Community services

Summary

Key points

  • Around 10.2 million community mental health care service contacts were provided to nearly 481,500 patients in 2020–21.
  • The most common specified principal diagnosis recorded for patients during a service contact was Mental disorder not otherwise specified (25%), while the most common for a known diagnosis was Schzipohrenia (21%).
  • Involuntary contacts accounted for more than 1 in 7 (15%) of all contacts.
  • The most frequently recorded type of community mental health care service contact was with an individual patient (as opposed to a group session). The most frequently recorded service contact duration was 5–15 minutes (38%).

Mental illness is often treated in community and hospital-based outpatient care services provided by state and territory governments. Collectively, these services are referred to as community mental health care (CMHC) services.

State and territory health authorities collect a core set of information for the Community Mental Health Care National Minimum Data Set (CMHC NMDS), which is compiled annually into the National Community Mental Health Care Database (NCMHCD). Datafrom the NCMHCD are used to describe the care provided by these services. More information about the NCMHCD is available in the data source section.

Spotlight Figure CMHC.1: Community mental health care services in Australia by location

Infographic containing a map of Australia showing community mental health services by location, principal diagnosis, estimated number of patients in community mental health care in Australia and involuntary contacts for the years 2005–06 to 2020–21.

Services provided

Around 10.2 million service contacts were provided by community mental health care services to nearly 481,500 patients in 2020–21. This equates to an average of about 21 per patient.

The national average rate of patients receiving services was 19 patients per 1,000 population. The rate was highest in the Northern Territory (31) (Figure CMHC.2). Differences in jurisdictional data reporting systems may contribute to the observed variation in rates.

Figure CMHC.2: Community mental health care patients, by states and territories, 2020–21

Interactive vertical bar chart showing the number of community mental health care patients, service contacts and treatment days as well as the rate of contacts and patients (rate per 1,000 population) for states and territories in 2020–21. New South Wales had the highest number of patients (146,498), followed by Queensland (113,493), Victoria (80,500), Western Australia (67,654), South Australia (43,860), the Australian Capital Territory (11,579), Tasmania (10,158) and the Northern Territory (7,711). The Northern Territory reported the highest rate (31 patients per 1,000 population) followed by the Australian Capital Territory (27), Western Australia (25), South Australia (25), Queensland (22), Tasmania (19), New South Wales (18), and Victoria (12). The national rate of community mental health care patients was 19 per 1,000 population (refer to Table CMHC.1).

Note: Community mental health care treatment days is only reported as a number.

Source data: Community mental health care services 2020–21 tables.

Changes over time

In 2005­–06, almost 5.7 million CMHC service contacts took place across Australia. This has increased to around 10.2 million in 2020–21.

Treatment periods

Nearly 2 in 5 registered patients (39%) had a length of treatment of 92 days or more (the time between their first and last service contact during the reporting period) in 2020–21.

These patients received the highest proportion of treatment days (​81%) from CMHC services (Figure CMHC.3).

Figure CMHC.3: Patients and total treatment days, by length of treatment period, 2020–21

Stacked vertical bar chart showing length of treatment period and the proportion of patients that received different lengths of treatment. 37% of patients received very brief treatment (1–14 days), 24% received short term treatment (15–91 days) and 39% received medium to longer term treatment (92+ days). 6% reported treatment days were very brief, 13% were short term treatment and 81% were medium to longer term treatment (refer to table CMHC.25).

Patient characteristics

In 2020–21, a slightly higher proportion of CMHC patients were females (53%). However, males accessed services at a similar rate to females (394 and 393 per 1,000 population respectively). People aged 12–17 years accounted for the highest rate of both patients (39) and service contacts (751), with females accounting for a higher rate of service contacts than males: 1,063 and 447 respectively.

People living in Major cities made up the majority of CMHC patients (64%) and people living in Very remote areas made up the smallest proportion (2%). However, the population adjusted rate of patients was highest for people living in Very remote areas (38 per 1,000 population) and people living in Major cities has the lowest rate (16).

Aboriginal and Torres Strait Islander patients comprised 11% of CMHC patients in 2020–21, however the rate per 1,000 population was more than 3 times that of non‑Indigenous patients (60 and 17 respectively) (Figure CMHC.4).

