Consumer outcomes in mental health care

Key points

  • Information was recorded for 202,234 people in 2019–20, representing 43.3% of consumers of public mental health services.
  • During 2019–20, the most common clinically significant problems for consumers aged 11–17 at the start of an episode of care were Emotional and Family issues; for adults aged 18 and over these were Depressed mood and Other mental and behavioural problems; and for people aged 65 and over Physical/disability problems were also common.
  • Clinician-rated measures were completed at much higher numbers than consumer-rated measures for all age bands during 2019–20.
  • During 2019–20, completed consumer episodes showing Improvement outcomes on clinician’s ratings were higher for inpatient than ambulatory (non-admitted) care:
    • inpatient care, at 57.9% (aged 11–17), 73.4% (aged 18–64) and 72.6% (65 and older) of episodes; consumers in this setting showed Deterioration in up to 9.5% of episodes.
    • ambulatory (non-admitted) care, at 55.0% (aged 11–17), 51.6% (aged 18–64), and 45.9% (65 and older) of episodes; consumers in this setting showed Deterioration in up to 6.8% of episodes.

The National Outcomes and Casemix Collection (NOCC) collects information using measures completed by clinicians and consumers about a person’s clinical status during their mental health care. During 2019–20, NOCC measures were collected for 202,234 people nationally, which is 43.3% of people who received clinical care from public sector specialised mental health services.

During 2019–20 the most frequent mental health-related problems affecting consumers were Emotional problems (adolescents) and Depressed mood and Other mental and behavioural problems (adults). Mental disorder not otherwise specified and Depressive episode were among the most frequent principal diagnoses recorded at discharge for all age groups.

Clinical outcomes can be calculated on a subset of care episodes where clinical measures have been completed twice in a matched pair. This shows whether consumers show improvement, no change or deterioration from mental health care.

For all age bands and consumer groups, clinician-rated outcome measures showed:

  • Improvement for between 25.2% of episodes (for consumers aged 18–64 years in ongoing ambulatory care) and 73.4% of episodes (for consumers aged 18–64 years who completed acute inpatient care)
  • No change for between 22.1% of episodes (for consumers aged 18–64 years who completed acute inpatient care) and 59.2% of episodes (for consumer aged 65 years and over in ongoing ambulatory care)
  • Deterioration in up to 17.5% of episodes (for consumers aged 18–64 years in ongoing ambulatory care).

Overall, a higher proportion of consumer episodes showed Improvement compared to other outcomes if the consumer had completed acute inpatient care, and a higher proportion of consumer episodes showed No change if the consumer was still receiving ongoing ambulatory care.

Data obtained using the NOCC protocol provide valuable information about the outcomes of people accessing Australian public mental health care and enables reporting under the Key Performance Indicators for Australian Public Mental Health Services. Data collection, reporting and development under the NOCC has been in place for two decades and continue due to significant ongoing collaboration between state/territory governments, the Australian Government Department of Health, the Australian Institute of Health and Welfare, and the Australian Mental Health Outcomes and Classification Network.

Spotlight data

Do people get better, get worse, or stay the same from their public mental health care?

Interactive NOCC.Spotlight: Horizontal stacked bar chart, showing the per cent of completed episodes showing clinician-rated outcomes for consumers, included in the National Outcomes and Casemix Collection (NOCC), by consumer group, during 2019–20. Each tab shows information for a specific age-band. People aged 11 and older showed significant improvement more often after admitted than non-admitted care. While most people aged 11–64 years showed significant improvement after care in completed episodes across both settings (admitted and non-admitted), generally people aged 65 and older showed no significant change after non-admitted care. Refer to NOCC Tables 21, 23 and 25

Change in mental health consumers’ clinical outcomes is a national indicator under the Key Performance Indicators for Australian Public Mental Health Services.

Data download

Consumer outcomes in mental health care tables 2019–20 (299KB XLXS)

Consumer outcomes in mental health care section 2019–20 (877KB PDF)

Data source information and key concepts related to this section.

