Data source and key concepts

National Mental Health Establishments Database

Collection of data for the Mental Health Establishments (MHE) NMDS began on 1 July 2005, replacing the Community Mental Health Establishments NMDS and the National Survey of Mental Health Services. The main aim of the development of the MHE NMDS was to expand on the Community Mental Health Establishments NMDS and replicate the data previously collected by the National Survey of Mental Health Services. The National Mental Health Establishments Database is compiled as specified by the MHE NMDS.

The scope of the MHE NMDS includes all specialised mental health services managed or funded, partially or fully, by state or territory health authorities. Specialised mental health services are those with the primary function of providing treatment, rehabilitation or community health support targeted towards people with a mental disorder or psychiatric disability. These activities are delivered from a service or facility that is readily identifiable as both specialised and serving a mental health care function.

The MHE NMDS data are provided at a number of levels: state, regional, organisational and individual mental health service unit. The data elements at each level in the NMDS collect information appropriate to that level. The state, regional and organisational levels include data elements for revenue, grants to non-government organisations and indirect expenditure. The organisational level also includes data elements for salary and non-salary expenditure, numbers of full-time-equivalent staff and consumer and carer worker participation arrangements. The individual mental health service unit level comprises data elements that describe the function of the unit. Where applicable, these include target population, program type, number of beds, number of accrued patient days, number of separations, and number of service contacts and episodes of residential care. In addition, the service unit level also includes salary and non-salary expenditure and depreciation.

Data Quality Statements for National Minimum Data Sets (NMDSs) are published annually on the Metadata Online Registry (METeOR). Statements provide information on the institutional environment, timelines, accessibility, interpretability, relevance, accuracy and coherence.

Data validation

Data presented in this publication are the most current data for all years presented. The validation process assesses the data for consistency in the current collection and across historical data. The validation process applies a range of rules to the data to test for potential issues. Jurisdictional representatives respond to each issue before the data are accepted as the most reliable current data collection. This process may highlight issues with historical data. In such cases, historical data may be adjusted to ensure data are more consistent. Therefore, comparisons made to previous versions of Mental health services in Australia publications should be approached with caution.

Consumer committee representation arrangements

Specialised mental health organisations report the extent to which consumer participation arrangements are in place to promote the inclusion of mental health consumers in the planning, delivery and evaluation of the service. Organisations report their consumer participation arrangements at various levels, as detailed below.

Data source FAC.1 Levels of consumer participation arrangements

Level Description

Level 1

Formal position(s) for consumers exist on the organisation’s management committee for the appointment of person(s) to represent the interests of consumers. Alternatively, specific consumer advisory committee(s) exists to advise on all relevant mental health services managed by the organisation.

Level 2

Specific consumer advisory committee(s) exists to advise on some but not all relevant mental health services managed by the organisation. 

Level 3

Consumers participate on a broadly based advisory committee that includes a mixture of organisations and groups representing a wide range of interests.

Level 4

Consumers are not represented on any advisory committee but are encouraged to meet with senior representatives of the organisation as required. Alternatively, no specific arrangements exist for consumer participation in planning and evaluation of services. 

National standards for mental health services review status

There are 8 levels used to describe the extent to which a service unit has implemented the National Standards, as shown in the table below.

Data source FAC.2 National standards for mental health services review status levels

Level Description
1 The service unit had been reviewed by an external accreditation agency and was judged to have met the National standards as determined by the accrediting agency.
2 The service unit had been reviewed by an external accrediting agency and was judged to have met some but not all of the National standards. 
3 The service unit was in the process of being reviewed by an external accrediting agency but the outcomes were not known. 
4 The service unit was booked for review by an external accrediting agency and was engaged in self‑assessment preparation prior to the formal external review. 
5 The service unit was engaged in self‑assessment in relation to the National standards but did not have a contractual arrangement with an external accreditation agency for review.
6 The service unit had not commenced the preparations for review by an external accrediting agency but this was intended to be undertaken in the future.
7 It had not been resolved whether the service unit would undertake review by an external accrediting agency under the National standards. 
8 The National standards are not applicable to this service unit. 