Figure CMHC.4: Community mental health care patients, by key demographics, 2005–06 to 2020–21

Two interactive charts. A horizontal bar chart showing the rate (per 1,000 population), per cent or number of community mental health care patients by demographic variables of age, sex, Indigenous status, remoteness area and SEIFA quintile in 2020–21. The lowest rate for patients by age was seen for those aged 0–4 years (2 people per 1,000 age specific population) and the highest rate was for patients aged 12–17 years (39).  Male and female patients had similar rates per 1,000 population (18 and 20 respectively). The highest rate of patients per 1,000 population by remoteness area was seen for patients living in Very remote areas (38), followed by Remote (33), Outer regional (26), Inner regional (22), and lowest for Major cities (16). The rate of patients per 1,000 population living in SEIFA Quintile 1 (most disadvantaged) was the highest of all quintiles (23), which decreased to 13 for Quintile 5 (least disadvantaged) (refer to Table CMHC.9). The 2ND figure is a time series of community service contacts by patient demographics from 2005–06 to 2020–21 (refer to Table CMHC.8).

Note: Age-standardised rate is shown for Indigenous Status.

Source data: Community mental health care services 2020–21 tables.

Principal diagnosis

In 2020–21, Mental disorder not otherwise specified was the most frequently recorded mental health-related principal diagnosis for CMHC contacts (25%). For those patients with a known diagnoses Schizophrenia (21%) was the most common followed by:

  • Depressive episode (6%)
  • Schizoaffective disorders (6%)
  • Reaction to severe stress and adjustment disorders (5%)
  • Specific personality disorders (5%) and
  • Bipolar affective disorders (5%)

A principal diagnosis was reported for 4 out of 5 (almost 8.5 million) CMHC service contacts.

There is variation however across age groups when looking at the most frequently recorded principal diagnosis for service contacts (Figure CMHC.5). Younger age groups (those aged up to 34 years) and older age groups (those aged 65 years and over) most frequently recorded Mental disorder not otherwise specified, while those aged 35–64 years most frequently recorded Schizophrenia.

Figure CMHC.5: Proportion of community mental health care service contacts for six commonly reported mental health-related principal diagnoses, by age group, 2020–21

Interactive horizontal bar chart showing 6 commonly reported specific principal diagnosis for community mental health care service contacts in 2020–21 by age group. The most frequently reported principal diagnosis for those aged 0–4 years, 5–11 years, 12–17 years, 18–24 years, 25–34 years, 65–74 years, 75–84 years and 85 years and over was Mental disorder not otherwise specified (25%, 28%, 26%, 27%, 26%, 21%, 21% and 24% respectively). For older ages, Schizophrenia was the most frequently reported principal diagnosis, ranging from 30% for those aged 55–64 years to 33% for those aged 35–44 years (refer to Table CMHC.18).

Characteristics of service contacts

CMHC service contacts can be conducted as either individual or group sessions. Service contacts can also be face-to-face, via telephone, or using other forms of direct communication such as video link. They can be conducted in the presence of the patient, with a third party (such as a carer or family member) and/or other professional or mental health worker.

The majority of service contacts reported in 2020–21 involved individual contact sessions (96%) and 4% of contacts were group sessions. Just over half of all contacts were individual sessions (52%), where the patient participated in the service contact (termed patient present).

Figure CMHC.6: Community mental health care service contacts, by session duration, 2005–06 to 2020–21

Two interactive charts. A stacked horizontal bar chart showing the duration of community mental health care service contacts by session duration and patient participation status in 2020–21. The most frequent contact duration was 5–15 minutes (38%), followed by 16–30 minutes (24%), >0.5–1 hour (20%), >1–3 hours (11%), <5 minutes (6%), and >3 hours (1%). 53% of contacts occurred with the patient present (5.4 million) and 47% occurred with the patient absent (4.8 million). Contacts lasting more than 3 hours were more likely to occur with the patient present than without the patient (1% and 0.2% respectively), while contacts lasting less than 5 minutes were more likely to occur without the patient than with the patient (11% and 0.6% respectively) (refer to Table CMHC.22). 2ND figure is a time series of service contacts by session duration from 2005–06 to 2020–21 (refer to Table CMHC.24).

Figure CMHC 6.1, time series of of service contacts by session duration  can be found on the MHSA website.

