Mental health services provided in emergency departments

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Summary

Key points

  • 309,657 presentations to public Australian EDs were mental health-related in 2020–21, which was 3.5% of all presentations. This is a slightly lower proportion than in 2019–20 (3.8%).

  • 78.1% of these mental health-related ED presentations were classified with a triage status of either Urgent (patient should be seen within 30 minutes) or Semi-urgent (within 60 minutes).

  • 63.8% of mental health-related ED presentations were seen on time (based on triage status) compared with 71% of all ED presentations.
  • 53.6% of mental health-related ED presentations had a principal diagnosis of either Mental and behavioural disorders due to psychoactive substance use or Neurotic, stress-related and somatoform disorders.

Hospital emergency departments (EDs) play a role in treating mental illness. People seek mental health-related services in EDs for a variety of reasons, often as an initial point of contact or for after-hours care (Morphet et al. 2012).

State and territory health authorities collect a core set of nationally comparable information on most public hospital ED presentations in their jurisdiction, which is compiled annually into the National Non-Admitted Patient Emergency Department Care Database (NNAPEDCD).

Mental health-related ED presentations in this section are defined as presentations to public hospital EDs that have a principal diagnosis of Mental and behavioural disorders. More details about NNAPEDCD and identifying mental health presentations are available in the data source section.

Spotlight data

Mental health related emergency department dashboard

Mental health dashboard showing mental health related emergency department activity summary. It show mental health presentations per 10,000 populaton over selected year, primary diagnosis driving an increase in mental health presentations and an activity trend between 2004-05 and 2020-21.

Service provision

In 2020–21, there were 309,657 public hospital ED presentations with a mental health-related principal diagnosis recorded, representing 3.5% of all ED presentations. South Australia had the highest mental health-related proportion of ED presentations (4.7%) and New South Wales had the lowest proportion (3.0%) (Figure ED.1).

Nationally, the rate of mental health-related ED presentations was 120.6 per 10,000 population, with an average annual change of 1.5% between 2016–17 and 2020–21. The Northern Territory had the highest rate (306.6) and Victoria the lowest (99.4).

Figure ED.1: Mental health-related presentations to public emergency departments, by states and territories, 2020–21

Vertical bar chart showing the proportion of mental health-related emergency department presentations in public hospitals by state or territory in 2020–21. South Australia had the highest per cent of mental health-related ED presentations accounting for 4.7% of all ED presentations, followed by 4.3% in the Northern Territory, 3.9% Western Australia, 3.7% in Victoria, 3.6% in Tasmania, 3.5% in Queensland and the Australian Capital Territory, and 3.0% in New South Wales. The national per cent of mental health-related ED presentations was 3.5%. Refer to Table ED.1.

Source data: Mental health services provided in emergency departments 2020–21 tables (372KB XLSX)

Patient characteristics

The rate of mental health-related ED presentations from young women had the fastest growth; with the highest average annual change (9.5%) being from women aged 12–17 between 2016–17 to 2020–21. Women aged 12–17 had the highest rate of mental health-related ED presentations in 2020–21 (251.8 per 10,000 population) followed by women aged 18–24 years (248.4 per 10,000 population). However, the rate of mental health-related ED presentations was still higher for males than for females overall (121.5 and 119.4 per 10,000 population respectively) (Figure ED.2). This is due to the higher proportion of those presentations from men aged 25–54 years. Overall, those aged 18–24 years had the highest rate of mental health-related presentations (219.8 per 10,000 population); by contrast, people aged 85 years and older had the highest rate for all ED presentations (7691.3 per 10,000 population). This difference is likely to be influenced by the typically young age of onset of many mental disorders (WHO 2019).

Aboriginal and Torres Strait Islander people represent about 3.3% of the Australian population (ABS 2018), but account for 12.3% of mental health-related ED presentations and 7.5% of all presentations. The rate of mental health-related ED presentations for Indigenous Australians was 4.5 times that of non-Indigenous Australians (478.3 and 106.4 per 10,000 population respectively).

