Admitted patients

Summary

Key points

  • There were about 57,260 same day mental health-related hospitalisations from public hospitals in 2020–21, representing about 1% of all same day hospitalisations.
  • In 2020–21, about 20,890 patients received same day admitted mental health care from private hospitals.
  • There were about 280,700 overnight mental health-related hospitalisations in 2020–21 across both public and private hospitals, representing about 6% of all overnight hospitalisations.
  • The most frequently reported principal diagnosis for mental health-related hospitalisations with specialised psychiatric care was Depressive episode (20% of same day public hospitalisations and 15% of overnight hospitalisations).
  • For public hospitals, the most frequently reported principal diagnosis for mental health-related hospitalisations without specialised psychiatric care was Mental and behavioural disorders due to use of alcohol (25% of same day hospitalisations, 21% of overnight hospitalisations).
  • In private hospitals, 45% of same day mental health-related episodes of care reported a principal diagnosis related to Major Affective and Other Mood Disorders.

Admitted patients are those who undergo a hospital’s formal admission processes. This section presents information on admitted patient mental health-related hospitalisations from Australian public and private hospitals.

To provide the most comprehensive view of mental health-related admitted care, two different data sources are used for private hospitals (described in detail in each section below). When considering the data presented in this section it should be noted that some activity reported as same day admitted care in the private hospitals data may be reported in the public sector data as community mental health care, due to differences in classification criteria. As such, any comparisons of the volume of care provided by public and private hospitals described in this section should be made with caution. Further information can be found in the data source section.

During 2019–20 there was a decline in admitted mental health-related care, likely due to the impact of the COVID-19 pandemic on Australia’s hospitals and health care provision from February 2020. In 2020–21, some pandemic-related restrictions were eased, leading to a small increase of some types of hospitalisations.

There were 110 overnight mental health-related hospitalisations and 22 same day public mental health-related hospitalisations per 10,000 population in 2020–21. In private hospitals there were 8 patients per 10,000 population receiving same day mental health-related admitted care.

For jurisdictions where figures are published and across both public and private sectors, the rate of overnight mental health-related hospitalisations with specialised psychiatric care was highest for Queensland (72 per 10,000 population), and for those without specialised psychiatric care, the rate was highest for South Australia (55).

Queensland had the highest rate of same day public mental health-related hospitalisations with specialised psychiatric care (16 per 10,000 population) and the Northern Territory had the highest rate of hospitalisations without specialised care (71). In private hospitals, the rate of patients was highest in Queensland (11).

Spotlight data

Figure AC.1 Mental health-related admitted cares shows seasonal variation across the year

Consecutive line charts showing seasonal variation of admitted mental health-related hospitalisations in public and private hospitals, by quarter across the years, from 2014–15 to 2020–21. Data on same day admitted mental health-related care in private hospitals is presented as count of episodes by quarter from 2016–17 to 2020–21. There was an unseasonable decline of admitted mental health-related care from January 2020 to June 2020, likely due to the COVID-19 impact on Australia’s hospitals and the changes affecting health care provision from February 2020. Refer to Tables ON.2, SD.2 and SD.14.

Introduction

Some people’s mental health care needs require care in a hospital setting such as a hospital ward, an emergency department and/or an outpatient clinic. When receiving hospital care, a patient may be admitted to hospital for part of a day (same day admitted mental health care), a single overnight stay, or for a number of days. Care that lasts more than one day is referred to as overnight admitted patient care.

Patients can receive specialised psychiatric care in a psychiatric hospital or in a hospital’s psychiatric unit. Patients with mental illness may also be admitted to other areas of the hospital for medical and/or surgical care (e.g. for a heart condition) where health care workers may not be specifically trained to care for the mentally ill. These admissions to hospitals are classified as being without specialised psychiatric care. Private hospital-based same day admitted mental health care is provided in either private hospitals with psychiatric beds or private psychiatric day hospitals (APHA 2021) (information on hospital types can be found in the mental health care facilities key concepts section). Further detail can be found in the data source section.

Hospitalisations

Same day

There were almost 3.9 million same day hospitalisations from public acute and psychiatric hospitals in 2020–21. Of these, about 57,260 were mental health-related, which is about 1% of all same day hospitalisations. A quarter of these involved specialised psychiatric care (25%).

In 2020–21, there were about 29,430 clinically substantive episodes of same day admitted mental health care from private hospitals.

Overnight

There were about 4.4 million overnight admitted hospitalisations in 2020–21 across both public and private sectors. Of these, about 280,710 were mental health-related, representing about 6% of all overnight hospitalisations. Almost two-thirds of these involved specialised psychiatric care (62%) and more than 3 in 4 occurred in public hospitals (78%).

States and territories

In comparing across states and territories, it should be noted that models of care differ between jurisdictions and between public and private hospitals. This can affect the reported volume of admitted care and the inclusion or omission of some types of care.

Specialised admitted patient mental health care

Specialised admitted patient mental health care (also referred to as specialised psychiatric care) takes place within a designated psychiatric ward/unit, which is staffed by health professionals with specialist mental health qualifications and/or training and have as their principal function the treatment and care of patients affected by mental illness.

Non-specialised admitted patient mental health care

Non-specialised admitted patient mental health care takes place outside a designated psychiatric unit but for which the principal diagnosis is considered to be mental health-related.

A list of mental health-related principal diagnoses is available in the technical information section. Data for public acute and public psychiatric hospitals are combined, as there were very few hospitalisations without specialised psychiatric care in public psychiatric hospitals in 2020–21.

Figure AC.2: Mental health-related admitted care, by state and territory, 2020–21

Two bar charts showing number and rate of mental health-related hospitalisations in public and private hospitals by state and territory in 2020–21. The bar chart on the left presents data for hospitalisations with specialised psychiatric care and the bar chart on the right presents data for hospitalisations without specialised psychiatric care. Data on same day admitted mental-health related care in private hospitals is presented as count of patients in 2020–21. There were 122,942 overnight and 14,567 same day mental health-related hospitalisations with specialised psychiatric care in public hospitals in Australia in 2020–21. In addition, there were 97,496 overnight and 42,691 same day hospitalisations without specialised psychiatric care in public hospitals. In private hospitals, there were 50,175 overnight mental health-related hospitalisations with specialised psychiatric care in private hospitals and 10,094 without specialised psychiatric care. There were 20,885 patients in same day private admitted mental health-related care. Refer to Tables ON.5, SD.5 and SD.15.

Patient demographics

There were variations in rates of mental health-related hospitalisations by age, sex, Indigenous status, remoteness of area of residence, and socioeconomic status of area of residence.

Same day

Variability in rates of same day mental health-related hospitalisations across demographics was more noticeable by age group than by other demographic factors.

Overnight

Variations in rates of overnight mental health-related hospitalisations across demographics were more noticeable by age group than by other demographic factors.

Figure AC.3: Mental health-related admitted care, by sex and age group, 2020–21

Horizontal bar chart showing the rate (per 10,000 population) and per cent of hospitalisations of admitted mental health-related separations by hospitalisation type, age group, sex, Indigenous status, remoteness and SEIFA quintiles in 2020–21. Data on same day admitted mental-health related care in private hospitals is presented as patients per 10,000 population in 2020–21. Refer to Table ON.6, SD.7, and SD.16.

Procedures

In 2020–21, Generalised allied health interventions and Cerebral Anaesthesia were among the 5 most commonly reported procedure blocks across all hospitalisation types and sectors for which data is available (information on procedures associated with same day private mental health-related hospitalisations is not reported). Cerebral anaesthesia is most likely associated with the administration of Electroconvulsive therapy (ECT), a frequently reported procedure for hospitalisations with specialised psychiatric care, and a form of treatment for depression, which was the most common principal diagnosis for hospitalisations with specialised psychiatric care in public hospitals.

Same day

The most frequently reported procedure blocks for same day public mental health-related hospitalisations with specialised psychiatric care in 2020–21 were Cerebral anaesthesia and Electroconvulsive therapy (ECT) (each made up 37% of procedures and were associated with 32% of hospitalisations) (Figure AC.4.2). The most frequent allied health interventions with specialised care were as follows:

Frequently reported allied health interventions for same day public specialised care
Allied health intervention procedure Per cent of procedures
Psychology 34%
Social work 30%
Occupational therapy 12%

For same day public hospitalisations without specialised psychiatric care, the most frequently reported procedure block was Cerebral anaesthesia (34%& of procedures, associated with 22% of hospitalisations) (Figure AC.4.2). The most frequent allied health interventions without specialised care were as follows:

Frequently reported allied health interventions for same day public non-specialised care
Allied health intervention procedure Per cent of procedures
Social work 48%
Pharmacy 14%
Physiotherapy 11%

Overnight

The most frequently reported procedure block for overnight mental health-related hospitalisations with specialised psychiatric care in 2020–21 was Generalised allied health interventions (45% of procedures and associated with 63% of hospitalisations) (Figure AC.4.1). Cerebral anaesthesia was associated with 5% of hospitalisations but it was the third most frequently reported procedure block (10% of procedures). The most frequent allied health interventions with specialised care were as follows:

Frequently reported allied health interventions for overnight specialised care
Allied health intervention procedure Per cent of procedures
Social work 25%
Pharmacy 19%
Occupational therapy 17%

Almost three-quarters (72%) of overnight mental health-related hospitalisations without specialised psychiatric care recorded at least 1 procedure in 2020–21. The most frequently reported procedure block was Generalised allied health intervention (71%), which was recorded for more than half of these hospitalisations (59%) (Figure AC.4.1).

The most frequent allied health interventions without specialised care were as follows:

Frequently reported allied health interventions for overnight non-specialised care
Allied health intervention procedure Per cent of procedures
Social work 21%
Pharmacy 20%
Occuptional therapy 16%

Figure AC.4: Proportion of admitted mental health-related hospitalisations, for the 5 most commonly reported procedure block, by hospitalisation type, 2020–21

Horizontal bar chart showing the per cent of admitted mental health-related hospitalisations with and without specialised psychiatric care for 5 of the most frequently reported principal diagnoses in private and public hospitals. Generalised allied health intervention was among the 5 most commonly reported procedure blocks across hospitalisation types and sectors (63% of overnight hospitalisations with specialised psychiatric care, 59% of overnight hospitalisations without it, 15% of same day public hospitalisations with specialised psychiatric care and 10% of same day public hospitalisations without it). Information of procedures associated to private hospital same day admitted mental health care is not available. Note that displayed percentages correspond to per cent of hospitalisation of each type and not per cent of reported procedures. Refer to Table ON.10 and SD.11.

Principal diagnosis

Where a distinction of specialised mental health-related care is made in both overnight and same day public admitted care (with or without specialised psychiatric care), Depressive episode was among the most frequently reported principal diagnoses in specialised care; while in non-specialised care it was Mental and behavioural disorders due to use of alcohol.

Private hospital-based same day admitted mental health care is provided in either private hospitals with psychiatric beds or private psychiatric day hospitals (APHA 2021). In the private sector, Major affective and other mood disorders was reported as diagnostic group of principal diagnosis in almost half (45%) of same day mental health-related episodes of care.

The profile of diagnoses in overnight mental health-related care with specialised psychiatric care varies significantly with hospital type (Figure AC.5.1). See examples below.

Proportion of overnight mental health-related hospitalisations with specialised psychiatric care, by hospital type, 2020–21

Principal diagnosis

Public acute hospitals

Public psychiatric hospitals

Private hospitals

Schizophrenia

17%

23%

2%

Depressive episode

11%

6%

25%

Mental and behavioural disorders due to use of alcohol

2%

4%

13%

Figure AC.5: Mental health-related admitted care, by principal diagnosis, 2020–21

Horizontal bar chart showing the per cent of admitted mental health-related hospitalisations with and without specialised psychiatric care for 5 of the most frequently reported principal diagnoses by private and public hospital types in 2020–21. Depressive episode was among the most frequently reported principal diagnoses in specialised care in both overnight and same day public admitted care (15% of hospitalisations and 19% respectively). In non-specialised care, Mental and behavioural disorders due to use of alcohol was among the most frequently reported principal diagnoses in public overnight, private overnight and same day public admitted care (21%, 24% and 25% respectively). In the private sector, Major affective and other mood disorders was reported as principal diagnosis in 45% of same day episodes of care. Refer to Table ON.7, SD.8 and SD.17.

Changes over time

In public hospitals, the population rate of overnight mental health-related hospitalisations has been steadily increasing since 2010–11 (an average annual change of 2% over this period). For same day public hospitalisations, the population rate has been relatively steady over the same period.

While the number of same day hospitalisations with specialised psychiatric care in public acute hospitals has been decreasing since 2016–17 (at an average annual change of -10%), the number of overnight hospitalisations of this type in public acute hospitals has been slowly increasing over the same period (at an average annual change of 1%). (Figure AC.6.1).

The number of procedure blocks associated with same day hospitalisations with specialised psychiatric care in public acute hospitals has slowly decreased since 2016–17 (at an average annual change of 3%), and those associated with overnight hospitalisations with specialised psychiatric care have rapidly increased over the same period (at an average annual change of 11%).

In private hospitals, overnight mental health-related hospitalisations have increased steadily between 2010–11 and 2020–21 at an average annual rate of 5%. For same day private hospital care, data is reported on number of episodes and patients. The number of private same day episodes of care has increased from about 28,120 in 2016–17 to 29,430 in 2020–21.

Figure AC.6: Mental health-related admitted care over time, 2020–21

Two line charts showing the number of mental health-related hospitalisations and procedures with and without specialised psychiatric care by hospital type from 2006–2007 to 2020–21. Overnight hospitalisations with specialised psychiatric care in public acute hospitals have been increasing at a faster rate than hospitalisations of the same type in public psychiatric hospitals. A similar pattern is observed for procedures associated to this type of hospitalisations. In private hospitals, overnight hospitalisations have been stably increasing over time. Refer to Table ON.3, SD.3 and SD.15.

Same day

While the number of same day public hospitalisations with specialised psychiatric care increased at an average annual rate of 3% from 2010–2011 to 2020–21 (from about 10,640 to 14,570), the number of this type of hospitalisations in public acute hospitals has shown more variability across the years (decreasing in some years) than in public psychiatric hospitals. The number of same day public mental health-related hospitalisations without specialised psychiatric care increased at an average rate of 1% over the same period (from about 37,430 in 2010–11 to 42,690 in 2020–21) (Figure AC.6.1).

Long-term trends of same day mental health-related hospitalisations varied by age and sex.

Since 2016–17 the total number of same day private mental health patients has increased from about 19,590 to 20,890 in 2020–21, an increase of 7%. The number of episodes increased at a different proportion (from about 28,120 to 29,430, or a 5% increase) (Figure AC.6.2). Over the same period there has been essentially no change in the overall average care days per patient.

Overnight

The rate of overall overnight mental health-related hospitalisations with and without specialised psychiatric care per 10,000 population has been steadily increasing in the past decade (average annual increase between 2010–11 and 2020–21 of 4% for both).

Overnight hospitalisations with specialised psychiatric care in public acute hospitals have been increasing at a faster rate than public psychiatric hospitals (average annual increase between 2010–11 and 2020–21 of 3% and 1% respectively) (Figure 6.1). A similar pattern is observed for procedures associated with this type of hospitalisation (average annual increase between 2010–11 and 2020–21 of 12% and 4% respectively).

Long-term trends of overnight mental health-related hospitalisations varied by age and sex.

Figure AC.7: Mental health-related admitted care over time, by age and sex 2020–21

Line chart showing the number of mental health-related hospitalisations by age and sex with and without specialised psychiatric care in public hospitals from 2006–2007 to 2020–21 and number of patients in same day private mental health-related care over the same period. There were variations in trends of mental health-related hospitalisations over time by age and sex. Refer to Table ON.4, SD.4 and SD.16.

Figure AC.8: Overnight mental health-related admitted care, patient days, 2020–21

The first sheet of the interactive dashboard is a vertical stacked bar chart showing the number and rate of patient days, psychiatric care days and length of stay of overnight mental health-related hospitalisations by state and territory with and without specialised psychiatric care by hospital type in 2020–21. The second sheet of the dashboard is a line chart showing the number of patient days and psychiatric care days over time by hospital type. Refer to Table ON.3 and ON.5.

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Data sources

Key concepts

Key concept

Description

Average length of stay

Average length of stay is the average number of patient days for admitted patient hospitalisations.

Care type

The care type defines the overall nature of a clinical service provided to an admitted patient during an episode of care (admitted care), or the type of service provided by the hospital for boarders or posthumous organ procurement (other care).

Clinically substantive episode

A period of care from admission to separation that has more than 2 contacts and where contacts are of less than 6 weeks intervals.

Diagnostic group

The classification of diagnostic groups is based on the ICD-10 principal diagnosis assigned to the episode of care at discharge. There are 8 clinical groupings of the ICD-10 diagnoses relating to mental and behavioural disorders. Further details of these diagnostic groups can be found in the data source section.

Episode

An episode of care in Private hospitals involves a period of care from admission to separation. Counts of episodes include only clinically substantive episodes of care (a period of care from admission to separation that has greater than 2 contacts and where contacts are of less than 6 weeks intervals). Episodes that are of brief duration (1 or 2 contacts only) and episodes during which contacts were sparse (average interval between contacts 6 weeks or greater) are excluded from the count. Consequently the count of episodes can in some cases be less than the count of unique patients.

Hospitalisation

Hospitalisation is the term used to refer to the episode of admitted patient care, which can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay beginning or ending in a change of type of care (for example, from acute care to rehabilitation).

Mental health-related

A hospitalisation is classified as mental health-related if:

  • it had a mental health-related principal diagnosis which, for admitted patient care, is defined as a principal diagnosis that is either a diagnosis that falls within the section on Mental and behavioural disorders (Chapter 5) in the International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM) classification (codes F00–F99) or a number of other selected diagnoses (the Classification Codes section for the full list of applicable diagnoses), or
  • it included any specialised psychiatric care.

Overnight admitted patient care

For this report overnight admitted patient hospitalisations refers to those hospitalisations when a patient undergoes a hospital’s formal admission process, completes an episode of care, is in hospital for more than 1 day and ‘separates’ from the hospital. Same-day hospitalisations are reported separately in admitted patient care.

Patient day

Patient day means the occupancy of a hospital bed (or chair in the case of some same day patients) by an admitted patient for all or part of a day. The length of stay for an overnight patient is calculated by subtracting the date the patient was admitted from the date of separation and deducting days the patient was on leave. A same-day patient is allocated a length of stay of 1 day. Patient day statistics can be used to provide information on hospital activity that, unlike hospitalisation statistics, account for differences in length of stay. The patient day data presented in this report include days within hospital stays that occurred before 1 July provided that the hospitalisation occurred during the relevant reporting period (that is, the financial year period). This has little or no impact in private and public acute hospitals, where hospitalisations are relatively brief, the amount of information delivered is relatively high and the patient days that occurred in the previous year are expected to be approximately balanced by the patient days not included in the counts because they are associated with patients yet to separate from the hospital and therefore yet to be reported. However, some public psychiatric hospitals provide very long stays for a small number of patients and, as a result, would have comparatively large numbers of patient days recorded that occurred before the relevant reporting period and may not be balanced by patient days associated with patients yet to separate from the hospital.

Principal diagnosis

The principal diagnosis is the diagnosis established after study to be chiefly responsible for occasioning the patient’s episode of admitted patient care.

Procedure

Procedure refers to a clinical intervention that is surgical in nature, carries an anaesthetic risk, requires specialised training and/or requires special facilities or services available only in an acute care setting. Procedures therefore encompass surgical procedures and non-surgical investigative and therapeutic procedures, such as X-rays. Patient support interventions that are neither investigative nor therapeutic (such as anaesthesia) are also included.

Psychiatric care days

Psychiatric care days are the number of days or part days the person received care as an admitted patient in a designated psychiatric unit or ward.

Hospitalisation

Hospitalisation is the term used to refer to the episode of admitted patient care, which can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay beginning or ending in a change of type of care (for example, from acute care to rehabilitation).

Same day admitted mental health care

The definition of same day admitted mental health care is slightly different between the two data sources.

A separation for Public hospitals is classified as same day admitted mental health care if the following applies:

  • the separation was a same day separation (that is, admission and separation occurred on the same day).

An admission for Private hospitals is classified as same day admitted mental health care based on data reported as ‘Same day episode’ including:

  • hospital-based same day admissions
  • single overnight for same day admissions for ECT
  • hospital-in-the-home or outreach care visits to patient’s homes recorded as same day admissions.

Separation

Separation means the process by which an admitted patient completes an episode of care by being discharged, dying, transferring to another hospital or changing type of care. Each record includes information on patient length of stay. A same-day separation occurs when a patient is admitted and separated from the hospital on the same date. An overnight separation occurs when a patient is admitted to and separated from the hospital on different dates.

Specialised psychiatric care

A separation is classified as having specialised psychiatric care if the patient was reported as having spent 1 or more days in a specialised psychiatric unit or ward.

Without specialised psychiatric care

A separation is classified as without specialised psychiatric care if the patient did not receive any days of care in a specialised psychiatric unit or ward. Despite this, these hospitalisations are classified as mental health related because the reported principal diagnosis for the separation is either one that falls within the Mental and behavioural disorders chapter (Chapter 5) in the ICD-10-AM classification (codes F00–F99) or is one of a number of other selected diagnoses (technical information).

 

Data coverage includes the time period 2006–07 to 2020–21. This section was last updated in December 2022.