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Specialised mental health organisations employ mental health consumer workers and mental health carer workers for the expertise developed from their lived experience of mental illness and caring for people with mental illness.

The definition used to describe this component of the workforce changed for the 2010–11 collection to better capture a variety of contemporary roles. Caution is therefore required when interpreting time series data for this workforce. More information can be found in the key concepts. In addition to reporting the number of employed workers, specialised mental health organisations also report the extent to which consumer committee representation arrangements are in place.

Of the 174 specialised mental health service organisations reported nationally in 2019–20, 85 (48.9%) employed mental health consumer workers and 57 (32.8%) employed mental health carer workers. South Australia and Queensland had the highest proportion of organisations employing consumer workers (80.0% and 71.4% respectively) and South Australia had the highest proportion employing carer workers (70.0%).

Nationally, the rate of mental health consumer workers employed increased from 44.3 FTE per 10,000 mental health care provider FTE staff in 2015–16 to 70.4 FTE in 2019–20; an annual average increase of 12.3%. Over the same period, the rate of mental health carer workers employed increased from 17.5 FTE per 10,000 mental health FTE staff in 2015–16 to 25.4 FTE in 2019–20; an annual average increase of 9.7%. Caution is required when interpreting these data though since consumer worker and carer worker FTE is relatively small, and therefore small changes in these FTE may have a relatively large percentage impact on the rates of change. 

In 2019–20, 106 (60.9%) specialised mental health organisations reported that they had a formal position on their organisation’s management committee or that a specific consumer advisory committee exists to provide advice on all relevant mental health services managed (Level 1 in the classification of consumer participation arrangements – the data source section provides full descriptions of each level). Levels 2–4 represent less consumer committee representation within the organisation.

The proportion of specialised mental health service organisations with Level 1 consumer committee representation arrangements increased from 60.6% in 2015–16 to 60.9% in 2019–20 (Figure FAC.2); and is substantially higher than the 16.8% in 1993–94, the first year of reported data. Conversely, the proportion of organisations with Level 4 consumer committee representation (no consumer representation on any advisory committee) has substantially decreased from 46.7% in 1993–94 to 25.3% in 2019–20. This change occurred in the years immediately following 1993–94, with 1998–99 being the first year in which over half of organisations were classified as Level 1. Between 1998–99 and 2019–20, the proportion classified as Level 1 has fluctuated, dipping to 49.3% in 2005–06, peaking at 65.4% in 2008–09, and remaining above 60.0% between 2015–16 and 2019–20 (Figure FAC.2).

Services provided by specialised mental health organisations are measured against the National Standards for Mental Health Services (the National Standards). There are 8 levels available to describe the degree to which a specialised mental health service organisation meets the National Standards, from Level 1 (a service unit has met all national standards) through to Level 8 (national standards do not apply). Reporting levels for National Standards can be found in the data source section, which provides full descriptions of all 8 levels and how they are grouped into 4 levels for reporting purposes.

To accurately reflect the proportion of mental health services meeting the various National Standards levels, the expenditure reported for each service unit is used to calculate the proportion of services meeting the four reporting levels. In this way, the relative size of a service unit is accounted for when calculating the proportion of services meeting the National Standards levels. It is important to note that the accreditation process is cyclical in nature and so state and territory results may vary from year to year.

Using this approach, 88.0% of all service units which were reviewed by an external accreditation agency, such as the Australian Council on Healthcare Standards (ACHS) or the Quality Improvement Council (QIC), met the National Standards (Level 1) in 2019–20. The jurisdictions reporting the highest proportion of service units meeting Level 1 were South Australia (100%), Queensland (98.9%), Western Australia (97.6%) and Tasmania (97.5%). The Northern Territory reported that all service units were assessed under service accreditation standards that do not include certification for the National Standards for Mental Health Services, therefore it has reported that 100% of service units meet Level 4.

During 2019–20, the majority of public sector specialised mental health hospital beds (5,044 or 71.9%) were in General services, 911 beds (13.0%) were in Older person services, 680 (9.7%) were in Forensic services and 312 (4.4%) were in Child and adolescent services. A small number of beds were located in Youth services (71 beds or 1.0%); a service category that was introduced in 2011–12.

The proportion of specialised mental health hospital beds for each target population category varied across states and territories, reflecting the different service profile adopted in each jurisdiction. The majority of beds were in services classified as General, accounting for at least 66.3% of beds in each jurisdiction.

