Consumer outcomes in mental health care

This page shows information about the mental health-related problems experienced by consumers of Australian public mental health services and whether they show improvement, no change, or deterioration in their clinical status and functioning from receiving care. Clinical outcomes are just one aspect of a consumer’s treatment and recovery. 

Information is collected using clinical measures that have been completed by clinicians or by consumers. Service settings include ambulatory (community) services and inpatient (admitted hospital) services.

Key points

In one year in Australia:

Source: National Outcomes and Casemix Collection Database, 2021–22

Data downloads:

Spotlight data

Interactive NOCC.Spotlight: Horizontal stacked bar chart, showing per cent of completed episodes with clinician-rated outcome types for consumers, by consumer group, during 2021–22. Each tab shows information for a specific age band. People aged 11 and older showed significant improvement more often after admitted than ambulatory care. Most people aged 11–64 years showed significant improvement after care in completed episodes in both admitted and ambulatory settings. Generally, people aged 65 and older showed no significant change after ambulatory care. Data source: National Outcomes and Casemix Collection (NOCC), refer to NOCC Tables 21, 23 and 25.

Who is included in the NOCC?

Figure NOCC.1: Demographic characteristics of consumers

Figure NOCC.1: Horizontal bar chart including 95% confidence intervals, showing the per cent of consumers included in the National Outcomes and Casemix Collection (NOCC) by consumer demographics, during one year, 2014–15 to 2021–22. Refer to NOCC Table 2.

Notes:

  1. Black bars representing 95% confidence intervals are displayed. For more information, refer to Notes to interpret the data. 
  2. Per cent of consumers in the NOCC.
  3. Children aged 10 years and under account for 3% of all consumers in the NOCC. As this is a relatively small number of consumers, the ability to undertake comprehensive reporting and disaggregation is limited. As such, data relating to children aged 10 years and under are not further reported in this section. Reports can be generated via other NOCC reporting products (Web Decision Support Tool and Reports Portal).

Figure NOCC.2: Proportions of involuntary mental health care are higher for acute inpatient care compared with ambulatory care

Figure NOCC.2: Horizontal bar chart including 95% confidence intervals, showing the per cent of discharge collection occasions in the National Outcomes and Casemix Collection (NOCC) where mental health legal status was recorded as involuntary, by age band and setting during one year, 2014–15 to 2021–22. Acute inpatient collection occasions had higher proportions of involuntary mental health legal status than ambulatory care. Refer to NOCC Table 11.

Notes: 

  1. Black bars representing 95% confidence intervals are displayed. For more information, refer to Notes to interpret the data.
  2. Per cent of discharge collection occasions where mental health legal status was recorded as involuntary.

Clinical issues for consumers

Figure NOCC.3: Self-injury, Hallucinations and Substance misuse are more commonly rated as significant problems for consumers in acute inpatient settings compared with ambulatory settings

Interactive NOCC.3: Interactive horizontal bar graph including 95% confidence intervals showing the per cent of admission collection occasions in the National Outcomes and Casemix Collection (NOCC) where clinically significant problems were recorded using the clinician-rated Health of the Nation Outcome Scales for the appropriate age band, by age band and setting, during one year, 2014–15 to 2021–22. Refer to NOCC Tables 8, 9 and 10.

Notes:

  1. Black bars representing 95% confidence intervals are displayed. For more information, refer to Notes to interpret the data.
  2. Per cent of admission collection occasions where clinically significant problems were recorded using the clinician-rated Health of the Nation Outcome Scales for the appropriate age band. 

Clinical diagnoses for consumers

Figure NOCC.4: Depressive episode remains among the five most common principal diagnoses but its frequency has decreased over the past 8 years

Interactive NOCC.4: interactive horizontal bar graph with 95% confidence intervals showing the per cent of discharge collection occasions in the National Outcomes and Casemix Collection (NOCC) where principal diagnosis was recorded for the 5 most commonly reported principal diagnoses, by age band and setting, during one year, 2014–15 to 2021–22. Refer to NOCC Table 12.

Notes: 

  1. Black bars representing 95% confidence intervals are displayed. For more information, refer to Notes to interpret the data.
  2. Per cent of discharge collections occasions where principal diagnosis was recorded using the International Classification of Diseases (ICD-10-AM).

Clinical outcomes of care

Figure NOCC.5: Number of episodes to calculate consumer outcomes is very low for consumer-rated measures compared with clinician-rated measures

Interactive NOCC.5: Interactive doughnut chart showing the number of in-scope episodes in the National Outcomes and Casemix Collection (NOCC) with and without matched pairs of collection occasions, by age band and consumer group during one year, 2014–15 to 2021–22. The user can choose to display episodes for clinician-rated or consumer-rated measures. Overall, clinician-rated measures show a greater proportion of in-scope episodes with matched pair collection occasions compared with consumer-rated measures. Refer to NOCC Tables 15­ to 20. 

