Mental health services in Australia

Mental health treatment and support services have an important role in the recovery of people with mental health issues. This section presents information about the mental health-related problems faced by consumers of public sector specialised mental health services and whether consumers improve after receiving mental health care, as measured by a set of clinically-derived indicators.

Data are available in this section about consumers of public sector specialised mental health services. There is a range of other mental health services not included here—for example, clinical measures may be collected to aid consumers’ recovery in private hospitals, private clinicians’ practices, non-government organisations, primary health care networks, and other services. However, outcomes data from those services are not routinely collected under national agreements and thus are not available for reporting.

Clinical measures are particular surveys or forms that are used to gather information about a person's clinical mental health status and functioning. Measures can be completed by clinicians about the consumer (known as clinician-rated), completed by the consumer (consumer-rated), and completed by families and carers about the consumer (carer-rated). When the same clinical measures are completed more than once, they can be used to determine whether a person shows improvement, no change, or deterioration from mental health care.

Data reported in this section are gathered under the National Outcomes and Casemix Collection (NOCC), first specified in 2003 to guide states and territories in the implementation of routine consumer outcomes measurement in public mental health services in Australia. All consumers who receive clinical care in public sector specialised mental health services should be included in the NOCC, including psychiatric inpatient, residential and ambulatory (non-admitted) service settings. More information about the NOCC is in the data source section.

This section provides an overview of the NOCC and key findings. More detailed data are available via the National Outcomes and Casemix Collection Web Decision Support Tool and Reports Portal.

Data downloads:

Consumer outcomes in mental health care 2018–19 tables (259KB XLSX)

Consumer outcomes in mental health care 2018–19 section (1.2MB PDF)

Data source information and key concepts related to this section.

Data coverage includes the time period 2014–15 to 2018–19. This section is new, and was first released on MHSA in July 2021.

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Key points

What are outcomes and casemix?

The NOCC collects information about a consumer's clinical mental health status and functioning during their mental health care. Measures completed by clinicians about the consumer (known as clinician-rated) and measures completed by the consumer (consumer-rated) are used. These measures are completed at multiple collection occasions during an episode of care to monitor changes in consumers' clinical status and functioning.

Ratings information is used to report on consumers’ outcomes of care—that is, whether consumers of mental health services show improvement, no change, or deterioration from receiving mental health care. Clinical outcomes such as these are just one aspect of a consumer’s recovery.

In addition to outcomes, data items in the NOCC gather information about other factors that together are known as casemix. In this section, casemix items include the consumers’ mental health legal status, diagnoses and phase of care—for example, whether care focuses on assessment, active short-phase treatment (acute care), or to improve personal, social or occupational functioning (gain).

The collection of the NOCC measures is guided by a set of rules on what measures to collect and when to collect them. More information is in the data source section and more detailed information is in the technical specifications.

Consumers included in the NOCC

Coverage

All consumers who receive clinical care in public sector specialised mental health services—including psychiatric inpatient, residential and ambulatory (non-admitted) services—should be included in the NOCC.

Nationally, in 2018–19, NOCC measures were collected for 196,045 people, which is 42.7% of the 458,820 people who received clinical care from public sector specialised mental health services (Table NOCC.1).

The proportions of people who received clinical care in public sector specialised mental health services who were included in the NOCC were highest among people aged 75–84 (47.3%) and 85 years and over (46.3%) and lowest among people aged 0–17 and 18–24 (41.1%) and 25–34 years (42.1%) (Table NOCC.2).

Demographics

In 2018–19, 49.9% of the consumers included in the NOCC were male and 50.0% were female. There were 68,909 people aged between 25 and 44 years, accounting for 35.1%. There were 17,693 Aboriginal and Torres Strait Islander peoples, accounting for 9.3%.

People living in Major cities made up the majority of consumers included in the NOCC (65.4%) and people living in Very remote areas made up the smallest proportion (1.4%). People living in areas of most socio-economic disadvantage made up the largest proportion at 25.3%, while people living in areas of least disadvantage made up the smallest at 14.6% (Figure NOCC.1).

