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This section reviews the available information on recurrent expenditure (running costs) for mental health-related services in Australia. Health expenditure (what was spent) and health funding (funding provided and who provided the funds) are distinct but related concepts essential to understanding the financial resources used by the health system. Data on expenditure and funding, calculated in both current and constant prices, are derived from a variety of sources, as outlined in the data source section.
In 2019–20, the national recurrent spending on mental health-related services was estimated to be $11.0 billion. This represents an annual average increase of 3.0% since 2015–16, in real terms (i.e. adjusted for inflation). Overall, national expenditure on mental health-related services increased from $409 per Australian in 2015–16 to $431 per person during 2019–20; an average annual increase of 1.3% in real terms.
Of the $11.0 billion spent nationally in 2019–20, state and territory governments spent 60.0% ($6.6 billion), the Australian Government 34.7% ($3.8 billion), and private health insurance funds and other third party insurers 5.3% ($584 million). These proportions have remained relatively stable over time, with 60.4% of national spending coming from state and territory governments, 34.4% from the Australian Government, and 5.2% from private health insurance funds and other insurers in 2015–16.
Government spending on mental health-related services in 2019–20 was estimated to be around 7.6% of total government health expenditure, in line with 2015–16 (7.6%) and up from 7.3% in 1992–93 when data collection began.
Spending by the Australian Government for mental health-related services (adjusted for inflation) has increased by an average annual rate of 3.2% over the period 2015–16 to 2019–20, while spending by state and territory governments increased by an average annual rate of 2.8%.
Around $6.7 billion was spent on state and territory specialised mental health services in 2019–20. The largest proportion of this spending was on public hospital services for admitted patients ($2.9b), comprising of public acute hospitals with a specialist psychiatric unit or ward ($2.3b) and public psychiatric hospitals ($0.6b). This was closely followed by spending on community mental health care services totalling almost $2.6b.
Per capita spending on specialised mental health services ranged from $247 per person in Queensland to $328 per person in the Northern Territory, compared to a national average of $260 per person during 2019–20.
Per capita spending on state and territory specialised mental health services increased in real terms by an average annual rate of 1.0% between 2015–16 and 2019–20. This equates to an increase of about $10 per person, from about $250 in 2015–16 to about $260 in 2019–20.
Detailed spending data are available covering more than 25 years to 2019–20. Figure EXP.1 shows the changes in state and territory spending patterns, for example, increased investment in community mental health care services, reflecting changes to the state and territory specialised mental health service profile mix over this time. Further information can be found in the Specialised mental health care facilities section.
Stacked area chart showing the per capita spending on specialised mental health services from 1992–93 to 2019–20. Public psychiatric hospital spending has decreased over the period. Spending increased for specialised psychiatric units of wards in public hospitals, community mental health care services, residential mental health services, grants to non-government-organisations and other indirect expenditure. Refer to Table EXP.4.
Sources: Australian Government Department of Health, National Survey of Mental Health Services Database (1992–93 to 2004–05), National Mental Health Establishments Database (2005–06 onwards); Table EXP.4.
The majority (96.5% or $6.4 billion of the $6.7 billion total cost) of funding for state and territory specialised mental health services was provided by state or territory governments in 2019–20. However, this estimate does not take into account the Australian Government payments to jurisdictions for the running of public hospital services which includes the community-based clinical services managed by public hospitals. Refer to the data source section for technical information regarding Australian Government expenditure.
The $2.9 billion of recurrent expenditure for public sector specialised mental health hospital services during 2019–20 equates to an average cost per patient day of $1,277. The Northern Territory ($1,674) had the highest average cost per patient day and Queensland ($1,093) was the lowest.
Recurrent expenditure on public sector specialised mental health hospital services can be further described using target population (General, Child and adolescent, Youth, Older person and Forensic target groups), program type (acute and non-acute) or a combination of these.
Mental health services classified as having a General target population ($2.1 billion or 72.5%) accounted for the majority of recurrent spending for public sector specialised mental health hospital services during 2019–20. Child and adolescent services ($2,548 per patient day) had the highest costs per patient day, continuing a long term trend of these services costing more to run than services with General target population ($1,247 per patient day), Older person ($1,124 per patient day) and Forensic ($1,318 per patient day) services.
There was an average annual increase in spending per patient day for General (1.5%), Child and adolescent (2.2%), Older person services (3.7%), and Forensic services (2.9%) between 2015–16 and 2019–20, in real terms.
Average patient day costs for acute public sector specialised mental health hospital services at the national level were higher than those for non-acute services for all target population categories in 2019–20.
Community mental health care services accounted for almost $2.6 billion of recurrent spending on mental health services during 2019–20, representing 38.6% of total state and territory spending.
Of the $420 million spent on residential mental health services during 2019–20, the majority was spent on 24-hour staffed services ($383m or 91.1%). General services ($293m) accounted for more than two thirds (69.8%) of the total residential spending.
