Data source and key concepts

Involuntary care data quality information

Each state or territory has legislation relating to the treatment of people with mental illness. A summary of the criteria for involuntary treatment for each Australian and New Zealand Mental Health Act is available from the Royal Australian and New Zealand College of Psychiatrists website (RANZCP 2017a).

Information on mental health legal status data are collected by state and territory governments and supplied to the AIHW for national reporting. Mental health legal status is recorded for service contacts, episodes, hospital separations, or admitted hospital patient days, depending on the service setting (data source) as specified below.

National Community Mental Health Care Database

Mental health legal status information is collected for the National Community Mental Health Care Database (NCMHCD)—which has coverage from 2000—and is collected for each service contact. Mental health legal status is recorded as involuntary if the person was given legislated involuntary treatment at the time of the service contact. It does not collect how much of their care involved involuntary treatment.

Data for the NCMHCD are supplied under the Community Mental Health Care National Minimum Data Set (CMHC NMDS) agreement. Data Quality Statements 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 Community mental health care NMDS 2019–20: National Community Care Database, 2021; Quality Statement. Previous years' data quality statements are also accessible via METeOR.

National Residential Mental Health Care Database

Mental health legal status has been collected for the National Residential Mental Health Care Database (NRMHCD) since 2004 and is collected for each episode of care. Mental health legal status is recorded as involuntary if the resident was given legislated involuntary treatment at any time during an episode of care. It does not collect how much of their care involved involuntary treatment.

Data for the NRMHCD are supplied under the Residential Mental Health Care National Minimum Data Set (RMHC NMDS) agreement. Data Quality Statements are published annually on METeOR. Statements provide information on the institutional environment, timeliness, accessibility, interpretability, relevance, accuracy and coherence. Refer to the Residential mental health care NMDS 2019–20: National Residential Mental Health Care Database, 2021; Quality Statement. Previous years' data quality statements are also accessible in METeOR.

National indicator set: Involuntary hospital care

Under the Fifth National Mental Health and Suicide Prevention Plan (2017–2022) the proportion of involuntary admissions to admitted patient specialised mental health services was introduced as national Performance Indicator (PI) 23: Rate of involuntary hospital treatment.

To facilitate a better understanding of the amount of involuntary treatment occurring in mental health hospitals, two involuntary treatment indicators under PI 23 were developed.

  • Involuntary hospital treatment measures the proportion of public­­ mental health hospital separations in which a person was given involuntary care under existing legislation at any time during their treatment (proportion of separations with a mental health legal status of involuntary). Distinction between acute and non-acute units is possible. It does not measure how much of the care received was involuntary.
  • Involuntary patient days measures the proportion of public mental health admitted patient days in which a person received care on an involuntary basis (NMHC 2020). Distinction between acute and non-acute units is possible.

These indicators were developed by pertinent committees of the day under the former Australian Health Ministers' Advisory Council (AHMAC) structure. The indicators were developed and established by the former Safety and Quality Partnership Standing Committee (SQPSC) and former Mental Health Information Strategy Standing Committee (MHISSC), with MHISSC’s former National Mental Health Performance Subcommittee (NMHPSC) having undertaken the technical development of the indicator specifications.

The two involuntary indicators have been included in the Key Performance Indicators for Australian Public Mental Health Services (Jurisdictional level) indicator set since 2021.

These indicators are published online annually on Mental health services in Australia, see Key Performance Indicators for Australian Public Mental Health Services.

For more detail on the indicators, refer to KPIs for Australian Public Mental Health Services: PI 17aJ – Involuntary hospital treatment, 2021 and KPIs for Australian Public Mental Health Services: PI 17bJ – Involuntary patient days, 2021.

Seclusion and restraint data quality information

The Royal Australian and New Zealand College of Psychiatrists notes that “…seclusion and restraint should only be used in accordance with approved protocols and best practice by properly trained professional staff in an appropriate environment…” (RANZCP 2021). Summary criteria for definitions, when and where seclusion and restraint may be used, and the authorisation of seclusion and restraint under the various Australian and New Zealand mental health legislation are available from the RANZCP website (RANZCP 2017b, 2017c).

Working towards eliminating the use of seclusion is a policy priority in Australian mental health care and has been supported by changes to legislation, policy and clinical practice. Reduction efforts were supported by the former AHMAC, through key mental health committees of the time, the SQPSC and MHISSC (Allan et al. 2017, SQPSC 2017). The National Towards Eliminating Restrictive Practices (TERP) Forum—the 12th most recently held in November 2018—is a collaborative initiative supported by all governments to share results and best practice and support broader change to remove seclusion and restraint practices in mental health. The National Mental Health Commission’s Statement on seclusion and restraint in mental health (NMHC 2015) called for leadership across a range of priorities including “…national monitoring and reporting on seclusion and restraint across jurisdictions and services”.

National Seclusion and Restraint Database

Seclusion and restraint data reported in this section are from the National Seclusion and Restraint Database (NSRD). Data are supplied by each Australian state and territory, under the Mental health Seclusion and Restraint National Best Endeavours Data Set (SECREST NBEDS) agreement. Historical data are available from 2008–09 for seclusion and 2015–16 for restraint. Data on the use of seclusion and restraint by hospital were reported for the first time in December 2018. Public reporting enables services to review their individual results against other states and territories, national rates and like services, thereby supporting service reform and quality improvement agendas.

