Admitted patients mental health-related care Print this page

The principal source of funding for a separation (hospitalisation) is collected as part of the Admitted Patient Care National Minimum Data Set (APC NMDS). However, it should be noted that a hospitalisation may be funded by more than one funding source and information on additional funding sources is not available. For public hospitals in 2020–21, 93% of same day mental health-related hospitalisations with specialised psychiatric care were public patients (e.g. funded by the health service budget or reciprocal health care agreement). Of those jurisdictions with published proportions, all except New South Wales reported a proportion of publicly funded hospitalisations above 90%. New South Wales reported a public patient proportion of 86%, with the remainder being accounted for by Private health insurance funding (12%).

The mode of separation from care is also collected and provides information on how each hospitalisation ended, and for some, the place to which the patient was discharged or transferred. The most common mode of separation for same day public mental health-related hospitalisations with specialised psychiatric care was discharge to ‘home’ (86%), which includes discharge to usual residence/own accommodation/welfare institution (including prisons, hostels and group homes providing primarily welfare services).

Four in 5 (80%) same day public mental health-related hospitalisations without specialised psychiatric care ended with the patient discharged to ‘home’. The remaining 20% consisted of transfers to another facility (9%, which includes transfers to another acute hospital), another psychiatric hospital, aged care facilities, and other health accommodation), statistical discharges (which include changes in care type and discharges from leave), and patients leaving against medical advice. Note that information on the place to which a patient was discharged or transferred may not be available for some hospitalisations..

Information on overnight mental health-related hospitalisations is reportable at smaller geographic areas than state and territory boundaries. Sub-jurisdictional reporting provides the opportunity to consider differences within jurisdictions. For the analysis presented here, the geographical area is based on the usual residence of the patient rather than the geographical location of the hospital. There are two types of geographical areas which are reported here:

Primary Health Network (PHN) areas – 31 geographic areas covering Australia, with boundaries defined by the Australian Government Department of Health and Aged Care.

Statistical Areas Level 3 (SA3s) – 340 geographic areas covering Australia, with boundaries defined by the Australian Bureau of Statistics.

In 2020–21, the national rate of mental health-related hospitalisations was 110 per 10,000 population. At the PHN level, Brisbane North had the highest rate (137), and Western Sydney had the lowest (84).

The observed variability in hospitalisation rates between geographical areas may be due to a range of factors including the proportion of the population in an area with a diagnosable mental illness who are admitted to hospital, availability of community-based services and variability in approaches to planning and delivering mental health support services across and within states and territories.

The most common mode of separation (e.g. leaving hospital) for overnight mental health-related hospitalisations with specialised psychiatric care in both public (85%) and private (94%) hospitals was discharge to ‘home’, which includes discharge to usual residence/own accommodation/welfare institution (including prisons, hostels and group homes providing primarily welfare services).

Note that information on the place to which a patient was discharged or transferred may not be available for some separations.

In 2020–21, there were 6 same day admitted mental health-related hospitalisations with specialised psychiatric care per 10,000 population in public hospitals in Australia. The rate of this type of hospitalisation was highest for Queensland (16).

Nationally, the rate of overnight mental health-related hospitalisations with specialised psychiatric care in public acute hospitals was higher than the rate in public psychiatric hospitals (44 and 4 respectively) (Figure AC.2.1).

In 2020–21, there were about 50,180 overnight admitted mental health-related hospitalisations with specialised psychiatric care in private hospitals, equivalent to a national rate of 20 per 10,000 population (Figure AC.2.2).

In 2020–21, the national rate of overnight mental health-related hospitalisations without specialised psychiatric care in public hospitals was 38 per 10,000 population.

There were about 42,690 same day public admitted mental health-related hospitalisations without specialised psychiatric care, equivalent to a national rate of 17 per 10,000 population (Figure AC.2.1). The majority (96%) were publicly funded.

The national rate of overnight mental health-related hospitalisations without specialised psychiatric care in private hospitals was 4 per 10,000 population in 2020–21 (Figure AC.2.2).

In 2020–21, the rate of same day public admitted mental health-related hospitalisations with specialised psychiatric care was highest for patients aged 18–24 years (13 per 10,000 population). Overall, the hospitalisation rate with specialised psychiatric care was higher for females than males (7 and 5 respectively).