New South Wales had the highest rate of hospital beds per 100,000 population for both General services (39.7) and Child and adolescent services (7.0) compared to the national rates of 31.9 and 5.5 respectively (Figure FAC.4). Western Australia (38.1) had the highest rate of Older person hospital beds per 100,000 population (national average 22.1) and the Australian Capital Territory (7.2) had the highest rate of Forensic hospital beds (national average 3.4). The Northern Territory reported the highest rate of Youth beds (17.7) compared to the national rate of 2.4.

Almost three-quarters (5,233 beds or 74.6%) of all public sector specialised mental health hospital beds across Australia were in Acute services during 2019–20 (Figure FAC.3).

The proportion of acute beds differed among the target population groups. The majority of General beds (75.9%), Child and adolescent beds (87.2%), Youth beds (100.0%), and Older person beds (81.7%) were in Acute services in 2019–20, compared with less than half of Forensic beds (46.9%).

In 2019–20, there were 2,438 residential mental health service beds available nationally. These can be characterised by the level of staffing provided, target population and the service operator (government or non-government), reflecting the service profile mix in each state or territory.

The total number of beds in government-operated services was 1,686 (69.1%). About three quarters (1,968 or 80.7%) of all residential beds were operated with mental health trained staff working in active shifts for 24 hours a day, with the majority of these beds in government operated services (1,656 beds). By contrast, non-24-hour staffed residential beds were predominantly provided by the non-government sector. More than two-thirds (1,648 beds or 67.6%) of all residential beds were in General services with more of these beds in 24-hour staffed facilities (1,306 or 79.2%) than in non-24-hour staffed facilities (342 or 20.8%).

In the Australian Capital Territory, from 2015–16 to 2016–17 there was a decline in the reported number of non-24 hour staffed residential beds, from 45 to 5 beds. There were also 5 beds between 2017–18 and 2019-20. These beds are still operational but as they are funded under the National Disability Insurance Scheme (NDIS), they are now out of scope for reporting to the Mental Health Establishments (MHE) NMDS. It is anticipated that as the NDIS is fully implemented across Australia, the number of non-24-hour staffed residential specialised mental health beds being reported to the MHE NMDS will decrease.

In 2019–20, there were 9.5 residential mental health beds per 100,000 population nationally. Amongst jurisdictions, Tasmania (30.3) had the highest rate while New South Wales (0.5) had the lowest (Figure FAC.5). Western Australia was the only jurisdiction where non-24-hour staffed residential services provided more beds than 24-hour staffed services. For all other jurisdictions, 24-hour staffed services provided more beds.

Victoria (48.2) had the highest rate of residential mental health beds per 100,000 population in Older persons 24-hour staffed care services. Tasmania had the highest rate of residential beds per 100,000 population in General services for both 24-hour staffed care (22.4) and non-24-hour staffed care (16.9). New South Wales (0.5 beds per 100,000 population) was the only state or territory that reported residential mental health service beds for Child and adolescent services in 2019–20. Four jurisdictions reported specialised Youth services, with Victoria reporting 17.6 beds per 100,000 population, Queensland 5.1, Western Australia 5.5 and the Australian Capital Territory 21.0.

The number of public sector specialised mental health hospital and residential mental health service beds increased from 9,440 beds in 2015–16 to 9,457 beds in 2019–20. The combined rate of hospital and residential specialised mental health beds per 100,000 population has declined since reporting began in 1992–93 from 50.2 to 35.2 in 2019–20.

There was a decrease in the number of public psychiatric hospital beds reported from 1,698 beds in 2015–16 to 1,584 beds in 2019–20. By contrast, there was an increase in the number of beds in specialised psychiatric units or wards in public acute hospitals over the same period (from 5,360 in 2015–16 to 5,434 in 2019–20). Time series comparisons should be approached with caution.

The number of specialised residential mental health service beds increased from 2,383 in 2015–16 to 2,438 in 2019–20. Reported residential beds per 100,000 population nationally have remained broadly stable for about 2 decades, being about 10 since 1999–00.

In addition to the services described above, jurisdictions also provide supported housing places for people with a mental illness, with 4,360 available in 2019–20. Western Australia (51.1 per 100,000 population) had the highest rate of supported housing places, compared with the national average of 17.1. However, caution should be exercised when comparing rates across jurisdictions as not all jurisdictional mental health housing support schemes are in-scope for the Mental Health Establishment NMDS. The data source section provides further information.

Around 2.3 million patient days were provided by public hospital specialised mental health services during 2019–20. Over three-quarters (77.4%) were in specialised psychiatric units or wards in public acute hospitals, mirroring the number of beds for this service type. New South Wales (103.9) had the highest rate of patient days per 1,000 population, while Tasmania (58.1) had the lowest, compared with the national rate of 89.0.