Figure ED.2: Mental health-related emergency departments presentations, by patient demographic characteristics, 2020–21

Horizontal bar chart showing the rate (per 10,000 population specific) of mental health-related emergency department presentations in public hospitals by patient demographics in 2020–21. Patients 18–24 years had the highest rate (per 10,000 age specific population) of mental health-related ED presentations at 219.8, followed by 85 years and over (183.5), 12–17 (180.0), 25–34 (164.8), 35–44 (157.2), 45–54 (131.3, 75–84 (95.2), 55–64 (81.2), 65–74 (61.5), and 0–11 (35.8). Males presented at a higher rate than females (121.5 and 119.4 respectively). Indigenous Australians presented at a higher rate than non-Indigenous Australians (478.3 and 106.4 respectively). The rate increased with increasing remoteness area; 106.9 per 10,000 in major cities, 128.4 in inner regional areas, 137.14 in outer regional areas and 234.7 in remote and very remote areas. Mental health-related presentations decreased with increasing socioeconomic quintile with 137.6 presentations per 10,000 for most disadvantaged quintile, followed by 134.7, 117.3, 102.8 and 85.3 for the least disadvantaged quintile. Refer to Table ED.8. 

Source data: Mental health services provided in emergency departments 2020–21 tables

Principal diagnosis

Data on mental health-related presentations by principal diagnosis is based on the broad categories within the Mental and behavioural disorders chapter of the ICD‑10‑AM (Chapter 5). More details on diagnosis codes can be found in the data source section.

About three quarters (74.5%) of mental health-related ED presentations in Australian public EDs were classified by 4 principal diagnosis groupings in 2020–21 (Figure ED.3, ED.3.1):

  • Mental and behavioural disorders due to psychoactive substance use (F10–F19); (26.7%)
  • Neurotic, stress-related and somatoform disorders (F40–F49); (26.9%)
  • Schizophrenia, schizotypal and delusional disorders (F20–F29); (11.6%)
  • Mood (affective) disorders (F30–F39); (9.3%).

Figure ED.3: Mental health-related emergency departments presentations, by principal diagnosis, 2020–21

Figure ED.3, horizontal bar chart showing mental health-related emergency department presentations in public hospitals by principal diagnosis in 2020-21. The majority of mental health-related ED presentations were for mental and behavioural disorders due to psychoactive substance use (26.7%), followed by neurotic, stress-related and somatoform disorders (26.9%). Schizophrenia, schizotypal and delusional disorders made up 11.6% of presentations; Mood (affective) disorders 9.3%; mental disorder, not otherwise specified 10.0%; organic, including symptomatic, mental disorders 8.4%; behavioural and emotional disorders with onset usually occurring in childhood and adolescence 3.0%; disorders of adult personality and behaviour 2.0%; behavioural syndromes associated with physiological disturbances and physical factors 1.9%; and disorders of psychological development 0.2%. Refer to Table ED.13.
Figure ED.3.1, horizontal bar chart showing mental health-related emergency department, by states and territories and principal diagnosis. New South Wales, Victoria, Tasmania and Northern Territory highest ED mental health related presentations were for mental and behavioural disorders due to psychoactive substance use (22.9%, 28.1%, 22.8% and 53.4% respectively). Queensland, Western Australia, South Australia and Australian Capital Territory highest ED mental health related presentations were for neurotic, stress-related and somatoform disorders (31.1%, 34.0%, 29.7% and 23.8% respectively). Refer to Table ED.13.

Key

F00–09: Organic, including symptomatic, mental disorders
F10–19: Mental and behavioural disorders due to psychoactive substance use
F20–29: Schizophrenia, schizotypal and delusional disorders
F30–39: Mood (affective) disorders
F40–49: Neurotic, stress-related and somatoform disorders
F50–59: Behavioural syndromes associated with physiological disturbances and physical factors
F60–69: Disorders of adult personality and behaviour
F70–79: Mental retardation
F80–89: Disorders of psychological development
F90–98: Behavioural and emotional disorders with onset usually occurring in childhood and adolescence
F99: Mental disorder, not otherwise specified

Source data: Mental health services provided in emergency departments 2020–21 tables

Figure ED.4: Mental health-related presentations to public emergency departments, by triage category, 2020–21

