Mental health services in Australia

This section presents information on same day admitted patient mental health-related separations 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. It is possible for individuals to have multiple separations in any given reference period. Further information can be found in the data source section.

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.

There were 3.6 million same day separations from public hospitals in 2017–18, inclusive of acute and psychiatric hospitals. Of these, 61,316 were mental health-related, accounting for roughly 1 in 60 (1.7%) of all same day public hospital separations. About one third of these mental health separations, involved specialised psychiatric care (19,825, or 32.3%).

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 2017–18, there were 19,825 same day public admitted mental health-related separations with specialised psychiatric care; equivalent to a national rate of 8.0 per 10,000 population, which is a reduction of about -12% year-on-year. The national rate for public acute hospitals was 7.4 per 10,000 population.

The rate of same day public acute hospital mental health-related separations with specialised psychiatric care was highest for Queensland (19.9 per 10,000 population). Tasmania and Northern Territory reported the lowest rates (0.6 and 0.7 per 10,000 population respectively) (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 2017–18, slightly more than three-quarters (76.1%) of same day mental health-related separations with specialised psychiatric care were public patients (e.g. the health service budget or reciprocal health care agreement). Of those jurisdictions with published proportions, all except New South Wales reported a proportion of publicly funded separations above 90%, which is substantially higher than the national proportion. New South Wales reported a public patient proportion of 46.3%, with the remainder being largely accounted for by DVA funding (51.8%).

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. In 2017–18, the most common mode of separation for same day public mental health-related separations with specialised psychiatric care was discharge to ‘home’ (89.9%), which includes discharge to usual residence/own accommodation/welfare institution (including prisons, hostels and group homes providing primarily welfare services). This was similar to the percentage reported for 2016–17.

Figure SD.1 Alternative text - Source data: Same day public admitted mental health-related care tables (102KB XLS).

Patient demographics

In 2017–18, the rate of same day public admitted mental health-related separations with specialised psychiatric care was highest for patients aged 85 years and older and lowest for those aged 0–4 years (61.3 and 0.7 per 10,000 population respectively) (Figure SD.2). Note that previously rates were published for patients aged 65 years and older, and the high rate for patients aged 85 years and older revealed in this report is similar to rates observed over the past few years. Overall, the separation rate was higher for females than males (9.3 and 6.7 per 10,000 population respectively).

Figure SD.2 Alternative text - Source data: Same day public admitted mental health-related care tables (102KB XLS).

There were 872 same day public mental health separations with specialised psychiatric care for Aboriginal and Torres Strait Islander people in 2017–18, which is 11.5 per 10,000 population, which compares to 7.6 per 10,000 population for other patients. Rates standardised on the 2001 age profile were 11.4 and 7.3 per 10,000 population respectively, so the standarised rate for Indigenous people was 1.6 times that of other patients.

People living in Major cities having the highest rate of same day public mental health-related separations with specialised psychiatric care, at 9.4 per 10,000 population. People living in Remote and Very remote areas had a rate of 1.6 per 10,000 population.

The three highest SEIFA quintiles (less disadvantaged) had somewhat higher separations per population (8.6 per 10,000 population and higher) than the two lowest SEIFA quintiles (7.1 per 10,000 population and lower).

Principal diagnosis

The most frequently reported principal diagnosis in 2017–18 for same day public mental health-related separations with specialised psychiatric care were Depressive episode (ICD-10-AM code: F32) (21.3%), followed by Other anxiety disorders (F41) (10.8%) and Schizophrenia (F20) (8.7%) (Figure SD.3). These were similar to the percentages reported in
2016–17.

Figure SD.3 Alternative text - Source data: Same day public admitted mental health-related care tables (102KB 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, there were 3,985 same day public mental health-related separations with specialised psychiatric care where the mental health legal status was ‘involuntary’— representing roughly a fifth (20.3%) of all same day public mental health-related separations with specialised psychiatric care. The majority of these (3,524 or 88.4%) occurred in public acute hospitals.

Involuntary separations accounted for 19.4% and 31.4% of same day separations with specialised psychiatric care in public acute hospital and public psychiatric hospitals respectively (Figure SD.4).

Figure SD.4 Alternative text - Source data: Same day public admitted mental health-related care tables (102KB 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 at 32.3% of procedures, and both associated with 21.9% of separations). 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 third most frequently reported procedure block was Generalised allied health interventions (14.0% of procedures and 7.4% of separations). Of these allied health interventions, procedures provided by Social work were the most common (34.9% of allied health interventions), followed by Psychology (28.5%) and Dietetics (15.8%).

