Mental health services provided in emergency departments
280,176 mental health-related presentations
to public ED's in 2021–22 which was 3% of all presentations.
77% of these were urgent or semi-urgent
Urgent (seen within 30 minutes) Semi-urgent (seen within 60 minutes)
60% seen on time
based on triage status compared with 67% if all ED presentations
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.
Summary of mental health-related emergency department activity
Mental health dashboard showing mental health related emergency department activity summary. It shows mental health presentations per 10,000 population over selected year, primary diagnosis driving an increase in mental health presentations and an activity trend between 2004-05 and 2021-22.
Source: Mental health services provided in emergency departments 2021–22 tables
From February 2020, Australian governments introduced a range of restrictions on travel, business, social interaction and border control in response to the COVID-19 pandemic. From October 2020, Australia was at the end of the second wave of the pandemic, leading to relaxation of those restrictions. Over the pandemic period to present, the total number of ED presentations and mental health-related ED presentations have been impacted by a range of factors which may have influenced an individual seeking mental health care or other care in the ED setting. These include changes to the accessibility of mental health care through general practice with the introduction of telehealth and increases in the number of Medicare-subsidised services which could be delivered by psychologists. ED presentations in 2020–21 increased by 7% from 2019–20 and remained stable in 2021–22 (AIHW 2023). In contrast, the number of mental health-related ED presentations increased in 2019–20 but decreased in both 2020–21 and 2021–22 compared with their respective previous year.
In 2021–22, there were almost 280,200 public hospital ED presentations with a mental health-related principal diagnosis recorded, representing 3% of all ED presentations. Over the past decade this proportion has been relatively stable nationally with some variation across states and territories and years ranging from 2% to 5%.
Nationally, the rate of mental health-related ED presentations was 109 per 10,000 population, with an average annual change of -2% between 2017–18 and 2021–22. Over the past decade the Northern Territory consistently had the highest rate annually (ranging from 198 to 303) and Victoria the lowest (ranging from 74 to 101).
Aboriginal and Torres Strait Islander people are proportionally overrepresented in terms of mental health-related ED presentations, making up about 3% of the Australian population (ABS 2022) but accounting for 13% of presentations. The rate of mental health-related ED presentations for Indigenous Australians was 4.6 times that of non-Indigenous Australians (443 and 95 per 10,000 population respectively).
Over the past 8 years the overall rate of mental health-related ED presentations for men has tended to be slightly higher than women, but the difference has been small over the past couple of years (108 and 109 per 10,000 population respectively). There is variability across age groups with women aged 12–17, 18–24 and 85+ having the highest rates over the past 8 years. For men the 25–34, 35–44 and 85+ age groups had the highest rates over time (Figure ED.1). These differences are likely to be influenced by differences in prevalence and age of onset of different mental disorders (WHO 2019).
Figure ED.1: Mental health-related emergency departments presentations, by patient demographic characteristics, 2021–22
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 2021–22. Patients 18–24 years had the highest rate of mental health-related ED presentations at 198, followed by 85 years and over (194), 25–34 (150), 12–17 (147), 35–44 (139), 45–54 (118), 75–84 (96), 55–64 (76), 65–74 (56), and 0–11 (32). Males presented at a similar rate to females (108 and 109 respectively). Indigenous Australians presented at a higher rate than non-Indigenous Australians (443 and 95 respectively). The rate increased with increased remoteness area; 96 per 10,000 in Major cities, 115 in Inner regional areas, 126 in Outer regional areas and 218 in Remote and Very remote areas. Mental health-related presentations decreased with increasing socioeconomic quintile with 126 presentations per 10,000 for the most disadvantaged quintile, followed by 121, 106, 93 and 76 for the least disadvantaged quintile. Refer to Table ED.8.
Source: Mental health services provided in emergency departments 2021–22 tables ED.8
Data for mental health-related presentations by local area – Primary Health Network (PHN) and Australian Statistical Geography Standard Statistical Area Level 3 (SA3) – show variation in the number and rate of presentations across Australia. In 2021–22, the highest rate of mental health-related ED presentations was in the Barkly SA3 region (950 per 10,000 population) in the Northern Territory, followed by Alice Springs (599) in the Northern Territory and Kimberly (428) in Western Australia.
Further information on NNAPEDCD coverage is available in the data source section. The observed variability in ED presentation rates between geographical areas may be due to a range of factors such as the proportion of the population in an area with a diagnosable mental illness who present to the ED, and the accessibility of EDs to people in remote and rural areas. Other factors include the availability of community-based services, and variability in approaches to planning and delivering mental health support services across and within states and territories.
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%) of mental health-related ED presentations in Australian public EDs were classified by 4 principal diagnosis groupings in 2021–22 (Figure ED.2, ED.2.1):
- Mental and behavioural disorders due to psychoactive substance use (F10–F19); (25%)
- Neurotic, stress-related and somatoform disorders (F40–F49); (27%)
- Schizophrenia, schizotypal and delusional disorders (F20–F29); (12%)
- Organic, including symptomatic mental disorders (F00–09):, & Mental disorder, not otherwise specified (F99); (10% respectively).