The average national cost per patient day for residential mental health services was $583 per day in 2019–20. Average costs varied between states and territories, ranging from $369 per patient day in Western Australia to $759 per patient day in Queensland.
Recurrent spending for public sector specialised mental health hospital, community and residential services can be combined and presented by target population. Spending on General services ($258 per person) was the highest of the 5 target populations during 2019–20, reflecting that many jurisdictions do not have the other specialised target population hospital services which contribute substantial costs to the overall spending profile. In real terms, General, Child and adolescent and Forensic services have had moderate per capita spending increases between 2015–16 and 2019–20 while per capita spending on Youth services increased by an average of 13% per year. Over this time period, per capita spending on Older person services decreased by an average of 1.0% per year, which reflects the fact that Older persons services have not increased to the same extent as the increases in the size of the Older persons population. For example, while the real spending on Older person services had an annual average increase of 2.3% to $630 million between 2015–16 and 2019–20, the Older person population (65 years and over) increased by 14.1% to 4.1 million people over the same period.
Total spending on specialised mental health private hospital services was $805 million in 2019–20, and the non-Commonwealth sourced component of this revenue was $584m. Adjusted for inflation, these represent annual average increases from 2015–16 of 3.5% and 3.2% per year respectively. Spending on specialised mental health services in private hospitals has not been available since 2017–18 due to changes in how the data is collected.
Australian Government spending on mental health-related services was estimated to be $3.8 billion in 2019–20. However, as noted previously and detailed in the data source section of this report, there are other known Australian government outlays attributable to supporting mental health issues which are not included in this estimate.
Australian Government spending on mental health-related services, in real terms, increased by an average annual rate of 3.2% between 2015–16 and 2019–20. This equates to an annual average increase of 1.6% in real terms, from $141 per person in 2015–16 to $150 in 2019–20. Changes in PBS/RPBS spending impacted the overall change, declining by around $3 per person over this time frame, specifically due to spending on antipsychotics and antidepressants declining by about $2 per capita respectively. This was likely the result of a decrease in the subsidised cost of some medications, partly due to some medications no longer being under patent.
Spending on MBS-subsidised mental health-specific services and mental health-related medications provided through the PBS accounted for 50.0% of the total Australian Government spending on mental health-related services in 2019–20 (Figure EXP.2). This was followed by:
Since 2008–09, there has been an overall decrease in the Government cost of PBS mental health-related prescriptions and an increase in Government spending on MBS-subsidised services and programs and National programs and initiatives. Medication prices can reduce for a variety of factors (for example, Price Disclosure or statutory price reductions due to patent changes - legislation mandated by the Government to reduce the PBS listed price of drugs), refer to the Mental health-related prescriptions section and PBS.gov.au for more information on the Pharmaceutical Benefits Scheme (PBS) or Repatriation Pharmaceutical Benefits Scheme (RPBS). Technical information regarding the calculation of these figures can be found in the data source section.
Stacked vertical bar chart showing the per capita spending by the Australian Government on specialised mental health services between 2009–10 and 2019–20. Expenditure increased for Mental health specific payments to states and territories, National programs and initiatives, the National Mental Health Commission and private health insurance premium rebates. Expenditure decreased for the Pharmaceuticals Benefit Scheme and research. Refer to Table EXP.31.
Note: National programs and initiatives includes: programs managed by DoH, programs managed by DSS, programs managed by DVA, DoD funded programs, Indigenous social and emotional wellbeing programs, National Suicide Prevention Program.
Source: Australian Government Department of Health (unpublished); Table EXP.31
Australian Government spending on Department of Defence funded mental health programs has increased by an average of 2.0% per year for the period 2015–16 ($50.2 million) to 2019–20 ($54.3m), in real terms. The spending covers a range of mental health programs and services delivered to Australian Defence Force (ADF) personnel. When the number of permanent ADF personnel is taken into consideration (59,760 people; Department of Defence 2020) this equates to $909 per permanent ADF member in 2019–20.
Medicare-subsidised mental health-specific services refers to the mental health-specific services subsidised by the Australian Government through the Medicare Benefits Schedule (MBS). These services include mental health-specific services provided by psychiatrists, general practitioners (GPs), psychologists (both clinical and other) and other allied health professionals and are defined in the MBS. Refer to the data source section for further information on the estimation of GP spending prior to 2007–08.
In 2019–20, $1.4 billion was paid in benefits for Medicare-subsidised mental health-specific services, equating to 5.4% of total MBS spending ($25.0b - including Dental Benefits Schedule and the Child Dental Benefits Schedule) (SA 2020). Spending for services provided by psychologists ($609 million or 45.0%) made up the largest proportion, comprising mostly Psychological Therapy Services (clinical psychologists; $334m) and Focused Psychological Strategies (other psychologists; $275m). Spending on services provided by psychiatrists was the next largest group ($389m or 28.8%). GP spending comprised $317m (23.4%) of total Medicare-subsidised mental health-related benefits.
