Specialised overnight admitted patient mental health care

Service provision

Specialised overnight admitted patient mental health care (also referred to as specialised psychiatric 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.

States and territories

In 2018–19, there were 171,286 overnight admitted mental health-related separations with specialised psychiatric care; equivalent to a national rate of 68.0 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 (public psychiatric hospitals and private hospitals). The Australian Capital Territory had the highest rate of public acute hospital separations with specialised psychiatric care (52.7 per 10,000 population) and Tasmania the lowest (30.7) (Figure ON.1).

For public acute hospitals, there were 674.8 patient days per 10,000 population for overnight mental health-related separations with specialised psychiatric care in 2018–19. The Australian Capital Territory had the highest rate of public acute hospital patient days (991.6 per 10,000 population respectively) which was much higher than the second highest rate of 738.6 for New South Wales. Tasmania recorded the lowest rate of patient days per 10,000 population (472.0). For states with public psychiatric hospitals, the rates ranged from a high of 641.1 patient days per 10,000 population in Tasmania to a low of 106.9 in Queensland. Among jurisdictions for which private hospital figures are published, Queensland reported the highest rate of patient days (500.8 per 10,000 population), while South Australia reported the lowest rate (126.5).

Figure ON.1: Overnight mental health-related separations with specialised psychiatric care, state and territory, by hospital type, 2018-19

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 in 2018–19. New South Wales had 17.5 overnight admitted mental health-related separations per 10,000 population in private hospitals, 41.8 in public acute hospitals and 6.8 in public psychiatric; Victoria: 23.0 private, 42.1 public acute, 1.1 public psychiatric; Queensland: 24.5 private, 48.3 public acute, 0.5 public psychiatric; Western Australia: 18.4 private, 50.2 public acute, 6.3 public psychiatric; South Australia: 7.6 private, 49.5 public acute, 6.7 public psychiatric; Tasmania: 30.7 public acute, 19.2 public psychiatric; the Australian Capital Territory: 52.7 public acute; the Northern Territory: 46.8 public acute; in total (national rate): 19.3 private, 44.6 public acute, 4.1 public psychiatric (Refer to Table ON.4). Private hospital data are not included for Tasmania, the Australian Capital Territory and the Northern Territory. Refer to table ON.4.

Visualisation not available for printing

Source data: Overnight admitted mental health-related care tables (147KB XLSX).

In 2018–19, the national average length of stay for overnight mental health-related separations in public acute hospitals was 15.1 days, which is consistent with 2017–18 figures (15.0 days). Please refer to the data source for information on patient day fluctuations over time. The Australian Capital Territory had the longest average length of stay (18.8 days) and the Northern Territory had the shortest (12.6 days). The average length of stay in public psychiatric hospitals ranged from 24.8 days in South Australia to 204.5 days in Queensland.

In 2018–19, the most common mode of separation for overnight mental health-related separations in both public (84.1%) and private (94.5%) 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). Most of the remaining separations were either transfers to other facilities (an (other) acute hospital, residential aged care facility, an (other) psychiatric hospital, or other health accommodation) (10.8% from public hospitals and 2.9% from private) or statistical discharges (changes in care type, or discharges from leave) (2.6% for public and 0.3% for private). For jurisdictions, the proportion of discharges from public hospitals to ‘home’ ranged from 87.8% in the Australian Capital Territory to 78.6% in South Australia.

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 2018–19, the rate of overnight mental health-related separations with specialised psychiatric care was highest for patients aged 35–44 years and 18–24 years (106.6 and 103.7 per 10,000 population respectively) and lowest for those aged 0‑4 years and 5–11 years (0.6 and 2.2 per 10,000 population respectively) (Figure ON.2). Overall, the separation rate was higher for females than males (70.8 and 65.2 per 10,000 population respectively), but there is variation across individual age groups.

Figure ON.2: Overnight mental health-related separations with specialised psychiatric care, by demographic variable, 2017-18

Horizontal bar chart showing the rate (per 10,000 population) of overnight admitted mental health-related separations with specialised psychiatric care by age group, sex, Indigenous status, remoteness and SEIFA quintiles in 2018–19. There were 0.6 separations per 10,000 population for persons aged 0–4 years with specialised psychiatric care; 2.2 for 5–11 years, 54.6 for 12–17 years, 103.7 for 18–24 years, 96.6 for 25–34 years, 106.6 for 35–44 years, 92.6 for 45–54 years, 63.7 for 55–64 years, 46.4 for 65–74 years, 36.2 for 75–84 years, and 24.7 for 85 years and older. There were 65.2 separations per 10,000 population for males and 70.8 for females. The 2001 age standardised rate was 153.6 separations per 10,000 population in 2018–19 for Indigenous Australians and 63.4 for Non-Indigenous Australians. There were 68.0 separations per 10,000 population for persons living in Major cities, 67.5 for Inner regional, 55.8 for Outer regional, and 37.2 for Remote and very remote. There were 64.7 separations per 10,000 population for people in SEIFA Quintile 1 (most disadvantaged), 69.0 for Quintile 2, 65.9 for Quintile 3, 67.3 for Quintile 4, and 64.7 for Quintile 5 (least disadvantaged) (Refer to Table ON.5).