Figure ED.2: Mental health-related emergency departments presentations, by principal diagnosis, 2021–22
Figure ED.2, horizontal bar chart showing mental health-related emergency department presentations in public hospitals by principal diagnosis in 2021–22. The majority of presentations were for neurotic, stress-related and somatoform disorders (27%) followed by mental and behavioural disorders due to psychoactive substance use (25%). Schizophrenia, schizotypal and delusional disorders made up 12% of presentations; Mental disorder, not otherwise specified 10%; organic, including symptomatic, mental disorders 10%; Mood (affective) disorders 9%; behavioural and emotional disorders with onset usually occurring in childhood and adolescence 3%; disorders of adult personality and behaviour 2%; behavioural syndromes associated with physiological disturbances and physical factors 2%; and disorders of psychological development >1%.
Figure ED.2.1, horizontal bar chart showing mental health-related emergency department, by states and territories and principal diagnosis. Victoria, Tasmania and Northern Territory highest ED mental health related presentations were for mental and behavioural disorders due to psychoactive substance use 27%, 21% and 55% respectively). New South Wales, Queensland, Western Australia, South Australia and Australian Capital Territory highest ED mental health related presentations were for neurotic, stress-related and somatoform disorders (26%, 32%, 36%, 26% and 23% respectively).
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: Mental health services provided in emergency departments 2021–22 tables ED.13.
The arrival mode records the way in which a person arrives at the ED. Half of mental health-related ED presentations in 2021–22 arrived via ambulance, air ambulance or helicopter rescue service (50%), about double the proportion of all ED presentations (26%). A smaller proportion of mental health-related ED presentations arrived by police or correctional service vehicles (8%), this was higher than the proportion of all ED presentations (1%).
When presenting to an ED, patients are clinically assessed to determine their priority for care (i.e. triaged) and an appropriate triage category is assigned. For example, patients triaged as the Emergency category require care within 10 minutes (ACEM 2013). However, due to a range of factors, care may or may not be received within the designated time-frames. Mental health-related ED presentations in 2021–22 had a higher proportion of presentations classified as Urgent (52%) than all ED presentations (38%). (Figure ED.3, 3.1 and 3.2).
Figure ED.3: Mental health-related presentations to public emergency departments, by triage category, 2021–22
Figure ED.3, vertical bar chart showing the per cent of mental health-related ED presentations in public hospitals by triage category. In 2021–22, ED presentations that were Urgent had the highest rate (52%), followed by Semi-urgent (25%), Emergency (18%), Non-urgent (3%), and Resuscitation (1%). Refer to Table ED.6.
Figure ED.3.1, horizontal bar chart showing mental health-related ED presentations by triage category and states and territories in 2021–22. The highest proportion of presentations for Emergency were in Victoria and Northern Territory (both 23%), Non-urgent were in the Australian Capital Territory (5%), Resuscitation in Victoria, South Australia and the Northern Territory (all at 2%), Semi-urgent in the Australian Capital Territory (30%) and Urgent in Queensland (57%). Refer to Table ED.5.
Figure ED.3.2, line chart showing mental health-related ED presentations by states and territories or triage category from 2004–05 to 2021–22. 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: Mental health services provided in emergency departments 2021–22 tables ED.6.
Waiting time is the time from presentation to clinical care commencement. The median waiting time to be seen for mental health-related ED presentations was 22 minutes, with 60% of presentations seen on time according to their triage category, compared to 67% of all ED presentations in 2020–21 (AIHW 2023). Ten per cent of mental health-related presentations had a waiting time longer than 134 minutes. For mental-health related presentations, the Australian Capital Territory had the lowest proportion of presentations seen on time (41%) and New South Wales had the highest (71%). Across states and territories, New South Wales had the lowest median waiting time (16 minutes), and the Australian Capital Territory the longest (54 minutes) (Figure ED.4).
Length of stay
Length of emergency department stay refers to the elapsed time from presentation to physical departure from the ED unit. Nationally, in 2021–22 the median length of stay for all mental health-related ED presentations was 4h:30m (Figure ED.4). Ten per cent of presentations had a length of stay longer than 16h:02m, longer than the same measure for all ED presentations (9h:10m) (AIHW 2023).
For mental health-related presentations ending in admission, the median length of stay was 6h:23m whereas the median length of stay for presentations not ending in admission was 3h:47m.
The most frequently recorded mode for ending a mental health-related ED presentation was for the episode end status to have been completed with the patient departing without being admitted or referred to another hospital. Over one-third of presentations resulted in the patient being admitted to the hospital where the emergency service was provided.
Figure ED.4: Mental health-related emergency department presentations, by service characteristics, by states and territories, 2021–22
Figure ED.4.1, map format 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, 2021–22. For wait times 50% of patients were seen within 54 minutes and 90%of patients were seen within 224 minutes in all states and territories.
