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 2018–19.

States and territories

In 2018–19, the national rate of public hospital mental health-related separations without specialised psychiatric care was 35.7 per 10,000 population. The rate ranged between 28.7 and 60.8 for individual jurisdictions, with only Tasmania reporting a rate below 30 (28.7) and only the Northern territory reporting a rate above 50 (60.8) (Figure ON.4).

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 7 separations per 10,000 population.

Figure ON.4: Overnight mental health-related separations without specialised psychiatric care, states and territories, by hospital type, 2018-19

Stacked bar chart showing the rate (per 10,000 population) of overnight admitted mental health-related separations without specialised psychiatric care in private and public hospitals for states and territories in 2018–19. There were 3.4 separations per 10,000 population in private hospitals in New South Wales and 36.3 in public hospitals; Victoria, 3.9 private and 32.9 public; Queensland, 6.2 private and 33.5 public; Western Australia, 3.4 private and 33.9 public; South Australia, 1.6 private and 48.4 public; Tasmania 28.7 public; the Australian Capital Territory, 44.7 public; the Northern Territory 60.8 public; Total, 4.0 private and 35.7 public. Private hospital data are not included for Tasmania, the Australian Capital Territory and the Northern Territory. Refer to Table ON.4.

Source data: Overnight admitted mental health-related care 2018–19 tables (202KB XLSX).

Patient characteristics

Patient demographics

In 2018–19, the highest rate of overnight mental health-related separations without specialised psychiatric care was for patients aged 85 and older (292.8 per 10,000 population) and the lowest for those aged 5–11 (3.4). The separation rate was slightly higher for females than males (40.6 and 38.5 per 10,000 population respectively) (Figure ON.5), 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.5: Overnight mental health-related separations without specialised psychiatric care, by demographic variable, 2018-19

Horizontal bar chart showing the rate (per 10,000 population) of overnight admitted mental health-related separations without specialised psychiatric care by age group, sex, Indigenous status, remoteness and SEIFA quintiles in 2018–19. There were 25.5 separations per 10,000 population for people aged 0–4 years, 3.4 for 5–11 years, 21.5 for 12–17 years, 28.6 for 18–24 years, 34.0 for 25–34 years, 39.3 for 35–44 years, 35.9 for 45–54 years, 29.8 for 55–64 years, 39.1 for 65–74 years, 118.9 for 75–84 years, and 292.8 for persons aged 85 years and over. There were 38.5 separations per 10,000 population for males and 40.6 for females. The 2001 age standardised rate was 105.2 for Indigenous Australians and 31.4 for other Australians. There were 37.0 separations per 10,000 population for persons living in Major cities, 38.3 for Inner regional, 48.5 for Outer regional, and 73.5 for Remote and very remote. There were 44.6 separations per 10,000 population for people in SEIFA Quintile 1 (most disadvantaged), 41.5 for Quintile 2, 39.1 for Quintile 3, 35.8 for Quintile 4, and 33.4 for Quintile 5 (least disadvantaged) (Refer to Table ON.5 Refer to Table ON.5.

Source data: Overnight admitted mental health-related care 2018–19 tables (202KB XLSX).

There were 7,214 overnight mental health-related separations without specialised psychiatric care for Aboriginal and Torres Strait Islander people in 2018–19, or 86.9 per 10,000 population, which is 2.3 times higher than the rate of 37.7 per 10,000 population for other patients. Rates standardised on the 2001 age profile were 105.2 and 31.4 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 the highest rate of overnight mental health-related separations without specialised psychiatric care in 2018–19 and those living in Major cities had the lowest rate (73.5 and 37.0 per 10,000 population respectively).

People living in the most disadvantaged socioeconomic quintile (SEIFA Quintile 1) had the highest rate of overnight mental health-related separations without specialised psychiatric care at 44.6 per 10,000 people. Those living in the least disadvantaged quintile (SEIFA Quintile 5) had the lowest rate of 33.4 per 10,000 people.

Changes over time

The rate of overall overnight mental health-related separations without specialised psychiatric care per 10,000 population has increased over the past decade at an average annual rate of 3.2% between 2008–09 and 2018–19, and an larger increase of 5.6% in the 5 years from 2014–15 and 2018–19.

For each year examined, and for each sex, the rate of overnight mental health‑related separations without specialised care per population was highest for older adults (75–84 years, and 85+ years). For the 12–17 years age group, the rate of separations for females was almost 3 times the rate of separations as males, a similar pattern to that seen for separations with specialised psychiatric care.

In both the 75–84 year old and 85+ year old age groups, the number of separations per 10,000 population have been increasing over time. For these age groups, males have consistently had a higher rate than the female population. The contrast with the rates for overnight mental health related separations with specialised care should be noted for these older age groups.

Principal diagnosis

In 2018–19, 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) (20.7% in public hospitals and 21.8% in private hospitals), followed by Other organic mental disorders (20.1% in public and 18.8% in private hospitals) (Figure ON.6).

Figure ON.6: Proportion of overnight mental health-related separations without specialised psychiatric care, for 5 commonly reported principal diagnoses, by hospital type, 2018-19

Horizontal bar chart showing the per cent of overnight admitted mental health-related separations without specialised psychiatric care for 5 of the most frequently reported principal diagnoses in private and public hospitals. In 2018–19, 21.8% of separations without specialised psychiatric care in private hospitals occurred for people with a principal diagnosis of Mental and behavioural disorders due to use of alcohol (F10), 20.7% in public hospitals; Other organic mental disorders (F04–09), 18.8% private, 20.1% public; Dementia (F00–03), 8.4% private, 9.6% public; Mental and behavioural disorders due to other psychoactive substance use (F11-19), 5.5% private, 8.5% public; Depressive episode (F32), 7.9% private, 5.3% public. Refer to Table ON.6.

Visualisation not available for printing

Source data: Overnight admitted mental health-related care 2018–19 tables (202KB XLSX).

Procedures

Almost two-thirds (68.3%) of overnight mental health-related separations without specialised psychiatric care recorded at least 1 procedure in 2018–19. The most frequently reported procedure block was Generalised allied health intervention (67.0%), which was recorded for just over half of separations without specialised psychiatric care (51.8%). The most frequent Allied health interventions were Social work (22.2% of allied health procedures), followed by Physiotherapy (21.9%) and Occupational therapy (17.0%).

The next most frequently reported procedure block was Alcohol and drug rehabilitation and detoxification, which was recorded for 9.0% 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 jurisdictions. 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) – 337 geographic areas covering Australia, with boundaries defined by the Australian Bureau of Statistics.

In 2018–19, the national rate of mental health-related separations both with and without specialised psychiatric care was 107.6 per 10,000 population. At the PHN level, Western Queensland (PHN code 305) had the highest rate (137.2 per 10,000 population) and Western Sydney (PHN code 103) had the lowest (82.9 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.