Figure ED.4, vertical bar chart showing the rate (per 10,000 population specific) of mental health-related ED presentations in public hospitals by triage category. In 2020–21, mental health-related ED presentations that were Urgent have the highest rate (63.0), followed by Semi-urgent (31.3), Emergency (20.9), Non-urgent (3.8), and Resuscitation (1.7). Refer to Table ED.6.
Figure ED.4.1, horizontal bar chart showing mental health-related ED presentations by triage category and states and territories in 2020–21. The highest presentations for Emergency were in Northern Territory (25.8%), Non-urgent were in Queensland (4.1%), Resuscitation in both Victoria and South Australia (1.9%), Semi-urgent in Tasmania (34.0%) and Urgent in Australian Capital Territory (57.6%). Refer to Table ED.5.
Figure ED.4.2, line chart showing mental health-related ED presentations by states and territories or triage category from 2004–05 to 2019–20. Urgent triage had a higher number of ED presentations, followed by Semi-urgent, Emergency, Non-urgent and Resuscitation across the whole time period. Refer to Table ED.1 and table ED.5.

Source data: Mental health services provided in emergency departments 2020–21 tables

Service characteristics

Waiting time

The median waiting time to be seen for mental health-related ED presentations was 20 minutes, with 63.8% of presentations seen on time according to their assessed triage status, compared to 71% of all ED presentations (AIHW 2022a). For mental health-related ED presentations, the Australian Capital Territory had the lowest proportion of presentations seen on time (38.2%) and New South Wales had the highest (74.1%). New South Wales also had the lowest median waiting time (15 minutes), and the Australian Capital Territory had the highest (58 minutes) (Figure ED.6).

Figure ED.5: Mental health-related emergency department presentations, by episode end status and states and territories, 2020–21

Figure ED.5, horizontal bar chart showing mental health-related ED presentations by episode end status and states and territories. The highest number of presentations for episode end status, Admitted to this hospital was in Northern Territory (56.4%), Departed without being admitted or referred to another hospital was in Tasmania (61.8%), Did not wait to be attended by a health care professional was in Tasmania (0.9%), Left at own risk was in New South Wales (4.5%), Referred to another hospital for admission was in New South Wales (5.0%). .

Source data: Mental health services provided in emergency departments 2020–21 tables

Length of stay

The median length of stay for all mental health-related ED presentations in 2020–21 was 3 hours and 57 minutes (Figure ED.6). For mental health-related ED presentations ending in admission, the median length of stay in the EDs was 5h:26m whereas the median length of stay for presentations not ending in admission was 3h:29m. Nationally, 90% of mental health-related ED presentations were completed within 13h:57m, which is longer than the same measure for all ED presentations (up to 8 hours) (AIHW 2022a) .

Figure ED.6: Mental health-related emergency department presentations, by service characteristics, by states and territories, 2020–21

Figure ED.6, chart presenting mental health-related ED presentations by wait time (minutes) and length of stay (hours) for the median and 90th percentile patient by State and Territory, 2020–21. For wait times, fifty per cent of patients were seen within 58 minutes in the Australian Capital Territory, 43 minutes in Tasmania, 36 minutes in Western Australia, 28 minutes in South Australia, 19 minutes in Victoria, 19 minutes in the Northern Territory, 18 minutes in Queensland and 15 minutes in New South Wales. Across Australia 50% of patients were seen within 20 minutes. 90% of patients were seen within 204 minutes in the Australian Capital Territory, 176 minutes in Tasmania, 171 minutes in South Australia, 172 minutes in Western Australia, 106 minutes in Victoria, 105 minutes in the Northern Territory, 89 minutes in New South Wales and 85 minutes in Queensland. Across Australia 90% of patients were seen within 117 minutes. Refer to Table ED.12 and ED.7.
For length of stay, fifty per cent of patients who presented to ED with a mental and behavioural diagnosis stayed in the ED for up to 5 hours 27 minutes in Tasmania, 5 hours 2 minutes in the Australian Capital Territory, 4 hours 51 minutes in South Australia, 4 hours 9 minutes in Western Australia, 4 hours 6 minutes in Victoria, 3 hours 48 minutes in New South Wales, 3 hours 37 minutes in Queensland, and 3 hours 31 minutes in the Northern Territory. Across Australia 50% of patients stayed up to 3 hours 57 minutes in the ED. Ninety per cent of patients who presented to ED with a mental and behavioural diagnosis stayed up to 21 hours 55 minutes in Tasmania, 18 hours 53 minutes in South Australia, 17 hours 45 minutes in the Australian Capital Territory, 16 hours 10 minutes in Western Australia, 14 hours 53 minutes in Victoria, 14 hours 6 minutes in the Northern Territory, 13 hours 3 minutes in New South Wales, and 10 hours 23 minutes in Queensland. Across Australia 90% of patients stayed up to 13 hours 57 minutes. Refer to Table ED.17.