Notes: 

  1. Clinical outcomes can only be calculated for episodes with a matched pair of collection occasions. For more information, refer to Data methods download.
  2. The per cent of in-scope episodes with and without matched pair collection occasions are represented by the coloured rings. The number of episodes with matched pair collection occasions is displayed in the centre of the ring for each age band and consumer group.

Figure NOCC.6: Clinician- and consumer-rated outcomes for consumers. The highest proportions of Improvement compared to other clinical outcomes were for consumers who completed acute inpatient care

Interactive NOCC.6: Interactive vertical bar chart with 95% confidence intervals showing consumer outcomes (significant improvement, no significant change, significant deterioration) calculated from the National Outcomes and Casemix Collection (NOCC), by age band and consumer group, during one year, 2014–15 to 2021–22. The user can choose to display outcomes for clinician-rated or consumer-rated measures. Refer to NOCC Tables 21 to 26. 

Notes: 

  1. Black bars representing 95% confidence intervals are displayed. For more information refer to Notes to interpret the data
  2. Per cent of episodes that contain completed measures for two collection occasions that form a matched pair.

Where can I find more information?

You may also be interested in:

More detailed data are available via the National Outcomes and Casemix Collection Web Decision Support Tool and Reports Portal.

Notes to interpret the data

Key concepts

Key conceptDescription
Age band

A more detailed classification of age than age group. For consumers aged less than 18 years, age bands (less than 4 years, 4–10 years and 11–17 years) correspond to the groups specified by the NOCC protocol to be offered different versions of the consumer-rated and carer-rated measures. 

Age group 

The age group to which the patient or client has been assigned for the purposes of the NOCC protocol. Generally, Adult is defined as persons between the age of 18 and 64 years inclusive, an Older person is defined as persons aged 65 years and over and a Child or adolescent is defined as persons aged less than 18 years of age. In some circumstances a person may be legitimately assigned to a different age group to that in which they would be assigned on the basis of their actual age. For example, a person aged 60 years who was being cared for in an inpatient psychogeriatric unit may be assigned to the Older person age group. 

Clinician-rated measureClinical measures are particular surveys or forms that are used to gather information about a person's clinical mental health status and functioning. Clinician-rated measures are completed by the clinician (mental health provider) about the consumer’s mental health.
The NOCC includes the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) for children and adolescents, the Health of the Nation Outcome Scales (HoNOS) for adults, and the Health of the Nation Outcome Scales 65+ (HoNOS 65+) for adults aged 65 years and older.
Collection occasion 

An occasion during an episode of mental health care when the required dataset is to be collected in accordance with a standard protocol. Three collection occasion types within an episode of mental health care are identified: Admission, Review, and Discharge. 

Comorbid problemsThe following are comorbid problems that clinicians consider when rating the Other mental and behavioural problems scale of the HoNOS (for adults) and HoNOS 65+ (for older persons):

A          Phobias – including fear of leaving home, crowds, public places, travelling, social phobias and specific phobias.

B          Anxiety and panics.

C          Obsessional and compulsive problems.

D         Reactions to severely stressful events and traumas.

E          Dissociative (‘conversion’) problems.

F          Somatisation – persisting physical complaints in spite of full investigation and reassurance that no disease is present.

G         Problems with appetite, over- or under-eating.

H         Sleep problems.

I           Sexual problems.

J           Problems not specified elsewhere including expansive or elated mood.

Confidence interval

A statistical term describing a range (interval) of values used to describe the uncertainty around an estimate. Generally speaking, confidence intervals describe how different the estimate could have been if the underlying conditions stayed the same but variability in sampling (i.e., selecting a different sample from the population) had led to a different set of data. Confidence intervals are calculated with a stated probability –usually 95% level of confidence–that, if the assumptions inherent in the calculation of the interval hold, the true value lies within the interval.  

Consumer-rated measure Clinical measures are particular surveys or forms that are used to gather information about a person's clinical mental health status and functioning. Consumer-rated measures are completed by the consumer about their own mental health.

The NOCC uses the Strengths and Difficulties Questionnaire Youth Report (SDQ-YR) for children and adolescents, and the Behaviour and Symptom Identification Scale (BASIS-32), Kessler Psychological Distress Scale (K10+), or Mental Health Inventory – 38 (MHI-38) for adults, depending on the state or territory in which the consumer receives mental health care.
Consumer groupConsumer group refers to a classification of episode types according to the setting in which treatment occurred. Three main episode types reported in this section are: Completed acute inpatient; Completed ambulatory; and Ongoing ambulatory.
Duration

The period of contact in an episode of mental health care. Duration is calculated as the number of days between collection occasions that form the start and end of the episode, including the episode start date.