Data coverage includes the time period 2014–15 to 2019–20. This section was last updated in July 2022.

You may also be interested in:

Consumer perspectives of mental health care

Restrictive practices in mental health care

Introduction

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 experienced by consumers of public sector specialised mental health services and whether there is improvement after receiving mental health care, as measured by a set of clinically-derived indicators.

Data are available for public sector specialised mental health services. A range of other mental health services are 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. This is due to the fact that outcomes data from those services are not currently 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. These 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), which was specified in 2003 to guide states and territories in the implementation of routine consumer outcomes measurement in public mental health services. 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 national findings. More detailed data are available via the National Outcomes and Casemix Collection Web Decision Support Tool and Reports Portal.

What are outcomes and casemix?

The NOCC collects information about a person's clinical mental health status and functioning during their episode of 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 treatment and recovery.

Change in mental health consumers’ clinical outcomes is included in the Key Performance Indicators for Australian Public Mental Health Services. These indicators contribute to measuring the performance and progress of mental health services in Australia. The indicators are also reported on Mental health services in Australia. Refer to the data source section for more information.

In addition to outcomes, data items in the NOCC gather information about other factors that together are known as casemix. In this section, the reported casemix items are the consumer’s mental health legal status and diagnosis.

The collection of measures for the NOCC 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.

Confidence intervals

In this section, measures of statistical uncertainty pertaining to estimates (95% confidence intervals) are shown in all data tables and represented in data visualisations by black bars. If the intervals for comparison groups do not overlap—that is, they do not include the same values in the range—the difference between groups can be generally inferred to be statistically significant.

Consumers

All people 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 during 2019–20, NOCC measures were collected for 202,234 people, which is 43.3% of the 467,062 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 higher among people aged 75–84 (47.1%) and 45–54 (45.9%) and lower among people aged 0–17 (40.9%) and 18–24 (41.6%) (Table NOCC.1).

Demographics

During 2019–20, half of the consumers included in the NOCC were male and half were female (49.5% and 50.4% respectively). There were 71,768 people aged between 25 and 44 years, accounting for 35.5%. There were 19,563 Aboriginal and Torres Strait Islander peoples, accounting for 9.9%.

People living in Major cities made up the majority of consumers included in the NOCC (65.2%) and people living in Remote and very remote areas made up the smallest proportion (3.3%). For socio-economic status, people living in areas of most disadvantage made up the largest proportion (25.0%), while people living in areas of least disadvantage made up the smallest (14.6%) (Figure NOCC.1).

Figure NOCC.1: Demographic characteristics of consumers included in the NOCC, 2019–20

Horizontal bar chart including 95% confidence intervals, showing the per cent of consumers included in the National Outcomes and Casemix Collection (NOCC) by consumer demographics during 2019–20. Refer to NOCC Table 2.

Notes:
1. Black bars representing 95% confidence intervals are displayed. More information is in the Data Source section.
2. Per cent of consumers in the NOCC.

Source data: XLS DownloadConsumer outcomes in mental health care tables 2019–20 (299KB XLSX)

There were 7,744 children aged 10 years and under, accounting for 3.8% of all consumers in the NOCC in 2019–20 (Table NOCC.2). As this is a relatively small number of consumers, the ability to undertake comprehensive reporting and disaggregations is limited. As such, 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).

Service setting

Under the NOCC specifications, clinical and casemix measures may be completed at collection occasions. The 3 collection occasion types are Admission, Review, and Discharge. A person may have multiple collection occasions.

During 2019–20 across all age bands, the majority of collection occasions were in ambulatory
service settings—accounting for 57,239 (88.2%) collection occasions for young people aged 11–17 years, 274,816 (71.6%) for people aged 18–64, and 48,671 (83.1%) for people aged 65 years and older.

