Emergency department mental health services

Hospital emergency departments (EDs) play a role in treating mental illness. People seek mental health-related services in EDs for a variety of reasons, often as an initial point of contact or for after-hours care (Morphet et al. 2012).

State and territory health authorities collect a core set of nationally comparable information on most public hospital ED presentations in their jurisdiction, which is compiled annually into the National Non-Admitted Patient Emergency Department Care Database (NNAPEDCD).

Mental health-related ED presentations in this section are defined as presentations to public hospital EDs that have a principal diagnosis of Mental and behavioural disorders. More details about NNAPEDCD and identifying mental health presentations are available in the data source section.

From February 2020, a range of restrictions on travel, business, social interaction and border control have been introduced to prevent and reduce the spread of SARS-CoV-2, the virus that causes COVID-19. This impacted the overall number of presentations to the ED, with a decrease of 1.4% between 2018–19 and 2019–20, compared to a 4.2% increase between 2017–18 and 2018–19 (AIHW 2021a). In contrast, the number of mental health presentations increased in 2019–20 compared with the previous year. Within this section, we have introduced some new data tables to explore the impact of COVID-19 on mental health-related presentations to the ED.

The AIHW’s Suicide and self-harm monitoring website has information relating to self-harm hospitalisations; and there is a section of Mental health services in Australia dedicated to the mental health impacts of COVID-19. Information on all ED presentations are available on the MyHospitals website.

Data downloads:

Mental health services provided in emergency departments 2019–20 tables (816KB XLSX)

Mental health services provided in emergency departments 2019–20 (816KB PDF)

Data source and key concepts related to this section

Data coverage includes the time period 2004–05 to 2019–20. This section was last updated in May 2021.

Key points

  • 310,471 presentations to public Australian EDs were mental health-related in 2019–20, which was 3.8% of all presentations. This is a slightly higher proportion than in 2018–2019 where mental health-related ED presentations comprised 3.6% of all presentations.
  • 77.1% of these mental health-related ED presentations were classified with a triage status of either Urgent (patient should be seen within 30 minutes) or Semi-urgent (within 60 minutes).

  • 68.0% of mental health-related ED presentations were seen on time (based on triage status) compared with 74% of all ED presentations.

  • 55.1% of mental health-related ED presentations had a principal diagnosis of either Mental and behavioural disorders due to psychoactive substance use or Neurotic, stress-related and somatoform disorders.

Service provision

States and territories

In 2019–20, there were 310,471 public hospital ED presentations with a mental health-related principal diagnosis recorded, representing 3.8% of all ED presentations. This proportion is slightly higher than in previous years as a result of the overall number of ED presentations decreasing due to COVID-19 restrictions and the number of mental health presentations increasing from 2018–19 levels. South Australia had the highest mental health-related proportion of ED presentations (5.0%) and New South Wales had the lowest proportion (3.3%) (Figure ED.1).

Nationally, the rate of mental health-related ED presentations was 121.6 per 10,000 population. The Northern Territory had the highest rate (285.5) and Victoria the lowest (97.7).

Figure ED.1: Mental health-related presentations to public emergency department by states and territories, 2019–20

Vertical bar chart showing the proportion of mental health-related emergency department presentations in public hospitals by state or territory in 2019–20. South Australia had the highest per cent of mental health-related ED presentations accounting for 5.0% of all ED presentations, followed by 4.2% in the Northern Territory, 4.1% in Queensland and Western Australia, 4.0% in Tasmania, 3.7% in the Australian Capital Territory, 3.6% in Victoria and 3.3% in New South Wales. The national per cent of mental health-related ED presentations was 3.8%. Refer to Table ED.1.

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Source dataMental health services provided in emergency departments 2019–20 tables (816KB XLSX)

Patient characteristics

Patient demographics

In 2019–20, women aged 18–24 had the highest rate of mental health-related ED presentations (226.8 per 10,000 population) followed by men aged 35–44 years (202.0 per 10,000 population). The rate of mental health-related ED presentations was higher for males than for females (127.9 and 115.4 per 10,000 population respectively) (Figure ED.2).

Overall, those aged 18–24 years had the highest rate of mental health-related presentations (209.3 per 10,000 population); by contrast, people aged 85 years and older had the highest rate for all ED presentations (7850.9 per 10,000 population). This difference is likely to be influenced by the typical age of onset of many mental disorders (WHO 2019).