Figure NOCC.1: Demographic characteristics of consumers included in the NOCC, 2018–19

Source data: Consumer outcomes in mental health care tables 2018–19 (259KB XLSX)

There were 8,326 children aged 10 years and under, accounting for 4.2% of all consumers in the NOCC in 2018–19 (Table NOCC.3). As this is a relatively small number of consumers, there is less capacity for comprehensive reporting and disaggregations; therefore, data relating to children aged 10 years and under are not further reported in this section. Reports can be generated via other NOCC reporting products (Web Decision Support Tool and Reports Portal).

Collection occasions

Under the NOCC specifications, clinical and casemix measures may be completed at collection occasions. The three collection occasion types are Admission, Review, and Discharge. A person may have multiple collection occasions.

In 2018–19 across all age bands, the majority of collection occasions were in ambulatory service settings—accounting for 54,633 (89.7%) collection occasions for young people aged 11–17 years, 254,987 (71.1%) for people aged 18–64, and 45,194 (82.1%) for people aged 65 years and older.

Inpatient settings accounted for 6,217 (10.2%) collection occasions for young people aged 11–17 years, and 95,885 (26.8%) for people aged 18–64. Within the inpatient setting, the majority of service programs provided acute care, accounting for 97.1% of inpatient collection occasions for 11–17 year olds, 94.7% for people aged 18–64, and 93.3% for people aged 65 years and older (Tables NOCC.4 and NOCC.5).

There were around 7,600 collection occasions in residential services accounting for no more than 2.1% in any age band (Table NOCC.4).

The remainder of this chapter reports data for ambulatory and acute inpatient service settings.

Mental health legal status

Mental health legal status indicates whether the person was treated on an involuntary basis under the relevant state or territory mental health legislation at some point during care.

In 2018–19 for people aged 11–17, Involuntary status was recorded for consumers for nearly 1 in 5 collection occasions at discharge in acute inpatient care (494 or 20.2%) and 1 in 45 (278 or 2.2%) for ambulatory care (Figure NOCC.2).

For consumers aged 18–64, Involuntary status was recorded for consumers for nearly 1 in 2 collection occasions at discharge in acute inpatient settings (15,824 or 45.5%) and 1 in 8 (7,844 or 12.1%) for ambulatory settings.

For consumers aged 65 years and older, Involuntary status was recorded for nearly 2 in 5 collection occasions at discharge in acute inpatient settings (1,363 or 38.6%) and nearly 1 in 12 (967 or 8.6%) in ambulatory settings.

Figure NOCC.2: Involuntary mental health legal status at discharge, by age band and setting, 2018–19

Source data: Consumer outcomes in mental health care tables 2018–19 (259KB XLSX)

Completion of measures

In 2018–19, clinician-rated measures were completed at much higher rates than consumer-rated measures for each type of collection occasion (admission, discharge and review) and across all age bands for both acute inpatient and ambulatory settings (Figure NOCC.3).

For example, depending on type of collection occasion, age band, and service setting, clinician-rated measures were collected at between 70.9% and 97.0% of expected collection occasions and consumer-rated measures were collected at between 12.4% and 38.3% of expected occasions for adults. More information by age band is presented in the data source section.

Figure NOCC.3: Collection occasions with completed with clinical measures, by setting, age band, occasion type and measure type, 2018–19

Source data: Consumer outcomes in mental health care tables 2018–19 (259KB XLSX)

Mental health-related problems for consumers at admission

The suite of Health of the Nation Outcome Scales (HoNOS) measures provide information about the mental health-related problems experienced by consumers at admission to a mental health service that are rated by clinicians to have a clinically significant impact on the consumer (Figure NOCC.4). Data from these measures indicates that in 2018–19, many consumers of public sector specialised mental health services, across all age bands, were facing more than one clinically significant problem.

