Same day admitted mental health care—public hospitals

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). 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 3.7 million same day separations from public hospitals in 2018–19, inclusive of acute and psychiatric hospitals. Of these, 59,888 were mental health-related, accounting for roughly 1 in 60 (1.6%) of all same day public hospital separations. About one third of these mental health separations involved specialised psychiatric care (18,836, or 31.5%).

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 or unit. These are staffed by health professionals with specialist mental health qualifications or training and have the treatment and care of patients affected by mental illness as their principal function. This may also be referred to as specialised psychiatric care.

States and territories

In 2018–19, there were 18,836 same day public admitted mental health-related separations with specialised psychiatric care; equivalent to a national rate of 7.5 per 10,000 population.

The rate of same day public acute hospital mental health-related separations with specialised psychiatric care was highest for Queensland (19.6 per 10,000 population) (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 2018–19, slightly more than three-quarters (77.2%) 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%. New South Wales reported a public patient proportion of 39.9%, with the remainder being largely accounted for by DVA funding (58.5%).

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 2018–19, the most common mode of separation for same day public mental health-related separations with specialised psychiatric care was discharge to ‘home’ (88.7%), which includes discharge to usual residence/own accommodation/welfare institution (including prisons, hostels and group homes providing primarily welfare services). Note that information on the place to which a patient was discharged or transferred may not be available for some separations.

Figure SD.1: Same day public admitted mental health-related separations with specialised psychiatric care, state and territory, by hospital type, 2018-19.

Vertical stacked 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. 6.5 per 10,000 population separations in New South Wales took place in public acute hospitals in 2018–19, 0.7 in public psychiatric hospitals; Victoria, 0.8 public acute; Queensland, 19.6 public acute; Western Australia, 5.6 public acute, 0.8 public psychiatric; South Australia, 3.5 public acute, 1.5 public psychiatric; Tasmania, 0.4 public acute, 0.3 public psychiatric; Northern Territory, 1.1 public acute; Total, 7.1 public acute, 0.4 public psychiatric. Refer to Table SD.4.

Visualisation not available for printing

Source data: Same day admitted mental health-related care 2018–19 tables (119KB XLSX).

Patient demographics

In 2018–19, 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 5–11 years (59.1 and 0.1 per 10,000 population respectively) (Figure SD.2). Overall, the separation rate was higher for females than males (8.9 and 6.1 per 10,000 population respectively).

There were 972 same day public mental health separations with specialised psychiatric care for Aboriginal and Torres Strait Islander people in 2018–19, or 11.7 per 10,000 population, which is higher than the rate for other patients (6.9 per 10,000 population). Rates standardised on the 2001 age profile were 11.7 and 6.1 per 10,000 population for Aboriginal and Torres Strait Islander patients and other patients respectively. The standardised rate for Indigenous people was 1.9 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 in 2018–19, at 8.6 per 10,000 population. People living in Remote and Very remote areas had the lowest rate at 1.4 per 10,000 population.

Figure SD.2: Same day public admitted mental health-related separations with specialised psychiatric care, by demographic category, 2018-19

Horizontal 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, sex, indigenous status, remoteness and SEIFA quintile . Persons by age group: 5–11 years 0.1; 12–17 years 7.0; 18–24 years 12.2; 25–34 years 7.8; 35–44 years 7.3; 45–54 years 7.0; 55–64 years 5.4; 65–74 years 5.6; 75–84 years 10.0; 85 years and older 59.1. Persons by sex: males 6.1; females 8.9. Persons by indigenous status: Indigenous Australians 11.7; Non-Indigenous Australians 6.1. Persons by remoteness: major cities 8.6; inner regional 4.4; outer regional 3.7; remote and very remote 1.4. Persons by SEIFA: quintile one (most disadvantaged) 6.9; quintile two 5.0; quintile three 7.6; quintile four 9.1; quintile five (least disadvantaged) 7.9. Refer to Table SD.5.

Visualisation not available for printing

Source data: Same day admitted mental health-related care 2018–19 tables (119KB XLSX).

Changes over time

The number of overall same day public mental health-related separations with specialised psychiatric care increased from 16,258 in 2008–09 to 18,836 in 2018–19 representing an average annual increase of 1.5%  over this period.

The proportion of separations for people aged 5–11 years who received specialised psychiatric care has decreased during this period from 7.9 per 10,000 population in 2008–09 to 0.1 in 2018–19. This represents an average annual decrease of -34.5%.

For both males and females aged 18–24 years, the separation rate per 10,000 population increased from 4.3 to 9.7 and from 4.8 to 14.8 respectively since 2008–09, with females showing a separation rate 1.5 times higher than males.

Principal diagnosis

The 5 most frequently reported principal diagnosis in 2018–19 for same day public mental health-related separations with specialised psychiatric care were Depressive episode (ICD-10-AM code: F32) (23.2%), Other anxiety disorders (F41) (11.9%), Schizophrenia (F20) (7.4%), Reaction to severe stress and adjustment disorders (F43) (5.5%), and Recurrent depressive disorders (F31) (4.8%) (Figure SD.3).

Figure SD.3: Proportion of same day public admitted mental health-related separations with specialised psychiatric care, for 5 commonly reported principal diagnoses, 2018-19

Horizontal bar chart showing the percent of same day public admitted mental health-related separations with specialised psychiatric care for 5 commonly reported principal diagnoses. The 5 common principal diagnoses: Depressive episode (F32) 23.2%; Other anxiety disorders (F41) 11.9%; Schizophrenia (F20) 7.4%; Reaction to severe stress and adjustment disorders (F43) 5.5%; Recurrent depressive disorders (F31) 4.8%. Refer to Table SD.6.