Source: National Standards for Mental Health Services status (see METeOR ID: 573549).

Reporting levels for national standards

To match definitions in the National Key Performance Indicator set for Mental Health Services, the data presented are restricted to 4 levels. Level 1 represents code 1, Level 2 represents code 2, Level 3 represents codes 3 and 4 and Level 4 represents codes 5–7. Code 8 is excluded as the standards do not apply to these units.

The National standards for mental health services were revised in 2010  (DoH 2010). In addition to these mental health-specific national standards, other national standards have been published and implemented against which mental health services may also be measured. Work is ongoing to improve the method for reporting the standards against which a service is measured.

New South Wales CADE and T-BASIS services

All New South Wales Confused and Disturbed Elderly (CADE) 24-hour staffed Residential mental health care services were reclassified as specialised mental health non-acute admitted patient hospital services, termed Transitional Behavioural Assessment and Intervention Service (T-BASIS), from 1 July 2007. All data relating to these services have been re-classified from 2007–08 onwards, including number of services, number of beds, staffing and expenditure. Comparison of data over time should therefore be approached with caution.

New South Wales Mental Health Community Living Programs

New South Wales has been developing the NSW Housing Accommodation Support Initiative (HASI) since it was established in 2002. This model of care is a partnership program between NSW Ministry of Health, Housing NSW and the non-government organisation (NGO) sector that provides housing linked to clinical and psychosocial rehabilitation services for people with a range of levels of psychiatric disability.

In 2016, Community Living Supports (CLS) commenced to support more people with severe mental illness to access the same type of support provided in HASI.

From 2017–18 New South Wales supported housing places reflect changes resulting from the conclusion of the Commonwealth National Partnership Agreement (NPA) on Mental Health Services. The NSW Government continued funding until Dec 2017 to allow for transition to alternative support arrangements (including the NDIS) for up to 200 people in NPA funded supported housing places.

Both HASI and CLS are reported as Specialised mental health service—supported mental health housing places (METeOR identifier 390929). These programs are out of scope as Residential mental health care services (METeOR identifier 373049). See the above hyperlink for further information about the NSW HASI program.

Public sector specialised mental health beds

In 2017–18, Queensland reported specialised residential mental health service beds to the Mental Health Establishments collection for the first time due to the reclassification of some public sector mental health hospital beds.

Organisational overhead setting

In 2012–13, the Organisational overhead setting was introduced for greater national consistency in reporting and greater clarity about staff delivering care to patients. The Organisational overhead setting consists of the components of specialised mental health service organisations not directly involved in the delivery of patient care services in the admitted patient, residential or community mental health care service settings, or in the operations of those settings. The definition does not imply that these roles do not have an impact on service delivery. For example, a chief operating officer not directly providing patient care, nor involved in the operation of services in a specific service setting, would be reported in the Organisational overhead setting. The reporting methodology for the new Organisational overhead setting is taking time for states and territories to implement (see Table FAC.39 for detailed time series data).

Rates calculations

Calculations of rates for target populations are based on age-specific populations as defined by the MHE NMDS metadata and outlined below.

  • General services: persons aged 18–64.
  • Child and adolescent services: persons aged 0–17.
  • Youth services: persons aged 16–24.
  • Older persons: persons aged 65 and over.
  • Forensic services: persons aged 18 and over.

Crude rates were calculated using the Australian Bureau of Statistics estimated resident population (ERP) at the midpoint of the data range (for example, rates for 2018–19 data were calculated using ERP at 31 December 2018). Historical rates have been recalculated using revised ERPs based on the 2011 Census of Population and Housing, as detailed in the online technical information.

Private Health Reporting

Private hospital specialised mental health services staffing

Staffing provided in private hospital specialised mental health service are no longer available. These data were previously provided by the Australian Bureau of Statistics through its Private Hospitals Establishment Collection (PHEC), but this survey was discontinued in 2016–17.