Mental health legal status

More than 1 in 7 (15%) CMHC service contacts in 2020–21 involved a patient with an involuntary mental health legal status. Western Australia reported the lowest proportion of involuntary contacts (3%), while Queensland reported the highest (25%). These differences most likely reflect the different legislative arrangements in place amongst the jurisdictions. More information can be found in the CMHC NMDS Data Quality Statement.

In 2020–21, of the 5 commonly reported principal diagnoses, the highest proportion of contacts involving a patient with an involuntary mental health legal status was seen for patients diagnosed with Schizoaffective disorders (43% involuntary) (Figure CMHC.7).

Figure CMHC.7: Community mental health care service contacts by mental health legal status, 2020–21

Two interactive charts. A horizontal bar chart comparing the number and proportion of voluntary and involuntary contacts for 5 of the most commonly reported principal diagnoses in 2020–21. Schizoaffective disorders (57% voluntary and 43% involuntary); Schizophrenia (63% voluntary and 37% involuntary); Bipolar affective disorders (77% voluntary and 23% involuntary); Reaction to severe stress and adjustment disorders (97% voluntary and 3% involuntary); Depressive episode (97% voluntary and 3% involuntary) (refer to Table CMHC.28). 2ND figure is a time series stacked vertical bar chart showing community mental health care service contacts by mental health legal status and by state and territory (refer to Table CMHC.27).

Figure CMHC.7.1 can be found on the MHSA website.

Key concepts
Key concept Description
Community mental health care Community mental health care refers to government‑funded and operated specialised mental health care provided by community mental health care services and hospital‑based ambulatory care services, such as outpatient and day clinics. 
Length of treatment period

 

Length of treatment period is the total amount of time between the first and last service contact for each registered patient during the reporting period. Treatment periods are defined in this report as Very brief (1-14 days), Short term (15–91 days) and Medium to longer term (92+ days).
The state and territory mental health acts and regulations provide legislation that safeguards the rights and governs the treatment of patients with mental illness in admitted patient care, residential care and community-based services. The legislation varies between state and territory jurisdictions but all legislation contains provisions for the assessment, admission and treatment of patients on an involuntary basis, defined as ”persons who are detained in hospital or compulsorily treated in the community under mental health legislation for the purpose of assessment or provision of appropriate treatment or care”.
Principal diagnosis The principal diagnosis reported for patients who have a community mental health care service contact is based on the broad categories listed in the Mental and behavioural disorders chapter (Chapter 5) of the International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM 11th edition). The data quality statement for the CMHC NMDS has further information on principal diagnosis data quality issues.
Service contacts Service contacts are defined as the provision of a clinically significant service by a specialised mental health service provider for patients/clients, other than those admitted to psychiatric hospitals or designated psychiatric units in acute care hospitals and residents in 24‑hour staffed specialised residential mental health services, where the nature of the service would normally warrant a dated entry in the clinical record of the patient/client in question. Any patient can have one or more service contacts over the relevant financial year period. Service contacts are not restricted to face‑to‑face communication and can include telephone, video link or other forms of direct communication. Service contacts can also be either with the patient or with a third party, such as a carer or family member, other professional or mental health worker, or other service provider.
Target population

Some specialised mental health services data are categorised using 5 target population groups (see METeOR identifier 682403):

  1. Child and adolescent services focus on those aged under 18 years.
  2. Older person services focus on those aged 65 years and over.
  3. Forensic health services provide services primarily for people whose health condition has led them to commit, or be suspected of, a criminal offence or will be likely to reoffend without adequate treatment or containment.
  4. General services targets services to the adult population, aged 18 to 64, however, these services may also provide assistance to children, adolescents or older people.
  5. Youth services target children and young people generally aged 16–24 years.

Note that in some states specialised mental health care beds for aged persons are jointly funded by the Australian federal and state and territory governments. However, not all states or territories report such jointly funded beds through the National Mental Health Establishments Database.

Treatment day

Treatment day refers to any day on which one or more service contacts (direct or indirect) are recorded for a registered patient (identified by a patient identifier number assigned to a uniquely identified person) during an ambulatory care episode.

The number of treatment days are grouped as follows in Table CMHC.25: 1–14 days, 15–91 days and 92+ days.

Data coverage includes the time period 2005–06 to 2020–21. Data in this section was last updated in October 2022.