Children and adolescents (11–17 years)

In 2018–19 for consumers aged 11–17 years, the mental health-related problems most frequently affecting consumers were Emotional and related symptoms (89.4% of collection occasions in acute inpatient care, 89.1% in ambulatory care), Family life and relationships (72.1% acute inpatient, 72.7% ambulatory), and Peer relationships (63.6% acute inpatient, 60.9% ambulatory). Non-accidental self-injury was rated a clinically significant problem for consumers in 66.2% of occasions in acute inpatient care and 42.9% of occasions in ambulatory care.

Adults (18–64 years)

In 2018–19 for consumers aged 18–64 years, the mental health-related problems most frequently affecting consumers were Depressed mood (59.4% of collection occasions in acute inpatient care, 55.0% in ambulatory care), Other mental and behavioural problems (57.5% acute inpatient, 60.2% ambulatory), and Relationships (50.7% acute inpatient, 45.0% ambulatory). The presence of clinically significant problems in Other mental and behavioural problems indicate comorbid problems for the consumer.

Older persons (65 years and older)

In 2018–19 for consumers aged 65 years and older, the mental health-related problems most frequently affecting consumers were Other mental and behavioural problems indicating comorbid problems (67.7% of collection occasions in acute inpatient, 55.2% ambulatory), Physical illness or disability problems (52.2% acute inpatient, 60.0% ambulatory) and Depressed mood (62.1% acute inpatient care, 49.5% in ambulatory care).

Problems with Behaviour and Hallucinations more frequently affected consumers in acute inpatient care (46.8% and 44.9%, respectively) than in ambulatory care (26.2% and 22.5%, respectively).

Figure NOCC.4: Clinically significant problems for consumers at admission, by age band and setting, 2018–19

Source data: Consumer outcomes in mental health care tables 2018–19 (259KB XLSX)

Principal diagnoses for consumers at discharge

Children and adolescents (11–17 years)

In 2018–19 for consumers aged 11–17, the most frequently recorded mental health-related principal diagnoses at discharge were Depressive episode (16.1% of collection occasions in acute inpatient, 10.4% in ambulatory), Other anxiety disorders (9.4% acute inpatient, 16.7% ambulatory), and Reaction to severe stress and adjustment disorders (15.0% acute inpatient, 14.6% ambulatory) (Figure NOCC.5).

In acute inpatient settings, Eating disorders (4.1%) and Specific personality disorders (5.9%) were also among the five most frequently recorded diagnoses at discharge; in ambulatory settings Other and unspecified disorders (9.5%) and Disorders of psychological development (6.0%) were among the five most frequent diagnoses.

Adults (18–64 years)

In 2018–19 for consumers aged 18–64, Schizophrenia was among the most frequently recorded mental health-related principal diagnoses at discharge (16.3% of collection occasions in acute inpatient settings, 13.0% ambulatory), followed by Depressive episode (9.9% acute inpatient, 10.7% ambulatory), and Reaction to severe stress and adjustment disorders (7.4% acute inpatient, 12.0% ambulatory) (Figure NOCC.5).

Bipolar affective disorders (7.3% acute inpatient, 6.1% ambulatory) and Specific personality disorders (7.0% acute inpatient, 7.8% ambulatory) were also among the five most frequently recorded diagnoses at discharge.

Older persons (65 years and older)

In 2018–19 for consumers aged 65 years and older, the most frequently recorded mental health-related principal diagnosis at discharge was Depressive episode (22.5% of collection occasions in acute inpatient settings, 19.2% ambulatory), followed by Dementia (11.7% acute inpatient, 12.9% ambulatory).

Schizophrenia (11.3% acute inpatient, 7.6% ambulatory) and Bipolar affective disorders (11.4% acute inpatient, 7.3% ambulatory) were also among the five most frequently recorded diagnoses at discharge, as were Schizoaffective disorders in acute inpatient settings (5.1%) and Recurrent depressive disorders in ambulatory settings (7.5%).

