Specialised overnight admitted patient mental health care

Service provision

Specialised overnight admitted patient mental health care (also referred to as specialised psychiatric care) takes place within a designated psychiatric ward/unit, which is staffed by health professionals with specialist mental health qualifications or training and have as their principal function the treatment and care of patients affected by mental illness.

States and territories

In 2016–17, there were 164,060 overnight admitted mental health-related separations with specialised care; equivalent to a national rate of 67.3 per 10,000 population.

For all states and territories, the rate of overnight mental health-related separations with specialised psychiatric care was higher for public acute hospitals than other hospital types. South Australia had the highest rate of public acute hospital separations (52.3 per 10,000 population) and Northern Territory the lowest (36.1) (Figure ON.1).

The rate of overnight mental health-related separations in public psychiatric hospitals was highest for Tasmania (18.7 per 10,000 population) and lowest for Victoria (0.7). The Northern Territory and Australian Capital Territory do not have any public psychiatric hospitals.

Among those jurisdictions for which private hospital figures are published, the rate of overnight mental health-related separations in private hospitals was highest for Victoria (21.3 per 10,000 population) and lowest for South Australia (8.0).

For public acute hospitals, there were 816.7 patient days per 10,000 population for overnight mental health-related separations with specialised psychiatric care in 2016–17. New South Wales had the highest rate of public acute hospital patient days (1,126.6 per 10,000 population) and Tasmania the lowest (450.8). For states with public psychiatric hospitals, the rates varied from 905.3 patient days per 10,000 population in New South Wales to 72.8 days in Victoria. Among jurisdictions for which private hospital figures are published, Queensland reported the highest rate of patient days in private hospitals (449.0 per 10,000 population), whilst South Australia reported the lowest rate (141.6).

 

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Figure ON.1 Alternative text - Source data: Overnight admitted mental health-related care Table ON.4 (911KB XLS).

In 2016–17, the national average length of stay for overnight mental health-related separations in public acute hospitals was 18.3 days. New South Wales had the longest average length of stay (24.9 days) and the South Australia the shortest (11.5 days). The greatest variation in average length of stay was for public psychiatric hospitals with Queensland reporting 224.3 days and Tasmania 22.1 days.

For public hospitals in 2016–17, the majority (91.5%) of overnight mental health-related separations with specialised psychiatric care had a funding source of Public patient (e.g. the health service budget or reciprocal health care agreement), followed by Private health insurance (6.1%). While data are available on the principal source of funding for a separation, it should be noted that a separation may be funded by more than one funding source and information on additional funding sources is not available. For private hospitals, the majority (88.6%) of their separations had a funding source of Private health insurance. Among the jurisdictions for which private hospital figures are published, the Private health insurance source ranged from 93.6% for Western Australia to 85.2% for New South Wales.

In 2016–17, the most common mode of separation for overnight mental health-related separations in both public (81.4%) and private (94.5%) 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). For public hospitals, this mode of separation ranged from 87.4% for the Northern Territory to 75.9% for South Australia. For private hospitals in jurisdictions for which private hospital data are published, discharge to ‘home’ ranged from 97.3% for South Australia to 92.1% for New South Wales. Note that information on the place to which a patient was discharged or transferred may not be available for some separations.

Patient characteristics

Patient demographics

In 2016–17, the rate of overnight mental health-related separations with specialised psychiatric care was highest for patients aged 35–44 and lowest for those aged under 15 (108.2 and 5.5 per 10,000 population respectively) (Figure ON.2). Overall, the separation rate was higher for females than males (69.6 and 64.9 per 10,000 population respectively), but there is some variability across individual age groups.

 

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Figure ON.2 Alternative text- Source data: Overnight admitted mental health-related care Table ON.6 (911KB XLS).

Aboriginal and Torres Strait Islander people had a rate of overnight mental health-related separation with specialised psychiatric care more than double that of other Australians (147.5 and 64.4 per 10,000 population respectively).

Those patients living in Major cities (68.3 per 10,000 population) had the highest rate of overnight mental health-related separations with specialised psychiatric care in 2016–17 whilst those living in Remote and Very remote areas (37.2) had the lowest.

Those patients living in the most disadvantaged areas (socioeconomic quintile 1) (73.0 per 10,000 population) had the highest rate of overnight mental health-related separations with specialised psychiatric care whilst those living in the least disadvantaged quintile (57.7) had the lowest.

Principal diagnosis

When considering all hospital types together, the most frequently reported principal diagnosis in 2016–17 for an overnight mental health-related separation with specialised psychiatric care was Schizophrenia (ICD-10-AM code: F20) (14.7%), followed by Depressive episode (F32) (14.4%) and Reaction to severe stress and adjustment disorders (F43) (10.0%).

The profile of diagnoses varies with hospital type. For example, about 1 in 5 separations in public acute hospitals and public psychiatric hospitals had a principal diagnosis of Schizophrenia (F20) (18.6% and 22.4% respectively), compared with 1 in 40 for private hospitals (2.5%). About 1 in 4 (22.9%) separations with specialised psychiatric care in private hospitals had a principal diagnosis of Depressive episode (F32), compared with 11.9% and 7.4% for public acute and public psychiatric hospitals respectively (Figure ON.3).

 

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Figure ON.3 Alternative text - Source data: Overnight admitted mental health-related care Table ON.7 (911KB XLS).

Mental health legal status

Mental health legal status refers to whether or not a person was treated in hospital involuntarily under the relevant state or territory mental health legislation. In 2016–17, there were 54,131 overnight mental health-related separations with specialised psychiatric care where the mental health legal status was ‘involuntary’— representing more than a third (36.6%) of all overnight mental health-related separations with specialised psychiartic care. The majority of involuntary separations (47,658 or 88.0%) occurred in public acute hospitals. 

In private hospitals, very few separations (0.7%) with specialised psychiatric care were for patients recorded as being treated on an involuntary basis, although a high number of private hospital separations did not have a mental health legal status recorded. Involuntary separations accounted for 44.8% and 50.5% of separations with specialised psychiatric care in public acute hospital and public psychiatric hospitals respectively (Figure ON.4).

 

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Figure ON.4 Alternative text - Source data: Overnight admitted mental health-related care Table ON.5 (911KB XLS).

Procedures

The most frequently reported procedure block for overnight mental health-related separations with specialised psychiatric care was Generalised allied health interventions, which was recorded for almost half (48.6%) of these separations. Of these allied health interventions, procedures provided by Social work were the most common (28.6% of allied health interventions), followed by Occupational therapy (18.9%) and Psychology (16.6%).

The next most frequently reported procedure block was Cerebral anaesthesia, which was recorded for 5.6% of separations with specialised psychiatric care. Cerebral anaesthesia is most likely associated with the administration of electroconvulsive therapy (ECT), a form of treatment for depression, which was the second most common principal diagnosis for separations with specialised psychiatric care.