Across all ages, the highest rate of same day public mental health-related hospitalisations without specialised psychiatric care was for patients aged 18–24 years (25). The hospitalisation rate was similar for males and females (16 and 17 respectively).

For private hospitals, almost two-thirds of same day mental health related hospitalisations were for female patients (65%). The population rate for females was almost twice that for males (11 and 6 respectively). Females aged 18–24 years had the highest patient rate (20) of all age groups (Figure AC.3.2).

There were about 980 same day public mental health hospitalisations with specialised psychiatric care for Aboriginal and Torres Strait Islander people in 2020–21, or 11 per 10,000 population, which is more than twice the rate for non-Indigenous patients (5).

There were about 4,840 same day public mental health hospitalisations without specialised psychiatric care for Indigenous Australians, or 56 per 10,000 population, which is almost four times higher than the rate of 15 for non-Indigenous patients (Figure AC.3.2).

People living in Major cities had the highest rate of same day public mental health-related hospitalisations with specialised psychiatric care in 2020–21 (6 per 10,000 population).

In contrast, the rate of same day public mental health-related hospitalisations without specialised psychiatric care increased with remoteness. People living in Remote and Very remote areas had the highest rate (45) (Figure AC.3.2).

The majority of patients receiving same day private admitted mental health care were from Urban areas. 

In 2020–21, the rate of overnight mental health-related hospitalisations with specialised psychiatric care was highest for patients aged 18–24 years (119 per 10,000 population) (Figure AC.3.1). Overall, across all ages, the rate was higher for females than males (72 and 63 respectively), but there is variation across age groups.

The highest rate of overnight mental health-related hospitalisations without specialised psychiatric care was for patients aged 85 and older (312). The rate was slightly higher for females than males (44 and 40 respectively) (Figure AC.3.1), but there is variation across age groups.

There were 13,270 overnight mental health-related hospitalisations with specialised psychiatric care for Indigenous Australians in 2020–21, or 154 per 10,000 population, which is 2.5 times higher than the rate for non-Indigenous patients (63) (Figure AC.3.1).

There were about 8,320 overnight mental health-related hospitalisations without specialised psychiatric care for Indigenous Australians, or 97 per 10,000 population, which is 2.5 times higher than the rate of other patients (39).

Patients living in Inner regional areas had the highest rate of overnight mental health-related hospitalisations with specialised psychiatric care in 2020–21 (68 per 10,000 population), whilst those living in Remote and Very remote areas had the lowest (42).

In contrast, people living in Remote and Very remote areas had the highest rate of overnight mental health-related hospitalisations without specialised psychiatric care (79) (Figure AC.3.1).

There was variability seen across socioeconomic status. People living in the most disadvantaged socioeconomic quintile (SEIFA Quintile 1) had the highest rate of overnight mental health-related hospitalisations without specialised psychiatric care at 45 per 10,000 population.

The 5 most frequently reported principal diagnoses in 2020–21 for same day public mental health-related hospitalisations with specialised psychiatric care were:

• Depressive episode (20% of hospitalisations)
• Schizophrenia (9%)
• Eating disorders (8%)
• Reaction to severe stress and adjustment disorders (6%)
• Specific personality disorders (6%) (Figure AC.5.2).

For same day public mental health-related hospitalisations without specialised psychiatric care, the most frequently reported principal diagnosis was Mental and behavioural disorders due to use of alcohol (25%).

The most common mental health diagnostic group of clinically significant episodes in same day private care was Major affective and other mood disorders (45% of episodes) (Figure AC.5.2).

The most frequently reported principal diagnoses in 2020–21 for an overnight mental health-related hospitalisation with specialised psychiatric care were:

• Depressive episode (15%)
• Schizophrenia (13%)
• Reaction to severe stress and adjustment disorders (11%).

The most frequently reported principal diagnosis for overnight mental health-related hospitalisations without specialised psychiatric care was Mental and behavioural disorders due to use of alcohol (21% in public hospitals and 24% in private hospitals).

Since 2010–11, for males aged 18–24 years, the hospitalisation rate with specialised psychiatric care increased from 3 to 9 per 10,000 population (with an average annual change of 10%), while for females aged 18–24 years, the hospitalisation rate increased from 4 to 18 (with an average annual change of 18%). For those aged 18–24 years, females showed a hospitalisation rate twice that of males (Figure AC.7.2).