Visualisation not available for printing

Source data: Overnight admitted mental health-related care tables (147KB XLSX).

There were 11,704 overnight mental health-related separations with specialised psychiatric care for Aboriginal and Torres Strait Islander people in 2018–19, or 140.9 per 10,000 population, which is 2.2 times higher than the rate of 64.3 per 10,000 population for other patients. Rates standardised on the 2001 age profile were 153.6 and 63.4 per 10,000 population respectively, so the standardised rate for Indigenous people was 2.4 times that of other patients. Patients living in Major Cities and Inner regional areas had the highest rates of overnight mental health-related separations with specialised psychiatric care in 2018–19 (68.0 and 67.5 per 10,000 population respectively), whilst those living in Remote and Very remote areas had the lowest (37.2).

Changes over time

The rate of overall overnight mental health-related separations with specialised psychiatric care per 10,000 population has been steadily increasing in the past decade with an average annual increase of 4.1% between 2008–09 and 2018–19, and an increase of 4.5% in the 5 years from 2014–15 and 2018–19.

Separation rates for people aged 12–17 years have increased substantially during the time period examined. In 2018–19 the separation rates for males and females in this age range were 32.1 and 78.2 per 10,000 population respectively, which are 75.4% and 109.7% increases on 2006–07 rates.

For male and female populations aged 18–24 years, the separations per 10,000 population have increased 23.6% and 65.9% respectively since 2006–07, and the female separation rate is 1.3 times the male separation rate in 2018‑19. The pattern is different for those aged 35–44 years. The 2018–19 male and female separation rates for 35‑44 year olds were 113.1 and 100.1 per 10,000 population respectively, which are 36.9% and 23.6% higher than 2006–07 rates (82.6 and 81.0 per 10,000 population respectively). In recent years, the rate for males has been 13% to 15% higher rate than the female rate in this age group.

Principal diagnosis

The most frequently reported  principal diagnosis in 2018–19 for an overnight mental health-related separation with specialised psychiatric care were Depressive episode (ICD‑10‑AM code: F32) (15.7%) followed by Schizophrenia (F20) (13.6%), and Reaction to severe stress and adjustment disorders (F43) (10.3%).

The profile of diagnoses varies with hospital type. For example, about 1 in 5 separations in public acute hospitals and public psychiatric hospitals had a principal diagnosis of Schizophrenia (F20) (17.8% and 19.9% respectively), compared with about 1 in 42 for private hospitals (2.4%). Over 1 in 4 (26.9%) separations with specialised psychiatric care in private hospitals had a principal diagnosis of Depressive episode (F32), compared with 11.7% and 6.2% for public acute and public psychiatric hospitals respectively (Figure ON.3).

Figure ON.3: Proportion of overnight mental health-related separations with specialised psychiatric care, for 5 commonly reported principal diagnoses, by hospital type, 2018-19

Horizontal bar chart showing the per cent of overnight admitted mental health-related separations with specialised psychiatric care for 5 of the most frequently reported principal diagnoses by private, public psychiatric and public acute hospital types in 2018–19. Depressive episode (ICD-10-AM code F32) was the principal diagnosis for 26.9% of separations in private hospitals, 6.2% in public psychiatric hospitals, and 11.7% in public acute hospitals; Schizophrenia (F20) accounted for 2.4% private, 19.9% public psychiatric, and 17.8% public acute; Reaction to severe stress and adjustment disorders (F43) accounted for 11.5% private, 9.8% public psychiatric, and 9.9% public acute; Bipolar affective disorders (F31) accounted for 11.0% private, 7.5% public psychiatric, and 7.8% public acute; Mental and behavioural disorders due to other psychoactive substance use (F11–19) accounted for 5.2% private, 11.3% public psychiatric, and 8.8% public acute (Refer to Table ON.6).

Visualisation not available for printing

Source data: Overnight admitted mental health-related care tables (147KB XLSX).

Procedures

The most frequently reported procedure block for overnight mental health-related separations with specialised psychiatric care in 2018–19 was Generalised allied health interventions (42.7% of procedures, and associated with 55.8% of separations). Of these allied health interventions, procedures provided by Social work were the most common (27.8% of allied health interventions), followed by Occupational therapy (18.1%) and Psychology (18.0%). The second most frequently reported procedure block was Psychological/psychosocial therapies (13.0% of procedures and 17.5% of separations), and Cerebral anesthesia was the third most frequently reported procedure block (11.8% of procedures and associated with 5.3% of separations). Cerebral anesthesia is most likely associated with the administration of electroconvulsive therapy (ECT), the fourth most frequently reported procedure block, and a form of treatment for depression, which was the most common principal diagnosis for separations with specialised psychiatric care.