Internal Practice Data Analysis · Sydney · 2011–2025 · Published 28 April 2026

Mental Health in Sydney:
What 15 Years of Client Data Reveals

An analysis of 36,309 clients and 139,687 appointments across Sydney practices – examining presenting issues over time, gender differences, socioeconomic patterns, the COVID anxiety spike, addiction, and suicidal ideation.

36,309Clients
139,687Appointments
15 yrs2011–2025
3.8Avg appts/client
30+Sydney suburbs
50+Issue types
01 – Overview

Key Findings at a Glance

Fifteen years of anonymised intake data from a multi-location Sydney counselling and psychology practice reveal clear patterns across time, gender, and suburb.

Top presenting issue – every year 38%

Relationship issues dominate across every year, gender, and suburb – 13,555 presentations across 15 years.

COVID anxiety spike +88%

Anxiety rate jumped from ~12% pre-COVID to 21.1% in 2020, peaking at 24.3% in 2021. Still elevated above 17% in 2025.

Work stress – 2025 all-time high 13.9%

Work stress in 2025 reached its highest-ever rate – more than double the 2011 rate of 6.0%. A structural shift, not a blip.

All addiction types – male vs female 3.6×

Combining all addiction types, men present at 18.5% vs 5.1% for women – the largest sustained gender gap across the entire dataset.

Annual Client Volume – All Sydney Locations (2011–2025)

COVID years (2020 onwards) shown in orange. Volume growth reflects both increasing mental health awareness and practice expansion.

03 – Gender Analysis

How Men and Women Seek Help Differently

Gender was inferred from client first names. Of 36,309 clients: 11,608 male (32%), 11,026 female (30%), 10,944 couples (30%). The differences in presenting issues are clinically significant.

Anger management – male:female 3×

16.6% of male clients present with anger management vs 5.5% female. Third-largest gender gap after combined addiction and gambling.

Anxiety – women's #1 issue 25.8%

Anxiety is the #1 presenting issue for women (25.8%) vs #2 for men (18.1%). Relationship issues rank #1 for men.

Work stress – women now higher F 12.2%

Women present with work stress at 12.2% vs 8.6% for men – a reversal from earlier in the dataset when men dominated this category.

All addiction combined M 18.5%

Combining all addiction types, nearly 1 in 5 male clients presents with some form of addiction vs 1 in 20 for female clients – a 3.6× gap.

Key Gender Differences – % of Clients (Male vs Female). All addiction types grouped into "All Addiction"
Male – Top 20 Presenting Issues

% of male clients (n=11,608)

#Issue% of clients
Female – Top 20 Presenting Issues

% of female clients (n=11,026)

#Issue% of clients
04 – Addiction

Addiction: Gender and Suburb Differences

Addiction-related presentations show the most pronounced gender and socioeconomic disparities of any category. Alcohol, substances, porn, gambling, and general addiction, when grouped together, affect men at 3.6 times the rate of women and are significantly more prevalent in lower-affluence suburbs.

★ All Addiction Combined – includes Alcohol · Substance Abuse · Porn Addiction · Gambling · General Addiction

Each client counted once if they present with any addiction type. The figures below represent the share of clients with at least one addiction presentation.

By Gender
3.6×
more likely in men
Male clients18.5%
Female clients5.1%
By Suburb
1.7×
higher in lower-affluence areas
High affluence7.7%
Lower affluence13.4%
Nearly 1 in 5 male clients presents with at least one form of addiction. Among lower-affluence clients of any gender, the rate rises to 1 in 7.5.
The gender gap is driven by porn addiction (37×), gambling (8×), substance abuse (4.3×), and general addiction (4.4×). Even the narrowest gap, alcohol, is 2.1× higher in men.

Individual addiction types below. A client may present with more than one type; the combined figure above counts each client once.

Porn Addiction
37×
more likely in men
Male4.0%
Female0.1%
High affluence1.3%
Lower affluence3.7% 2.8×

Rising sharply: 16 cases in 2011, 99 in 2025 (6× increase)

Alcohol
2.1×
more likely in men
Male7.4%
Female3.5%
High affluence3.8%
Lower affluence4.2%

Most equal addiction type by suburb. Female alcohol presentations rising since 2019.

