Mental health services in Australia

Patient demographics

Mental health-related ED presentations had a higher proportion of patients aged 15–54 (77.0%) compared with all emergency department presentations (48.4%) in 2016–17. By contrast, there was a lower proportion of patients aged less than 15 (4.1%) compared with all emergency department presentations (21.3%). Patients less than 15 had the lowest rate per 10,000 population of mental health-related presentations (25.0), whereas those aged 15–24 years had the highest (192.6). This is likely to be influenced by the typical age of onset of many mental disorders.

Males had a higher proportion of mental-health related ED presentations than females (52.0% and 48.0% respectively) in 2016–17 but were more equally represented in all ED presentations (50.3% and 49.7% respectively). The rate of mental health-related ED presentations for males was higher than the rate for females (119.0 and 108.2 per 10,000 population respectively).

Aboriginal and Torres Strait Islander people, who represent about 3.3% of the Australian population (ABS 2017), accounted for 10.7% of mental health-related ED presentations, compared with 6.5% of all ED presentations. The rate of mental health-related ED presentations for Indigenous Australians was more than 4 times that for other Australians (443.0 and 105.0 per 10,000 population respectively).

People living in areas classified as having the lowest socioeconomic status (quintile 1) had the highest rate of mental health-related ED presentations (26.8%), with the rate decreasing with increasing socioeconomic status to 13.8% for people in the least disadvantaged area (quintile 5) (Figure ED.2). A similar result was seen with rate per population. People living in Major cities accounted for almost two-thirds (65.6%) of mental health-related ED presentations, compared to those in Remote and Very remote areas which accounted for only 3.5% of presentations. The rate per 10,000 population of mental health-related ED presentations for patients living in in Major cities was the lowest (101.2) while that for patients in Remote and Very remote areas was the highest (185.3).

Figure ED.2 Alternative text - Source data: Mental health services provided in emergency departments (157KB 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). See data source for more details on diagnosis codes.

More than three quarters (76.5%) of mental health-related ED presentations in Australian EDs were classified by four principal diagnosis groupings in 2015–16 (Figure ED.3):

• Mental and behavioural disorders due to psychoactive substance use (F10–F19; 26.9%)
• Neurotic, stress-related and somatoform disorders (F40–F49; 26.7%)
• Mood (affective) disorders (F30–F39; 11.6%)
• Schizophrenia, schizotypal and delusional disorders (F20–F29; 11.4%).

Figure ED.3 Alternative text - Source data: Mental health services provided in emergency departments (157KB XLS)

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 Unspecified mental disorder

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 arrived via ambulance, air ambulance or helicopter rescue service (44.8%). This was almost double the proportion of all ED presentations that arrived by ambulance, air ambulance or helicopter rescue (24.5%) (AIHW 2017). A small proportion of mental-health related ED presentations arrived by police or correctional service vehicles (7.7%); however, this was higher than the proportion of all ED presentations with this arrival mode (0.7%) (AIHW 2017).

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 (79.2%) of mental health-related ED presentations in 2016–17 were classified as either Urgent or Semi-urgent. This figure is similar to all ED presentations (77.5%) (AIHW 2017) (Figure ED.4).

Figure ED.4 Alternative text - Source data: Mental health services provided in emergency departments (157KB XLS).

Type of visit

The most common type of visit among mental health-related ED presentations was an emergency presentation (97.1%) with a small portion of these presentations being for a planned return visit (2.5%). This finding is similar to the pattern in all ED presentations (AIHW 2017).

Waiting time

The median waiting time for mental health-related ED presentations was 19 minutes, with more than two thirds (68.0%) seen on time according to their assessed triage status. New South Wales had the lowest median waiting time of 14 minutes, and Tasmania and Western Australia had the highest of 30 minutes (Figure ED.5). South Australia had the lowest proportion seen on time (55.8%) whereas New South Wales had the highest (76.5%).

Figure ED.5 Alternative text - Source data: Mental health services provided in Emergency departments (157KB 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 (58.0%). More than a third (39.1%) of presentations resulted in the patient being admitted to hospital, either where the emergency service was provided (34.8%) or referral to another hospital for admission (4.2%). This is higher than the result for all ED presentation in 2016–17, with 32.5% being admitted to hospital (either where the service was provided or referred to another hospital) (AIHW 2017).

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 (0.5%).

Length of stay

The median length of stay for all mental health-related ED presentations was 207 minutes (about 3.5 hrs), which is longer than the median length of stay for all ED presentations (2.8 hrs) (AIHW 2017). New South Wales had the shortest median length of stay (188 minutes) and South Australia had the highest (260 minutes) for mental health-related ED presentations (Figure ED.6).

Figure ED.6 Alternative text - Source data: Mental health services provided in emergency departments (157KB XLS)