During 2019–20, Residential mental health care services provided just over 720,000 patient days. About four-fifths (80.4%) of all patient days were for residents of 24-hour staffed services. Tasmania (128.7) had the highest rate of patient days per 1,000 population in General services, while New South Wales (2.3) had the lowest; compared with the national rate of 31.8.

During 2019–20, private specialised mental health hospital services provided about 1.2 million patient days, equating to 48.1days per 1,000 population. However, in contrast with public sector services, this figure also includes same-day separations.

Across the history of reporting, the population rate of FTE staff employed by Hospital admitted patient services has ranged between 58.2 and 76.8 FTE per 100,000 population, and has been stable, at about 60, for the last 8 reporting periods. The rate of FTE staff employed by Community mental health care services increased every year from 1993–94 to 2011–12 (from 23.7 to 57.7 FTE), and then levelled off in the low 50s for the last 8 reporting periods. The rate of FTE staff employed by Residential mental health care services has been broadly stable over the past 20 reporting periods (typically between just below 9 and 10 FTE). Organisational overhead service settings have been reported as a service setting since 2012–13, with the rate ranging between 9.8 and 14.2 FTE.

Health care providers include the staffing categories of salaried medical officers, nurses, diagnostic and allied health professionals, mental health consumer and carer workers and other personal care staff. These staff can be described at the overall organisational level, by service setting and by target population. In 2019–20, public hospital specialised mental health services employed 56.7 FTE health care providers per 100,000 population (Figure FAC.8). Community mental health care services employed 49.0 FTE health care providers per 100,000 population in 2019–20 and Residential mental health care services employed 8.9.

Between 1992–93 and 2019–20 the FTE rate was consistently highest for Hospital admitted patient service settings, ranging between 45.1 and 57.1 (in 2000–01 and 1992–93 respectively). The rate was consistently second highest for Community mental health care service settings, which increased from 19.1 to peaking at 49.0 in 2019–20. The rate for Residential mental health care service settings increased from 4.0 to 9.0 between 1992–93 and 2019–20, with a low of 3.4 in 1993–94. The Organisation overhead setting was reported on from 2012–13, with a rate ranging between 3.7 and 5.7 during the past 8 reporting periods.

National Mental Health Establishments Database

Collection of data for the Mental Health Establishments (MHE) 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 provided 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 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, and 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.

Data validation

Data presented in this publication are the most current data for all years presented. The validation process assesses the data for consistency in the current collection and across historical data. The validation process applies a range of 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.

Consumer committee representation arrangements

Specialised mental health organisations report the extent to which consumer participation arrangements are in place to promote the inclusion of mental health consumers in the planning, delivery and evaluation of the service. Organisations report their consumer participation arrangements at various levels, as detailed below.

Data source FAC.1 Levels of consumer participation arrangements

Level	Description
Level 1	Formal position(s) for consumers exist on the organisation’s management committee for the appointment of person(s) to represent the interests of consumers. Alternatively, specific consumer advisory committee(s) exists to advise on all relevant mental health services managed by the organisation.
Level 2	Specific consumer advisory committee(s) exists to advise on some but not all relevant mental health services managed by the organisation.
Level 3	Consumers participate on a broadly based advisory committee that includes a mixture of organisations and groups representing a wide range of interests.
Level 4	Consumers are not represented on any advisory committee but are encouraged to meet with senior representatives of the organisation as required. Alternatively, no specific arrangements exist for consumer participation in planning and evaluation of services.

National standards for mental health services review status

There are 8 levels used to describe the extent to which a service unit has implemented the National Standards, as shown in the table below.

Data source FAC.2 National standards for mental health services review status levels

Level	Description
1	The service unit had been reviewed by an external accreditation agency and was judged to have met the National standards as determined by the accrediting agency.
2	The service unit had been reviewed by an external accrediting agency and was judged to have met some but not all of the National standards.
3	The service unit was in the process of being reviewed by an external accrediting agency but the outcomes were not known.
4	The service unit was booked for review by an external accrediting agency and was engaged in self‑assessment preparation prior to the formal external review.
5	The service unit was engaged in self‑assessment in relation to the National standards but did not have a contractual arrangement with an external accreditation agency for review.
6	The service unit had not commenced the preparations for review by an external accrediting agency but this was intended to be undertaken in the future.
7	It had not been resolved whether the service unit would undertake review by an external accrediting agency under the National standards.
8	The National standards are not applicable to this service unit.

Source: National Standards for Mental Health Services status (see METEOR ID: 573549).