Visualisation not available for printing

Source data: Same day admitted mental health-related care 2018–19 tables (119KB XLSX).

Procedures

The most frequently reported procedure blocks for same day public mental health-related separations with specialised psychiatric care in 2018–19 were Cerebral anaesthesia (33.3% of procedures), and Electroconvulsive therapy (33.2% of procedures), which were associated with 24.0% and 23.9% of separations respectively. 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 (13.3% of procedures and 7.9% of separations). Of these allied health interventions, procedures provided by Social work were the most common (41.3% of allied health interventions), followed by Psychology (28.521.4%) and Occupational therapy (14.5%).

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 2018–19.

States and territories

In 2018–19, there were 41,052 same day public admitted mental health-related separations without specialised psychiatric care; equivalent to a national rate of 16.3 per 10,000 population. The majority (93.7%) of the separations were publically funded.

About three quarters (77.1%) 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 (13.7%, which includes transfers to another acute or psychiatric hospital, aged care facilities, and other health accommodation), statistical discharges (6.1%, which include changes in care type and discharges from leave), patients leaving against medical advice (3.0%), and deaths (0.1%) respectively).

Patient demographics

In 2018–19, the highest rate of same day public mental health-related separations without specialised psychiatric care was observed for patients aged 85 years and over (26.0 per 10,000 population) and the lowest for those aged 5 to 11 years (2.0 per 10,000 population) (Figure SD.4). The separation rate was similar for males and females (16.1 and 16.5 per 10,000 population respectively).

There were 4,236 same day public mental health separations without specialised psychiatric care for Indigenous people in 2018–19, or 51.0 per 10,000 population, which is more than three times higher than the rate of 15.0 per 10,000 population for other patients. The 2001 age profile standardised rate was 58.4 per 10,000 population for Indigenous Australians which was 4.2 times higher than the standardised rate of 14.0 per 10,000 population for non-Indigenous Australians.

The rate per 10,000 population of same day public mental health-related separations without specialised psychiatric care increased with increasing remoteness, which contrasts with the inverse patterns observed for separations with specialised psychiatric care. People living in Major cities had the lowest rate (14.3 per 10,000 population), and people living in Remote and Very remote areas had the highest rate (40.0 per 10,000 population).

Figure SD.4: Same day public admitted mental health-related separations without specialised psychiatric care, by demographic category, 2018-19.

Horizontal 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, sex, indigenous status, remoteness and SEIFA quintile. Persons by age group: 0–4 years 7.6; 5–11 years 2.0; 12–17 years 10.3; 18–24 years 20.9; 25–34 years 19.2; 35–44 years 21.1; 45–54 years 19.8; 55–64 years 14.2; 65–74 years 16.3; 75–84 years 23.1; 85 years and older 26.0. Persons by sex: males 16.1; females 16.5. Persons by indigenous status: Indigenous Australians 58.4; Non-Indigenous 14.0. Persons by remoteness: major cities 14.3; inner regional 16.2; outer regional 23.7; remote and very remote 40.0. Persons by SEIFA: quintile one (most disadvantaged) 20.6; quintile two 16.6; quintile three 15.3; quintile four 14.9; quintile five 11.9. Refer to Table SD.5.

Visualisation not available for printing

Source data: Same day admitted mental health-related care 2018–19 tables (119KB XLSX).

Changes over time

The number of overall same day public mental health-related separations without specialised psychiatric care increased from 28,339 in 2008–09 to 41,052 in 2018–19. This represents an average annual change of 3.8% over this period.

Separation rates for persons over 85 in same day public mental health-related separations without specialised psychiatric care had the biggest decrease from 53.8 in 2008–09 to 26.0 in 2018–19.

The average annual change in the separation rate per 10,000 population over this time period for females was highest for those aged 5–11 (7.2%). For males, the average annual change was highest for males aged 85 years and over (a decrease of 14.8%) followed by 55–64 years (6.4%).

Principal diagnosis

In 2018–19, 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) (24.0%), followed by Depressive episode (F32) (14.3%) (Figure SD.5).

Figure SD.5: Proportion of same day public mental health-related separations without specialised psychiatric care, for 5 commonly reported principal diagnoses, 2018-19.

Horizontal bar chart showing the percent of same day public admitted mental health-related separations without specialised psychiatric care for 5 commonly reported principal diagnoses for all public hospitals: Mental and behavioural disorders due to use of alcohol (F10) 24.0%; Depressive episode (F32) 14.3%; Mental and behavioural disorders due to other psychoactive substance use (F11-19) 9.0%; Other anxiety disorders (F41) 8.7%; Schizophrenia (F20) 6.2%. Refer to Table SD.6.

Visualisation not available for printing

Source data: Same day admitted mental health-related care 2018–19 tables (119KB XLSX).

Procedures

The most frequently reported procedure block for same day public mental health-related separations without specialised psychiatric care was Cerebral anaesthesia (35.1% of procedures, and associated with 23.6% of separations), followed by Electroconvulsive therapy (32.7% of procedures, and associated with 22.0% 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 second most common principal diagnosis for separations without specialised psychiatric care.

The third most frequently reported procedure block was Generalised allied health interventions (13.7% of procedures, and associated with 7.7% of separations). Of these allied health interventions, Social work procedures were the most common (46.8% of allied health interventions), followed by Physiotherapy (13.2%) and Occupational therapy (11.2%).