Same day admitted mental health care—public hospitals

This section presents information on same day admitted patient mental health-related separation in Australian public hospitals. Data are sourced from the National Hospital Morbidity Database (NHMD); a collation of data on admitted patient care in Australian hospitals defined by the Admitted Patient Care National Minimum Data Set (APC NMDS). The information describes separations.The information describes separations. It is possible for individuals to have multiple separations in any given reference period. For further information see the data source.

There were a total of 3.3 million same day separations from public acute and public psychiatric hospitals in 2015–16. There were 59,364 same day admitted mental health-related separations in 2015–16, accounting for 1 in 50 (1.8%) of all same day public hospital separations. Of these, 19,336 (32.6%) separations involved specialised psychiatric care and 40,028 (67.4%) did not.

Due to the relatively small number of same day admitted patient mental health-related separations from public psychiatric hospitals, these separations have been combined with the public acute hospitals separations for reporting purposes in this section. Where possible, a distinction is made between separations with and without specialised psychiatric care.

Specialised same day admitted patient mental health care— public hospitals

Service provision

Specialised same day public admitted mental health 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. It may also be referred to as specialised psychiatric care.

States and territories

In 2015–16, there were 19,336 same day public admitted mental health-related separations with specialised psychiatric care; equivalent to a national rate of 8.1 per 10,000 population.

The rate of same day public mental health-related separations with specialised psychiatric care in 2015–16 was highest for Queensland (18.8 per 10,000 population) and lowest for the Northern Territory (0.7) (Figure SD.1).

The principal source of funding for a separation is collected as part of the APC NMDS. However, 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 public hospitals in 2015–16, more than three-quarters (78.4%) of same day public mental health-related separations with specialised psychiatric care were public patients (e.g. the health service budget or reciprocal health care agreement). This ranged from 100.0% for the Northern Territory to 50.2% for New South Wales.

The mode of separation is also collected and provides information on how each separation ended, and for some separations, the place to which the patient was discharged or transferred to. In 2015–16 the most common mode of separation for same day public mental health-related separations was discharge to ‘home’ (88.2%), which includes discharge to usual residence/own accommodation/welfare institution (including prisons, hostels and group homes providing primarily welfare services). For public hospitals this ranged from 92.7% for the Australian Capital Territory to 50.0% for the Northern Territory.

Figure SD.1: Same day public admitted mental health-related separations with specialised psychiatric care, state and territory, by hospital type, 2015–16

Vertical bar chart showing the rate (per 10,000 population) of same day public admitted mental health-related separations with specialised psychiatric care for all states and territories by type of hospital. The highest rate was for public acute hospitals (7.6) followed by public psychiatric hospitals (0.5). Refer to Table SD.4

Note: The Northern Territory and Australian Capital Territory do not have any public psychiatric hospitals.

Source: National Hospital Morbidity Database.

Source data: Same day public admitted mental health-related care Table SD.7 (773KB XLS).

Patient demographics

In 2015–16, the rate of same day public admitted mental health-related separations with specialised psychiatric care was highest for patients aged 65 years and older and lowest for those aged less than 15 (14.5 and 4.0 per 10,000 population respectively) (Figure SD.2). Overall, the separation rate was higher for females than males (8.9 and 7.2 per 10,000 population respectively).

Figure SD.2: Same day public admitted mental health-related separations with specialised psychiatric care, by sex and age, 2015–16

Vertical bar chart showing the rate (per 10,000 population) of same day public admitted mental health-related separations with specialised psychiatric care by age-group and sex. In aggregate terms, females (8.9) had a higher rate than males (7.2). Persons by age group: <15 years 4.0; 15-24 years 11.2; 25-34 years 7.4; 35-44 years 7.3; 45-54 years 7.4; 55-64 years 5.3; 65 years and older 14.5. Refer to Table SD.3

Source: National Hospital Morbidity Database.

Source data: Same day public admitted mental health-related care Table SD.7 (773KB XLS).

Aboriginal and Torres Strait Islander people had a rate of same day public mental health-related separation with specialised psychiatric care that was nearly double that of other Australians (13.2 and 7.4 per 10,000 population respectively).