Nationally, benefits paid for Medicare-subsidised mental health-related services averaged $53 per person in 2019–20, a small increase on the $51 per person in 2018–19 (in real terms compared to 2018–19 prices) (Figure EXP.3). The average benefits paid per person was highest in Victoria ($58 per person, in real terms), and lowest in the Northern Territory ($17 per person).
Stacked vertical bar chart showing the Australian Government per capita expenditure on Medicare-subsidised mental health-specific services by provider type and states and territories in 2019–20. There was no consistent trend across the states and territories as to which provider had the highest per capita expenditure, with psychiatrists, clinical psychologists and general practitioners all having the highest per capita expenditure in at least one state or territory. Per capita expenditure for Other allied health was the lowest of all providers in every state and territory.
Note: ‘Clinical psychologist’ refers to psychological therapy services provided by a clinical psychologist, and ‘Other psychologist’ includes other psychology services involving clinical psychologists and other psychologists.
Source: Medicare Benefits Schedule data; Table EXP.20.
There was an average annual increase of 3.6% in the total spending on Medicare-subsidised mental health-specific services (adjusted for inflation) between 2015–16 and 2019–20. This change equates to an average annual increase (per person) in spending of 2.0%, in real terms, from $48 in 2015–16 to $52 in 2019–20.
Australian Government spending on mental health-related subsidised prescriptions under the PBS and RPBS was $566 million, or $22 per person in the Australian population, in 2019–20. This was equivalent to 4.4% of all PBS and RPBS subsidies ($13.0 billion) (SA 2020). Prescriptions for antipsychotics (48.1%) and antidepressants (32.5%) accounted for the majority of mental health-related PBS and RPBS spending in 2019–20, followed by prescriptions for psychostimulants, agents used for Attention-deficit hyperactivity disorder (ADHD) and nootropics (13.1%), anxiolytics (4.1%) and hypnotics and sedatives (2.2%).
In 2019–20, Tasmania ($28 per person) had the highest per capita cost of PBS/RPBS medications, and the Northern Territory ($14) the lowest, compared with the national per capita cost of $22 (Figure EXP.4). For most states and territories, the cost of antipsychotics was the largest proportion of PBS/RPBS costs, followed by antidepressants, except for Tasmania where the cost of antidepressants was slightly more than antipsychotics.
Stacked vertical bar chart showing the Australian Government per capita expenditure on mental health-related medications subsidised under the PBS/RPBS by type of medication prescribed and states and territories in 2019–20. The highest per capita spend was on Antipsychotics in all states and territories, except for Tasmania where Antidepressants was the highest. Hypnotics and sedatives had the lowest per capita spend across all states and territories. Refer to Table EXP.28.
Source: Pharmaceutical Benefits Scheme data; Table EXP.28.
Over two-thirds (69.3% or $375 million) of the spending on mental health-related subsidised prescriptions was for prescriptions issued by GPs. This was followed by prescriptions written by psychiatrists (16.3% or $88m), with non-psychiatrist specialists’ prescriptions accounting for 9.2% ($50m).
Real expenditure (constant prices) for mental health-related prescriptions declined between 2014–15 and 2019–20, from $708m to $541m. This was the result of a decrease in the subsided cost of some medications rather than a reduction in prescribing. The subsidised and total number of mental health-related prescriptions grew at annual average rates of 0.4% and 3.2% per year respectively over this period (see table PBS.7). Medication prices can reduce for a variety of reasons (for example, Price Disclosure); refer to the Mental health-related prescriptions section for more information.
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The National Mental Health Commission’s 2014 Review of Mental Health Programmes and Services (NMHC 2014) used a broad methodology to estimate Australian Government expenditure on mental health. The methodology included mental health-related costs, such as the Disability Support Pension and Carer Payment and allowances. The Australian Government mental health-related expenditure in 2012–13 was estimated to be $9.6 billion, compared to $2.8b using the methodology employed in this publication, as outlined in the data source section. More recently, the Productivity Commission’s Inquiry into Mental Health examined the costs to governments, individuals and insurers of mental healthcare and related services, including broader services such as housing, employment and education as well as expenditure on treatment, research, and promotion and prevention. The Productivity Commission estimated this cost in 2018–19 was $15.5b (noting this includes only the estimated costs for mental health care and related services) (Productivity Commission 2020), compared to almost $11.0b in this report.
Collection of data for the Mental Health Establishments (MHE) National Minimum Data Set (NMDS) began on 1 July 2005, replacing the Community Mental Health Establishments NMDS and the National Survey of Mental Health Services. The main aim of the development of the MHE NMDS was to expand on the Community Mental Health Establishments NMDS and replicate the data previously collected by the National Survey of Mental Health Services. The National Mental Health Establishments Database is compiled as specified by the MHE NMDS.
The scope of the MHE NMDS includes all specialised mental health services managed or funded, partially or fully, by state or territory health authorities. Specialised mental health services are those with the primary function of providing 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.
