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 2017–18, there were 165,452 overnight admitted mental health-related separations with specialised psychiatric care; equivalent to a national rate of 66.8 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 (50.1 per 10,000 population) and Tasmania the lowest (33.7) (Figure ON.1).

The rate of overnight mental health-related separations in public psychiatric hospitals was highest for Tasmania (18.9 per 10,000 population) and lowest for Queensland and Victoria (0.6 and 0.8 respectively). The Northern Territory and Australian Capital Territory do not have any public psychiatric hospitals.

Private hospital figures are not published for Tasmania, the Australian Capital Territory, or the Northern Territory. Among other jurisdictions, the rate of overnight mental health-related separations in private hospitals was highest for Queensland and Victoria (22.4 and 22.1 per 10,000 population respectively) and lowest for South Australia (7.6).

For public acute hospitals, there were 657.9 patient days per 10,000 population for overnight mental health-related separations with specialised psychiatric care in 2017–18. The Australian Capital Territory and New South Wales had the highest rates of public acute hospital patient days (748.7 and 727.1 per 10,000 population respectively) and Tasmania the lowest (455.7). For states with public psychiatric hospitals, the rates ranged from 471.7 patient days per 10,000 population in Tasmania to 77.8 in Victoria. Among jurisdictions for which private hospital figures are published, Queensland reported the highest rate of patient days (475.6 per 10,000 population), whilst South Australia reported the lowest rate (134.1).

 

Figure ON.1 Alternative text - Source data: Overnight admitted mental health-related care tables (272KB XLS).

In 2017–18, the national average length of stay for overnight mental health-related separations in public acute hospitals was 15.0 days, which is an 18.0% reduction from 2016–17. This is the shortest average length of stay reported in the period analysed (2006–07 to 2017–18). New South Wales had the longest average length of stay (17.3 days) and the South Australia the shortest (12.0 days). The average length of stay in public psychiatric hospitals ranged from 24.9 days in Tasmania to 155.9 days in Queensland.

For public hospitals in 2017–18, the majority (91.4%) 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 (6.3%). 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 (87.6%) of their separations had a funding source of Private health insurance.

In 2017–18, the most common mode of separation for overnight mental health-related separations in both public (83.5%) and private (94.7%) 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 or statistical discharges (changes in care type, or discharges from leave). For public hospitals, the proportion of discharges to home ranged from 87.5% for the Australian Capital Territory to 77.3% for South Australia.

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 2017–18, the rate of overnight mental health-related separations with specialised psychiatric care was highest for patients aged 35–44 years and lowest for those aged 0–4 years (105.4 and 0.7 per 10,000 population respectively) (Figure ON.2). Overall, the separation rate was higher for females than males (69.2 and 64.3 per 10,000 population respectively), but there is variation across individual age groups.

Over the past 12 years analysed (2006–07 to 2017–18), several notable changes have emerged in the age and sex profile of overnight mental health separations with specialised care. These are detailed in the next section, but the most substantial long term change in separation rate was seen for females aged 12–17 years, which doubled between 2006–07 and 2017–18. The largest difference between sexes was also observed for this age group, with females having more than double the rate of separations as males.

 

Figure ON.2 Alternative text - Source data: Overnight admitted mental health-related care tables (272KB XLS).

There were 10,505 overnight mental health separations with specialised psychiatric care for Aboriginal and Torres Strait Islander people in 2017–18, which is 138.0 per 10,000 population, which compares to 63.2 per 10,000 population for other patients. Rates standardised on the 2001 age profile were 150.6 and 63.7 per 10,000 population respectively, so the standardised rate for Indigenous people was 2.4 times that of other patients. Those patients living in Major Cities and Inner regional areas had the highest rates of overnight mental health-related separations with specialised psychiatric care in 2017–18 (66.8 and 67.1 per 10,000 population respectively), whilst those living in Remote and Very remote areas had the lowest (36.9).