Aboriginal and Torres Strait Islander people, who represent about 3.3% of the Australian population (ABS 2018), accounted for 12.0% of mental health-related ED presentations, compared with 7.5% of all ED presentations. The rate of mental health-related ED presentations for Indigenous Australians was more than 4 times that of non-Indigenous Australians (480.9 and 107.9 per 10,000 population respectively).

Figure ED.2: Mental health-related emergency department presentations, by patient demographic characteristics, 2019–20

Horizontal bar chart showing the rate (per 10,000 population specific) of mental health-related emergency department presentations in public hospitals by patient demographics in 2019–20. Patients 18–24 years had the highest rate (per 10,000 age specific population) of mental health-related ED presentations at 209.3, followed by 85 years and over (182.0), 35–44 (171.2), 25–34 (168.5), 12–17 (147.7), 45–54 (141.4), 75–84 (95.1), 55–64 (81.9), 65–74 (62.3), 5–11 (18.0) and 0–4 (10.1). Males presented at a higher rate than females (127.9 and 115.4 respectively). Indigenous Australians presented at a higher rate than non-Indigenous Australians (480.9 and 107.9 respectively). The rate increased with increasing remoteness area; 105.6 per 10,000 in major cities, 139.4 in inner regional areas, 141.1 in outer regional areas and 225.4 in remote and very remote areas. Mental health-related presentations decreased with increasing socioeconomic quintile with 147.5 presentations per 10,000 for most disadvantaged quintile, followed by 136.5, 116.1, 102.0 and 81.4 for the least disadvantaged quintile. Refer to Table ED.8.

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Source data: Mental health services provided in emergency departments 2019–20 tables (816KB XLSX)

Patient area of usual residence

Detailed data for mental health-related presentations by local area — Primary Health Network (PHN) and Australian Statistical Geography Standard Statistical Area Level 3 (SA3) — show variation in the number and rate of presentations by geographical area across Australia. In 2019–20, the highest rate of mental health-related ED presentations was in the Barkly SA3 region (770.0 per 10,000 population) in the Northern Territory, followed by Alice Springs (541.5) in the Northern Territory and Young – Yass (534.1) in New South Wales.

Further information on NNAPEDCD coverage is available in the data source section. The observed variability in ED presentation rates between geographical areas may be due to a range of factors such as the proportion of the population in an area with a diagnosable mental illness who present to the emergency department, and the accessibility of EDs to people in remote and rural areas. Other factors include the availability of community-based services, and variability in approaches to planning and delivering mental health support services across and within states and territories.

Principal diagnosis

Data on mental health-related presentations by principal diagnosis is based on the broad categories within the Mental and behavioural disorders chapter of the ICD‑10‑AM (Chapter 5). More details on diagnosis codes can be found in the data source section.

More than three quarters (76.6%) of mental health-related ED presentations in Australian public EDs were classified by 4 principal diagnosis groupings in 2019–20 (Figure ED.3 and ED.3.1):

  • Mental and behavioural disorders due to psychoactive substance use (F10–F19); (28.1%)
  • Neurotic, stress-related and somatoform disorders (F40–F49); (27.0%)
  • Schizophrenia, schizotypal and delusional disorders (F20–F29); (11.9%)
  • Mood (affective) disorders (F30–F39); (9.7%).

Figure ED.3: Mental health-related presentations to emergency departments, by principal diagnosis, 2019–20

Figure ED.3, horizontal bar chart showing mental health-related emergency department presentations in public hospitals by principal diagnosis in 2019-20. The majority of mental health-related ED presentations were for mental and behavioural disorders due to psychoactive substance use (28.1%), followed by neurotic, stress-related and somatoform disorders (27.0%). Schizophrenia, schizotypal and delusional disorders made up 11.9% of presentations; Mood (affective) disorders 9.7%; mental disorder, not otherwise specified 9.3%; organic, including symptomatic, mental disorders 7.8%; behavioural and emotional disorders with onset usually occurring in childhood and adolescence 2.7%; disorders of adult personality and behaviour 2.1%; behavioural syndromes associated with physiological disturbances and physical factors 1.3%; and disorders of psychological development 0.2%. Refer to Table ED.13.
Figure ED.3.1, horizontal bar chart showing mental health-related emergency department, by states and territories and principal diagnosis. New South Wales, Victoria, Tasmania and Northern Territory highest ED mental health related presentations were for mental and behavioural disorders due to psychoactive substance use (27.6%, 28.9%, 24.1% and 53.6% respectively). Queensland, Western Australia, South Australia and Australian Capital Territory highest ED mental health related presentations were for neurotic, stress-related and somatoform disorders (32.9%, 34.3%, 30.2% and 23.2% respectively).

