A needs assessment for self-management services for adults awaiting community-based mental health services

**Background:** High demand for mental health services has led to lengthy waiting times in Australia and internationally, increasing the risk of deterioration, suicidality, and hospitalisation. Lifestyle interventions (exercise, nutrition, sleep) are evidence-based and cost-effective but are underutilised in clinical practice for waitlisted clients. This study aimed to understand the experiences and preferences of clients waiting for community mental health services and to identify interest in additional lifestyle supports.

**Methods:** An anonymous cross-sectional online survey was distributed via text message to 2,147 clients of Sonder, a not-for-profit primary health organisation in South Australia. Eligibility included having been a client in the previous 12 months, having spent time on the waitlist, being aged ≥16 years, and having sufficient English proficiency. The 22-item survey covered demographics, waitlist experience, and preferences for exercise, healthy eating, sleep education, and additional mental health support. Responses used 5-point Likert scales. Subgroup analyses (gender, geographical location, Aboriginal status, LGBTQI+ status) used Chi-square tests with Holm-Bonferroni correction. A reminder text was sent to 1,867 clients who did not opt out.

**Key Results:** 334 participants responded (15.6% response rate). Mean age was 41.7 years (SD=15.4); 70.4% were female; 82.9% were from metropolitan areas; 13.8% identified as LGBTQI+; 4.3% as Aboriginal and/or Torres Strait Islander. The most common mental health concerns were panic attacks/generalised anxiety (61.4%), life stressors (58.7%), and lack of motivation/loss of interest (58.7%). Most respondents (52.7%) waited 4–12+ months for services; 47% reported their mental health deteriorated while waiting, while 35.3% reported no change. Interest in additional supports was high: 78.4% wanted additional mental health support (most commonly phone support, 46.7%), 57.4% wanted exercise programs (most preferred walking at 60.5% and weekly face-to-face groups at 34.4%), 56.6% wanted sleep education (preferring online materials at 29.3% and self-guided programs at 28.7%), and 41% wanted healthy eating support (preferring cooking workshops at 34.7%). Subgroup analyses revealed that females were more likely than males to prefer yoga/Pilates (46.3% vs. 15.9%, p<0.01), dancing (25.1% vs. 7.9%, p<0.01), and self-guided online exercise (31.1% vs. 14.3%, p<0.01). LGBTQI+ participants showed greater interest than non-LGBTQI+ participants in swimming (56.5% vs. 30.1%, p<0.01), dancing (43.5% vs. 17.8%, p<0.01), face-to-face individual exercise sessions (43.5% vs. 20.5%, p<0.01), cooking workshops (54.3% vs. 33.6%, p<0.01), and self-guided online sleep programs (52.2% vs. 27.4%, p<0.01). Aboriginal participants were less likely to express interest in healthy eating support compared to non-Aboriginal participants (28.5% vs. 66.7%, p<0.01). No significant differences by geographical location persisted after correction.

**Clinical Implications:** The high rate of self-reported deterioration (47%) during wait times underscores the urgent need for interim support. The strong demand for lifestyle interventions—particularly in-person walking groups and self-directed sleep education—suggests that low-intensity programs could fill a critical gap. Preferences varied meaningfully by subgroup, indicating that tailored approaches may be needed, especially for LGBTQI+ individuals who reported higher complexity and receptiveness to support. Limitations include a low response rate (15.6%), potential recall bias, and possible overestimation of demand due to motivated participants. Future work should focus on developing, implementing, and cost-effectively evaluating lifestyle support programs for mental health waitlists, with lived-experience involvement and attention to underserved groups.