Mental health related hospital separations with specialised psychiatric care were broadly similar across socioeconomic quintiles, ranging between 63.6 per 10,000 population for quintile 5 (least disadvantaged) and 68.5 per 10,000 population for quintile 2 (second most disadvantaged).

Changes over time

For each year examined, and for each sex, the age profile of overnight mental health separations with specialised care per population had a similar broad pattern of being very low for younger children (age groups 0–4 years and 5–11 years), increasing to a peak for either younger adults and decreasing to relatively moderate rates for older adults. While this broad description applies across the time period studied, and to both males and females, several noteworthy changes have evolved over time.

Separation rates for people aged 12–17 years have increased substantially during the time period examined, especially for females. In 2017–18 the separation rates for males and females in this age range were 31.9 and 74.8 per 10,000 population respectively, which are 74.2% and 101% increases on 2006–07 rates.

For male and female populations aged 18–24 years the reported separation rates have also increased over time. In 2006–07 male and female populations had relatively similar rates (73.4 and 70.7 per 10,000 population respectively), however a substantial difference has emerged over time, with 2017–18 separation rates being 92.1 and 113.5 for males and females respectively. These are 25.5% and 60.5% increases from 2006–07, resulting in the female separation rate being 1.2 times the male separation rate in 2017–18.

For the age range 35–44 years, male and female separation rates in 2017–18 were 111.7 and 99.2 per 10,000 population respectively, which are 35.2% and 22.5% higher than 2006–07 rates. Male and female rates tended to be similar for most of the earlier part of 12 years analysed, but a difference has emerged in recent years, with the males having a 13% to 15% higher rate than females over the past 3 reporting periods.

For populations aged 75–84 years, and 85 years and over, separation rates have tended to decrease substantially over the time period analysed. However, rates of separations without specialised psychiatric care have increased over time in this age group.

Principal diagnosis

The most frequently reported principal diagnosis in 2017–18 for an overnight mental health-related separation with specialised psychiatric care were Depressive episode (ICD‑10‑AM code: F32) (14.8%) followed by Schizophrenia (F20) (14.1%), 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) (18.3% and 21.6% respectively), compared with about 1 in 40 for private hospitals (2.4%). About 1 in 4 (24.1%) separations with specialised psychiatric care in private hospitals had a principal diagnosis of Depressive episode (F32), compared with 11.7% and 7.4% for public acute and public psychiatric hospitals respectively (Figure ON.3).

 

Figure ON.3 Alternative text - Source data: Overnight admitted mental health-related care tables (272KB 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 2017–18, about 90% of overnight mental health-related separations with specialised psychiatric care had a reported legal status, of these, more than a third (36.3%) were ‘Involuntary’, which is a 0.3 percentage point decline from the percentage reported in 2016–17, and a 3 percentage point decline from the percentage reported in 2015–16. Nearly all involuntary separations (99.6%) occurred in public hospitals.

The proportions of involuntary separations were similar between Public Acute and Public psychiatric hospitals, at 45.6% and 47.7% respectively (Figure ON.4). Private hospitals reported few involuntary separations with specialised psychiatric care (0.7%), although a large number of private hospital separations did not have a mental health legal status recorded (31.2%).

 

Figure ON.4 Alternative text - Source data: Overnight admitted mental health-related care tables (272KB XLS).

Procedures

The most frequently reported procedure block for overnight mental health-related separations with specialised psychiatric care in 2017–18 was Generalised allied health interventions (43.6% of procedures, and associated with 54.2% of separations). Of these allied health interventions, procedures provided by Social work were the most common (28.1% of allied health interventions), followed by Occupational therapy (18.6%) and Psychology (17.2%). The second most frequently reported procedure block was Cerebral anaesthesia (12.2% of procedures and associated with 5.4% of separations). Cerebral anaesthesia is most likely associated with the administration of electroconvulsive therapy (ECT), the third most frequently reported procedure block, and a form of treatment for depression, which was the most common principal diagnosis for separations with specialised psychiatric care.