The number of hospitalisations (including non-mental health) for persons aged 85 and over increased by an average annual change of 9% between 2007–08 and 2011–12 (AIHW 2012). Since 2013–14, all types of hospitalisations for people aged 85 and over increased at a faster rate than the average population growth for this age group (average annual increase of 5% from 2013–14 to 2017–18 compared to 4% population growth). In 2017–18, people aged 65 and over, who made up 15% of Australia’s population, accounted for 42% of hospitalisations and 48% of patient days (AIHW 2018).

Even though the rate of same day public hospitalisation for people aged 85 and over has been decreasing at an average annual change of 5% for specialised care and 12% for non-specialised care between 2010–11 and 2020–21, the rate of same day public mental health-related hospitalisations per 10,000 population for this age group has been among the highest between 2010–11 and 2019–20. In particular, the rate for people aged 85 and over who received specialised psychiatric care in public hospitals decreased from 46 in 2019–20 to 4 in 2020–21 (Figure AC.7.2). This represents a decrease of 92% since 2019–20. This change has been largely driven by a shift from an admitted care setting to non-admitted care, for example, outpatient clinics and/or community mental health care.

Overnight hospitalisation rates with specialised psychiatric care for people aged 12–17 years have almost doubled from 35 to 62 hospitalisations per 10,000 population since 2010–11. This increase is largely accounted for by hospitalisations of female patients. The hospitalisation rate with specialised psychiatric care for females aged 12–17 years was more than 3 times the rate of males aged 12–17 years (95 per 10,000 population and 31 respectively). This represents an average annual change of 8% for females and 3% for males between 2010–11 to 2020–21 (Figure AC.7.1).

While the overnight hospitalisation rate without specialised psychiatric care of female patients aged 12–17 years has increased between 2010–11 and 2020–21 (from 28 to 53), the rate for male patients has decreased by an average annual change of 1% over the same period. Across both sexes, the overnight hospitalisation rate without specialised psychiatric care for people aged 12–17 years has increased (average annual increase of 5% between 2010–11 and 2020–21).

For people aged 18–24 years receiving specialised psychiatric care, the hospitalisation rate with specialised psychiatric care has almost doubled since 2010–11 (from 69 to 119 in 2020–21), largely due to hospitalisations of female patients (with an average annual increase between 2010–11 and 2020–21 of 7% compared with 4% average annual increase for male patients) (Figure AC.7.1).

Hospitalisation rates with specialised psychiatric care for people aged 85 years and over has decreased by an annual average of 4% between 2010–11 and 2020–21. For each year examined, and for each sex, the rate of overnight mental health‑related hospitalisations without specialised care per population was highest for older adults (75–84 years, and 85+ years).

In contrast to hospitalisations with specialised psychiatric care, hospitalisation rate without specialised psychiatric care for people aged 85 years and over has increased by an annual average of 6% between 2010–11 and 2020–21. For this age group, males have had a consistently higher hospitalisation rate than the females.

For public acute hospitals and public psychiatric hospitals, there were 687 and 188 patient days per 10,000 population respectively for overnight mental health-related hospitalisations with specialised psychiatric care in 2020–21. Among jurisdictions for which figures are published, the highest rate for patient days for public acute hospitals was in the Australian Capital Territory (1,006) while the highest for public psychiatric hospitals was in Tasmania (499). Queensland reported the highest rate of patient days in private hospitals (502) (Figure AC.8.1).

In 2020–21, the national average length of stay for overnight mental health-related hospitalisations with specialised psychiatric care in public acute hospitals was about 16 days, which is similar to the 2019–20 figure (15) (Figure AC.8.2). Please refer to the data source for information on patient day fluctuations over the period between 2014–15 and 2017–18.

Private hospital same day admitted mental health care data is sourced from the Australian Private Hospitals Association Private Psychiatric Hospitals Data Reporting and Analysis Service (PPHDRAS) and is not comparable with data from the NHMD.

Some state and territory data from the PPHDRAS is aggregated to maintain privacy for participating hospitals. New South Wales and the Australian Capital Territory are reported together (NSW/ACT) as are Western Australia, South Australia, Tasmania and Northern Territory (WA/SA/Tas/NT). Victoria and Queensland are reported separately.