Those patients living in Major cities (9.3 per 10,000 population) had the highest rate of same day public mental health-related separations with specialised psychiatric care in 2015–16 whilst those living in Remote and very remote areas (1.3 per 10,000 population) had the lowest.

In 2015–16, the highest rate of same day public mental health-related separations with specialised psychiatric care was for those patients living in the most disadvantaged socioeconomic quintile (8.0 per 10,000 population) and the lowest rate was for those living in the second most disadvantaged quintile (6.0).

Principal diagnosis

The most frequently reported principal diagnosis in 2015–16 for same day public mental health-related separations with specialised psychiatric care was Depressive episode (ICD-10-AM code: F32) (25.9%), followed by Other anxiety disorders (F41) (11.3%) and Schizophrenia  (F20) (10.3%).

Figure SD.3: Same day public admitted mental health-related separations with specialised psychiatric care (per cent), the 5 most frequently reported principal diagnoses, 2015–16

Horizontal bar chart showing the percent of same day public admitted mental health-related separations with specialised psychiatric care for the 5 most frequently reported principal diagnoses. The 5 most common principal diagnoses: Depressive episode (F32) 25.9%25; Other anxiety disorders (F41) 11.3%25; Schizophrenia (F20) 10.3%25; Reaction to severe stress and adjustment disorders (F43) 5.2%25; Bipolar affective disorder (F31) 4.9%25. Refer to Table SD.7.

Source: National Hospital Morbidity Database.

Source data: Same day public admitted mental health-related care Table SD.7 (773KB 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 2015–16, there were 4,288 same day public mental health-related separations with specialised psychiatric care where the mental health legal status was ‘involuntary’— representing more than a quarter (22.2%) of these separations. The majority of these (3,802 or 88.7%) occurred in public acute hospitals. 

Involuntary separations accounted for 21.0% and 38.7% of same day separations with specialised psychiatric care in public acute hospital and public psychiatric hospitals respectively.

Figure SD.4: Same day public admitted mental health-related separations with specialised psychiatric care (per cent), by mental health legal status and hospital type, 2015–16

Vertical bar chart showing the proportion of same day public admitted mental health-related separations with specialised psychiatric care by legal status and hospital type. More than a quarter (22.2%25) of all these separations were involuntary. By hospital type: Public acute 21.0%25 involuntary; Public psychiatric 38.7%25 involuntary. Refer to Table SD.5.

Source: National Hospital Morbidity Database.

Source data: Same day public admitted mental health-related care Table SD.7 (773KB XLS).

Procedures

The most frequently reported procedure block for same day public mental health-related separations with specialised psychiatric care was Electroconvulsive therapy and Cerebral anaesthesia (both 26.9%). Cerebral anaesthesia is a form of general anaesthesia most likely associated with the administration of electroconvulsive therapy, a form of treatment for depression, which was the most common principal diagnosis for separations with specialised psychiatric care.

The next most frequently reported procedure block was Generalised allied health interventions, which was recorded for 1 in 14 (7.2%) of these separations. Of these allied health interventions, procedures provided by Social work were the most common (37.1% of allied health interventions), followed by Occupational therapy  (25.2%) and Psychology  (20.1%).

Non-specialised admitted patient mental health care

Service provision

Non-specialised admitted patient mental health care takes place outside of a designated psychiatric unit, as mentioned earlier, 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 usually combined in this section as there were very few separations without specialised psychiatric care in public psychiatric hospitals in 2015–16.

States and territories

In 2015–16, the national rate of same day public mental health-related separations without specialised psychiatric care was 16.7 per 10,000 population. The Northern Territory had the highest rate (62.1 per 10,000 population) while the Australian Capital Territory had the lowest (9.8) (Figure SD.5).

Figure SD.5: Same day public admitted mental health-related separations without specialised psychiatric care, states and territories, 2015–16

Vertical bar chart showing the rate (per 10,000 population) of same day public admitted mental health-related separations without specialised psychiatric care for all states and territories. The aggregate rate for all public hospitals was 16.7 separations per 10,000 population. By state or territory: NSW 11.1; Vic 22.1; Qld 17.7; WA 10.3; SA 24.7; Tas 17.9; ACT 9.8; NT 62.1. Refer to Table SD.12

Note: The Northern Territory and Australian Capital Territory do not have any public psychiatric hospitals.