Private Health Establishments Collection

From 1992–93 to 2016–17 (excluding 2007–08) the ABS conducted a census of all private hospitals licensed by state and territory health authorities and all freestanding day hospitals facilities approved by the Commonwealth Department of Health. As part of that census, data on the staffing, finances and activity of these establishments were collected and compiled in the Private Health Establishments Collection. Additional information on the Private Health Establishments Collection can be obtained from the ABS publication Private hospitals, Australia (ABS 2018).

The data definitions used in the Private Health Establishments Collection are largely based on definitions in the National health data dictionary (NHDD) published on the AIHW’s Metadata Online Registry (METeOR) website (AIHW 2015). The ABS defines private psychiatric hospitals as those licensed or approved by a state or territory health authority and which cater primarily for admitted patients with psychiatric, mental or behavioural disorders (ABS 2018). This is further defined as those hospitals providing 50% or more of the total patient days for psychiatric patients. This definition can be extended to include specialised units or wards in private hospitals, consistent with the approach in the public sector. For further technical information, see the Private psychiatric hospital data section of the National mental health report 2013 (DoH 2013).

The last data were collected for the 2016–17 period. Increases in psychiatric beds were the result of improvements in methodology to apportion the data between psychiatric and alcohol/drug treatment wards, new establishments reporting for the first time, and a general increase in psychiatric beds in establishments that have reported psychiatric units in the past. Caution is required when comparing data for 2010–11 to other years as the survey was altered such that psychiatric units could no longer be separately identified from alcohol/drug treatment units. Therefore, the data for beds, patient days, separations and staffing were estimates based on reported 2010–11 data and trends observed in previous years. Data from the Private Mental Health collection suggest that these data may be underestimates  (PMHA 2013).

Private Psychiatric Hospitals Data Reporting and Analysis Service

The Australian Private Hospitals Association Private Psychiatric Hospitals Data Reporting and Analysis Service (PPHDRAS), previously known as the Private Mental Health Alliance Centralised Data Management Service (PMHA CDMS), was launched in Australia in 2001 to support private hospitals with psychiatric beds to routinely collect and report on a nationally agreed suite of clinical measures and related data for the purposes of monitoring, evaluating and improving the quality of and effectiveness of care. The PPHDRAS works closely with private hospitals, health insurers and other funders (e.g. Department of Veterans’ Affairs) to provide a detailed quarterly statistical reporting service on participating hospitals’ service provision and patient outcomes.

The PPHDRAS fulfils two main objectives. Firstly, it assists participating private hospitals with implementation of their National Model for the Collection and Analysis of a Minimum Data Set with Outcome Measures. Secondly, the PPHDRAS provides hospitals and private health funds with a data management service that routinely prepares and distributes standard reports to assist them in the monitoring and evaluation of health care quality. The PPHDRAS also maintains training resources for hospitals and a database application, which enables hospitals to submit de-identified data to the PPHDRAS. The PPHDRAS produces an annual statistical report. In 2019–20, the PPHDRAS accounted for 98% of all private psychiatric beds in Australia (PPHDRAS 2020)

From 2017–18, all private hospital data is sourced from the PPHDRAS. Data on expenditure and Staffing (FTE) are not collected in the PPHDRAS.

Key concepts - Specialised mental health care facilities
Key concept Description
Beds The number of available specialised mental health beds refers to the average number of beds that are immediately available for use by an admitted patient within the mental health facility over the financial year, estimated using monthly figures (METeOR identifier 616014). Data prior to 2005–06 were sourced from the National Survey of Mental Health Services, which reported the total number of beds available as at 30 June. Comparison of historical data should therefore be approached with caution.
Community mental health care services Community mental health care services include hospital outpatient clinics and non‑hospital community mental health care services, such as crisis or mobile assessment and treatment services, day programs, outreach services, and consultation/liaison services.
Consumer committee representation arrangements Specialised mental health organisations report the level of consumer committee representation arrangements. To be regarded as having a formal position on a management or advisory committee, the consumer representative needs to be a voting member (METeOR identifier288855). This is independent to the employment of consumer and carer consultants. The data source section provides information on the levels available.
Government-operated residential mental health services

