Mental health services in Australia

Three jurisdictions, New South Wales, Victoria and Queensland, have implemented the Your Experience of Service (YES) patient experience survey in their public specialised mental health services and supply data for annual national reporting under the YES National Best Endeavours Data Set.

During 2019–20 and 2020–21, Australians and Australian mental health services have been impacted by the COVID-19 pandemic. Victoria did not conduct the YES survey in 2019–20 and the number of surveys received across all states during 2020–21 is lower than 2018–19 before the pandemic.

During 2020–21, a higher proportion of consumers reported a positive experience of service:

• in ambulatory or residential mental health care compared to admitted settings (with the exception of consumers aged 65 and older in Victoria), and/or
• if the person was recorded as receiving care under Voluntary status rather than Involuntary mental health legal status, and/or
• if the person reported they were not of Aboriginal and/or Torres Strait Islander origin and received ambulatory care.

Generally, during 2020–21, higher proportions of consumers who completed the YES survey had a positive experience of service than not. However, consumers rated their experience of service as Poor in 861 surveys in admitted care (about 4.6%) and 383 surveys in ambulatory care (about 3.9%). YES was designed to help Australian mental health services and consumers work together to build better services. The jurisdictions that have implemented the survey advise they have developed local practices to translate the data received from consumers completing YES to drive quality improvement in their services.

Other states and territories are planning to roll out YES in their specialised mental health services. It is anticipated that YES data will become progressively available from additional jurisdictions in the coming years.

The majority of surveys were received from consumers in admitted and ambulatory (non-admitted) care settings (18,581 and 9,730 surveys, respectively) with a smaller number received from consumers in residential care (708). This is consistent with the lower number of consumers accessing residential care services observed in relevant data collections (reported in the section Specialised mental health care facilities of Mental health services in Australia). NSW reported zero surveys received from consumers in residential care during 2020–21 and Queensland did not report residential mental health services prior to 2017–18 (Table CP.1). Note that an individual consumer may have completed the survey more than once in the reporting period.

18,581 YES surveys were received from admitted care consumers during 2020–21. The highest number of responses was from consumers aged 25–34 years (3,658 or 21.8%), followed by consumers aged 35–44 (3,194 or 19.0%) and 45–54 (2,952 or 17.6%). This is consistent with the observed demographic patterns for these data collections. Males returned 49.3% of the surveys, females 49.1% and 275 surveys were received from consumers who identified as ‘Other’ gender (1.6%).

Of ambulatory (non-admitted) care consumers, there were 9,730 returned YES surveys during 2020–21. The highest number of responses was from consumers aged 45–54 years (1,561 or 17.0%), followed by consumers aged 35–44 (1,496 or 16.3%) and less than 18 years (1,466 or 16.0%). More responses were received from female (52.8%) than male (45.3%) consumers and 172 responses were from consumers who identified as ‘Other’ gender (1.9%).

In residential care, Victoria and Queensland received 708 YES survey responses during 2020–21 and New South Wales reported zero. The highest number of responses was from consumers aged 35–44 (161 or 24.1%) followed by 25–34 (153 or 22.9%) and 45–54 (147 or 22.0%). More responses were received from male (50.7%) than female (48.1%) consumers and 8 responses were from consumers who identified as ‘Other’ gender (1.2%) (Figure CP.2).

Aboriginal and/or Torres Strait Islander consumers in admitted care returned 2,007 surveys (12.0%) and non-Indigenous Australians returned 14,651 (88.0%). There were an additional 1,923 surveys returned where Indigenous status of the respondent was not stated or not recorded.

Indigenous Australians in ambulatory care returned 926 surveys (10.2%) and non-Indigenous Australians returned 8,186 (89.8%). An additional 618 surveys were returned where Indigenous status of the respondent was not stated or not recorded.

In residential care Indigenous Australians returned 37 surveys (5.6%) and non-Indigenous Australians returned 626 (94.4%). 45 surveys were returned where Indigenous status of the respondent was not stated or not recorded (Figure CP.2).

Mental health legal status refers to whether or not a person was provided care under the relevant state or territory mental health legislation compulsory treatment provisions. In admitted care, 6,389 (47.2%) returned YES surveys were from consumers with a recorded Involuntary status. There were 1,892 (26.1%) returned surveys in ambulatory care and 156 (28.3%) in residential care from consumers who were also recorded to have Involuntary status (Figure CP.2).

In admitted care during 2020–21, a higher proportion of surveys were from consumers who rated the care they received as ‘Excellent’ than ‘Very Good’, ‘Good’, ‘Fair’ or ‘Poor’ in NSW, Victoria and Queensland (Figure CP.3). In New South Wales, 86.7% of respondents in admitted care rated the care they received as ‘Good’, ‘Very Good’, or ‘Excellent’. 77.0% and 74.1% of respondents gave these ratings in Victoria and Queensland respectively.

