Specialised overnight admitted patient mental health care

Service provision

Specialised overnight admitted patient 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 is also referred to as specialised psychiatric care.

States and territories

In 2015–16, there were 156,118 overnight admitted mental health-related separations with specialised psychiatric care; equivalent to a national rate of 65.2 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 (51.5 per 10,000 population) and Tasmania the lowest (39.0) (Figure ON.1).

The rate of overnight mental health-related separations in public psychiatric hospitals was highest for Tasmania (19.3 per 10,000 population) and lowest for Victoria (0.7). The Northern Territory and Australian Capital Territory do not have any public psychiatric hospitals.

Among the jurisdictions for which private hospital figures are published, the rate of overnight mental health-related separations in private hospitals was highest for Victoria (20.3 per 10,000 population) and lowest for South Australia (7.9).

For public acute hospitals, there were 727.4 patient days per 10,000 population for overnight mental health-related separations with specialised psychiatric care in 2015–16 (Table ON.4). New South Wales had the highest rate of public acute hospital patient days (852.5 per 10,000 population) and Tasmania the lowest (429.9). For states with public psychiatric hospitals, the rates varied from 926.9 patient days per 10,000 population in Queensland to 62.5 days in Victoria. Queensland also reported the highest rate of patient days in private hospitals (419.0 per 10,000 population).

Figure ON.1: Overnight mental health-related separations with specialised psychiatric care, state and territory, by hospital type, 2015–16

Stacked bar chart showing the rate (per 10,000 population) of overnight 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 (4.4) followed by private hospitals (1.7) and public psychiatric hospitals (0.5). Separations per 10,000 population for public acute hospitals: NSW 42.6; Vic 40.9 ; Qld 48.4; WA 40.6; SA 51.5; Tas 39.0; ACT 40.1; NT 40.8. Refer to Table ON.4

Notes:

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

2. Private hospital figures for Tasmania, the Australian Capital Territory and the Northern Territory are not published for confidentiality reasons.

Source: National Hospital Morbidity Database.

Source data: Overnight admitted mental health-related care Table ON.4 (690KB XLS).

In 2015–16, the national average length of stay for overnight mental health-related separations in public acute hospitals was 16.7 days. New South Wales had the longest average length of stay (20.0 days) and the Northern Territory the shortest (10.8 days). The greatest variation in average length of stay was for public psychiatric hospitals with Queensland reporting 609.7 days and Tasmania 22.6 days.

For public hospitals in 2015–16, the majority (91.9%) of overnight mental health-related separations with specialised psychiatric care were public patient (e.g. the health service budget or reciprocal health care agreement), followed by private patients (5.9%). 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. This ranged from 98.2% for the Australian Capital Territory to 87.4% for New South Wales. For private hospitals, the majority (89.4%) of their separations had a funding source of Private health insurance. Among the jurisdictions for which private hospital figures are published, the Private health insurance source ranged from 93.2% for Western Australia to 86.1% for New South Wales.

In 2015–16 the most common mode of separation for overnight mental health-related separations in both public (82.0%) and private (94.9%) 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). For public hospitals this mode of separation ranged from 87.2% for the Northern Territory to 67.3% for South Australia. For private hospitals in jurisdictions for which private hospital data are published, discharge to ‘home’ ranged from 97.6% for Western Australia to 92.5% for New South Wales. 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 2015–16, the rate of overnight mental health-related separations with specialised psychiatric care was highest for patients aged 35–44 and lowest for those aged under 15 (106.1 and 5.1 per 10,000 population respectively) (Figure ON.2). Overall, the separation rate was higher for females than males (67.1 and 63.3 per 10,000 population respectively), but there is some variability across individual age groups.

Figure ON.2: Overnight 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 overnight admitted mental health-related separations with specialised psychiatric care by age-group and sex. In aggregate terms, females (67.1) had a higher rate than males (63.3). Persons by age group: <15 years 5.1; 15-24 years 89.8; 25-34 years 96.2; 35-44 years 106.1; 45-54 years 83.1; 55-64 years 58.2; 65 years and older 41.7. Refer to Table ON.3

Source: National Hospital Morbidity Database.