Although seclusion and restraint may occur across a range of mental health service settings, the scope of the NSRD and SECREST NBEDS is acute specialised mental health hospital units—this service setting has been the focus of many associated quality improvement initiatives, including data collection and reporting developments.

Data Quality Statements are published annually on METeOR. Statements provide information on the institutional environment, timeliness, accessibility, interpretability, relevance, accuracy and coherence. Refer to the National Seclusion and Restraint Database; Mental health seclusion and restraint NBEDS 2015-, 2021; Quality Statement. Previous years' data quality statements are also accessible in METeOR.

Interpretation of seclusion data

States and territories have different policy, regulatory and legislative requirements regarding seclusion practices. Direct data comparisons between jurisdictions should be made with caution.

High numbers of seclusion events for a few individuals can have a disproportional effect on the rate of seclusion reported. For example, the increases in the state-wide Tasmanian seclusion rate between 2012–13 and 2013–14 for the ACT from 2017–18 to 2019–20, for SA in 2017–18 and 2018–19, and for WA in 2018–19, are due to a small number of clients having a higher number of seclusion events.

Data on the frequency and duration of seclusion events were collected for the first time for 2013–14. The ACT was unable to provide the number of admitted patient care episodes prior to 2018–19; as such, the national results for the frequency of seclusion during episodes of care up to 2017–18 exclude the ACT and include the ACT from 2018–19 onwards. Duration data for SA are excluded from the national average duration from 2013–14 to 2017–18, due to issues with the data recording methodology used in SA. SA has been included in the national average duration for 2018–19 onwards.

Interpretation of restraint data

States and territories have different policy, regulatory and legislative requirements regarding restraint practices and different systems in place for collecting data. There are also differences in the types of restraint that are reported. Unspecified restraint was reported from 2015–16 to represent combined restraint or when data providers were unable to disaggregate mechanical and physical restraint events.

The first release of data occurred in May 2017 and it is expected that data quality will continue to improve over time as information systems are refined and definitions are better understood by the sector. As such, caution should be exercised when interpreting this data and comparing results between states and territories and over time.

High numbers of restraint events for a few individuals can have a disproportional effect on the rate of restraint reported.

Target population

The data presented is the target population of the service unit; that is, the age group that the service is intended to serve, not the age of individual patients. For the 2013–14 reporting period improvements were made to the reporting of target population categories. The Mixed service category was removed as an option for reporting. Data for the Mixed category most commonly involved a combination of General, Child and adolescent and/or Older person services. Time series data by target population should therefore be approached with caution. Seclusion and restraint data for a small number of Youth hospital beds reported by Victoria, Western Australia, and the Northern Territory are also included in the General category.

Forensic services provide services primarily for people whose health condition has led them to commit, or be suspected of committing, a criminal offence or make it likely that they will reoffend without adequate treatment or containment. The average duration of a seclusion event is reported excluding Forensic services, as forensic seclusion events are typically of longer duration, and substantially skew the overall duration average.

Remoteness

Due to the small number of hospitals located in Outer regional and Remote geographical areas, for the purpose of analysis these categories have been combined. There were no hospitals in the seclusion or restraint dataset located in Very remote areas.

National indicator set: Rate of seclusion and restraint

The Key Performance Indicators for Australian Public Mental Health Services (KPIs) were developed for the purpose of improving public mental health services. In keeping with the national priority to reduce the use of seclusion and restraint, KPI 15 Seclusion rate and KPI 16 Restraint rate draw on the National Seclusion and Restraint Database for reporting. These indicators contribute to measuring the performance and progress of mental health services in Australia.

The original KPI set was released in 2005, with the aim to measure and improve the performance of public mental health services. The indicators have been revised over time through the former National Mental Health Performance Subcommittee (NMHPSC) of the former Mental Health Information Strategy Standing Committee (MHISSC), to drive and incorporate improvements made to data sources, jurisdictional implementation and results of nation-wide projects (NMHPSC 2013).

Rate of seclusion was added to the national KPI set in 2011 (NMHPSC 2013) and Rate of restraint was added in 2018. Both indicators fall under the priority area of safety in mental health services, in which reducing the use of seclusion and restraint is considered a key aspect (CHC 2017; National Mental Health Working Group 2005 as cited in NMHPSC 2013).

Key concept

Description

Admitted patient mental health care

Admitted patient mental health care refers to a specialised mental health service in a psychiatric hospital or specialised mental health unit in an acute hospital that provides overnight care (METeOR ID 409067).

There are two types of admitted patient care. 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. Other or non‑acute care refers to all other admitted patient programs, including rehabilitation and extended care services (METeOR ID 288889).

Community mental health care

Community mental health care refers to government‑funded and operated specialised mental health care provided by community mental health care services and hospital‑based ambulatory care services, such as outpatient and day clinics.