Substance Abuse
4.3×
more likely in men
Male5.2%
Female1.2%
High affluence1.7%
Lower affluence3.7% 2.2×

Strongest socioeconomic gradient of any individual addiction type.

Addiction (General / Behavioural)
4.4×
more likely in men
Male6.0%
Female1.4%
High affluence2.5%
Lower affluence4.3% 1.7×

Includes behavioural addictions not classified elsewhere (gaming, sex, etc.)

Gambling
8×
more likely in men
Male2.4%
Female0.3%
High affluence0.6%
Lower affluence1.8% 3×

Second-largest gender gap after porn addiction. High socioeconomic gradient.

Individual Addiction Types – Male vs Female (% of clients within gender)
Key finding: When all addiction presentations are aggregated, nearly 1 in 5 male clients (18.5%) presents with some form of addiction, compared to just 1 in 20 women (5.1%). The 37× gender gap in porn addiction is the most extreme ratio in the entire dataset, and it is accelerating, with 99 presentations in 2025 vs 16 in 2011.
05 – Depth of Treatment

Average Appointments per Client, by Presenting Issue

Not all issues require the same depth of treatment. Trauma-related presentations lead to significantly more appointments on average than interpersonal or situational issues – a useful indicator of both clinical complexity and likely treatment duration.

Average Total Appointments per Client – By Presenting Issue (minimum 30 clients)

Colour indicates depth tier: red = 5+ avg appointments (complex trauma), orange = 4.4–4.9 (significant), teal = 3.8–4.3 (moderate), grey = under 3.8 (shorter term).

Most appointments – PTSD & self-harm 5.7 avg

PTSD and self-harm average the most appointments of any issue. Trauma-related presentations dominate the top of this list – abuse (5.2), childhood trauma (5.1), trauma (4.9).

Work stress & burnout 4.2 avg

Work stress (4.2) and burnout (4.2) sit well above the average – reflecting that occupational mental health issues often have complex contributing factors requiring longer work.

Relationship issues 3.5 avg

The most common presenting issue averages only 3.5 appointments – shorter-term, goal-focused couples or relationship work. Communication (3.2) and conflict resolution (3.2) similarly short.

Gambling – shortest engagement 2.8 avg

Despite its severity, gambling averages the fewest appointments – possibly reflecting early dropout or referral to specialist gambling services after initial assessment.

Clinical insight: There is a clear two-tier structure. Trauma-related issues (PTSD, abuse, childhood trauma, self-harm) consistently cluster above 5 appointments per client. Interpersonal and situational issues (relationship problems, communication, trust) cluster at 3.2–3.6. Issues like suicidal ideation (4.4) and depression (4.1) sit in the moderate tier – complex but more focused than deep trauma histories.
06 – Suburb & Socioeconomic Analysis

High vs Lower Affluence Sydney Suburbs

Practice locations were classified into affluence tiers using ABS SEIFA data. Practitioner location serves as a proxy for client socioeconomic background. 7,674 clients were seen in high-affluence suburbs; 1,360 in lower-affluence areas.

HIGH AFFLUENCE (7,674 clients): Double Bay · Mosman · Lane Cove · North Sydney · CBD · Chatswood · Northbridge · Potts Point · St Leonards · Cremorne

MIDDLE AFFLUENCE (21,266 clients): Surry Hills · Bondi Junction · Glebe · Miranda · Caringbah · Castle Hill · Earlwood · Hornsby · Norwest · Ryde · Dulwich Hill · Narraweena/Dee Why

LOWER AFFLUENCE (1,360 clients): Parramatta · Blacktown · Campbelltown · Cabramatta · Stanhope Gardens · Wattle Grove

High Affluence – Top 15 Issues

% of high-affluence clients (n=7,674)

#Issue%
Lower Affluence – Top 15 Issues

% of lower-affluence clients (n=1,360)

#Issue%
Core anxiety & depression – consistent ~equal

Anxiety (High: 16.1% / Low: 17.4%) and depression (High: 11.3% / Low: 12.8%) are strikingly consistent across income tiers. Mental distress is not a problem of poverty.