Source data: Overnight admitted mental health-related care Table ON.3 (690KB XLS).

Aboriginal and Torres Strait Islander people had a rate of overnight mental health-related separation with specialised psychiatric care nearly double that of other Australians (135.9 and 68.1 per 10,000 population respectively).

Those patients living in Major cities (65.4 per 10,000 population) had the highest rate of overnight mental health-related separations with specialised psychiatric care in 2015–16 whilst those living in Remote and very remote areas (36.7) had the lowest.

Those patients living in the most disadvantaged socioeconomic quintile (70.8 per 10,000 population) had the highest rate of overnight mental health-related separations with specialised psychiatric care whilst those living in the least disadvantaged quintile (56.4) had the lowest.

Principal diagnosis

When considering all hospital types together, the most frequently reported principal diagnosis in 2015–16 for an overnight mental health-related separation with specialised psychiatric care was Depressive episode (ICD-10-AM code: F32) (14.9%), followed by Schizophrenia (F20) (14.8%) and Reaction to severe stress and adjustment disorders (F43) (9.7%).

The profile of diagnoses varies with hospital type. For example, about 1 in 4 (23.9%) separations with specialised psychiatric care in private hospitals had a principal diagnosis of Depressive episode (F32), compared with 12.2% and 8.0% for public acute and public psychiatric hospitals respectively (Figure ON.3). About 1 in 5 separations in public acute hospitals and public psychiatric hospitals had a principal diagnosis of Schizophrenia (F20) (18.8% and 22.0% respectively), compared with less than 1 in 40 for private hospitals (2.5%).

Figure ON.3: Overnight mental health-related separations with specialised psychiatric care (per cent), the 5 most frequently reported principal diagnoses, by hospital type, 2015–16

Horizontal bar chart showing the percent of overnight admitted mental health-related separations with specialised psychiatric care for the 5 most frequently reported principal diagnoses for all hospital types: Depressive episode (F32) 14.9%25; Schizophrenia (F20) 14.8%25; Reaction to severe stress and adjustment disorders (F43) 9.7%25; Bipolar affective disorder (F31) 8.9%25; Mental and behavioural disorders due to other psychoactive substance use (F11-19) 8.2 %25. Refer to Table ON.7.

Source: National Hospital Morbidity Database.

Source data: Overnight admitted mental health-related care Table ON.7 (690KB 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 54,970 overnight mental health-related separations with specialised psychiatric care where the mental health legal status was ‘involuntary’— representing more than a third (35.2%) of these separations. The majority of these (48,731 or 88.7%) occurred in public acute hospitals.  

In private hospitals, very few separations (0.3%) with specialised psychiatric care were for patients recorded as being treated on an involuntary basis, although a high proportion of private hospital separations did not have a mental health legal status recorded (35.3%) (Figure ON.4). Involuntary separations accounted for 46.7% and 52.7% of separations with specialised psychiatric care in public acute hospital and public psychiatric hospitals respectively.

Figure ON.4: Overnight 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 overnight admitted mental health-related separations with specialised psychiatric care by legal status and hospital type. More than a third (35.2%25) of all these separations were involuntary. By hospital type: Public acute 46.7%25 involuntary; Public psychiatric 52.7%25 involuntary; and Private 0.3%25 involuntary. Refer to Table ON.5.

Source: National Hospital Morbidity Database.

Source data: Overnight admitted mental health-related care Table ON.5 (690KB XLS).

Procedures

The most frequently reported procedure block for overnight mental health-related separations with specialised psychiatric care was Generalised allied health interventions, which was recorded for almost half (49.4%) of these separations. Of these allied health interventions, procedures provided by Social work were the most common (29.0% of allied health interventions), followed by Occupational therapy (18.2%) and Psychology (16.8%).

The next most frequently reported procedure block was Cerebral anaesthesia (general anaesthesia), which was recorded for 6.0% of separations with specialised psychiatric care. Cerebral anaesthesia was most likely associated with the administration of electroconvulsive therapy (ECT), a form of treatment for depression, which was the most common principal diagnosis for separations with specialised psychiatric care.

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