The MHE NMDS data are reported at a number of levels: state, regional, organisational and individual mental health service unit. The data elements at each level in the NMDS collect information appropriate to that level. The state, regional and organisational levels include data elements for revenue, grants to non-government organisations and indirect expenditure. The organisational level also includes data elements for salary and non-salary expenditure, numbers of full-time-equivalent staff and mental health consumer and carer worker participation arrangements. The individual mental health service unit level comprises data elements that describe the function of the unit. Where applicable, these include target population, program type, number of beds, number of accrued patient days, number of separations, number of service contacts and episodes of residential care. In addition, the service unit level also includes salary and non-salary expenditure and depreciation.
Data Quality Statements for National Minimum Data Sets (NMDSs) are published annually on the Metadata Online Registry (METeOR). Statements provide information on the institutional environment, timelines, accessibility, interpretability, relevance, accuracy and coherence. Refer to the Mental health establishments NMDS 2019–20: National Mental Health Establishments Database, 2021; Quality Statement.
Data presented in this publication are the most current data for all years presented. The validation process scrutinises the data for consistency in the current collection and across historical data. The validation process applies rules to the data to test for potential issues. Jurisdictional representatives respond to each issue before the data are accepted as the most reliable current data collection. This process may highlight issues with historical data. In such cases, historical data may be adjusted to ensure data are more consistent. Therefore, comparisons made to previous versions of Mental health services in Australia publications should be approached with caution.
All New South Wales Confused and Disturbed Elderly (CADE) 24-hour staffed residential mental health services were reclassified as specialised mental health non-acute admitted patient hospital services, termed Transitional Behavioural Assessment and Intervention Service (T-BASIS), from 1 July 2007. All data relating to these services have been reclassified from 2007–08 onwards, including number of services, number of beds, staffing and expenditure. Comparison of data over time should therefore be approached with caution.
New South Wales has been developing the Housing Accommodation Support Initiative (HASI) since it was established in 2002. This model of care is a partnership program between NSW Ministry of Health, Housing NSW and the non-government organisation (NGO) sector that provides housing linked to clinical and psychosocial rehabilitation services for people with a range of levels of psychiatric disability.
More recently, in 2016, Community Living Supports (CLS) commenced to support more people with severe mental illness to access the same type of support provided in HASI.
Both HASI and CLS are reported as Specialised mental health service – supported mental health housing places. These programs are out of scope as Residential mental health care services.
Calculations of rates for target populations are based on age-specific populations as defined by the MHE NMDS metadata and outlined below:
As the ages included in the target population groups overlap, the rates for the target populations cannot be summed to generate the total rate.
Crude rates were calculated using the Australian Bureau of Statistics estimated resident population (ERP) at the midpoint of the data range (for example, rates for 2019–20 data were calculated using ERP at 31 December 2019). Historical rates have been recalculated using revised ERPs, as detailed in the online technical information.
From 1992–93 to 2016–17 (excluding 2007–08) the ABS conducted a census of all private hospitals licensed by state and territory health authorities and all freestanding day hospitals facilities approved by the Department of Health. As part of that census, data on the staffing, finances and activity of these establishments were collected and compiled in the Private Health Establishments Collection. Additional information on the Private Health Establishments Collection can be obtained from the ABS publication Private hospitals, Australia (ABS 2018).
The data definitions used in the Private Health Establishments Collection are largely based on definitions in the National Health Data Dictionary (NHDD) published on the AIHW’s Metadata Online Registry (METEOR) website (AIHW 2015). The ABS defines private psychiatric hospitals as those licensed or approved by a state or territory health authority and which cater primarily for admitted patients with psychiatric, mental or behavioural disorders (ABS 2018). This is further defined as those hospitals providing 50% or more of the total patient days for psychiatric patients. This definition can be extended to include specialised units or wards in private hospitals, consistent with the approach in the public sector. For further technical information, see the Private psychiatric hospital data section of the National Mental Health Report 2013 (DoH 2013).
Caution is required when comparing the ABS data for 2011–12 onwards to earlier years because the survey was altered in 2010–11 such that psychiatric units could no longer be separately identified from alcohol/drug treatment units. Therefore, the data for beds, patient days, separations and staffing from 2011–12 onwards are estimates based on reported 2010–11 data and trends observed in previous years. Data from the Private Mental Health collection suggest that these data may be underestimates.
The Private Health Establishments Collection was discontinued in 2016–17.
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 (PPHDRAS 2020).
From 2017–18, all private hospital data is sourced from the Private Psychiatric Hospitals Data Reporting and Analysis Service (PPHDRAS). Data on expenditure and staffing (Full Time Equivalent) are not collected in PPHDRAS.
In previous years, estimates of expenditure on specialised mental health services in private hospitals were derived from the annual Private Health Establishment Collection (PHEC) undertaken annually by the Australian Bureau of Statistics. PHEC was discontinued after 2016–17. Commencing 2017–18, estimates of private psychiatric hospital care are based on the PPHDRAS, a collection jointly funded by the Australian Private Hospitals Association and the Australian Government Department of Health.