Episodes of residential care

Episodes of residential care are defined as a period of care between the start of residential care (either through the formal start of the residential stay or the start of a new reference period (that is, 1 July)) and the end of residential care (either through the formal end of residential care, commencement of leave intended to be greater than 7 days, or the end of the reference period (that is, 30 June)). An individual can have one or more episodes of care during the reference period.

Hospitalisation

Hospitalisation is the term used to refer to the episode of admitted patient care, which can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay beginning or ending in a change of type of care (for example, from acute care to rehabilitation).

Mental health legal status

Mental health legal status is defined as whether a person is treated on an involuntary basis under the relevant state or territory mental health legislation, at any time during an episode of admitted patient care, an episode of residential care or treatment of a patient/client by a community based service during a reporting period (METeOR Identifier 722675).

Patient days

Patient day means the occupancy of a hospital bed (or chair in the case of some same day patients) by an admitted patient for all or part of a day. The length of stay for an overnight patient is calculated by subtracting the date the patient was admitted from the date of separation and deducting days the patient was on leave. A same-day patient is allocated a length of stay of 1 day. Patient day statistics can be used to provide information on hospital activity that, unlike separation statistics, account for differences in length of stay. The patient day data presented in this report include days within hospital stays that occurred before 1 July provided that the separation from hospital occurred during the relevant reporting period (that is, the financial year period). This has little or no impact in private and public acute hospitals, where separations are relatively brief, throughput is relatively high and the patient days that occurred in the previous year are expected to be approximately balanced by the patient days not included in the counts because they are associated with patients yet to separate from the hospital and therefore yet to be reported. However, some public psychiatric hospitals provide very long stays for a small number of patients and, as a result, would have comparatively large numbers of patient days recorded that occurred before the relevant reporting period and may not be balanced by patient days associated with patients yet to separate from the hospital.

Residential mental health care

Residential mental health care refers to residential care provided by residential mental health services. A residential mental health service is a specialised mental health service that:

  • employs mental health trained staff on‑site
  • provides rehabilitation, treatment or extended care to residents for whom the care is intended to be on an overnight basis and in a domestic‑like environment
  • encourages the residents to take responsibility for their daily living activities.

These services include those that employ mental health trained staff on-site 24 hours per day and other services with less intensive staffing. However, all these services employ on‑site mental health trained staff for some part of the day.

Restraint

Restraint is defined as the restriction of an individual's freedom of movement by physical or mechanical means.

Mechanical restraint

The application of devices (including belts, harnesses, manacles, sheets and straps) on a person's body to restrict his or her movement. This is to prevent the person from harming themselves or endangering others or to ensure the provision of essential medical treatment. It does not include the use of furniture (including beds with cot sides and chairs with tables fitted on their arms) that restricts the person's capacity to get off the furniture except where the devices are used solely for the purpose of restraining a person's freedom of movement.

The use of a medical or surgical appliance for the proper treatment of physical disorder or injury is not considered mechanical restraint.

Physical restraint

The application by health care staff of ‘hands-on’ immobilisation or the physical restriction of a person to prevent the person from harming themselves or endangering others or to ensure the provision of essential medical treatment.

Seclusion

Seclusion is defined as the confinement of a person at any time of the day or night alone in a room or area from which free exit is prevented.

Key elements include that:

  1. The person is alone.
  2. The seclusion applies at any time of the day or night.
  3. Duration is not relevant in determining what is or is not seclusion.
  4. The person cannot leave of their own accord.

The intended purpose of the confinement is not relevant in determining what is or is not seclusion. Seclusion applies even if the person agrees or requests the confinement.

The awareness of the person that they are confined alone and denied exit is not relevant in determining what is or is not seclusion. The structure and dimensions of the area to which the consumer is confined is not relevant in determining what is or is not seclusion. The area may be an open area, for example, a courtyard. Seclusion does not include confinement of people to High Dependency sections of gazetted mental health units, unless it meets the definition.

More information can be found in the data source section about jurisdictional consistency with this definition.

Service contacts

Service contacts are defined as the provision of a clinically significant service by a specialised mental health service provider for patients/clients, other than those admitted to psychiatric hospitals or designated psychiatric units in acute care hospitals and residents in 24‑hour staffed specialised residential mental health services, where the nature of the service would normally warrant a dated entry in the clinical record of the patient/client in question. Any patient can have one or more service contacts over the relevant financial year period. Service contacts are not restricted to face‑to‑face communication and can include telephone, video link or other forms of direct communication. Service contacts can also be either with the patient or with a third party, such as a carer or family member, other professional or mental health worker, or other service provider.

Target population

Some specialised mental health services data are categorised using 5 target population groups (see METeOR ID 682403):

  • Child and adolescent services focus on those aged under 18 years.
  • Older person services focus on those aged 65 years and over.
  • Forensic health services provide services primarily for people whose health condition has led them to commit, or be suspected of, a criminal offence or make it likely that they will reoffend without adequate treatment or containment.
  • General services provide services to the adult population, aged 18 to 64, however, these services may also provide assistance to children, adolescents or older people.
  • Youth services target children and young people generally aged 16-24 years.

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.