Many young people fall into the “missing middle” gap in the youth mental health care system. Their needs are too complex for short-term or clinic based support, or they cannot engage in the medicalised model of tertiary care or hospital-based care.
Barriers include stigma, long waitlists, and services that feel unsafe or unwelcoming.In regional and rural communities, barriers such as geography, cost, stigma, and service shortages make this gap even wider.

This presentation shares findings from the first independent evaluation of Human Nature, a free, outreach-based, nature-focused mental health service supporting adolescents aged 14–18 in Northern NSW, and who are assessed as being in need of a moderate mental health service.

Conducted by the Rural Health Research Institute at Charles Sturt University, the study analysed routinely collected data from 106 participants engaged with Human Nature between 2023 and 2024. Participants presented with multiple vulnerabilities, including high rates of family violence (63%), mental health concerns (42%), and unstable living situations. More than one-quarter (27%) identified as Aboriginal or Torres Strait Islander, and 11% identified as LGBTQIA+.

Results demonstrate significant improvements in wellbeing across all measures. Outcome Rating Scale (ORS) scores increased from a mean of 22.0 to 29.5, surpassing the clinical cut-off for recovery, with effect sizes remaining significant after adjusting for demographic factors. Similarly, the My Mind Star tool showed improvements across all seven domains of wellbeing, with the greatest gains in self-esteem, use of time, and educational engagement. Importantly, outcomes were consistent across diverse subgroups, underscoring the inclusivity of the model.

The findings highlight the effectiveness of trauma-informed, relationship-based care delivered in flexible, non-clinical, and nature-based environments.

This session will discuss the research findings, explore the role of nature as a therapeutic environment, consider implications for scaling innovative models that address the missing middle in youth mental health.

Three Key Learnings:
1.Nature-based, trauma-informed care works: Human Nature achieved statistically significant improvements in wellbeing across all domains, including self-esteem, education, and emotional health.

2. Inclusive and engaging for vulnerable youth: The program successfully reached adolescents often excluded from mainstream services, including Aboriginal and Torres Strait Islander young people, LGBTQIA+ youth, and those experiencing multiple vulnerabilities.

3. A scalable model for the “missing middle”: Delivering flexible, relational care in non-clinical settings offers a viable solution to service gaps in regional youth mental health.