Inpatient settings accounted for 7,556 (11.6%) collection occasions for young people aged 11–17 years, and 100,208 (26.1%) for people aged 18–64. Within the inpatient setting, the majority of service programs provided acute care, accounting for 97.5% of inpatient collection occasions for 11–17 year olds, 95.1% for people aged 18–64, and 94.5% for people aged 65 years and older (Tables NOCC.3 and NOCC.4).

There were nearly 8,800 collection occasions in residential services accounting for no more than 2.3% in any age band (Table NOCC.3).

The remainder of this section 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 during care.

Overall during 2019–20, Involuntary status was recorded for higher proportions of discharge collection occasions in acute inpatient care than in ambulatory care—up to 40.9% for inpatient and up to 12.9% for ambulatory, depending on age (Figure NOCC.2).

Figure NOCC.2: Involuntary mental health legal status recorded at discharge, by age band and setting, 2019–20

Interactive horizontal bar chart including 95% confidence intervals, showing the per cent of discharge collection occasions in the National Outcomes and Casemix Collection (NOCC) where mental health legal status was recorded as involuntary, by age band and setting during 2019–20. Acute inpatient collection occasions had higher proportions of involuntary mental health legal status than ambulatory care. Refer to NOCC Table 11.

Notes:
1. Black bars representing 95% confidence intervals are displayed. More information is in the Data Source section.

2. Per cent of discharge collection occasions where mental health legal status was recorded as involuntary.

Mental health-related problems for consumers

Clinician-rated measures and consumer-rated measures provide information about the mental health related symptoms experienced by a consumer and how severe or frequent they are.

The suite of clinician-rated Health of the Nation Outcome Scales (HoNOS) provides information about the mental health-related problems experienced by consumers at admission to a mental health service that are rated by a clinician to have a clinically significant impact on the consumer.

During 2019–20, many consumers in all age bands were facing more than one clinically significant problem. Overall, Emotional problems (adolescents) and Depressed mood (adults) were common along with Other mental health and behavioural problems for adults, indicating the presence of co-morbid problems (Figure NOCC.3).

Across all age bands, Hallucinations more frequently affected consumers in acute inpatient care than ambulatory care.

Figure NOCC.3: Clinically significant problems for consumers at admission, by age band and setting, 2019–20

Interactive horizontal bar graph including 95% confidence intervals showing the per cent of admission collection occasions in the National Outcomes and Casemix Collection (NOCC) where clinically significant problems were recorded using the clinician-rated Health of the Nation Outcome Scales for the appropriate age band, by age band and setting, during 2019–20. Refer to NOCC Tables 8, 9 and 10.

Notes: 
1. Black bars representing 95% confidence intervals are displayed. More information is in the Data Source section. 
2. Per cent of admission collection occasions where clinically significant problems were recorded using the clinician-rated Health of the Nation Outcome Scales for the appropriate age band. 

 

Principal diagnoses for consumers

The principal diagnosis recorded at discharge provides an indication of the treated prevalence of specific mental illnesses in specialised mental health care services. Principal diagnosis is recorded as a code from the International Classification of Diseases and Related Health Problems (ICD-10-AM, 11th Edition).

Mental disorder not otherwise specified was among the most frequent principal diagnoses recorded at discharge during 2019–20 for all age bands and settings (Figure NOCC.4). This suggests heterogeneity in the clinical presentation of mental health diagnoses for consumers.

Of specified mental health-related diagnoses, Depressive episode was among the five most frequent principal diagnoses for all age bands and settings.

Figure NOCC.4: Five most commonly recorded mental health-related principal diagnoses for consumers at discharge, by age band and setting, 2019–20

Interactive horizontal bar graph with 95% confidence intervals showing the per cent of discharge collection occasions in the National Outcomes and Casemix Collection (NOCC) where principal diagnosis was recorded for the 5 most commonly reported principal diagnoses, by age band and setting, during 2019–20. Refer to NOCC Table 12.