Episode of mental health care

For the purposes of the NOCC, a period of more or less continuous contact between the consumer and a mental health service organisation within a single setting. Two business rules apply to episodes: a) one episode at a time; and b) change of setting implies a change of episode. 

Episode types 

A classification of episodes of mental health care defined on the basis of the type of collection occasion, and reason for collection, at the ‘Start’ and ‘End’ of the episode, within the annual reporting period. The three categories are: Completed, Ongoing, and Closed. Completed episodes are those that started and ended within in the reporting period (e.g., Admission to Discharge). Ongoing episodes were still open at the conclusion of the reporting period (e.g., Admission to Review, or Review to Review). Closed episodes were already open at the commencement of the reporting period and closed within the reporting period (e.g., Review to Discharge).

In-scope

‘In-scope’ refers to the collection of information as specified in the NOCC protocol. In-scope collection occasions are collection occasions for which a given measure type is expected to be completed or offered as specified in the NOCC protocol. In-scope episodes are episodes for which a matched pair of ratings was expected to be completed according to the NOCC protocol.A pair of collection occasions that form a valid sequence within an episode of mental health care, and for which the same measure was able to be rated on both collection occasions. A valid sequence is when collection occasions are logically ordered, for example an Admission collection occasion followed by a Discharge collection occasion. Conversely, an example of an invalid sequence is a Review collection occasion followed by an Admission collection occasion. In this section, NOCC ratings for an episode are categorised according to their completion status as follows: Matched pair and No matched pair.

Matched pair

A pair of collection occasions that form a valid sequence within an episode of mental health care, and for which the same measure was able to be rated on both collection occasions. A valid sequence is when collection occasions are logically ordered, for example an Admission collection occasion followed by a Discharge collection occasion. Conversely, an example of an invalid sequence is a Review collection occasion followed by an Admission collection occasion. In this section, NOCC ratings for an episode are categorised according to their completion status as follows: Matched pair and No matched pair.

Mental health legal status

Whether a person was provided care on an involuntary basis under the relevant state or territory mental health legislation, at some point during the period of care preceding the collection occasion. 

NOCC coverage

The extent to which consumers included in the NOCC protocol are representative of the population receiving clinical care from public sector specialised mental health services. Coverage is derived by comparing the number of persons with at least one valid NOCC measure to the overall number of persons reported as receiving clinical care from public sector specialised mental health services. 

NOCC protocol

The minimum requirement for the collection of the NOCC measures. Together, the three concepts of collection occasion (Admission, Review, Discharge), service setting (Inpatient, Residential, Ambulatory) and the consumers’ age group (Children and adolescents, Adults, Older persons) determine what measures to collect and when to collect them. 

Outcome

A change in health status that can be attributed to specific health care investments or interventions (CIHI 2021).

Outcome classificationA classification of the extent of change between the clinical ratings at the ‘Start’ and ‘End’ of an episode of mental health care. Classification is based on statistical testing using an effect size metric. The categories are Significant improvement, No significant change, and Significant deterioration. 

A ‘medium’ effect size of 0.5 (Cohen, 1988) is used to assign change scores to one of the 3 outcome categories. A medium effect size is equivalent to an individual change score of at least one half (0.5) of a standard deviation. Individual episodes are classified as: ‘significant improvement’ if the effect size index is greater than or equal to positive 0.5; ‘significant deterioration’ if the effect size index is less than or equal to negative 0.5; or ‘no significant change’ if the index is greater than negative 0.5 and less than positive 0.5. 
Period of care

The period bound by one collection occasion and another, and immediately preceding the current collection occasion.

Principal diagnosis

The diagnosis established after study to be chiefly responsible for occasioning the patient or client’s care during the period of care preceding the collection occasion. The principal diagnosis must be a valid code from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) (11th Edition). 

Public sector specialised mental health services

Publicly funded or managed services with a primary function to provide treatment, rehabilitation or community health support targeted towards people with a mental disorder or psychiatric disability. These activities are delivered from a service or facility that is readily identifiable as both specialised and serving a mental health care function. 

Service settingThe setting in which the episode of mental health care takes place. The categories are as follows. 

Inpatient: overnight care provided in public psychiatric hospitals and designated psychiatric units in public acute hospitals

Residential: overnight care provided in residential units staffed on a 24-hour basis by health professionals with specialist mental health qualifications or training and established in a community setting which provides specialised treatment, rehabilitation or care for people affected by a mental illness or psychiatric disability 

Ambulatory: non-admitted, non-residential services provided by health professionals with specialist mental health qualifications or training. 

Data coverage includes the time period 2014–15 to 2021–22 for collection occasions and episodes and 2014–15 to 2020–21 for coverage of consumers. This section was last updated in October 2023.