Figure NOCC.5: Five most commonly reported principal diagnoses for consumers at discharge, by age band and setting, 2018–19

Source data: Consumer outcomes in mental health care tables 2018–19 (259KB XLSX)

Clinical outcomes of care

Under the NOCC, measures are completed at multiple collection occasions during an episode of care to monitor changes in consumers' clinical status and functioning. The most frequent episode types are:

• Completed acute inpatient (admitted services)—duration longer than 3 days.
• Completed ambulatory (non-admitted)—duration longer than 14 days.
• Ongoing ambulatory—episodes of care that were still open at the end of the reporting year (2018–19) (Tables NOCC.15–17).

Where clinical measures have been completed on two collection occasions (matched pairs), test of effect size are used to determine whether consumers showed significant improvement, no change, or significant deterioration from their episode of mental health care.

Clinical outcomes can be calculated on a subset of episodes in the NOCC dataset. The data source section provides information on the proportion of episodes for which clinical outcomes could be calculated. The proportions of episodes where consumer-rated measures are completed on two collection occasions are particularly low and means that consumer-rated clinical outcomes could be calculated for 4.9% to 21.7% of episodes, depending on episode type and age band of the consumer. Clinician-rated clinical outcomes could be calculated for 70.6% to 95.5% of episodes. As consumer-rated measures are completed less often than the clinician-rated measures, caution should be applied in comparing outcomes based on the clinician-rated and consumer-rated measures because it cannot be assumed they represent the same groups of people.

Children and adolescents (11–17 years)

In 2018–19 on clinician-rated measures (where matched pairs are available), most consumer episodes for people aged 11–17 showed improvement in outcomes in completed acute inpatient care (54.4% of episodes) and completed ambulatory care (52.6%). However for consumers in this age band the biggest single category for those in ongoing ambulatory care was no change (46.1%) (Figure NOCC.6).

Consumers showed deterioration on clinician-rated measures in 15.4% of ongoing ambulatory episodes, 9.9% of completed acute inpatient episodes and 6.5% of completed ambulatory episodes.

Adults (18–64 years)

For both clinician and consumer-rated measures (where matched pairs are available) in 2018–19, most episodes for consumers aged 18–64 showed improvement in completed acute inpatient care (73.8% clinician-rated and 62.7% consumer-rated episodes) and completed ambulatory care (51.2% clinician-rated and 54.3% consumer-rated episodes). (Figure NOCC.6).

The biggest single category for consumers in this age band in ongoing ambulatory care on both clinician-rated (56.6%) and consumer-rated (64.3%) measures was no change.

In 2018–19 on clinician-rated measures, consumers aged 18–64 showed deterioration in 18.1% of ongoing ambulatory episodes, 6.4% of completed ambulatory episodes and 4.5% of completed acute inpatient episodes.

On consumer-rated measures, consumers in this age band showed deterioration in 9.7% of ongoing ambulatory episodes, 5.3% of completed ambulatory episodes and 4.5% of completed acute inpatient episodes.

Older persons (65 years and older)

In 2018–19 on clinician-rated measures, most episodes for consumers aged 65 and older in completed acute inpatient care showed improvement (72.6% of episodes). For completed ambulatory care nearly half of all episodes showed improvement on clinician-rated measures (48.4%). The biggest category for consumers in this age band in ongoing ambulatory care was no change (60.0%) (Figure NOCC.6).

Consumers showed deterioration on clinician-rated measures in 16.4% of ongoing ambulatory episodes, 6.4% of completed ambulatory episodes and 5.1% of completed acute inpatient episodes.

In 2018–19 on consumer-rated measures (where matched pairs are available), most episodes for consumers aged 65 and older in completed acute inpatient care showed improvement (63.1% of episodes). For ongoing ambulatory care most episodes (61.9% of episodes) showed no change. In completed ambulatory care, there was no significant difference between the per cent of consumers’ episodes showing improvement and per cent showing no change (47.4% for improvement, 48.1% of episodes for no change).

Consumers showed deterioration on consumer-rated measures in 10.0% of ongoing ambulatory episodes, 4.5% completed ambulatory episodes and 4.1% completed acute inpatient episodes.

Figure NOCC.6: Clinician- and consumer-rated outcomes for consumers, by age band and episode type, 2018–19

Source data: Consumer outcomes in mental health care tables 2018–19 (259KB XLSX)