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. Due to the relatively small number of patients in Outer regional, Remote or Very remote areas, only Urban (defined as major cities) versus Non-urban (everywhere else) is reported.

Counts of episodes include only clinically substantive episodes of care. 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.

Overnight admitted mental health care data and public same day admitted mental health care data are sourced from the National Hospital Morbidity Database (NHMD), a collation of data on admitted patient care in Australian hospitals defined by the Admitted Patient Care National Minimum Data Set (APC NMDS). It is possible for individuals to have multiple separations (hospitalisations) in any given reference period.

Due to the relatively small number of admitted patient mental health-related hospitalisations without specialised psychiatric care from public psychiatric hospitals, these have been combined with the public acute hospitals for reporting purposes in the admitted care without specialised psychiatric care section.

The NHMD is a compilation of episode-level records from admitted patient morbidity data collections in Australian hospitals. Items includes demographic, administrative and length of stay data for each hospitalisation. Clinical information such as diagnoses, procedures undergone and external causes of injury and poisoning are also recorded. For further details on the scope and quality of data in the NHMD, refer to the data quality statement in Admitted patients: 2020–21.

Further information on admitted patient care for the 2020–21 reporting period can be found in the report Admitted patients 2020–21 (AIHW 2022). The 2020–21 collection contains data for hospitalisations that occurred between 1 July 2020 and 30 June 2021. Admitted patient episodes of care/hospitalisations that began before 1 July 2020 are included if the separation date fell within the collection period. A record is generated for each hospitalisation rather than each patient. Therefore, those patients who had more than one hospitalisation in the reference year will have more than one record in the database.

Specialised mental health care is identified by the patient having one or more psychiatric care days recorded – that is, care was received in a specialised psychiatric unit or ward during that separation. 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.

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 principal diagnosis refers to the diagnosis established after observation by medical staff to be chiefly responsible for the patient’s episode of admitted patient care. For 2020–21, diagnoses are classified according to the International Statistical Classification of Diseases and Related Health Problems, 11th revision, Australian Modification (ICD-11-AM 11^th edition) (ACCD 2021). Further information on this is included in the technical information section.

For 2020–21, procedures are classified according to the Australian Classification of Health Interventions, 11^th edition. Further information on this classification is included in the technical information section. More than one procedure can be reported for a separation and not all hospitalisations have a procedure reported.

The large decline in patient days associated with public hospital mental health-related hospitalisations from 2016–17 to 2017–18 followed large increases from 2014–15 to 2016–17. These fluctuations are likely to 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 rise in patient days is substantially impacted by long stay mental health patients, who can individually account for hundreds, or in some cases thousands, of days. 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.

The Australian Private Hospitals Association Private Psychiatric Hospitals Data Reporting and Analysis Service (PPHDRAS), previously known as the Private Mental Health Alliance Centralised Data Management Service (PMHA CDMS), was launched in Australia in 2001 to support private hospitals with psychiatric beds to routinely collect and report on a nationally agreed suite of clinical measures and related data for the purposes of monitoring, evaluating and improving the quality of and effectiveness of care. The PPHDRAS works closely with private hospitals, health insurers and other funders (e.g. Department of Veterans’ Affairs) to provide a detailed quarterly statistical reporting service on participating hospitals’ service provision and patient outcomes.

The PPHDRAS fulfils two main objectives. Firstly, it assists participating private hospitals with implementation of their National Model for the Collection and Analysis of a Minimum Data Set with Outcome Measures. Secondly, the PPHDRAS provides hospitals and private health funds with a data management service that routinely prepares and distributes standard reports to assist them in the monitoring and evaluation of health care quality. The PPHDRAS also maintains training resources for hospitals and a database application which enables hospitals to submit de-identified data to the PPHDRAS. The PPHDRAS produces an annual statistical report. In 2019–20, the PPHDRAS accounted for 98% of all private psychiatric beds in Australia (APHA 2021).

