health are pervasive in the reporting, with no interviews with the people who are discussed as using violence and no coverage of the violence that those people experienced from the system. Violence that has been described as gross human rights violations. There are assumptions that psychiatrists and the biomedical model in which they operate in should be the primary lens through which we should understand and respond to distress, despite the World Health Organization - hardly a bunch of radicals - describing this hegemony as a fundamental barrier to a better system.
In effect, we can summarise the problem definition’s limitations as:
‘The problem definition assumes a narrow biomedical view, ignoring - holistic, culturally responsive and rights based care, questions of efficacy and data, systemic violence and other prominent and well-evidenced perspectives.’
The core problem definition misses so much that it will likely lead us to miss the right solutions and select the wrong ones.
How has this representation of the ‘problem’ come about?
This representation stems from what it privileges and marginalises. Biomedical perspectives are overwhelmingly privileged. Psychiatrists, whose professional lens is rooted in a biomedical model, are the primary voices. The reliance on diagnostic categories to promote fear and false explanations facilitated this. There was a hyper-focus on acute and clinical care, with community care discussed through a clinical lens. The implied solution—more beds, psychiatrists, and clinical infrastructure—also privileged this definition.
Many crucial perspectives were marginalised. Community Mental Health Australia stated that pouring more resources into hospital emergency departments alone won't solve the problem; the full continuum of care, including undervalued community-based mental health services, must be properly funded. The National Mental Health Consumer Alliance (NMHCA), along with Being NSW, was not included. NMHCA stated that ABC’s treatment "silenced the collective voice of mental health consumers" and they "were not contacted for comment". NMHCA believes the future of mental health support lies in community-based, peer-led services, which should be the default. They also advocate for human rights-focused services, eliminating coercive control and discriminatory "treatments". Other people with lived experience and peak bodies tried to contact producers but faced similar discrimination.
What is left unproblematic about this problem representation? What are the silences? Can the ‘problem’ be thought about differently?
Consulting a broader group could have led to more productive and holistic problem definitions. For example, the problems of:
A system designed around psychiatrists, not people with lived experience.
Marginalisation of evidence-based peer practices and peer-led services from policy and funding.
People with lived experience consulted only for their stories, not their collective knowledge for system reform.
A system held together by coercion, regardless of funding.
‘Health’ as the primary lens for understanding distress, despite shifts in disability models.
The failure to bring any analysis to the social, economic, corporate and ecological determinants of distress that are placing pressure on the system.
All these and more problem definitions were marginalised.
What effects are produced by this representation of the ‘problem’?
This representation of the problem comes from what it privileges and what it marginalised. There is an overwhelming privileging of biomedical perspectives across the news story. The primary voices of the story are psychiatrists, whose professional lens is deeply rooted in a biomedical model of mental health and its treatment. The constant, almost salacious at times, reliance on diagnostic categories to promote both fear and false explanation enabled this. A hyper focus on acute and clinical care was also provided here. Where community care was discussed through a clinical lens. This problem definition was also privileged by the framing of the solution - an implied call for more beds, more psychiatrists and more clinical infrastructure.
Marginalised were an enormous number of perspectives that should have been centered. Community Mental Health Australia highlighted in their statement that:
‘We cannot solve this by pouring more resources into hospital emergency departments alone. We must properly fund the full continuum of care, and that includes community-based mental health services that are currently overstretched, undervalued, and under-recognised.’
The National Mental Health Consumer Alliance who alongside Being NSW (the representative peak body for NSW) were not included in this story stated:
‘Early in the program, Dr Anu Kataria, a Consultant Psychiatrist, states that "The people that we look after, especially in the public health system, are essentially voiceless". ABC's treatment of this important issue has indeed silenced the collective voice of mental health consumers. The National Mental Health Consumer Alliance — the national peak body for people with lived experience of mental health challenges — was not contacted for comment on this program.’
Indeed, as the NMHCA stated:
‘Instead, we believe that the future of mental health support is in community-based services, and that these become the default support for people with mental health challenges. Specifically, we believe that peer-led services are best placed to provide supportive environments for mental health consumers. We also believe that services need to be human rights-focussed, which means eliminating coercive control and "treatments" that people with any other diagnosis would not be subjected to. These treatments are discriminatory.’
Half a dozen other people with lived experience or peak bodies had sought to contact the producers of this show months ahead, only to face the same discrimination in the reporting that exists in the system.
How/where has this representation of the ‘problem’ been produced, disseminated and defended? How has it been (or could it be) questioned, disrupted and replaced?
The ABC produced, disseminated, and defended this problem definition in ways inconsistent with its editorial standards on harm, impartiality, and accuracy. The failure to interview consumer peak bodies and contextualise the dispute meant the ABC was doing "one professional discipline’s industrial bidding". Reversing this will be difficult due to centuries of inertia, decades of policy neglect, and a community fed poor information by media outlets.
Had the problem definition been more inclusive, the following could be pursued in the short-term:
Addressing psychiatrist pay rates while reforming governance structures to reduce reliance on their hegemony.
Empowering the NSW Mental Health Commission to advise government and hold it accountable.
Investing heavily in community-based and peer-led models that draw on psychiatric knowledge without being governed by that discipline. In the medium to longer term:
Reconceptualising the mental health system away from coercion and biomedical dominance, using an empowered NSW Mental Health Commission.
Establishing a human rights framework via a legislated Human Rights Act and independent enforcement to protect rights.
Establishing an independent accountability framework, overseen by the NSW Mental Health Commission, for system performance and policies affecting wellbeing.
Ensuring providers deliver quality mental health services.
Prioritising a rebalancing towards more community-based, Aboriginal community-controlled, and peer-led services, including crisis services. The ABC’s reporting did not provide this, leaving us worse off.
[1] Bacchi, C. (2012). Introducing the ‘What’s the Problem Represented to be?’approach. Engaging with Carol Bacchi: Strategic interventions and exchanges, 21-24.