Non-specialised admitted patient mental health care

Service provision

Non-specialised admitted patient mental health care takes place outside of 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 majority (93.4%) of public hospital same day mental health-related separations without specialised psychiatric care were publically funded in 2017–18. Individual jurisdictions varied from the national proportion by up to about 8 percentage points, with New South Wales reporting the lowest proportion (86.0%), and Northern Territory and South Australia reporting the highest proportions (97.9% and 97.6% respectively).

About three quarters (74.3%) of same day public mental health-related separations without specialised psychiatric care were discharges to ‘home’, which includes discharge to usual residence/own accommodation/welfare institution (including prisons, hostels and group homes providing primarily welfare services). The remaining quarter consisted of transfers to another facility (15.2%, includes transfers to another hospital, aged care facilities, and other health accommodation), statistical discharges (7.3%, which includes changes in care type, and discharges from leave), patients leaving against medical advice (3.1%), and deaths (0.1%). There were some substantial variations in this breakdown between individual jurisdictions, for example, New South Wales reported a relatively high proportion of statistical discharges (31.0%), and a relatively small proportion of discharges to ‘home’ (56.0%). Victoria and South Australia reported relatively high proportions of transfers (22.0% and 21.3% respectively). Western Australia, Northern Territory, and New South Wales reported the highest proportions of patients leaving against medical advice (6.8%, 5.9%, and 5.1% respectively).

Patient demographics

In 2017–18, the highest rate of same day public mental health-related separations without specialised psychiatric care was observed for patients aged 85 years and over (26.4 per 10,000 population) and the lowest for those aged 5 to 11 years (1.8 per 10,000 population) (Figure SD.5). The separation rate was similar for males and females (16.6 and 16.9 per 10,000 population respectively).

There were 4,209 same day public mental health separations without specialised psychiatric care for Indigenous people in 2017–18, which is 55.3 per 10,000 population, which compares to 15.4 per 10,000 population for other patients. Rates standardised on the 2001 age profile were 64.7 and 15.2 per 10,000 population respectively, so the standardised rate for Indigenous people was 4.3 times that of other patients.

The rate per population of same day public mental health-related separations without specialised psychiatric care increased with increasing remoteness, and with increasing socioeconomic disadvantage, which contrasts with the inverse patterns observed for separations with specialised psychiatric care. People living in Major cities had the lowest rate (15.1 per 10,000 population), and people living in Remote and Very remote areas had the highest rate (39.3 per 10,000 population). Populations of the most disadvantaged SEIFA quintile had the highest rate (21.4 per 10,000 population), and populations of the least disadvantages quintile had the lowest rate (12.1 per 10,000 population).

Figure SD.5 Alternative text -Source data: Same day public admitted mental health-related care tables (102KB XLS).

Principal diagnosis

In 2017–18, 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) (22.9%), followed by Depressive episode (F32) (14.7%) (Figure SD.6).

Figure SD.6 Alternative text - Source data: Same day public admitted mental health-related care tables (102KB XLS).

Procedures

The most frequently reported procedure block for same day public mental health-related separations without specialised psychiatric care was Cerebral anesthesia (36.5% of procedures, and associated with 24.3% of separations), followed by Electroconvulsive therapy (34.3% of procedures, and associated with 22.7% of separations). Cerebral anesthesia is a form of general anesthesia 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 without specialised psychiatric care.

The third most frequently reported procedure block was Generalised allied health interventions (12.2% of procedures, and associated with 6.9% of separations). Of these allied health interventions, Social work procedures were the most common (49.2% of allied health interventions), followed by Physiotherapy (12.6%) and Occupational therapy (10.1%).

Changes over time

For the time span 2006–07 to 2017–18, notable changes in the population rates of same day mental health separations included:

• For patients aged 5–11 years, the separation rate with specialised psychiatric care decreased by 80.9%, (13.6 and 2.6 per 10,000 population, in 2006–07 and 2017–18 respectively), while rates without specialised psychiatric care were consistently below 2 in this time range.
• For patients aged 18–24 years, the separation rate with specialised psychiatric care increased from 3.4 to 11.7 per 10,000 population between 2006–07 and 2017–18, while rates without specialised care were higher, but comparatively steady over this time span.
• For patients aged 45–54 years, separation rates with and without specialised care increased by 79.2% and 58.7% respectively, over this time span.