For length of stay, 50% of patients who presented stayed in the ED for up to 5 hours in Tas, ACT, SA, and, 4 hours in Vic, WA, NSW, NT, and Qld. Across Australia 50% of patients stayed up to 4 hours 30 minutes in the ED. 90% of patients who presented to ED 23 hours in Tas, 21 hours in SA, 17 hours in Vic, and WA, 16 hours in the NT,15 ACT, and NSW, and 12 hours 2 minutes in Qld. Across Australia 90% of patients stayed up to 16 hours 2 minutes
Figure ED.4.2, chart presenting mental health-related ED presentations by day of week and time of presentation by state and territories, 2021–22. All states and territories except the NT had the highest proportion of daily presentations between 12pm and 3:59pm on a weekday. The NT had the highest proportion of daily presentations between 4pm and 7:59pm on Mondays and between 8pm and 11:59pm on Thursdays (30%) and Thursday from 12pm to 3:59pm (30%) and the NT on Monday from 4pm to 7:59pm (27%).
Figure ED.4.3, chart presenting proportion of mental health-related ED presentations by age group and week of presentation day of week and time of presentation by state and territories, 2021–22. In Australia from 1 July 2021 to 30 June 2022, the highest proportion of ED presentations were for patients aged 25–44, followed by 45–64, 12–24, 65 and over and 0–11 years.
Source data: Mental health services provided in emergency departments 2021–22 table ED.12 (wait time) and Ed.17 (length of stay)
National Non-Admitted Patient Emergency Department Care Database
All state and territory health authorities collect a core set of nationally comparable information on emergency department (ED) presentations (including mental health-related ED presentations) in public hospitals within their jurisdiction. The AIHW compiles this data annually to form the National Non-Admitted Patient Emergency Department Care Database (NNAPEDCD). In 2021–22, 293 of Australia's public hospital emergency departments reported emergency department presentations to the NNAPEDCD (AIHW 2023).
Prior to 2014–15, diagnosis-related information was not included in the NNAPEDCD and states and territories provided the AIHW with a bespoke analysis of mental health-related ED presentations. Diagnosis-related data has subsequently been included in the NNAPEDCD. In this report, data from 2014–15 to 2021–22 are sourced from the NNAPEDCD.
Definition of mental health-related emergency department presentations
Mental health-related ED presentations in this report are defined as presentations in public hospital EDs that have a principal diagnosis of Mental and behavioural disorders (that is, codes F00–F99) in ICD-10-AM or the equivalent codes in other coding schemas. It does not include codes for self-harm or poisoning.
For 2021–22, principal diagnosis information is reported for the NNAPEDCD using ICD-10-AM (10th Ed) Principal Diagnosis Short List, developed by the Independent Health and Aged Care Hospital Pricing Authority (IHACPA) from the full version of ICD-10-AM. Further information is available in Emergency department care 2020–21 Appendixes (AIHW 2023).
The Mental and behavioural disorders principal diagnosis codes may not fully capture all mental health-related presentations to EDs, such as presentations for self-harm. Diagnosis codes for intentional self-harm sit outside the Mental and behavioural disorders chapter (X60–X84). Additionally, a presentation for self-harm may have a principal diagnosis relating to the injury, for example Open wound to wrist and hand. These presentations cannot be identified as mental health-related presentations in the NNAPEDCD and are not included in this report.
Further information on the NNAPEDCD is available on METEOR, the AIHW’s Metadata Online Registry.
Presentation of regional data
Please refer to the technical notes for information on how data at regional levels are reported.
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 patient emergency department care NMDS 2021–22
|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 Metadata Online Registry (METEOR)|
Mental health‑related emergency department (ED) presentation refers to an ED 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 EDs emergency departments, as detailed above. Additional information about this and applicable caveats can be found in the data source section.
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.
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.
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.
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.
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:
ABS (Australian Bureau of Statistics) (2022). Census of Population and Housing – Counts of Aboriginal and Torres Strait Islander Australians, August 2021. Canberra: ABS. Accessed 18 April 2023.
ACEM (Australasian College for Emergency Medicine) (2013). Policy on the Australasian Triage Scale (P06). Melbourne: Australasian College for Emergency Medicine. Accessed 6 May 2022.
AIHW (Australian Institute of Health and Welfare) (2023). Hospitals info & downloads: About the data. Canberra: AIHW. Accessed 26 April 2023.
Morphet J, Innes K, Munro I, O'Brien A, Gaskin CJ, Reed F, Kudinoff T (2012). Managing people with mental health presentations in emergency departments – a service exploration of the issues surrounding responsiveness from a mental health care consumer and carer perspective. Australasian Emergency Nursing Journal 15:148-55.
World Health Organization (WHO) (2019). Adolescent mental health. Geneva: WHO. Accessed 6 May 2022.
Note: A revision has been made to the 2021-22 rate of mental health-related emergency department presentations for those aged 0-11 contained in Figure ED.1 and Table ED.8
Data coverage includes the time period 2004–05 to 2021–22. This section was last updated in July 2023.