Patient characteristics

Patient demographics

In 2018–19, there was a higher proportion of mental health-related presentations among patients aged 18–54 (70.6%) compared with all emergency department presentations (44.6%). By contrast, there was a lower proportion of mental health-related presentations among patients aged less than 18 (10.3%) compared with all emergency department presentations (24.2%). Of all patient age groups, those aged 25–34 represented the highest proportion of both mental health-related (20.7%) and all (13.6%) ED presentations. The highest population rate of all ED presentations occurred among patients aged 85 years and over (8,033.5 per 10,000 population), whereas the highest rate of mental health-related presentations occurred among patients aged 18–24 (205.1 per 10,000 population). This is likely to be influenced by the typical age of onset of many mental disorders (WHO 2019).

Males had a higher number of mental-health related ED presentations than females in 2018–19 (representing 52.3% and 47.7% respectively), but were more equally represented in all ED presentations (49.9% and 50.1% respectively). The population-rate of mental health-related ED presentations for males was higher than the rate for females (127.1 and 113.9 per 10,000 population respectively).

Aboriginal and Torres Strait Islander people, who represent about 3.3% of the Australian population (ABS 2018), accounted for 11.2% of mental health-related ED presentations, compared with 7.1% 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 (449.4 and 108.0 per 10,000 population respectively).

People living in areas classified as having the lowest socioeconomic status (SEIFA Quintile 1) had the highest population-rate of mental health-related ED presentations (149.6 per 10,000 population), with the rate decreasing with increasing socioeconomic status, to 79.8 per 10,000 population for people in the least disadvantaged area (Quintile 5) (Figure ED.2).

People living in Major cities accounted for almost two-thirds (64.7%) of mental health-related ED presentations, and those in Remote and Very remote areas accounted for 3.4% of presentations in 2018–19. The rate per 10,000 population of mental health-related ED presentations for patients living in Major cities was the lowest (104.1) while that for patients in Remote and Very remote areas was the highest (202.6).

Detailed ED data for mental health-related presentations by Primary Health Network (PHN) show variation in the number and rate of presentations within PHN groups at the Statistical Area 3 (SA3) region level. In 2018–19, the highest mental health-related ED presentation rate occurred among patients living in the Tumut-Tumbarumba SA3 region (1,520.8 per 10,000 population) in New South Wales, followed by Barkly (585.4) and Alice Springs (540.5) in the Northern Territory. Note that some areas do not have EDs in scope for provision to the National Non-Admitted Patient Emergency Department Care Database (NNAPEDCD). Further information on NNAPEDCD coverage is available in the data source section. The observed variability in emergency department presentation rates between geographical areas may be due to a range of factors including the proportion of the population in an area with a diagnosable mental illness who present to the emergency department, availability of community-based services and variability in approaches to planning and delivering mental health support services across and within states and territories.

Figure ED.2: Mental health-related emergency department presentations, by patient demographic characteristics, 2018-19

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 2018–19. Patients 18–24 years had the highest rate (per 10,000 age specific population) of mental health-related ED presentations at 205.1, followed by 85 years and over (178.6), 35–44 (175.0), 25–34 (166.3), 12–17 (148.3), 45–54 (137.9), 75–84 (94.5), 55–64 (81.8), 65–74 (60.5), 5–11 (17.3) and 0–4 (6.5). Males presented at a higher rate than females (127.1 and 113.9 respectively). Indigenous Australians  presented at a higher rate than non-Indigenous Australians (449.4 and 108.0 respectively). The rate increased with increasing remoteness area; 104.1 per 10,000 in major cities, 140.5 in inner regional areas, 144.3 in outer regional areas and 202.6 in remote and very remote areas. Mental health related presentations decreased with increasing socioeconomic quintile with 149.6  presentations per 10,000 for most disadvantaged quintile, followed by 135.9, 114.7, 98.7 and 79.8 for the least disadvantaged quintile. Refer to Table ED.7. 

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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.

More than three quarters (76.0%) of mental health-related ED presentations in Australian EDs were classified by 4 principal diagnosis groupings in 2018–19 (Figure ED.3):

  • Mental and behavioural disorders due to psychoactive substance use (F10–F19); (28.4%)
  • Neurotic, stress-related and somatoform disorders (F40–F49); (25.4%)
  • Schizophrenia, schizotypal and delusional disorders (F20–F29); (11.5%)
  • Mood (affective) disorders (F30–F39); (10.7%)

Figure ED.3: Per cent of mental-health related emergency department presentations by principal diagnosis, 2018-19

Horizontal bar chart showing mental health-related emergency department presentations in public hospitals by principal diagnosis in 2018–19. The majority of mental health-related ED presentations were for mental and behavioural disorders due to psychoactive substance use (28.4%), followed by neurotic, stress-related and somatoform disorders (25.4%). Schizophrenia, schizotypal and delusional disorders made up 11.5% of presentations; Mood (affective) disorders 10.7%; mental disorder, not otherwise specified 9.7%; organic, including symptomatic, mental disorders 8.1%; 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 1.1%; and disorders of psychological development 0.2%. Refer to Table ED.10

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Service characteristics

Arrival Mode

The arrival mode records the transport mode of arrival to the emergency department. Almost half of mental health-related ED presentations in 2018–19 arrived via ambulance, air ambulance or helicopter rescue service (48.1%). This was almost double the proportion of all ED presentations that arrived by ambulance, air ambulance or helicopter rescue (25.9%). A smaller proportion of mental-health related ED presentations arrived by police or correctional service vehicles (6.4%); however, this was almost 10 times higher than the proportion of all ED presentations with this arrival mode (0.7%).