Government‑operated residential mental health services are specialised Residential mental health care services that: 

  • are operated by a state or territory government
  • employ mental health-trained staff on‑site for a minimum of 6 hours per day and at least 50 hours per week
  • provide rehabilitation, treatment or extended care to residents for whom the care is intended to be on an overnight basis and in a domestic‑like environment
  • encourage the resident to take responsibility for their daily living activities.
Health care providers

Health care providers refers to the following staffing categories: salaried medical officers, nurses, diagnostic and allied health professionals, other personal care staff and mental health consumer and carer workers. 
Mental health carer worker Mental health carer workers are employed (or engaged via contract) on a part-time or full-time basis specifically for their expertise developed from their experience as a mental health carer (METeOR identifier 717103). Mental health carer workers include the job titles of, but not limited to, carer consultants, peer support workers, carer support workers, carer representatives and carer advocates. Roles that mental health carer workers may perform include, but are not limited to, mental health policy development, advocacy roles and carer support roles.
Mental health consumer worker Mental health consumer workers are employed (or engaged through contracts) on a part-time or full-time basis specifically due to the expertise developed from their lived experience of mental illness (METeOR identifier 450727). Mental health consumer workers include the job titles of, but not limited to, consumer consultants, peer support workers, peer specialists, consumer companions, consumer representatives, consumer project officers and recovery support workers. Roles that mental health consumer workers may perform include, but are not limited to, participation in mental health service planning, mental health service evaluation and peer support roles.
National standards for mental health services

The National standards for mental health services (DOH 2010) were developed under the First National Mental Health Plan and are applicable to individual service units. There are 8 levels available to describe a service unit's status (METeOR identifier 722190). The data source section provides information for the full description of all 8 levels and information relating to the revised 2010 national standards (DOH 2010). For reporting purposes, the data are collated into the following 4 levels:

