Patient characteristics

Patient demographics

This release contains a more detailed age breakdown for ED presentations than past releases. In 2017–18, there was a higher proportion of mental health-related presentations among patients aged 18–54 (70.5%) compared with all emergency department presentations (44.5%). 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 (24.5%). Of all patient age groups, those aged 25–34 represented the highest proportion of both mental health-related (20.6%) and all (13.5%) ED presentations (Table ED.7). The highest population rate of all ED presentations occurred among patients aged 85 years and over, whereas the highest rate of mental health-related presentations occurred among patients aged 18–24 (197.0 per 10,000 population). This is likely to be influenced by the typical age of onset of many mental disorders.

Males had a higher number of mental-health related ED presentations than females in 2017–18 (representing 52.1% and 47.9% respectively), but were more equally represented in all ED presentations (50.2% and 49.8% respectively). The population-rate of mental health-related ED presentations for males was higher than the rate for females (121.7 and 110.0 per 10,000 population respectively).

Aboriginal and Torres Strait Islander people, who represent about 3.3% of the Australian population (ABS 2018), accounted for 10.9% of mental health-related ED presentations, compared with 6.7% of all ED presentations. The rate of mental health-related ED presentations for Indigenous Australians was more than 4 times that for other Australians (455.9 and 106.8 per 10,000 population respectively).

People living in areas classified as having the lowest socioeconomic status (Quintile 1) had the highest population-rate of mental health-related ED presentations (139.9 per 10,000 population), with the rate decreasing with increasing socioeconomic status, to 76.3 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 (65.6%) of mental health-related ED presentations, and those in Remote and Very remote areas accounted for only 3.7% of presentations in 2017–18. The rate per 10,000 population of mental health-related ED presentations for patients living in Major cities was the lowest (101.3) while that for patients in Remote and Very remote areas was the highest (203.6).

Detailed ED data for mental health-related presentations by Primary Health Network (PHN) are presented for the first time in this release, and have been included with the data downloads for this section (Table ED.14 and 15). This data shows variation in the number of presentations within PHN groups at the Statistical Area 3 (SA3) region level. In 2017–18, the highest mental health-related ED presentation rate occurred among patients living in the Tumut-Tumbarumba SA3 region (1,209.4 per 10,000 population) in New South Wales, followed by Barkly (715.6) and Alice Springs (707.0) 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.

 

Figure ED.2 Alternative text - Source data: XLS DownloadMental health services provided in emergency departments tables (687KB XLS)

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 (76.0%) of mental health-related ED presentations in Australian EDs were classified by four principal diagnosis groupings in 2017–18 (Figure ED.3):

  • Mental and behavioural disorders due to psychoactive substance use (F10–F19; 27.2%)
  • Neurotic, stress-related and somatoform disorders (F40–F49; 26.2%)
  • Schizophrenia, schizotypal and delusional disorders (F20–F29; 11.6%)
  • Mood (affective) disorders (F30–F39; 11.0%).

 

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Figure ED.3 Alternative text - Source data: XLS DownloadMental health services provided in emergency departments tables (687KB XLS)

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 2017–18 arrived via ambulance, air ambulance or helicopter rescue service (46.6%). This was almost double the proportion of all ED presentations that arrived by ambulance, air ambulance or helicopter rescue (25.2%). A smaller proportion of mental-health related ED presentations arrived by police or correctional service vehicles (7.1%); however, this was about 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. However, due to a range of factors, care may or may not be received within the designated time-frames. The majority (78.6%) of mental health-related ED presentations in 2017–18 were classified as either Urgent or Semi-urgent, and 14.4% were classified as Emergency. These figures are similar to all ED presentations (78.1% and 13.2% respectively) (AIHW 2018) (Figure ED.4).

 

Figure ED.4 Alternative text - Source data: XLS DownloadMental health services provided in emergency departments tables (687KB XLS)

Type of visit

The most common type of visit among mental health-related ED presentations in 2017–18 was an emergency presentation (97.1%), with a small portion of presentations being for a planned return visit (2.6%). A similar pattern was observed for all ED presentations (AIHW 2018).

Waiting time

The median waiting time for mental health-related ED presentations was 20 minutes, with approximately two thirds (66.8%) of presentations seen on time according to their assessed triage status, compared to 72% for all ED presentations (AIHW 2018). For mental health-related ED presentations, the Australian Capital Territory had the lowest proportion of presentations seen on time (43.0%) whereas New South Wales had the highest (76.6%). New South Wales had the lowest median waiting time of 15 minutes, and the Australian Capital Territory had the highest of 47 minutes (Figure ED.5).

 

Figure ED.5 Alternative text - Source data: XLS DownloadMental health services provided in emergency departments tables (687KB XLS)

Episode end status

The most frequently recorded mode for ending a mental health-related ED presentation was for the episode to have been completed without the patient being admitted or referred to another hospital for admission (58.1%). More than a third (39.1%) of presentations resulted in the patient being admitted to hospital, either where the emergency service was provided (34.9%) or the patient was referred to another hospital for admission (4.2%). This is higher than the result for all ED presentations in 2017–18, with 33.0% being admitted to hospital (either where the service was provided or referred to another hospital) (AIHW 2018).

A small proportion of mental health-related ED presentations ended when the patient left before the service was completed, either after care had commenced but before it was complete (2.5%) or because the patient did not wait to be attended by a health care professional (0.4%).

Length of stay

The median length of stay for all mental health-related ED presentations in 2017–18 was 3 hours and 33 minutes (Figure ED.6). For mental health-related ED presentations ending in admission, the median length of stay was 4 hours and 49 minutes whereas the median length of stay for presentations not ending in admission was 3 hours and 2 minutes. Nationally, 90% of mental health-related ED presentations stayed for up to 12 hours and 24 minutes, which is longer than the same measure for all ED presentations (up to 7 hrs 14 mins) (AIHW 2018).