The Australian Government Department of Health annually compiles the total Australian Government expenditure on mental health-related services. This practice was initiated in 1992–93 for publication in the National Mental Health Report which continued through to 2013 as the final publication year, and subsequently incorporated in related reports. Estimated Australian Government expenditure reported in table EXP.31 of this report covers only those areas of expenditure that have a clear and identifiable mental health purpose. A range of other expenditure, which may be either directly or indirectly related to the provision of support for people affected by mental illness, is not covered in this table. Broadly, this covers:
Expenditure that can be directly linked to mental health service provision, but not counted in the Australian Government spending estimates includes:
For the years indicated, most state and territory mental health services were delivered through public hospitals, and made up about 10% of state-run health services, it is reasonable to assume they benefitted from Australian Government funding contributions. However, estimates have not been included in reporting for historical reasons – principally because payments were not specifically tagged for mental health purposes and therefore fell outside the definition of ‘mental health specific’ services when decisions were made about how Australian Government funding contributions would be attributed across the two levels of government.
Mental health-related costs for support packages delivered under the National Disability Insurance Scheme are also currently excluded from estimates of Australian Government expenditure. A staged implementation of the National Disability Insurance Scheme (NDIS) began in July 2013. People with a psychiatric disability who have significant and permanent functional impairment are eligible to access funding through the NDIS. In addition, people with a disability other than a psychiatric disability, may also be eligible for funding for mental health-related services and support if required. These costs are expected to be significant at full NDIS scheme roll-out.
In addition, the Australian Government provides significant support to people affected by mental illness through income security provisions and other social and welfare programs. Consistent with the focus on mental health specific expenditure, these costs have been excluded from the analysis.
The following detailed notes on how estimates specific to Australian Government mental health specific expenditure have been revised in consultation with the Department of Health, building on those described in Appendix 11 of the National Mental Health Report 2010 (DoHA 2010).
For years up to 2008–09, this category covers specific payments made to states and territories by the Australian Government for mental health reform under the Medicare Agreements 1993–98, and Australian Health Care Agreements 1998–2003 and 2008–09. From July 2009, the Australian Government provided Specific Purpose Payments (SPP) to state and territory governments under the National Healthcare Agreement (NHA) that do not specify the amount to be spent on mental health or any other health area. Therefore, specific mental health funding cannot be identified under the NHA.
From 2008–09 onwards, the amounts include:
Nil payments are shown from 2016–17 as all three National Partnerships were completed by 2015–16.
For 2019–20 the amounts shown include:
The expenditure reported here excludes payments to states and territories for the development of subacute mental health beds made under Schedule E of the National Partnership Agreement – Improving Public Hospital Services, which totalled $175 million over the period 2010–11 to 2013–14. Mental-health specific payments cannot be separately identified from payments for other categories of subacute beds made to states and territories.
The data under this item do not include Department of Veterans’ Affairs payments to states and territories for public hospital mental health services delivered to veterans and other eligible recipients. These costs are included under the item ‘National programs and initiatives (DVA managed)’.
This category of expenditure includes the following programs and activities:
Initiatives funded through national mental health reform funding provided under special appropriations linked to the Australian Health Care Agreements (excluding amounts reported against Mental health specific payments to states and territories above).
Some of these programs were time limited and do not apply to all data presented in this section
More recently, there has been a consolidation of Department of Health Mental Health Program funding into a reduced set of categories, arising largely from the Australian Government response to the 2014 National Mental Health Commission Review of Mental Health Programs and Services. Direct spending on mental health related programs is split into 5 broad program areas: national leadership; primary mental health care services; promotion, prevention and early intervention; psychosocial support; and suicide prevention (see below). Over half of the Mental Health Program funding is provided to Primary Health Networks to plan and commission mental health services at a regional level.
Note also that the category excludes expenditure on the National Suicide Prevention Program which is reported separately in the relevant expenditure tables of Australian Government spending. While managed by the Department of Health this is reported separately.
Expenditure reported under the item 'Indigenous social and emotional wellbeing programmes' has previously been reported under 'National programs and initiatives (Department of Health managed)'. This expenditure is now separately reported following the transfer of the former OATSIH Social and Emotional Wellbeing program to the Department of the Prime Minister and Cabinet and the National Indigenous Australians Agency. Adjustments have been made to all years.
Expenditure on DSS (previously FaHCSIA) managed programs commenced with three measures introduced in 2006–07 through the COAG Action Plan on Mental Health (Personal Helpers and Mentors, Mental Health Respite, Family Mental Health Support Services). Subsequently a number of additional new measures have been added from Federal Budgets that are managed through the DSS portfolio and are included in expenditure reporting ('A Better Life', 'Carers and Work', and 'Individual Placement and Support Trial'). DSS has advised that, from 2016–17, two programs (Personal Helpers and Mentors, Mental Health Respite Care) began transitioning to the NDIS and, expenditure reported for these programs is inclusive of funding transferred to the NDIS.
