In any year in Australia, around 1 in 5 (20%) people aged 16–85 will experience mental illness (ABS 2008). Mental illness can affect not just the individual, but also their family, friends and the community—in 2015, Mental and substance use disorders were responsible for around 12% of the total disease burden in Australia (AIHW 2019). See Mental health for more information.

People with mental illness can access a variety of support services, which are delivered by governments, and by the private and not-for-profit sectors.

Mental health treatment, care and support is provided in a range of settings and services, including:

  • specialised hospital services—public and private
  • residential mental health services
  • community mental health care services
  • private clinical practices
  • non-government organisation services
  • primary care services
  • allied health services.

Mental health-related care may also be delivered through other services such as disability and homelessness support services.

Health care professionals who provide treatment, care and support within the mental health system include:

  • general practitioners
  • psychiatrists and other medical staff
  • psychologists
  • nurses—registered and enrolled
  • social workers
  • other allied health professionals
  • mental health consumer and carer workers
  • other personal care staff.

Service use

A considerable number of support services are provided to people with a mental illness each year. For example, state and territory community mental health care services provided around 9.5 million service contacts in 2017–18 (Table 1).

Table 1: Selected mental health-related services provided, 2017–18/2018–19

Service type

Volume

Selected findings

Medicare-subsidised mental health-related services(a)

12.1 million services in 2018⁠–⁠19

General practitioners (GPs) (31%) were the largest providers of these services.

People accessing Medicare-subsidised mental health-related services

2.7 million people in
2018⁠–⁠19

Almost 11% of Australians accessed these services, up from 5.7% in 2008–09.

Mental health-related prescriptions(b)

39.0 million prescriptions in
2018⁠–⁠19

4.3 million patients (17% of the Australian population) received these prescriptions

71% of prescriptions were for antidepressant medication(b).

Public sector community mental health care service contacts

9.5 million contacts in
2017⁠–⁠18

Aboriginal and Torres Strait Islander patients received community mental health care services at around 3 times the rate of non-Indigenous patients.

Emergency department (ED) services (public hospitals)

287,000 presentations in
2017⁠–⁠18

287,000 presentations to public Australian EDs were mental health-related, which was 3.6% of all presentations (up from 2.9% in 2011–12).

Overnight admitted patient hospitalisations

260,250 hospitalisations in
2017⁠–⁠18

For females aged 12–17, the population rate of overnight separations with specialised care has doubled between 2006–07 and 2017–18.

Same-day admitted patient hospitalisations

61,300 hospitalisations in
2017⁠–⁠18

For patients aged 18–24, there has been a greater than 3-fold increase, between 2006–07 and 2017–18, in the population rate of same day separations with specialised psychiatric care.

Source: AIHW 2020. Mental health services in Australia.

  1. Includes psychiatrists, GPs, clinical psychologists, other psychologists and other allied health services. These services are billed as mental health-related items, which underestimates the total mental health-related activity, especially for services provided by GPs.

  2. Prescriptions subsidised and under co-payment under the Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme.

Spending

About $9.9 billion, or $400 per person, was spent on mental health-related services in Australia in 2017–18; $9.4 billion of this was government mental health expenditure, representing 7.6% of total government health expenditure. Total spending on mental health increased (in real terms) by an annual average of 1.1% per person from 2013–14 to 2017–18. The total expenditure in 2017–18 included:

  • about $6.0 billion, or $244 per person, spent on state and territory specialised mental health services (including $2.6 billion on public hospital services for admitted patients and $2.3 billion on community mental health care)
  • about $1.2 billion, or $50 per person, spent on Medicare-subsidised services. This spending increased by an annual average of 3.8% per person from 2013–14 to 2017–18
  • about $534 million, or $22 per person, spent on mental health-related prescriptions subsidised under the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS), mostly to subsidise antipsychotic (49%) and antidepressant (33%) medications.

Between 2007–08 and 2017–18, recurrent per person spending on state and territory specialised mental health services has increased (in real terms) from $209 to $244. This includes increases from:

  • $62 to $84 for specialised psychiatric units or wards in public acute hospitals (average annual increase of 3.0%)
  • $82 to $91 for community mental health care services (average annual increase of 1.0%)
  • $12 to $15 for residential mental health services (annual average increase of 2.3%)
  • $15 to $18 for grants to non-government organisations (average annual increase of 2.0%)
  • $10 to $13 for other indirect expenditure (average annual increase of 2.5%).

During the same period, per person spending decreased from $27 to $23 for public psychiatric hospitals (average annual decrease of 1.8%).

See Health expenditure.