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Key
F00–09: Organic, including symptomatic, mental disorders
F10–19: Mental and behavioural disorders due to psychoactive substance use
F20–29: Schizophrenia, schizotypal and delusional disorders
F30–39: Mood (affective) disorders
F40–49: Neurotic, stress-related and somatoform disorders
F50–59: Behavioural syndromes associated with physiological disturbances and physical factors
F60–69: Disorders of adult personality and behaviour
F70–79: Mental retardation
F80–89: Disorders of psychological development
F90–98: Behavioural and emotional disorders with onset usually occurring in childhood and adolescence
F99: Mental disorder, not otherwise specified

Source data: Mental health services provided in emergency departments 2019–20 tables (816KB XLSX)

Arrival mode

The arrival mode records the mode of transport by which the person arrives at the emergency department. Half of mental health-related ED presentations in 2019–20 arrived via ambulance, air ambulance or helicopter rescue service (50.5%). This was almost double the proportion of all ED presentations that arrived by ambulance, air ambulance or helicopter rescue (26.9%). A smaller proportion of mental health-related ED presentations arrived by police or correctional service vehicles (6.0%); however, this was 10 times higher than the proportion of all ED presentations with this arrival mode (0.6%).

Triage category

When presenting to an emergency department, patients are assessed to determine their need for care (i.e. triaged) and an appropriate triage category is assigned to reflect priority for care. For example, patients triaged as the Emergency category require care within 10 minutes (ACEM 2013). However, due to a range of factors, care may or may not be received within the designated time-frames. Mental health-related ED presentations in 2019–20 had a higher proportion of presentations classified as Urgent (50.3%) than the proportion for all ED presentations (38.2%) (Figure ED.4, ED.4.1 and ED.4.2).

Figure ED.4: Mental health-related presentations to public emergency departments, by triage category, 2019–20

Figure ED.4, vertical bar chart showing mental health-related ED presentations in public hospitals by triage category. In 2019–20, 50.3% of mental health-related ED presentations were Urgent, 26.7% Semi-urgent, 16.3% Emergency, 5.4% Non-urgent, and 1.3% Resuscitation. Refer to Table ED.6.
Figure ED.4.1, horizontal bar chart showing mental health-related ED presentations by triage category and states and territories in 2019–20. The highest presentations for Emergency were in Northern Territory (23.9%), Non-urgent were in New South Wales (9.7%), Resuscitation in South Australia (2.0%), Semi-urgent in Tasmania (35.0%) and Urgent in Australian Capital Territory (59.8%).
Figure ED.4.2, line chart showing mental health-related ED presentations by states and territories or triage category from 2004–05 to 2019–20. Urgent triage had a higher number of ED presentations, followed by Semi-urgent, Emergency, Non-urgent and Resuscitation across the whole time period.
 

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Source data: Mental health services provided in emergency departments 2019–20 tables (816KB XLSX)

Service characteristics

Waiting time

The median waiting time to be seen for mental health-related ED presentations was 18 minutes, with 68.0% of presentations seen on time according to their assessed triage status, compared to 74% of all ED presentations (AIHW 2021a). For mental health-related ED presentations, the Australian Capital Territory had the lowest proportion of presentations seen on time (41.9%) and New South Wales had the highest (76.5%). New South Wales also had the lowest median waiting time (14 minutes), and the Australian Capital Territory had the highest (47 minutes) (Figure ED.6).

Episode end status

The most frequently recorded mode for ending a mental health-related ED presentation was for the episode end status to have been completed with the patient departing without being admitted or referred to another hospital (58.1%). Just over one-third (34.0%) of presentations resulted in the patient being admitted to the hospital where the emergency service was provided, with a further 3.7% referred to another hospital for admission. This is higher than the result for all ED presentations in 2019–20, with 32.5% being admitted to hospital, either where the service was provided or referred to another hospital (AIHW 2021a). (Figure ED.5)

Figure ED.5: Mental health-related emergency department presentations, by episode end status and states and territories, 2019–20

Figure ED.5, horizontal bar chart showing mental health-related ED presentations by episode end status and states and territories. The highest number of presentations for episode end status, Admitted to this hospital was in Northern Territory (56.7%), Departed without being admitted or referred to another hospital was in New South Wales (61.4%), Did not wait to be attended by a health care professional was in Tasmania (2.9%), Left at own risk was in New South Wales (4.5%), Referred to another hospital for admission was in Western Australia (5.8%).