Source: National Hospital Morbidity Database.

Source data: Same day public admitted mental health-related care Table SD.7 (773KB XLS).

For public hospitals in 2015–16, the majority (93.8%) of same day public mental health-related separations without specialised psychiatric care were public patients (e.g. the health service budget or reciprocal health care agreement). This ranged from 98.3% for the Northern Territory to 87.6% for Tasmania.

In 2015–16 the most common mode of separation for same day public mental health-related separations without specialised psychiatric care was discharge to ‘home’ (73.2%), which includes discharge to usual residence/own accommodation/welfare institution (including prisons, hostels and group homes providing primarily welfare services), followed by separation to an(other) acute hospital (16.3%). This ranged from 90.7% for Tasmania to 62.6% for New South Wales.

Patient demographics

In 2015–16, the highest rate of same day public mental health-related separations without specialised psychiatric care was for patients aged 35 to 44 years (23.0 per 10,000 population) and the lowest for those aged under 15 (4.9 per 10,000 population) (Figure SD.6). The separation rate was slightly higher for males than females (16.9 and 16.5 per 10,000 population respectively).

Aboriginal and Torres Strait Islander people had a rate of same day public mental health-related separations without specialised psychiatric care that was more than four times that of other Australians (63.7 and 15.1 per 10,000 population respectively).

The highest rate of same day public mental health-related separations without specialised psychiatric care in 2015–16 was for those living in Remote and very remote areas (36.8 per 1,000 population) and the lowest for those in Major cities (14.9 per 10,000 population).

In 2015–16, the highest rate same day public mental health-related separations without specialised psychiatric care was for those living in the least disadvantaged socioeconomic quintile (23.8 per 10,000 population) and the lowest rate was seen for those living in the most disadvantaged quintile (9.7).

Figure SD.6: Same day public admitted mental health-related separations without specialised psychiatric care, by sex and age, 2015–16

Vertical bar chart showing the rate (per 10,000 population) of same day public admitted mental health-related separations without specialised psychiatric care by age-group and sex. In aggregate terms, males (16.9) had a slightly higher rate than females (16.5). Refer to Table SD.21

Source: National Hospital Morbidity Database.  

Source data: Same day public admitted mental health-related care Table SD.7 (773KB XLS).

Principal diagnosis

In 2015–16, the most frequently reported principal diagnosis for same day public mental health-related separations without specialised psychiatric care were Mental and behavioural disorders due to use of alcohol (ICD-10-AM code F10) (22.8%), followed by Depressive episode (F32) (15.3%) (Figure SD.7).

Figure SD.7: Same day public admitted mental health-related separations without specialised psychiatric care (per cent), by the 5 most frequently reported principal diagnoses, 2015–16

Horizontal bar chart showing the percent of same day public admitted mental health-related separations without specialised psychiatric care for the 5 most frequently reported principal diagnoses for all public hospitals: Mental and behavioural disorders due to use of alcohol (F10) 22.8%25; Depressive episode (F32) 15.3%25; Mental and behavioural disorders due to other psychoactive substance use (F11-19) 8.8%25; Other anxiety disorders (F41) 8.3%25; Schizophrenia (F20) 7.1%25. Refer to Table SD.14.

Source: National Hospital Morbidity Database.

Source data: Same day public admitted mental health-related care Table SD.7 (773KB XLS).

Procedures

The most frequently reported procedure block for same day public mental health-related separations without specialised psychiatric care was Cerebral anaesthesia (22.5%) followed by Electroconvulsive therapy  (21.1%). Cerebral anaesthesia is a form of general anaesthesia most likely associated with the administration of electroconvulsive therapy, a form of treatment for depression, which was the second most common principal diagnosis for separations with specialised psychiatric care.

The next most frequently reported procedure block was Generalised allied health interventions, which was recorded for 1 in 16 (6.3%) of these separations. Of these allied health interventions, Social work procedures were the most common (51.2% of allied health interventions), followed by Physiotherapy (11.8%) and Occupational therapy (10.8%).