Notes: 
1. Black bars representing 95% confidence intervals are displayed. More information is in the Data Source section. 
2. Per cent of discharge collections occasions where principal diagnosis was recorded using the International Classification of Diseases (ICD-10-AM).

Clinical outcomes of care

Information gathered at collection occasions can be organised into consumer groups, which pairs the episode type (completed, ongoing, closed) with the setting in which treatment is provided (acute, inpatient, ambulatory).

Clinical outcomes can only be calculated on a subset of episodes in the NOCC dataset—those with a matched pair of collection occasions where the same clinical measure has been completed twice for a particular consumer during an episode of care.

The number of episodes with matched pairs are low for consumer-rated measures and high for clinician-rated measures. During 2019–20, consumer-rated clinical outcomes could be calculated for 7.2% to 30.4% of episodes, depending on consumer group and age band. Clinician-rated clinical outcomes could be calculated for 73.3% to 93.8% of episodes (Figure NOCC.5).

Caution should be applied in comparing outcomes using clinician-rated with consumer-rated measures because it cannot be assumed they are the same consumers.

Figure NOCC.5: Episodes for which consumer outcomes can be calculated, clinician- and consumer-rated measures, by age band and consumer group, 2019–20

Interactive doughnut chart showing the number of in-scope episodes in the National Outcomes and Casemix Collection (NOCC) with and without matched pairs of collection occasions, by age band and consumer group during 2019–20. The user can choose to display episodes for clinician-rated or consumer-rated measures. Overall, clinician-rated measures show a greater proportion of in-scope episodes with matched pair collection occasions than consumer-rated measures. Refer to NOCC Tables 15­ to 20. 

Notes: 
1. Clinical outcomes can only be calculated for episodes with a matched pair of collection occasions.

2. The percent of in-scope episodes with and without matched pair collection occasions are represented by the coloured rings. The number of episodes with matched pair collection occasions is displayed in the centre of the ring for each age band and consumer group.

Consumer episodes can be classified into clinical outcomes of Improvement, No change, or Deterioration. These classifications rely on significance testing to identify change.

Clinical outcomes during 2019–20 vary depending on consumer group and age band. There are some overall patterns in the data that apply across all age bands (Figure NOCC.6).

  • The highest proportions of Improvement compared to other clinical outcomes were for consumers who accessed completed acute inpatient care. This held for both clinician- and consumer-rated measures using available data. People in this consumer group showed improvement for between 57.9% and 73.4% of episodes.
  • People were more likely to show No change compared to other clinical outcomes if they were in ongoing ambulatory care, for both clinician- and consumer-rated measures. People in this consumer group showed no change for between 46.7% and 68.6% of episodes.
  • Deterioration was the least common outcome compared with other clinical outcomes across all consumer groups. Consumers showed deterioration for between 1.3% and 17.5% of episodes.

Figure NOCC.6: Clinician- and consumer-rated outcomes for consumers, by age band and consumer group, 2019–20

Interactive horizontal bar graph with 95% confidence interval showing per cent completion rates of clinician- and consumer-rated measures for consumers, by age band, episode type, outcome and rating type (clinician-rated or consumer-rated), 2018-19. Clinician ratings and consumer ratings patterns mostly matched, with the exception of Completed inpatient acute for 11-17 year olds. Significant improvement was found in all age bands and rating types for Completed acute inpatient and completed ambulatory episodes with the exception of Completed inpatient acute for 11-17 year olds. Outcomes for ongoing ambulatory care for all age bands and rating type we most likely to be no significant change. Significant deterioration in all categories ranged from 4.1% to 18.1% and was never the most likely outcome in any scenario. Refer to tables NOCC.21, NOCC.22, NOCC.23, NOCC.24, NOCC.25 and NOCC.26

Notes
1. Black bars representing 95% confidence intervals are displayed. More information is in the Data Source section. 
2. Per cent of episodes that contain completed measures for two collection occasions that form a matched pair.

More information can be found in the data source page