Reported expenditure includes Repatriation Pharmaceutical Benefits Scheme expenditure, Repatriation Medical Benefits expenditure on general practitioners, psychiatrists and allied health providing mental health care, payment for mental health care provided in public and private hospitals for veterans, grants to Phoenix Australia and expenditure on OpenArms and related mental health programs. Note that estimated expenditure on mental health-related Pharmaceuticals includes the costs of anti-dementia drugs for years up to and including to 2009–10 but these have been removed for subsequent years.
DVA provided the following information in respect of its mental health related expenditure in 2019–20.
OpenArms (previously Veterans and Veterans’ Families Counselling Service)
Private psychologists and allied health
Phoenix Australia (previously Australian Centre for Posttraumatic Mental Health)
Veterans' mental health care – improving access for younger veterans
(a) Expenditure is indicative as not all data sets are fully complete. Small variations may be expected over time.
(b) Based only on payments made for patients classified to Major Diagnostic Category (MDC) 19 (Mental Diseases and Disorders) under the Australian Refined Diagnosis Related Groups (AR-DRG) classification system. Excludes payments made for patients classified to MDC 20 (Alcohol/drug use and alcohol/drug induced organic mental disorders).
(c) Private hospital figure includes payments to the hospital only (i.e. any other payments during these episodes such as payments to doctors have been excluded).
(d) DVA depends on submitted Hospital Casemix Protocol data from private hospitals and Diagnostic Procedure Combinations to obtain correct MDC and diagnosis information. When this information is not available (e.g. provided by hospitals on a quarterly basis and most recent quarter’s data not yet received) then an understatement can occur in reporting. For this report, and only in relation to private psychiatric facilities, billing item codes have been used to identify and include mental health data in this category.
(e) Excludes anti-dementia drugs.
The Commission commenced operation in January 2012. Source data for 2019–20: NMHC Annual Report 2019–20.
Expenditure covers a range of mental health programs and services delivered to ADF personnel, as of 2009–10 onwards; data for prior years is unavailable. Increased expenditure over the period reflects, in part, increased accuracy of data capture. Details of the ADF Mental Health Strategy are available at Defence's website.
The Department provided the following information in respect of its mental health related expenditure in 2019–20.
JHC Direct Mental Health Program and Implementation Costs[a]
Mental Health Personnel Costs[b]
FFS Garrison Psychology Services
FFS Garrison Psychiatrist Services[c]
Mental Health Treatment Programs
Contracted General Practitioner Costs[d]
Contracted Mental Health Professionals [e]
MIMS Dispensed Therapeutic Classification Drugs[f]
(a) JHC Direct Mental Health Program and Implementation Costs includes ASL Services. The FY 2018-19 expense is higher than usual due to Research & Development Contract.
(b) FY 18-19 personnel costs includes both APS and ADF MH personnel (incl. GPs) working in Garrison Health. This is calculated using the average FY17-18 MH personnel costs plus 2.5%.
(c) Mental Health Treatment Programs data capture commenced with ADF Health Services contract implementation in FY 2012-13.
(d) Represents the methodology whereby 10% of a Contracted General Practitioners consultations relate to mental health.
(e) Contracted Mental Health Professionals for FY2009-10 to FY2011-12 was coded into a generic Health Contractor GL account and therefore no costs could be identified.
(f) Data collection processed refined to include data from Pharmaceutical Integrated Logistic System (PILS) dispensing records from FY2018-19
This program commenced in 1995–96 as the National Youth Suicide Prevention Strategy but was broadened in later years. Reported expenditure includes all Australian Government allocations made under the national program, including additional funding made available under the COAG Action Plan and subsequent Federal Government Budgets. Changes in administrative arrangements and financial reporting make the estimates from 2015–16 not directly comparable to previous years. Components of the National Suicide Prevention Program are based on estimated expenditure to as closely as possible match the former methodology.
This expenditure refers to two programs:
In previous years’ reporting, expenditure on these programmes was included under ‘National program and initiatives (Department of Health managed) ‘. From 2013–14, relevant expenditure is now reported separately, with appropriate adjustments to previous years.
Reported expenditure refers to benefits paid for all services by consultant psychiatrists processed in each of the index years. Data exclude payments made by the Department of Veterans’ Affairs under the Repatriation Medical Benefits Schedule which are reported in the item National programs and initiatives (DVA managed).
Reported expenditure includes data for the Medicare-subsidised Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS initiative described above and in the Medicare-subsidised specialised mental health-specific services section. Expenditure on GP mental health care is based solely on benefits paid against MBS mental health specific GP items, which are predominantly the Better Access GP mental health items plus a small number of other items that were created in the years preceding the introduction of the Better Access initiative. This estimate of mental health-related GP costs is conservative because it does not attempt to assign a cost to the range of GP mental health work that is not billed as a specific mental health item.