Substance abuse – strongest gradient 2.2×

Substance abuse presents in 1.7% of high-affluence clients vs 3.7% lower-affluence – the strongest socioeconomic gradient of any issue type.

Life transitions – high affluence +55%

Life transitions appear more often in high-affluence sessions – career change, identity, relocation. Lower-affluence clients more often present with financial stress and family conflict.

07 – Suicide & Suicidal Ideation

Suicide: Who Seeks Help vs Who Dies

Safe Messaging: This section uses aggregate statistical data for clinical and research purposes. If you or someone you know is struggling, please contact Lifeline on 13 11 14 or Beyond Blue on 1300 22 4636.

The most striking finding in this dataset is the mismatch between who presents for help with suicidal ideation and who actually dies by suicide nationally. Men and women seek help at near-equal rates in private practice – yet men die by suicide at 3.2 times the rate of women.

Help-Seeking – This Practice (2011–2025)

Suicidal ideation – male clients0.84%
Suicidal ideation – female clients0.82%
Self-harm – male clients0.24%
Self-harm – female clients0.41%

Suicidal ideation presentations are near-equal (male 90, female 84 over 15 years). Self-harm skews female. Note: these figures likely under-capture ideation – many clients present primarily with depression and disclose ideation during session.

National Deaths by Suicide – ABS 2024

Male suicide rate (per 100,000)18.7
Female suicide rate (per 100,000)5.9
Male share of all suicide deaths76.5%
Total deaths by suicide (2024)3,307

Source: ABS Causes of Death, Australia 2024 (preliminary). Men die by suicide at 3.2× the rate of women. Suicide is the leading cause of death for Australians aged 15–44.

The critical gap: Men die by suicide at 3.2× the rate of women nationally, yet present for help with suicidal ideation at almost exactly the same rate as women in private practice. This is not explained by higher distress in men – it is explained by dramatically lower help-seeking, later presentation, and use of more lethal means. Men aged 55–64 have the highest suicide rate of any demographic group (30.9 per 100,000), yet this age group is substantially under-represented in counselling attendance.
National suicide deaths 2024 3,307

An average of 9 deaths per day. The 2024 rate of 12.2 per 100,000 is 6.5% higher than 2023 – after years of relative stability.

Men aged 55–64 30.9/100k

The highest suicide rate of any demographic group in Australia. Yet substantially under-represented in counselling data relative to their population size and risk level.

National rate trend Rising

The national rate rose in 2024. Preliminary 2025 indicators suggest a continued increase. Help-seeking as captured in this dataset has not correspondingly increased.

08 – Full Conditions Summary

All Presenting Issues – 2011–2025

Top 25 presenting issues across all 36,309 clients. A client may have more than one presenting issue recorded at intake.

Top 15 Presenting Issues – All Clients 2011–2025
#IssueTotal Clients% of All Clients
09 – Methodology

How This Data Was Collected & Analysed

Data Source
Internal client intake records from Associated Counsellors & Psychologists Sydney. Records span May 2011 to December 2025. Dataset: 36,309 clients, 139,687 total appointments. Presenting issues were AI-classified from intake notes.
Gender Classification
Gender inferred from client first names using the gender-guesser Python library. Couple sessions classified as "Couple." Accuracy ~85–90% for common English-language names. Unknown gender (~8%) excluded from gender-specific analysis.
Affluence Classification
Practitioner locations assigned to affluence tiers using ABS SEIFA Index of Relative Socio-economic Advantage and Disadvantage (Census 2021) and median household income. Online (8%) and Regional (6%) sessions excluded from affluence analysis.
Limitations
This dataset reflects one private practice's client base – it is not a random population sample. It captures people who seek and can afford private counselling. Lower-affluence suburbs are under-represented relative to their share of Sydney's population. Practice growth over 15 years means raw volume comparisons are directional. National suicide data: ABS Causes of Death 2024 (preliminary).