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Source data: Mental health services provided in emergency departments 2019–20 tables (816KB XLSX)

Length of stay

The median length of stay for all mental health-related ED presentations in 2019–20 was 3 hours and 41 minutes (Figure ED.6). For mental health-related ED presentations ending in admission, the median length of stay in EDs was 5 hours and 2 minutes whereas the median length of stay for presentations not ending in admission was 3 hours and 11 minutes. Nationally, 90% of mental health-related ED presentations were completed within 13 hours and 22 minutes, which is longer than the same measure for all ED presentations (up to 7 hours 30 minutes) (AIHW 2021a) (Figure ED.6.1, 6.2 and 6.3).

Figure ED.6: Mental health-related emergency department presentation by service characteristics, by states and territories, 2019–20

Figure ED.6, chart presenting mental health-related ED presentations by wait time (minutes) and length of stay (hours) for the median and 90th percentile patient by State and Territory, 2019–20. For wait times, fifty per cent of patients were seen within 47 minutes in the Australian Capital Territory, 34 minutes in Tasmania, 27 minutes in Western Australia, 24 minutes in South Australia, 19 minutes in Victoria, 18 minutes in the Northern Territory, 16 minutes in Queensland and 14 minutes in New South Wales. Across Australia 50% of patients were seen within 18 minutes. 90% of patients were seen within 184 minutes in the Australian Capital Territory, 150 minutes in Tasmania, 143 minutes in South Australia, 133 minutes in Western Australia, 103 minutes in Victoria, 94 minutes in the Northern Territory, 80 minutes in New South Wales and 73 minutes in Queensland. Across Australia 90% of patients were seen within 101 minutes. Refer to Table ED.12 and ED.7.
For length of stay, fifty per cent of patients who presented to ED with a mental and behavioural diagnosis stayed in the ED for up to 4 hours 58 minutes in Tasmania, 4 hours 43 minutes in the Australian Capital Territory, 4 hours 36 minutes in South Australia, 3 hours 58 minutes in Victoria, 3 hours 41 minutes in Western Australia, 3 hours 27 minutes in New South Wales, 3 hours 23 minutes in the Northern Territory and 3 hours 19 minutes in Queensland. Across Australia 50% of patients stayed up to 3 hours 41 minutes in the ED. Ninety per cent of patients who presented to ED with a mental and behavioural diagnosis stayed up to 22 hours 56 minutes in Tasmania, 20 hours 2 minutes in South Australia, 15 hours 40 minutes in the Australian Capital Territory, 15 hours 3 minutes in Victoria, 14 hours 36 minutes in Western Australia, 12 hours 29 minutes in the Northern Territory, 11 hours 53 minutes in New South Wales, and 9 hours 53 minutes in Queensland. Across Australia 90% of patients stayed up to 13 hours 22 minutes. Refer to Table ED.17.
Figure ED.6.1, map format of figure ED.6.
Figure ED.6.2, chart presenting mental health-related ED presentations by day of week and time of presentation by state and territories, 2019–20. The highest proportion (25.8%) of ED presentations in New South Wales took place on Tuesday from 12pm to 3:49pm, Victoria on Tuesday from 4pm to 7:59pm (25.5%), Queensland on Thursday from 12pm to 3:49pm (25.9%), Western Australia on Monday from 4pm to 7:59pm (25.3%), South Australia on Tuesday from 12pm to 3:49pm (26.4%), Tasmania on Friday from 12 to 3:49pm (29.0%), Australian Capital Territory on Monday from 12pm to 3:49pm (30.3%) and Northern Territory on Friday from 8pm to 11:59pm (27.1%).
Figure ED.6.3, chart presenting mental health-related ED presentations by age group and week of presentation day of week and time of presentation by state and territories, 2019–20. In Australia from 1 July 2019 to 30 June 2020, the highest ED presentations were for patients aged 25–44, followed by 12–24, 45–64, 65 and over and 0–11 years.

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