As the Better Access items were introduced in November 2006, the 2006–07 data do not represent a full financial year for these specific items. The data for this item before November 2006 were estimated to be 6.1% of total MBS benefits paid for GP attendances, based on data and assumptions as detailed in the National Mental Health report 2010 (DoHA 2010). To incorporate these changes, GP expenditure reported for 2006–07 was based on total MBS benefits paid against these new items specific to mental health, plus 6.1% of total GP benefits paid in the period preceding the introduction of the new items (July to November 2006). For future years, all expenditure on GP mental health care is based solely on benefits paid against MBS Better Access mental health items, plus a small number of other items that were created in the years preceding the introduction of the Better Access initiative. The latter group includes items that may be claimed by other medical practitioners. This provides a significantly lower expenditure figure than obtained using the 6.1% estimate of previous year because it does not attempt to assign a cost to the range of GP mental health work that is not billed as a specific Better Access item. Comparisons of GP mental health related expenditure reported in Table EXP.19 prior to 2007–08 with subsequent years are therefore not valid as the apparent decrease reflects the different approach to counting GP mental health services. Data exclude Repatriation Medical Benefits expenditure on general practitioner mental health care which is included in the item National programs and initiatives (DVA managed).
Expenditure refers to MBS benefits paid for services provided by clinical psychologists, psychologists, social workers and occupational therapists approved by Medicare, for items introduced through the Better Access to Mental Health Care initiative on 1 November 2006. Note that these items commenced 1 November 2006 and were not available for the full 2006–07 period. In 2004, a small number of allied health programs that were introduced under the Enhanced Primary Care program were also included but represent less than 1% of the overall spending reported (DoHA 2010).
Refers to all Australian Government benefits for psychiatric medication in each of the index years, defined as drugs included in the following classes of the Anatomical Therapeutic Chemical Drug Classification System: antipsychotics; anxiolytics; hypnotics and sedatives; psychostimulants; and antidepressants. In addition, payments include Clozapine dispensed in public hospitals under the Highly Specialised Drug program and funded separately through special arrangements prior to December 2013. The amounts reported exclude payments made by the Department of Veterans’ Affairs under the Repatriation Pharmaceutical Benefits Schedule which are included in the item National programs and initiatives (DVA managed).
Estimates of the ‘mental health share’ of Australian Government Private Health Insurance Rebates are derived from a combination of sources and based on the assumption that a proportion of Australian Government outlays designed to increase public take up of private health insurance have subsidised private psychiatric care in hospitals and other services paid by private health insurers. For illustrative purposes, the methodology underpinning these estimates is described below, sourced from Appendix 11 of the National Mental Health Report 2010 (DoHA 2010).
In 1997, the Australian Government passed the Private Health Insurance Incentives Act 1997. This introduced the Private Health Insurance Incentives Scheme (PHIIS) effective from 1 July 1997. Under the PHIIS, fixed-rate rebates were provided to low and middle-income earners with hospital and/or ancillary cover with a private health insurance fund. Those rebates could be taken in the form of reduced premiums (with health funds reimbursed by the Australian Government out of appropriations) or as income tax rebates, claimable after the end of the income year. On 1 January 1999, the means-tested PHIIS was replaced with a 30% rebate on premiums, available to all persons with private health insurance cover. As with the PHISS, the 30% rebate could be taken either as a reduced premium (with the health funds being reimbursed by the Australian Government) or as an income tax rebate (DoHA 2010).
The combined Australian Government outlays under the two schemes, and the estimated amounts spent on private hospital care for 2019–20 are as follows (current prices):
(A) Total Australian Government outlays on private health insurance subsidies
(B) Estimated component of Australian Government private health insurance subsidies spent on hospital care
Source: AIHW 2021.
Estimation of the ‘mental health share’ of the amounts shown at (B) is based on the proportion of total private hospital revenue accounted for by psychiatric care. This assumes that if psychiatric care provided by the private hospital sector accounts for x% of revenue, then x% of the component of the Australian Government private health insurance subsidies spent by health insurance funds in paying for private hospital care is directed to psychiatric care. The estimates provided by this approach are shown below (current prices):
A new element introduced from 2015–16 includes an estimate of the PHI Premium Rebates contribution to ancillary benefits paid by private health insurers for private psychologists. All years have been adjusted to include this component.
The previous method for estimating the private hospital activity and revenue relied on data provided by the Australian Bureau of Statistics through its Private Health Establishment Collection (PHEC) which was discontinued in 2016–17. Commencing 2017–18, the estimate is based on the Private Psychiatric Hospitals Data Reporting and Analysis Service (PPHDRAS), a collection jointly funded by the Australian Private Hospitals Association and the Australian Government Department of Health, complemented by data from the Department's Private Hospital Data Bureau.
Estimated component of Australian Government private health insurance subsidies spent on hospital care
Per cent of total private hospital revenue earned through the provision of psychiatric care
Estimated ‘mental health share’ of Australian Government private health insurance subsidies spent on hospital care
Research expenditure represents the value of mental health related grants administered by the National Health and Medical Research Council (NHMRC) during the relevant year. Data were provided by the NHMRC. Minor amendments have been made to years preceding 2017–18.
