Mental health services in Australia

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.