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).