Refer to the data source section of the Medicare services section for more information.
Refer to the data source section of the Mental health-related prescriptions section.
Population estimates used to calculate population rates were sourced from the Australian Bureau of Statistics.
Average cost per patient day is determined by dividing the total recurrent expenditure of the specialised mental health service by the total number of patient days as presented in the Specialised mental health care facilities section.
Constant price estimates are derived by adjusting the current prices to remove the effects of inflation. This allows for expenditures in different years to be compared and for changes in expenditure to reflect changes in the volume of health goods and services. Generally, the constant price estimates have been derived using annually re-weighted chain price indexes produced by the Australian Bureau of Statistics (ABS). In some cases, such indexes are not available, and ABS implicit price deflators have been used instead.
Current price refers to expenditures reported for a particular year, unadjusted for inflation. Changes in current price expenditure reflect changes in both price and volume.
Health expenditure is reported in terms of who incurs the expenditure rather than who ultimately provides the funding. In the case of public hospital care, for example, all expenditures (that is, expenditure on medical and surgical supplies, drugs, salaries of doctors and nurses, and so forth) are incurred by the states and territories, but a proportion of those expenditures are funded by transfers from the Australian Government.
Health funding is reported in terms of who provides the funds that are used to pay for health expenditure. In the case of public hospital care, for example, the Australian Government and the states and territories together provide over 90% of the funding; these funds are derived ultimately from taxation and other sources of government revenue. Some other funding comes from private health insurers and from individuals who choose to be treated as private patients and pay hospital fees out of their own pockets. The national recurrent expenditure on all mental health-related services can be estimated by combining funding from 3 sources:
Patient days are days of admitted patient care provided to admitted patients in public psychiatric hospitals or specialised psychiatric units or wards in public acute hospitals and in residential mental health services. The total number of patient days is reported by specialised mental health service units. For consistency in data reporting, the following patient day data collection guidelines apply: admission and separation on the same day equals 1 day; all days are counted during a period of admission except for the day of separation; and leave days are excluded from the total. Note that the number of patient days reported to the National Mental Health Establishments Database is not directly comparable with the number of patient days reported either to the National Hospital Morbidity Database (Overnight admitted mental health-related care section) or the number of residential care days reported to the National Residential Mental Health Care Database (Residential mental health care services section)
Public sector specialised mental health hospital services can be categorised based on program type, which describes the principal purpose(s) of the program rather than the classification of the individual patients. Acute care admitted patient programs involve short‑term treatment for individuals with acute episodes of a mental disorder, characterised by recent onset of severe clinical symptoms that have the potential for prolonged dysfunction or risk to self and/or others. Non‑acute care refers to all other admitted patient programs, including rehabilitation and extended care services.
Recurrent expenditure refers to expenditure that does not result in the acquisition or enhancement of an asset – for example, salaries and wages expenditure and non‑salary expenditure such as payments to visiting medical officers.
Some specialised mental health services data are categorised using 5 target population groups (see METeOR identifier:
Note that, in some states, specialised mental health beds for aged persons are jointly funded by the Australian and state and territory governments. However, not all states or territories report such jointly funded beds through the National Mental Health Establishments Database.
ABS (Australian Bureau of Statistics) 2018. Private hospitals, Australia, 2016–17. ABS cat. no. 4390.0. Canberra: ABS.
AIHW (Australian Institute of Health and Welfare) 2015. National Health Data Dictionary version 16.2. Cat. no. HWI 131. Canberra: AIHW.
AIHW 2021. Health expenditure Australia 2019–20. Cat. no. HWE 87. Canberra: AIHW.
Department of Defence 2020. Defence Annual Report 2019–20. Canberra: Department of Defence.
DoH (Department of Health) 2013. National mental health report: tracking progress of mental health reform in Australia, 1993–2011. Canberra: Commonwealth of Australia.
DoHA (Department of Health and Ageing) 2010. National mental health report 2010: summary of 15 years of reform in Australia’s mental health services under the National Mental Health Strategy 1993–2008. Canberra: Commonwealth of Australia.
SA (Services Australia) 2019. Department of Human Services annual report 2018–19. Canberra: Department of Human Services.
NMHC (National Mental Health Commission) 2014. The national review of mental health programmes and services. Sydney: NMHC.
PPHDRAS (Private Hospital–based Psychiatric Services) 2020. Private Hospital-based Psychiatric Services 1 July 2019 to 30 June 2020. Viewed November 2021.
Productivity Commission 2020. Mental Health, Report no. 95, Canberra.
Data presented in this section is for the 2019–20 period, constant prices are adjusted to 2019–20 levels. Further information on health spending is also available in Health Expenditure Australia 2019–20.
Data coverage includes the time period 1992–93 to 2019–20. Australian Government Medicare expenditure and mental health-related medications subsidised under the PBS and RPBS expenditure data for 2019–20 in this section were last updated in May 2021.
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