Figure ED.6.1, map format of figure ED.6.

Figure ED.6.2, chart presenting mental health-related ED presentations by day of week and time of presentation by state and territories, 2020–21. The highest proportion (26.5%) of ED presentations in New South Wales took place on Thursday from 12pm to 3:49pm, Victoria on Tuesday from 4pm to 7:59pm (25.2%) and Thursday from 12pm to 3:59pm (25.2%), Queensland on Thursday from 12pm to 3:59pm (25.9%), Western Australia on Tuesday from 4pm to 7:59pm (25.1%), South Australia on Wednesday from 4pm to 7:59pm (26.1%), Tasmania on Thursday from 12 to 3:59pm (30.8%), Australian Capital Territory on Monday from 12pm to 3:59pm (30.6%) and Northern Territory on Monday from 8pm to 11:59pm (27.4%).

Figure ED.6.3, chart presenting mental health-related ED presentations by age group and week of presentation day of week and time of presentation by state and territories, 2020–21. In Australia from 1 July 2020 to 30 June 2021, the highest ED presentations were for patients aged 25–44, followed by 12–24, 45–64, 65 and over and 0–11 years.

Source data: Mental health services provided in emergency departments 2020–21 tables

Key concepts

Key concept Description

Emergency department (ED) presentation

Emergency department (ED) presentation refers to the period of treatment or care between when a patient presents at an ED and when that person is recorded as having physically departed the ED. It includes presentations for patients who do not wait for treatment once registered or triaged in the ED, those who are dead on arrival, and those who are subsequently admitted to hospital or to beds or units in the ED. An individual may have multiple presentations in a year. For further information can be found in the Non-admitted emergency department care NMDS 2020–21
Episode end status The episode end status indicates the status of the patient at the end of the non-admitted patient emergency department service episode. Further details on episode end status codes are available from the AIHW AIHW the Metadata Online Registry (METEOR)

Mental health‑related emergency department (ED) presentation refers to an emergency department presentation that has a principal diagnosis that falls within the Mental and behavioural disorders chapter (Chapter 5) of ICD‑10‑AM (codes F00–F99). It should be noted that this definition does not encompass all mental health‑related presentations to emergency departments, as detailed above. Additional information about this and applicable caveats can be found in the data source section.

Primary Health Network (PHN)

A Primary Health Network is an administrative health region established to deliver access to primary care services for patients, as well as co-ordinate with local hospitals in order to improve the overall operational efficiency of the network. Further details on PHNs are available from the Australian Government Department of Health.

Principal diagnosis

The principal diagnosis is the diagnosis established at the conclusion of the patient’s attendance in an emergency department to be mainly responsible for occasioning the attendance.

Socio-Economic Indexes for Areas (SEIFA)

SEIFA is a product developed by the Australian Bureau of Statistics (ABS) that ranks areas in Australia according to relative socio-economic advantage and disadvantage. It consists of 4 indexes based on information from the five-yearly Census of Population and Housing, each being a summary of a different subset of Census variables and focuses on a different aspect of socio-economic advantage and disadvantage. Further details are available from the ABS.

Statistical Area 3 (SA3)

SA3s create a standard framework for the analysis of ABS data at the regional level through clustering larger geographic groups that have similar regional characteristics, administrative boundaries or labour markets. SA3s generally have populations between 30,000 and 130,000 persons. In regional areas, SA3s represent the area serviced by regional cities that have a population over 20,000 people. In the major cities, SA3s represent the area serviced by a major transport and commercial hub.

Triage

The triage category indicates the urgency of the patient’s need for medical and nursing care. It is usually assigned by an experienced registered nurse or medical practitioner at, or shortly after, the time of presentation to the emergency department. The triage category assigned is in response to the question: ‘This patient should wait for medical assessment and treatment no longer than...?’

The Australasian Triage Scale has 5 categories that incorporate the time by which the patient should receive care:

  • Resuscitation: immediate (within seconds)
  • Emergency: within 10 minutes
  • Urgent: within 30 minutes
  • Semi-urgent: within 60 minutes
  • Non-urgent: within 120 minutes.

 

Data coverage includes the time period 2004–05 to 2020–21. This section was last updated in July 2022.