Workforce

A variety of professionals deliver care and support to people with mental illness, including psychologists, psychiatrists, mental health nurses, GPs, social workers, counsellors and peer workers. Available workforce data for some of these professions indicate that in 2017:

  • there were about 26,300 registered psychologists, 22,200 mental health nurses and 3,400 psychiatrists in Australia
  • about 4 in 5 (79%) psychologists were women while about 3 in 5 (61%) psychiatrists were men
  • 3 in 10 (30%) mental health nurses were men compared with about 1 in 10 (11%) people in the general nursing workforce
  • 1 in 3 (33%) mental health nurses and about 2 in 5 (44%) psychiatrists were aged 55 and over. The age profile of registered psychologists was younger, with around 7 in 10 (72%) aged under 55.

In 2017–18, there were about 33,500 full-time equivalent (FTE) staff employed in state and territory specialised mental health care services. Nationally, this equates to 135 FTE staff per 100,000 population. In 2016–17, about 3,500 FTE staff were employed in private hospital specialised mental health services, equating to 15 FTE staff employed per 100,000 population.

See Health workforce.

Safety and quality

In Australia, there has been a sustained effort to minimise the use of restrictive practices, such as seclusion and restraint, in mental health care settings. The National Mental Health Commission’s Position Statement on seclusion and restraint in mental health calls for leadership across a range of priorities, including ‘national monitoring and reporting on seclusion and restraint across jurisdictions and services’ (NMHC 2015).

See Safety and quality of health care.

Restrictive practices

Seclusion is defined as the confinement of a patient at any time of the day or night alone in a room or area from which free exit is prevented. Restraint is defined as the restriction of an individual's freedom of movement by physical or mechanical means. Reducing and, where possible, eliminating the use of seclusion and restraint is a policy priority in Australian mental health care and has been supported by changes to legislation, policy and clinical practice.

The rate of seclusion has fallen in specialised acute public hospital mental health services over the past decade—from 13.9 seclusion events per 1,000 bed days in 2009–10 to 7.3 events per 1,000 bed days in 2018–19 (Figure 1). This is equivalent to an average annual fall of 7.0% over this period. There has also been a reduction in the duration of seclusion events, which fell by an annual average of 9.0% between 2014–15 and 2018–19.

The use of mechanical restraint has fallen from 1.7 events per 1,000 days of patient care in 2015–16 to 0.6 in 2018–19. The use of physical restraint has remained relatively stable, since reporting began in 2015–16, at about 10 to 11 events per 1,000 days of patient care (Figure 1).
 

The rate of seclusion events per 1,000 bed days for public sector acute mental health hospital services in Australia has generally decreased between 2009–10 (13.9) and 2018–19 (7.3), most rapidly between 2009–10 and 2013–14. It is difficult to make out trends for restraint, but from the 4 years available, there has been a decline in mechanical restraint between 2015–16 (1.7 events per 1,000 bed days) and 2018–19 (0.6 events per 1,000 bed days), while physical restraint has varied between around 10 and 11 events per 1,000 bed days.

Patient experience

The Your Experience of Service (YES) survey is designed to gather information from mental health consumers about their experiences of care. To date, New South Wales, Victoria and Queensland state specialised mental health services have implemented the YES survey and it is expected that data from other jurisdictions will become available once they have fully implemented the survey. Each state has chosen a method of administration that best suits its local needs. New South Wales uses a ‘continuous’ approach, where consumers are offered the YES survey at the end of each episode of care. Victoria and Queensland use a ‘snapshot’ approach, where consumers are offered the YES survey over a particular time of the year (2 or 3 months in Victoria and 4 or 6 weeks in Queensland). Therefore, comparisons between jurisdictions with different methods should be made with caution. In 2017–18, more than 28,600 YES surveys were collected by 85 mental health service organisations across New South Wales, Victoria and Queensland. The results of the survey found that:

  • in admitted care in 2017–18, 69% of respondents in New South Wales, 50% in Victoria and 47% in Queensland reported a positive experience of service
  • in ambulatory (non–admitted) care in 2017–18, 79% of respondents in Queensland, 78% in New South Wales and 74% in Victoria reported a positive experience of service
  • in residential care in 2017–18, 79% of respondents in Queensland and 78% in Victoria reported a positive experience of service.

See Patient experience of health care and Physical health of people with mental illness.

Where do I go for more information?

For more information on mental health services, see:

Visit Mental health services for more on this topic.

If you or someone you know needs help please call:

References

ABS (Australian Bureau of Statistics) 2008. National Survey of Mental Health and Wellbeing: summary of results, Australia, 2007. ABS cat. no. 4326.0. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2019. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease Study series no. 19. Cat. no. BOD 22. Canberra: AIHW.

AIHW 2020. Mental Health Services in Australia. Web report. Viewed 30 January 2020.

NMHC (National Mental Health Commission) 2015. Position statement on seclusion and restraint in mental health. Sydney: NMHC.