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. There are eight clinical groupings of the ICD-10 diagnoses relating to mental and behavioural disorders, they are as follows:

• Schizophrenia, Schizoaffective and Other Psychotic Disorders. This group includes ICD-10 diagnoses of: Psychotic disorders due to psychoactive substance use (F1x.5 and F1x.7), Schizophrenia (F20), Schizotypal disorders (F21), Delusional disorders (F22 and F24), Acute and transient psychotic disorders (F23), Schizoaffective disorders (F25), and Other non-organic psychotic disorders (F28 and F29).
• Major Affective and Other Mood Disorders. This group includes ICD-10 diagnoses of Manic episodes and bipolar affective disorders with current episode manic (F30, F31.0, F31.1 and F31.2), Depressive episodes, bipolar disorders with current episode depressed or mixed, and Recurrent depressive disorders (F31.3, F31.4, F31.5, F31.6, F31.7, F31.8, F31.9, F32 and F33), and Persistent mood disorders including cyclothymia and dysthymia, and Other mood disorders (F34, F38 and F39).
• Post Traumatic and Other Stress-related Disorders. This group includes ICD-10 diagnoses of Reactions to severe stress including acute stress reactions (F43.0, F43.8 and F43.9), Adjustment disorders with brief depressive reactions (F43.20), Adjustment disorders with prolonged depressive reactions (F43.21), Other adjustment disorders (F43.22 and F43.28) and Posttraumatic stress disorders (F43.1).
• Anxiety Disorders. This group includes ICD-10 diagnoses of Anxiety disorders including phobic anxiety, Panic disorder, Generalised anxiety disorder and Other neurotic disorders (F40, F41 and F48), and Dissociative disorders (F44). It does not include Obsessive Compulsive Disorders (F42) or Somatoform Disorders (F45) which are classified elsewhere.
• Alcohol and Other Substance Use Disorders. This group includes ICD-10 diagnoses of Alcohol and Other psychoactive substance intoxication, harmful, use, dependence and withdrawal (F1x.0, F1x.1, F1x.2, F1x.3, F1x.4, F1x.8 and F1x.9).
• Eating Disorders. This group includes ICD-10 diagnoses of Anorexia nervosa and Atypical anorexia nervosa (F50.0 and F50.1), and Eating disorders other than anorexia nervosa (F50.2, F50.3, F50.4- and F50.9).
• Personality Disorders. This group includes ICD-10 diagnoses of Paranoid and schizoid personality disorders (F60.0 and F60.1), Dissocial personality disorders including antisocial personality disorder (F60.2), Emotionally unstable personality disorders (includes borderline and impulsive) (F60.3), Histrionic, Anankastic (obsessive-compulsive), Anxious, and Dependent personality disorders (F60.4, F60.5, F60.6 and F60.7), and Other personality disorders (F60.8, F60.9, F61.0, F61.1, F62, F63, F68 and F69).
• Other Disorders, Not Elsewhere Classified. This group includes all remaining psychiatric and other diagnoses including: Organic Disorders (F00 through F09 and F1x.6); Obsessive Compulsive Disorders (F42); Somatoform disorders (F45); Behavioural Syndromes Associated with Physiological Disturbances and Physical Factors (F51, F53, F54, and F59); Sexual Disorders (F52, F64, F65 and F66); Mental Retardation (F70, F71, F72, F73, F78 and F79); Disorders of Psychological Development (F80, F81, F82, F83, F84, F88 and F89); Disorders of Childhood and Adolescence (F90, F91, F92, F93, F94, F95 and F98.0); Other Disorders, including ICD-10 diagnoses of Mental disorders, not otherwise specified (F99) and all other valid non-psychiatric diagnoses (i.e., diagnoses not grouped under either MDC 19 or MDC 20 in AR-DRG 4).

The classification of patients into urban versus non-urban groups was based on the ASGS Remoteness classification of the Postcode of their Area of usual residence, at the first day of care within the financial year. In cases whether the Area of usual residence was missing from that first day’s record, the first valid value for the patient is used. Patients, whose Area of usual residence was in ASGC group Major cities were classified as “Urban”, whilst those in the remaining groups (Inner regional, Outer regional, Remote and Very remote) were classified as “Non-urban”.

Statistics for states and territories were aggregated in accordance with PPHDRAS policy which, in order to ensure the privacy and confidentiality of both patients and providers, prohibits individual State or Territory statistics being reported in cases where the number of Hospitals is less than 5. As a consequence, statistics for the Australian Capital Territory are aggregated with those for New South Wales, whilst those for South Australia, Western Australia, Tasmania and Northern Territory are also aggregated.