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. The majority (77.3%) of mental health-related ED presentations in 2018–19 were classified as either Urgent or Semi-urgent, and 15.3% were classified as Emergency. These figures are similar to all ED presentations (77.2% and 13.6% respectively) (AIHW 2020a) (Figure ED.4).

Figured ED.4: Per cent of mental health-related emergency department presentations by principal diagnosis, 2018-19

Vertical bar chart showing mental health-related ED presentations in public hospitals by triage category. In 2018–19, 49.4% of mental health-related ED presentations were urgent, 27.9% semi-urgent, 15.3% emergency, 6.3% non-urgent, and 1.0% resuscitation. Refer to Table ED.5.  

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Type of visit

The most common type of visit among mental health-related ED presentations in
2018–19 was an emergency presentation (96.4%). A small portion of presentations was for a planned return visit (3.5%). A similar pattern was observed for all ED presentations with emergency presentation and planned return visit accounting for 98.3% and 1.5% respectively (AIHW 2020a).

Waiting time

The median waiting time for mental health-related ED presentations was 20 minutes, with approximately two thirds (65.6%) of presentations seen on time according to their assessed triage status, compared to 71% for all ED presentations (AIHW 2020a). For mental health-related ED presentations, the Australian Capital Territory had the lowest proportion of presentations seen on time (38.4%) and New South Wales had the highest (75.0%). New South Wales also had the lowest median waiting time (15 minutes), and the Australian Capital Territory had the highest (55 minutes) (Figure ED.5).

Figure ED.5: Mental health-related emergency department presentation wait times, by state and territories, 2018-19

Chart presenting mental health-related ED presentation wait time (minutes) for 50th percentile (median) and 90th percentile of patients by State and Territory, 2018–19. Fifty per cent of patients were seen within 55 minutes in the Australian Capital Territory, 34 minutes in Tasmania, 31 minutes in Western Australia and South Australia, 22 minutes in the Northern Territory, 21 minutes in Queensland, 18 minutes in Victoria and 15 minutes in New South Wales. Across Australia 50% of patients were seen within 20 minutes. 90% of patients were seen within 181 minutes in the Australian Capital Territory, 167 minutes in South Australia, 157 minutes in Tasmania, 142 minutes in Western Australia, 111 minutes in the Northern Territory, 100 minutes in Queensland, 98 minutes in Victoria and 84 minutes in New South Wales. Across Australia 90% of patients were seen within 111 minutes. Refer to Table ED.9.

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Episode end status

The most frequently recorded mode for ending a mental health-related ED presentation was for the episode to have been completed with the patient departing without being admitted or referred to another hospital (58.3%). Just over one-third (33.7%) of presentations resulted in the patient being admitted to the hospital where the emergency service was provided, with a further 3.8% referred to another hospital for admission. This is higher than the result for all ED presentations in 2018–19, with 32.9% being admitted to hospital, either where the service was provided or referred to another hospital (AIHW 2020a).

A small proportion of mental health-related ED presentations ended when the patient left before the service was completed, either leaving at their own risk (2.8%) or because the patient did not wait to be attended by a health care professional (0.5%).

Length of stay

The median length of stay for all mental health-related ED presentations in 2018–19 was 3 hours and 39 minutes (Figure ED.6). For mental health-related ED presentations ending in admission, the median length of stay was 5 hours and 5 minutes whereas the median length of stay for presentations not ending in admission was 3 hours and 7 minutes. Nationally, 90% of mental health-related ED presentations completed their stay within 13 hours, which is longer than the same measure for all ED presentations (up to 7 hours 29 minutes) (AIHW 2020a).

Figire ED.6: Length of stay in emergency departments for mental health-related presentations by state and territories, 2018-19

Chart presenting mental health-related ED presentations by length of stay (hours) for the median and 90th percentile patient by State and Territory, 2018–19. Fifty per cent of patients who presented to ED with a mental and behavioural diagnosis stayed in the ED for up to 5 hours 4 minutes in Tasmania, 4 hours 53 minutes in South Australia, 4 hours 31 minutes in the Australian Capital Territory, 3 hours 54 minutes in Victoria, 3 hours 42 minutes in Western Australia, 3 hours 32 minutes in Queensland, 3 hours 27 minutes in the Northern Territory and 3 hours 14 minutes in New South Wales. Across Australia 50% of patients stayed up to 3 hours 39 minutes in the ED. Ninety per cent of patients who presented to ED with a mental and behavioural diagnosis stayed up to 24 hours 5 minutes in Tasmania, 19 hours 46 minutes in South Australia, 17 hours 45 minutes in the Australian Capital Territory, 14 hours 48 minutes in Victoria, 14 hours 19 minutes in Western Australia, 12 hours 10 minutes in the Northern Territory, 11 hours in New South Wales, and 10 hours 3 minutes in Queensland. Across Australia 90% of patients stayed up to 13 hours. Refer to Table ED.13.

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Changes over time

Overall, the proportion of ED presentations which are mental health-related has increased by 1.2% from 2014–15 and 2018–19. However, Queensland, Tasmania and the Northern Territory have seen reductions in the proportion of mental health-related ED presentations by -1.1%, -0.7% and -1.3%, respectively.

Between 2014–15 and 2018–19, the proportion of mental health-related ED presentations assigned a triage category of Emergency increased by an annual average of 5.6%, with reductions in the categories of Semi-urgent (-3.6%) and Non-urgent (-3.8%).

Over this same period, more mental health-related ED presentations were assigned an episode end status of Referred to another hospital for admission, increasing at an average annual rate of 9.1%.