Unlocking the Mental Health System one session at a time | Suzanne Fuzzard | TEDxVictor Harbor

Unlocking the Mental Health System one session at a time | Suzanne Fuzzard | TEDxVictor Harbor

I’d like you to imagine standing in front of a door. A door that’s chained, bolted, locked. And on the other side of that door is the mental health support that you’ve reached out for. But no matter how many times you knock on that door, no one answers. Sadly, for many people today, that’s what our mental health system feels like. A system full of process but lacking hope. But what if we could change that? What if we could optimize that first moment when someone reaches out for help? that first session. What if instead of extensive, lengthy assessments and waiting lists, you could be provided with meaningful therapeutic connection? And what if for some people one session would be enough and for others it started their journey towards recovery? What if the safest, most responsible thing we could do was not to screen people more thoroughly, but to help sooner. The World Health Organization estimates over a billion people are living with a mental health condition. That’s approximately 1 in seven people on the planet. And sadly, if you are aged between 15 and 29, the third leading cause of death is suicide. If you live in Australia and you are aged between 15 and 24, suicide is the leading cause of death. We have done much to improve mental health literacy. More people understand the importance of reaching out for help sooner. But what happens when all those people are reaching out for help and nobody’s answering? I want to tell you a story. It’s a sadly common story. I’d like to call this person Billy and they’re age 17. Billy has been feeling incredibly anxious and has stopped going to school. Billy is feeling very low and doesn’t even want to hang out with their friends. They don’t feel like anybody actually understands them and they don’t want to talk to their parents. But Billy does an amazing thing. Billy decides to reach out for help. Now, if you’re a young person around the world, getting that help can have many barriers. And some of those barriers are things like consent laws, cost, and it can depend where you live, what country, whether you live rural or in the city. But let’s say that Billy lives in a country and in a region that offers government youth mental health services that are free. So Billy knocks on door number one and door number one is Billy’s doctor and the doctor does an assessment to determine what the best treatment’s going to be and decides for Billy that counseling psychological support would be the best support and explains that in this region what happens is that referral goes to a central triaging unit who determine what’s the best service in your region for you. So, Billy arrives at door number two. And at door number two, Billy gets a phone call from the central triaging unit to find out a little bit more about the problem. How big is your problem, Billy? How small is your problem so we can decide the best fit for you? And they say, “We’ve got a service locally for you. will pass the referral on. So, Billy comes to door number three. At door number three, Billy gets another phone call from the local service who want to determine what the best fit within their service would be for Billy. So, they ask Billy, “How big is your problem? How small is your problem? Let’s decide if we’ve got a service that will fit for you. And fantastic. Finally, there is actually a fit. We’ve got a fit for you. We’ve got a service that would be perfect for you, and we would love to help you. But stop. I’m sorry, Billy. We’ve got a bit of a waiting list. It’ll be about six months. I have worked in the mental health system for the last 36 years and I have observed our processes in which we screen, we assess, we label and then we ask people to wait. I’ve noticed that ironically the more complex your needs are, the more concerns that you have, the longer you’re likely to wait for a service and you’re often excluded from early intervention services. I’ve also noticed that if you do live in a rural region, services for you just may not exist. We are often told that the reason these processes exist is to help us manage risk. But I can’t help but wonder, how does placing somebody on a waiting list manage risk? How does placing somebody on a waiting list improve hope? How might the billies in the world be feeling on a six-month waiting list? We know from best evidence that there are important factors that improve recovery and outcomes and reduce distress. And these are things like hope, empowerment, and feeling emotionally contained and supported. And when I talk about Billy’s example, which is sadly not an uncommon situation, I do wonder how is Billy feeling around hope, empowerment, and feeling contained. Six years ago, I was leading a youth mental health service and we were in this exact predicament with waiting list. We had a six-month waiting list and we had young people and families really losing faith in our systems and in our services. But we decided to do something different. We decided to renovate our front door. And I went out to the community and to young people and I asked them and I put to them,”What if instead of at your first contact, we did extensive assessment, we offered you a session of therapy where we would do enough assessment to be helpful and you could come back for more if you needed it.” And those young people just said, “Actually sounds like common sense.” So we decided we decided to place single session therapy at the front door of our services. Within months, our six-month waiting list went to zero. No wait times gone. Single session therapy harnesses natural human behavior. It acknowledges that that first moment when people reach out for help, they are often most motivated. You might have heard of single session therapy if you’ve read Oprah Winfreyy’s magazine. In 2018, Oprah Winfreyy’s magazine interviewed one of the originators of single session therapy, Michael Hoy, and he spoke about the mindset of a single session therapist, and that being to embrace every session as if it could be the only or last session. He talked about two powerful principles in single session therapy. Those being that is the most important time to act is now and also that for some people one session will be enough while at the same time simultaneously opening up more sessions for those people needing more without the bottleneck of waiting lists. Single session therapy focuses on strengths not deficits. Agency not dependency. hope, not helplessness. Single session therapy aims to provide people with no more and no less than they need. It got def single session therapy first became defined in the 80s when a psychologist called Mosha Talman was working in America and he was reviewing thousands and thousands of statistics and data of patients through the office of psychiatry and he noticed a really interesting fact. He noticed no matter the therapist, no matter the kind of therapy, no matter the concern the person came with, the most common number of sessions per therapist wasn’t 10, wasn’t five, it was one. And then he did something else really interesting. He followed up 200 patients to actually ask them why had they stopped coming to therapy and the why had they dropped out and the vast majority told him they had got enough out of one session. They had in fact not dropped out of therapy. they’d graduated and so began the journey to actually define single session therapy and Mosha Talman partnered with two of his psychology colleagues Hoy and Rosenbalm to define what intentional single sessions of therapy would look like. Decades of research have reinforced these original statistics. And in 2015, there was a study out of Ontario, Canada, that compared people who’d attended a 4-week single session model of therapy alongside of people who’d been on weight list and had attended traditional therapy. And at a four-week follow-up, they found that those people that had attended the single session therapy had improved faster and had higher levels of hope. In 2023, there was a study out of Australia that actually showed the correlation between higher accessibility to services and greater levels of hope and recovery. And in 2025, there was a huge review of the literature that covered 415 trials of single session therapy and single session interventions. And of those, 83% highlighted significant positive outcomes. I would like you to also imagine a new front door for our mental health systems. a new front door that when you knock, you are asked how how can I help you today? Imagine the ripple effects not just on our waiting list but on our emergency departments and our inpatient beds if some people got enough from one session. Imagine scaling this across communities and countries. It is starting to happen. I attended the single session international symposium in Chicago this year 2025 and there were 17 countries represented all speaking about ways they were embedding single session therapy and interventions into their service systems. I call on all of you and want to empower you to raise your voice and demand a different front door to our mental health systems. It is possible. There are other ways of thinking and doing our mental health systems. And I want to empower you and not just have you rely that clinicians or policy makers are going to do this. Your voices matter. And those people that bravely reach out for support deserve systems brave enough to change. Let’s create a front door that doesn’t require a key to unlock, but merely a knock on the door. Let’s create a shift. One session, one service, one policy, one life at a time. Thank you.

Mental health care is often described as broken—but what if it’s paralysed by the very systems meant to help? This talk challenges long-held assumptions about therapy and introduces Single Session Therapy, a framework that prioritises timely, hope-giving care from the very first contact. It calls on funders, governments, and services to rethink system design so people receive the right support, at the right time—without waiting
Mental Health, Reform, Therapy
Mental health occupational therapist and clinical family therapist with 36 years’ experience. Specialises in single session therapy for timely mental health services. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx