Admitted patients mental health-related care

Spotlight data

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

Spotlight data summarising admitted patient mental health-related hospitalisation activity. A series of line graphs all summarise various data in numbers and rates (per 10,000 population) by separation type (same day and overnight) and sector (public or private hospital) including observed and expected trend from 2012–13 to 2021–22 which can be filtered per state and territory or at the national level. Another figure summarises state and territory jurisdiction hospitalisation rates (per 10,000 population) which can be filtered by year between 2012–13 to 2021–22. Another line graph summarises the observed time series trends for number of episodes and number of patients for same day admitted activity in private hospitals from 2017–18 to 2021–22. The last line graph shows the top 5 principal diagnoses by hospitalisations and rates (per 1,000,000 population) by care setting from 2012–13 to 2021–22.

Source: National Hospital Morbidity Database; Admitted patients mental health-related care tables: Tables AC.4, AC.7; Admitted patients mental health-related care supplementary tables: Table ‘Same Day Private Quarterly’


Introduction

Some people’s mental health needs require accessing care in a hospital setting such as a hospital ward, an emergency department and/or an outpatient clinic. This report presents information on admitted patient (those who undergo a hospital’s formal admission process) mental health-related hospitalisations from Australian public and private hospitals. When receiving mental health hospital care, a patient may be admitted to hospital for part of a day (same day admitted mental health care), or for one or more overnight stays (overnight admitted patient care). 

National overview

Patient demographics

Rates of mental health-related hospitalisations over the last 10 years varied by age, sex, First Nations status, state and territory, remoteness area of usual residence, and socio-economic status area of usual residence.

These differences may be due to a range of factors including differential access to hospital-based mental health services and the prevalence and impact of mental illness across demographic groups.

Figure AC.1:  Admitted patient mental health-related hospitalisations by key demographics, separation type and care setting 2012–13 to 2021–22

Five bar charts showing age group, sex, Indigenous status, remoteness area of usual residence, and SEIFA quintile of usual residence from 2012–13 to 2021–22. Data can be displayed by hospitalisation numbers, age standardised hospitalisation rates (per 10,000 population), or hospitalisation rates (per 10,000 population), care setting (with or without specialised psychiatric care), and by separation type (same day and overnight). Data summaries listed below.

Source: Admitted patients mental health-related care tables: Tables AC.3 and AC.5

Figure AC.2: Admitted patient mental health-related hospitalisations by sex/age group, separation type and care setting, 2012–13 to 2021–22

Figure AC.2.1: Four line graphs comparing admitted patient mental health-related hospitalisations by age group for sex (males, females, or persons), separation type (same day and overnight), and care setting (with and without specialised psychiatric care) from 2012–13 to 2021–22. Sex and either specific age groups (or all ages) can be selected to display data by hospitalisation numbers or rates (per 10,000 population). Compared to 2020–21, in 2021–22 rates for most age groups decreased for overnight hospitalisations with specialised psychiatric care. Across the decade from 2012–13 to 2020–21, rates for most age groups remained stable for same day hospitalisations with specialised psychiatric care.

Figure AC.2.2: Four line graphs comparing admitted patient mental health-related hospitalisations by age group for sex (males, females, or persons), separation type (same day and overnight), and care setting (with and without specialised psychiatric care) from 2012–13 to 2021–22. Sex and either specific age groups (or all ages) can be selected to display data by hospitalisation numbers or rates (per 10,000 population). Compared to 2020–21, in 2021–22 rates for most age groups decreased for overnight hospitalisations with specialised psychiatric care. Across the decade from 2012–13 to 2020–21, rates for most age groups remained stable for same day hospitalisations with specialised psychiatric care.

Source (both Figures): Admitted patients mental health-related care tables: Table AC.3

Figure AC.3: First Nations admitted patient mental health-related hospitalisations by sector, separation type and care setting, 2012–13 to 2021–22

Four line graphs comparing admitted patient mental health-related hospitalisations by First Nations status for sector (public, private, or public and private combined), separation type (same day and overnight), and care setting (with and without specialised psychiatric care) from 2012–13 to 2021–22. Aboriginal and Torres Strait Islander people can be compared to non-Indigenous Australians based on sector for hospitalisation numbers, age standardised hospitalisation rates (per 10,000 population), or hospitalisation rates (per 10,000 population). In 2021–22 the difference in age standardised rates between First Nations and non-Indigenous Australians for hospitalisations in public hospitals with specialised psychiatric care was larger for overnight hospitalisations (134 for First Nations people and 41 for non-Indigenous Australians) than for same day hospitalisations (11 for First Nations people and 5 for non-Indigenous Australians).

Source: Admitted patients mental health-related care tables: Table AC.5

Figure AC.4: State and territory admitted patient mental health-related hospitalisations by sector, separation type and care setting, 2012–13 to 2021–22

Four line graphs comparing admitted patient mental health-related hospitalisations by state and territory for sector (public, private, or public and private combined), separation type (same day and overnight) and care setting (with and without specialised psychiatric care) from 2012–13 to 2021–22. Individual jurisdictions (or national level) and sectors can be separately selected to display data by hospitalisation numbers or rates (per 10,000 population). For public hospital same day hospitalisations with specialised psychiatric care, Queensland has consistently had the highest rates from 2014–15 to 2020–21 (12 versus 16 per 10,000). Compared to 2020–21, in 2021–22 rates across most states and territories decreased for overnight hospitalisations with specialised psychiatric care.

Source: Admitted patients mental health-related care tables: Table AC.4

Figure AC.5: Admitted patient mental health-related hospitalisations for remoteness of usual residence by sector, separation type and care setting, 2012–13 to 2021–22

Four line graphs comparing admitted patient mental health-related hospitalisations by remoteness area of usual residence for sector (public, private, or public and private combined), separation type (same day and overnight), and care setting (with and without specialised psychiatric care) from 2012–13 to 2021–22. Sectors can be selected separately to display data by hospitalisation numbers or rates (per 10,000 population). Across the past decade from 2012–13 to 2020–21, rates have generally been stable for remoteness areas of usual residence.

Source: Admitted patients mental health-related care tables: Table AC.5

Socio-economic status

Hospitalisation rates for the past 10 years (2012–13 to 2021–22), showed that public hospital same day without specialised psychiatric care and overnight with and without specialised psychiatric care have been consistently highest for SEIFA quintile 1 (most disadvantaged) and lowest for quintile 5 (least disadvantaged) (Figure AC.6).

Rates have been consistently highest for quintile 5 (least disadvantaged) for private hospital overnight stays in both care settings (with and without).

Figure AC.6: Admitted patient mental-health related hospitalisations for socioeconomic status (SEIFA) by sector, separation type and care setting, 2012–13 to 2021–22

Four line graphs comparing admitted patient mental health-related hospitalisations by level of socio-economic status (SEIFA) quintile (quintile 1 – most disadvantaged to quintile 5 – least disadvantaged) for sector (public, private, or public and private combined), separation type (same day and overnight), and care setting (with and without specialised psychiatric care) from 2012–13 to 2021–22. Sectors can be separately selected to display data for hospitalisation numbers or rates (per 10,000 population). Across the past decade from 2012–13 to 2020–21, rates have remained relatively stable for SEIFA quintiles.

Source: Admitted patients mental health-related care tables: Table AC.5

Principal diagnosis

During 2012–13 to 2021–22, Depression and other affective disorders have consistently been the most frequently reported principal diagnoses for same day public and overnight private hospital admissions with specialised psychiatric care. Whereas, for overnight public hospital admissions with specialised psychiatric care, Schizophrenia has been the most common principal diagnosis.

Dementia, other organic mental disorders, Alzheimer’s disease have been the most frequently reported principal diagnoses for overnight public hospitalisations without specialised psychiatric care, and the rate (per 1,000,000 population) has nearly doubled over the ten-year period from 677 in 2012–13 to 1,322 in 2021–22. The principal diagnosis rate (per 1,000,000 population) for Eating disorders also increased and almost tripled, from 57 in 2012–13 to 187 in 2021–22.

Mental and behavioural disorders due to use of alcohol have been the most frequently reported principal diagnoses each year for same day public hospitalisations without specialised psychiatric care (Figure AC.7).

The top 3 principal diagnostic groups (Major affective and other mood disorders, Alcohol or other substance use disorders, and Anxiety and adjustment disorders) for same day private hospital episodes all decreased by 7% each in 2021–22.

Figure AC.7: Admitted patient mental health-related hospitalisations for principal diagnosis by sector, separation type and care setting, 2012–13 to 2021–22

: Four line graphs comparing admitted patient mental health-related hospitalisations by top principal diagnosis for sector (public, private, or public and private combined), separation type (same day and overnight), and care setting (with and without specialised psychiatric care) from 2012–13 to 2021–22. Sectors can be separately selected to display data for hospitalisation numbers or rates (per 1,000,000 population). Across the past decade, Depression and other affective disorders were the most common diagnoses for public hospital same day with specialised psychiatric care hospitalisations, however it has been steadily decreasing from 2012–13 (5,324) to 2021–22 (3,661). Across the past decade from 2012–13 to 2021–22, Schizophrenia was the most common diagnosis for public hospital overnight with specialised psychiatric care hospitalisations, peaking in 2016–17 (23,103) then decreasing onwards.

Source: Admitted patients mental health-related care tables: Table AC.7

Figure AC.8: Admitted patient mental health-related procedures by sector, separation type and care setting, 2017–18 to 2021–22

Four line graphs comparing admitted patient mental health-related patient hospitalisations by top procedure for sector (public, private, or public and private combined), separation type (same day and overnight), and care setting (with and without specialised psychiatric care) from 2017–18 to 2021–22. Sectors can be separately selected to display data by hospitalisation numbers, hospitalisation rates (per 1,000,000 population), procedure numbers, or procedure rates (per 1,000,000 population). Procedure rates for Generalised allied health interventions for public hospital same day with specialised psychiatric care, while generally lower than overnight, have consistently increased from 2018–19 to 2021–22 (72 to 118 per 1,000,000). Generalised allied health interventions for public hospital overnight with specialised psychiatric care increased from 2017–18 to 2020–21 (5,621 to 7,055 per 1,000,000) before declining slightly in 2021–22 (6,656 per 1,000,000). 

Source: Admitted patient mental health-related care supplementary data tables: Table ‘Procedures’

Figure AC.9: Admitted patient mental health-related allied health procedures by sector, separation type and care setting, 2017–18 to 2021–22

Four line graphs comparing admitted patient mental health-related patient hospitalisations by top allied health procedure for sector (public, private, or public and private combined), separation type (same day and overnight), and care setting (with and without specialised psychiatric care) from 2017–18 to 2021–22. Sectors can be separately selected to display data by procedure numbers or rates (per 1,000,000 population). For public hospital overnight with specialised psychiatric care, Pharmacy procedures increased from 2017–18 (26,409) to 2020–21 (40,694), before decreasing in 2021–22 (39,811).

Source Admitted patient mental health-related care supplementary data tables: Table ‘Allied Procedures’

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Data sources

Although there are national standards for data on admitted patient care, the results presented here may be affected by variations in admission and reporting practices between states and territories. Interpretation of the differences between states and territories therefore needs to be made with care.

The large decline in patient days associated with public hospital mental health-related hospitalisations from 2016–17 to 2017–18 occurred after large increases from 2014–15 to 2016–17. The rise in patient days is substantially impacted by long stay mental health patients, primarily in specialised psychiatric care settings, who can individually account for hundreds of days. These fluctuations are likely to also be related to the introduction of the Mental health care type from 1 July 2015. For example, to change the care type of patients receiving mental health care, Queensland (2015–16) and New South Wales (2016–17) discharged and readmitted patients, causing the rise in hospitalisations and patient days counted in those years. The subsequent decline in patient days seen in 2017–18 is impacted by days accrued before the change in care type being counted in an earlier year.

Key concepts

Key Concept

Description

Average length of stay

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

Care setting

The care setting refers to the type of care received that can be either with specialised psychiatric care or without specialised psychiatric care. See “specialised psychiatric care” and “without specialised psychiatric care” definitions below.

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).

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 used in the PPHDRAS data set. Further details of these diagnostic groups can be found in the data sources section.

Episode

An episode of care in private hospitals (episode is only used for same day private hospital stays throughout this report) 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 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). This term is used throughout this report referring to either same day or overnight public hospital stays, or overnight private hospital stays. A hospitalisation can be interchangeably referred to as a ‘separation’.

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

Overnight admitted patient hospitalisations refer 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.

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 public and private 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 diagnoses

The principal diagnosis is the ICD-10 diagnosis established after study to be chiefly responsible for occasioning the patient’s episode of admitted patient care in the NHMD dataset for public same day and public and private overnight data. The classification of diagnostic groups used by the PPHDRAS is based on the ICD-10 principal diagnosis assigned to the episode of care at discharge.

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.

Remoteness area

Remoteness area is coded in accordance with the Australian Bureau of Statistics’ (ABS) Australian Statistical Geography Standard (ASGS) Remoteness Structure to the following categories: Major cities, Inner regional, Outer regional, Remote and Very remote. In this report, these categories are based on area of usual residence.

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, or
  • hospital-in-the-home or outreach care visits to patient’s homes recorded as same day admissions
Sector

Sector refers to the type of hospital (public or private) patients were admitted to, not the funding source, noting that patients can receive private care in public hospitals. Public hospitals include either public acute or public psychiatric hospitals for those hospitalisations with specialised psychiatric care.

Separation mode

The mode of separation from care provides information on how each period of care ended, and for some, the place to which the patient was discharged or transferred. These modes include: to home, to an(other) acute or psychiatric hospital, to residential aged care facility, other separation modes (to other health accommodation, statistical discharge/leave, left against medical advice, statistical discharge/type change, and died).

Separation type

The separation type is referred to throughout this report as the type of patient length of stay: same day or overnight.

Socio-economic (SEIFA) status

Socio-Economic Indexes for Areas (SEIFA) IRSD (The Index of Relative Socio-economic Disadvantage) scores are calculated by the Australian Bureau of Statistics (ABS), accounting for social and economic indicators of advantage and disadvantage, such as education, occupation, employment, income, families, and housing, and are used to summarise the socio-economic conditions of a geographical area. The index scores, based on information from the five-yearly Census, are used to categorise geographical areas of Australia into five categories to represent one-fifth (20%, a quintile) of the estimated resident population. Quintiles in this report are based on area of usual residence, with quintile 1 categorised as most disadvantaged and quintile 5 categorised as least disadvantaged.

Specialised psychiatric care

A separation is classified as having specialised psychiatric care if the patient was reported as having spent one or more days in a specialised psychiatric unit or ward. In public acute hospitals, a specialised episode of care or separation may comprise some psychiatric care days and some days in general care. An episode of care from a public psychiatric hospital is deemed to comprise psychiatric care days only and to be specialised, unless some care was given in a unit other than a psychiatric unit, such as a drug and alcohol unit.

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 2021–22. This section was last updated in December 2023.