Non-specialised admitted patient mental health care

Service provision

Non-specialised admitted patient mental health care takes place outside a designated psychiatric unit but for which the principal diagnosis is considered to be mental health-related. A list of mental health-related principal diagnoses is available in the technical information section. Data for public acute and public psychiatric hospitals are combined in this section, as there were very few separations without specialised psychiatric care in public psychiatric hospitals in 2017–18.

States and territories

In 2017–18, the national rate of public hospital mental health-related separations without specialised psychiatric care was 34.5 per 10,000 population. The rate ranged between 28.2 and 56.0 for individual jurisdictions, with Tasmania and the Australian Capital Territory reporting rates below 30 and only the Northern territory reporting a rate above 50 (Figure ON.5). 

The rate of mental health-related separations without specialised psychiatric care in private hospitals for the Australian Capital Territory, Tasmania, and the Northern Territory are not published for confidentiality reasons. In all other reported jurisdictions, the rates were less than 6 separations per 10,000 population (Figure ON.5).

 

Figure ON.5 Alternative text - Source data: Overnight admitted mental health-related care tables (272KB XLS).

For public hospitals in 2017–18, the majority (83.8%) of overnight mental health-related separations without specialised psychiatric care had a funding source of Public patient (e.g. health service budget or reciprocal health care agreement). This ranged from 97.4% for the Northern Territory to 78.4% for New South Wales. For private hospitals, the majority (83.1%) of these separations had a funding source of Private health insurance.

In 2017–18 the most common mode of separations for overnight mental health-related separations without specialised psychiatric care in both public (65.7%) and private (84.7%) hospitals was discharge to ‘home’, which includes discharge to usual residence/own accommodation/welfare institution (including prisons, hostels and group homes providing primarily welfare services). Most of the remaining separations were either transfers to other facilities (16.4%), or statistical discharges (11.8%). A small portion were patients leaving against medical advice (3.7%) or deaths (1.2%).

For public hospitals the proportion discharged to home ranged between 62.2% in New South Wales and over 72% in Tasmania and the Australian Capital Territory.

Patient characteristics

Patient demographics

In 2017–18, the highest rate of overnight mental health-related separations without specialised psychiatric care was for patients aged 85 and older (281.8 per 10,000 population) and the lowest for those aged 5–11 (3.2). The separation rate was slightly higher for females than males (39.1 and 37.4 per 10,000 population respectively) (Figure ON.6), but there is variation across individual age groups. Females had higher rates for age groups 12–17 years, 18–24 years, and 25–34 years, while males had higher rates for all other age groups.

 

Figure ON.6 Alternative text - Source data: Overnight admitted mental health-related care tables (272KB XLS).

There were 6,937 overnight mental health separations without specialised psychiatric care for Aboriginal and Torres Strait Islander people in 2017–18, which is 91.1 per 10,000 population, which compares to 36.3 per 10,000 population for other patients. Rates standardised on the 2001 age profile were 116.6 and 33.9 per 10,000 population respectively, so the standardised rate for Indigenous people was 3.4 times that of other patients.

People living in Remote and very remote areas had a higher rate of overnight mental health-related separations without specialised psychiatric care than those in Major cities in 2017–18 (72.2 and 35.3 per 10,000 population respectively).

People living in the most disadvantaged socioeconomic quintile had 44.7 separations per 10,000 people and those living in the least disadvantaged quintile had 31.6 per 10,000 people.

Changes over time

For each year examined, and for each sex, the age profile of overnight mental health separations without specialised care per population had a similar broad pattern of being relatively low for most age groups (with the lowest rate for age group 5–11 years), and relatively high for older adults (75–84 years, and 85+ years). As for separations with specialised psychiatric care, the largest difference between sexes for separations without specialised psychiatric care also occurred for the age group 12–17 years, with females having almost three times the rate of separations as males.

In the most recent reporting period (2017–18) the rates for 75–84 year old males and females were 129.2 and 109.5 per 10,000 population respectively, which are 50.5% and -37.1% increases on rates reported for the earliest reporting period analysed (2006–07). These increases have evolved quite consistently across the period analysed, with most year-on-year changes being increases. For this age group, males have consistently had a higher rate than the female population, and this difference was largest in the most recent reporting period (about 18% higher).

In the most recent reporting period (2017–18) the rates for 85+ year old males and females were 305.3 and 267.4 per 10,000 population respectively, which are 72.8% and -75.1% increases on rates reported for the earliest reporting period analysed (2006–07). For this age group, males have consistently had a higher rate than the female population (between 14% and 23% higher). The contrast with the rates for overnight mental health separations with specialised care should be noted for this age group.

Principal diagnosis

In 2017–18, the most frequently reported principal diagnosis for overnight mental health-related separations without specialised psychiatric care were Mental and behavioural disorders due to use of alcohol (ICD‑10‑AM code F10) (21.1% in public hospitals and 21.7% in private hospitals), followed by Other organic mental disorders (20.0% in public and 19.1% in private hospitals) (Figure ON.7).

 

Figure ON.7 Alternative text - Source data: Overnight admitted mental health-related care tables (272KB XLS).

Procedures

Almost two-thirds (65.7%) of overnight mental health-related separations without specialised psychiatric care recorded at least 1 procedure in 2017–18. The most frequently reported procedure block was Generalised allied health intervention, which was recorded for just over half of separations without specialised psychiatric care (50.6%). The most frequent Allied health interventions were Social work (22.6% of allied health procedures), followed by Physiotherapy (22.1%) and Occupational therapy (16.9%).

The next most frequently reported procedure block was Alcohol and drug rehabilitation and detoxification, which was recorded for 9.7% of overnight separations without specialised psychiatric care.

Regional reporting

Information on overnight mental health-related separations is reportable at smaller geographic areas than state and territory boundaries. Sub-jurisdictional reporting provides the opportunity to consider differences within the jurisdictions boundary. For the analysis presented here, the geographical area is based on the usual residence of the patient rather than the geographical location of the hospital. There are 2 types of geographical areas which are reported here:

  • Primary Health Network (PHN) areas – 31 geographic areas covering Australia, with boundaries defined by the Australian Government Department of Health.
  • Statistical Areas Level 3 (SA3s) – 336 geographic areas covering Australia, with boundaries defined by the Australian Bureau of Statistics.

In 2017–18, the national rate of mental health-related separations both with and without specialised psychiatric care was 105 per 10,000 population. At the PHN level, Western Queensland had the highest rate (126.6 per 10,000 population) and the Australian Capital Territory the lowest (83.8 per 10,000 population).

The observed variability in hospitalisation 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 are admitted to hospital, availability of community-based services and variability in approaches to planning and delivering mental health support services across and within states and territories.