In ambulatory care a higher proportion of surveys were from consumers who rated their care as ‘Excellent’ than ‘Very Good’, ‘Good’, ‘Fair’ or ‘Poor’ in New South Wales, Victoria and Queensland. In Queensland, 91.6% of respondents in ambulatory care rated the care they received as ‘Good’, ‘Very Good’, or ‘Excellent’, 90.5% of respondents in New South Wales and 86.9% of respondents in Victoria also gave these ratings. These proportions are higher than those observed for admitted care respondents.

In residential care during 2020–21, a higher proportion of surveys were from consumers who rated their care as ‘Excellent’ than ‘Very Good’, ‘Good’, ‘Fair’ or ‘Poor’. In Queensland, 94.6% of respondents in residential care rated the care they received as ‘Good’, ‘Very Good’, or ‘Excellent’ and 90.9% of respondents gave these ratings in Victoria. These proportions are higher than those observed for admitted care respondents.

In admitted care, 71.3% of respondents in New South Wales reported a positive experience of service, 52.5% in Victoria and 50.7% in Queensland. In ambulatory care, New South Wales had 81.4% of respondents with a positive experience of service, Victoria had 74.6% and Queensland 81.8%. In residential care, 77.5% of Victorian respondents and 78.1% of Queensland respondents had a positive experience of service (Figure CP.4).

During 2020–21 the proportion of surveys in admitted care with a positive experience of service score was higher for respondents 65 years and over (77.0% in New South Wales, 71.4% in Victoria, 60.0% in Queensland) than for other age groups. For surveys in which gender was identified by the consumer, the proportion of respondents with a positive experience of service was higher for males (73.5% in New South Wales, 53.1% in Victoria, 52.6% in Queensland) than females (69.8% in New South Wales, 52.1% in Victoria, 48.1% in Queensland). Consumers who identified as ‘Other’ gender had the lowest proportions of surveys with a positive experience of service, with 54.8% in New South Wales, 41.2% in Victoria and 37.5% in Queensland (Figure CP.4.1).

In ambulatory care during 2020–21 the proportion of surveys with a positive experience of service score was higher for respondents 65 years and over in New South Wales (86.4%) and Queensland (86.1%). In Victoria the proportion of surveys reporting a positive experience of service was higher for respondents aged less than 18 years (77.8%). For surveys in which gender was identified by the consumer, the proportion of surveys with a positive experience of service was higher for females (82.8% in New South Wales, 75.9% in Victoria, 83.6% in Queensland) than males (80.4% in New South Wales, 74.1% in Victoria, 80.7% in Queensland). Consumers who identified as ‘Other’ gender in ambulatory care had the lowest proportions of surveys with a positive experience of service, with 72.0% in NSW, 57.9% in Victoria and 80.4% in Queensland.

The relatively small number of respondents who identified as ‘Other’ gender should be taken into consideration when comparing results to people who identified as male and female.

In admitted care, New South Wales and Victoria had higher proportions of Indigenous respondents who generated a positive experience of service score than the proportions for non-Indigenous Australians. In New South Wales 72.1% of Indigenous respondents and 71.4% of non-Indigenous respondents rated their experience of service positively. In Victoria the proportions were 58.3% of Indigenous respondents and 52.4% of non-Indigenous respondents. In contrast, Queensland had a higher proportion of non-Indigenous respondents (51.1%) who generated a positive experience of service score than the proportion of Indigenous respondents (46.7%)  (Figure CP.4.1).

The proportions of Indigenous respondents who had a positive experience of service were lower than for non-Indigenous respondents in ambulatory care. Queensland respondents had 82.7% of non-Indigenous respondents and 79.9% of Indigenous respondents rating their experience of service positively. In New South Wales and Victoria the proportions were 82.1% and 75.0% of non-Indigenous and 77.3% and 71.4% of Indigenous respondents respectively.

In admitted care during 2020–21, the proportion of surveys with a positive experience of service score was higher for respondents with Voluntary mental health legal status (77.4% in New South Wales, 63.1% in Victoria and 63.4% in Queensland) than Involuntary status (65.6% in New South Wales, 39.9% in Victoria and 44.7% in Queensland) and mental health legal status Not reported  (69.4% in NSW, 54.9% in Victoria and 50.4% in Queensland) (Figure CP.4.1).

In ambulatory care, the proportion of surveys with a positive experience of service score was higher for respondents with Voluntary mental health legal status than Involuntary status and mental health legal status Not reported. For example in Queensland, 87.5% of respondents with Voluntary status, 73.3% with Involuntary status, and 78.7% with status Not reported, rated their experience of service positively. This same pattern was also observed for New South Wales and Victoria.