  • Level 1: the service unit has been reviewed by an external accreditation agency and was judged to have met the standards.
  • Level 2: the service unit was in the process of being reviewed by an external accreditation agency and was judged to have met some but not all of the National Standards for Mental Health Services.
  • Level 3: the service unit was in the process of being reviewed by an external accreditation agency but the outcomes are not known; or the service unit is booked for review by an external accreditation agency.
  • Level 4: the service unit does not meet the criteria detailed in levels 1 to 3.
Non-government-operated residential mental health services Non‑government‑operated residential mental health services are specialised Residential mental health care services which meet the same criteria as government‑operated Residential mental health care services. These services, while partially or fully funded by governments, are operated by non‑government agencies. Expenditure reported as non-government operated Residential mental health care services includes the total operating costs for the residential service, not the total operating costs of the non-government organisation as an entity. Expenditure reported as Grants to non-government organisations includes grants made by state and territory government departments to non-government organisations specifically for mental health-related programs and initiatives and are reported separately to expenditure reported for non-government-operated Residential mental health care services.
Patient days Patient days are days of admitted patient care provided to admitted patients in public psychiatric hospitals or specialised psychiatric units or wards in public acute hospitals and in Residential mental health care services. The total number of patient days is reported by specialised mental health service units. For consistency in data reporting, the following patient day data collection guidelines apply: admission and discharge on the same day equals 1 day; all days are counted during a period of admission except for the day of discharge; and leave days are excluded from the total. Note that the number of patient days reported to the National Mental Health Establishments Database is not directly comparable with either the number of patient days reported to the National Hospital Morbidity Database (Overnight admitted patient mental health-related care section) or the number of residential care days reported to the National Residential Mental Health Care Database (Residential mental health care section).
Private psychiatric hospital A private psychiatric hospital is an establishment devoted primarily to the treatment and care of admitted patients with psychiatric, mental or behavioural disorders. From 2017–18, all private hospital data is sourced from the Private Psychiatric Hospitals Data Reporting and Analysis Service (PPHDRAS). Data on expenditure and Staffing (FTE) are not collected in PPHADRAS. Up to 2016–17, data were sourced from the Private Health Establishments Collection (PHEC), held by the Australian Bureau of Statistics (ABS), which identifies private psychiatric hospitals as those that are licensed/approved by a state or territory health authority, and which cater primarily for admitted patients with psychiatric, mental or behavioural disorders (ABS 2018), that is, providing 50% or more of the total patient days for psychiatric patients. The data published in this section also include psychiatric units or wards in private hospitals. Further information can be found in the data source section.
Program type Public sector specialised mental health hospital services can be categorised based on program type, which describes the principal purpose(s) of the program rather than the classification of the individual patients. Acute care admitted patient programs involve short‑term treatment for individuals with acute episodes of a mental disorder, characterised by recent onset of severe clinical symptoms that have the potential for prolonged dysfunction or risk to self and/or others. Non‑acute care refers to all other admitted patient programs, including rehabilitation and extended care services (see METeOR identifier 288889).
Psychiatric units or wards Psychiatric units or wards are specialised units or wards that are dedicated to the treatment and care of admitted patients with psychiatric, mental or behavioural disorders.
Public acute hospital A public acute hospital is an establishment that provides at least minimal medical, surgical or obstetric services for admitted patient treatment and/or care and provides round‑the‑clock comprehensive qualified nursing services as well as other necessary professional services. They must be licensed by the state or territory health department or be controlled by government departments. Most of the patients have acute conditions or temporary ailments and the average length of stay is relatively short.
Public psychiatric hospital A public psychiatric hospital is an establishment devoted primarily to the treatment and care of admitted patients with psychiatric, mental or behavioural disorders that is controlled by a state or territory health authority and offers free diagnostic services, treatment, care and accommodation to all eligible patients.
Service setting Staffing of specialised mental health service units is reported as service setting level data for three specialist mental health service types. These settings are admitted patient services in public psychiatric hospitals and public acute hospitals with specialised psychiatric units or wards; Community mental health care services; Residential mental health care services, including government and non-government-operated services; and at the Organisational overhead setting. The Organisational overhead setting level has been included from 2012–13 capturing staff employed by specialised mental health service organisations, performing organisational management roles.
Specialised mental health service organisation A specialised mental health service organisation is a separate entity within states and territories responsible for the clinical governance, administration and financial management of services providing specialised mental health care. For most states and territories, a specialised mental health service organisation is equivalent to the area/district mental health service. These organisations may consist of one or more specialised mental health service units, sometimes based in different locations. Each separately identifiable unit provides either specialised mental health admitted patient hospital services, Residential mental health care services or Community mental health care services (METeOR identifier 286449).
Staff

Staff numbers reported in this section refer to the average number of full-time-equivalent (FTE) staff employed, that is, the total hours actually worked divided by the number of normal hours worked by a full-time staff member (METeOR identifier 269172).
Supported housing places Supported housing places are reported by jurisdictions to describe the capacity of supported housing targeted to people affected by mental illness (METeOR identifier 390929). This is reported at the number available at 30 June and is therefore not comparable to the average available beds measures for specialised mental health hospital and residential services.
Target population

Some specialised mental health services data are categorised using 5 target population groups (see METeOR identifier 682403):

  • Child and adolescent services focus on those aged under 18 years.
  • Older person programs focus on those aged 65 years and over.
  • Forensic health services provide services primarily for people whose health condition has led them to commit, or be suspected of, a criminal offence or make it likely that they will reoffend without adequate treatment or containment.
  • General programs provide services to the adult population, aged 18 to 64; however, these services may also provide assistance to children, adolescents or older people. 
  • Youth services target children and young people generally aged 16–24 years.

Note that, in some states, specialised mental health beds for aged persons are jointly funded by the Australian and state and territory governments. However, not all states or territories report such jointly funded beds through the National Mental Health Establishments Database.