Reporting levels for national standards

To match definitions in the National Key Performance Indicator set for Mental Health Services, the data presented are restricted to 4 levels. Level 1 represents code 1, Level 2 represents code 2, Level 3 represents codes 3 and 4 and Level 4 represents codes 5–7. Code 8 is excluded as the standards do not apply to these units.

The National standards for mental health services were revised in 2010 (DoH 2010). In addition to these mental health-specific national standards, other national standards have been published and implemented against which mental health services may also be measured. Work is ongoing to improve the method for reporting the standards against which a service is measured.

New South Wales CADE and T-BASIS services

All New South Wales Confused and Disturbed Elderly (CADE) 24-hour staffed Residential mental health care 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 re-classified 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 Mental Health Community Living Programs

New South Wales has been developing the NSW 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.

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.

From 2017–18 New South Wales supported housing places reflect changes resulting from the conclusion of the Commonwealth National Partnership Agreement (NPA) on Mental Health Services. The NSW Government continued funding until Dec 2017 to allow for transition to alternative support arrangements (including the NDIS) for up to 200 people in NPA funded supported housing places.

Both HASI and CLS are reported as Specialised mental health service – supported mental health housing places (METEOR identifier 390929). These programs are out of scope as Residential mental health care services (METEOR identifier 373049). See the above hyperlink for further information about the NSW HASI program.

Public sector specialised mental health beds

In 2017–18, Queensland reported specialised residential mental health service beds to the Mental Health Establishments collection for the first time due to the reclassification of some public sector mental health hospital beds.

Organisational overhead setting

In 2012–13, the Organisational overhead setting was introduced for greater national consistency in reporting and greater clarity about staff delivering care to patients. The Organisational overhead setting consists of the components of specialised mental health service organisations not directly involved in the delivery of patient care services in the admitted patient, residential or community mental health care service settings, or in the operations of those settings. The definition does not imply that these roles do not have an impact on service delivery. For example, a chief operating officer not directly providing patient care, nor involved in the operation of services in a specific service setting, would be reported in the Organisational overhead setting. The reporting methodology for the new Organisational overhead setting is taking time for states and territories to implement (see Table FAC.39 for detailed time series data).

Rates calculations

Calculations of rates for target populations are based on age-specific populations as defined by the MHE NMDS metadata and outlined below.

• General services: persons aged 18–64.
• Child and adolescent services: persons aged 0–17.
• Youth services: persons aged 16–24.
• Older persons: persons aged 65 and over.
• Forensic services: persons aged 18 and over.

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 2018–19 data were calculated using ERP at 31 December 2018). Historical rates have been recalculated using revised ERPs based on the 2011 Census of Population and Housing, as detailed in the online technical information.

Private health reporting

Private hospital specialised mental health services staffing

Staffing provided in private hospital specialised mental health service are no longer available. These data were previously provided by the Australian Bureau of Statistics through its Private Hospitals Establishment Collection (PHEC), but this survey was discontinued in 2016–17.

Private Health Establishments Collection

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 Commonwealth 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).

The last data were collected for the 2016–17 period. Increases in psychiatric beds were the result of improvements in methodology to apportion the data between psychiatric and alcohol/drug treatment wards, new establishments reporting for the first time, and a general increase in psychiatric beds in establishments that have reported psychiatric units in the past. Caution is required when comparing data for 2010–11 to other years as the survey was altered 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 were 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 (PMHA 2013).

Private Psychiatric Hospitals Data Reporting and Analysis Service

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 PPHDRAS. Data on expenditure and Staffing (FTE) are not collected in the PPHDRAS.

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 2012 version 16.2. Cat. no. HWI 131. Canberra: AIHW.

AIHW 2021. Aboriginal and Torres Strait Islander-specific primary health care: results from the OSR and nKPI collections. Cat. no. IHW 227. Canberra: AIHW. Viewed November 2021

APHA (Australian Private Hospitals Association) 2020. Private Hospital-based Psychiatric Services 1 July 2019 to 30 June 2020. Canberra: APHA.

DoH (Department of Health) 2010. National Standards for Mental Health Services . Canberra: Commonwealth of Australia. Viewed 3 March 2021.

DoH 2013. National mental health report: tracking progress of mental health reform in Australia, 1993–2011. Canberra: Commonwealth of Australia.

PMHA (Private Mental Health Alliance) 2013. Private Hospital-based Psychiatric Services 1 July 2011 to 30 June 2012. PMHA-CDMS annual statistical report for the 2011–2012. Private Mental Health Alliance.

PPHDRAS (Private Psychiatric Hospitals Data Reporting and Analysis Service) 2020. Private Hospital-based Psychiatric Services 1 July 2019 to 30 June 2020. Viewed November 2021.