In a calendar year, 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 2018, Mental and substance use disorders were responsible for around 13% of the total disease burden in Australia (MHSA, AIHW 2021). 

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
  • primary care 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 large 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 10 million service contacts in 2019–20 (Table 1).

Table 1: Selected mental health-related services provided, 2019–20

Service type

Volume

Selected findings

Medicare-subsidised mental health-related services(a)

12.4 million services

Psychologists (including Clinical Psychologists) (45%) were the largest providers of these services.

11.8% of services were delivered via telehealth.

People accessing Medicare-subsidised mental health-related services

2.7 million people

10.7% of Australians accessed these services, up from 5.7% in 2008–09.

Mental health-related prescriptions(b)

40.7 million prescriptions

4.4 million patients (17.2% of the Australian population) received these prescriptions

72% of prescriptions were for antidepressant medication(b).

Public sector community mental health care service contacts

10.0 million contacts

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

Emergency department (ED) services (public hospitals)

310,471 presentations in 2019–20

310,471 presentations to public Australian EDs were mental health-related, which was 3.8% of all presentations (up from 2.9% in 2011-12).

Overnight admitted patient hospitalisations

275,270 hospitalisations

Depressive episode (15.4%) and Schizophrenia (13.4%) were the most common principal diagnoses for overnight mental health-related hospitalisations with specialised psychiatric care.

Same-day admitted patient hospitalisations

59,002 hospitalisations

Almost 1 in 4 (22.4%) of same day, admitted mental health-related hospitalisations with specialised psychiatric care in public hospitals had a principal diagnosis of Depressive episode.

  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 $11.0 billion, or $431 per person, was spent on mental health-related services in Australia in 2019–20; $10.4 billion of this was government mental health expenditure, representing 7.6% of total government health expenditure. Per person, total spending on mental health increased (in real terms) by an annual average of 1.3% between 2015–16 and 2019–20. The total expenditure in 2019–20 included:

  • about $6.7 billion, or $260 per person, spent on state and territory specialised mental health services
  • about $1.4 billion, or $53 per person, spent on Medicare Benefits Scheme (MBS) subsidised services
  • about $566 million, or $22 per person, spent on mental health-related prescriptions subsidised under the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS).

Comparing 2015–16 with 2019–20, recurrent per person spending on state and territory specialised mental health services increased (in real terms) from $250 to $260.

See Expenditure on mental health services for more information.

Workforce

A variety of professionals deliver care and support to people with mental illness, including psychologists, psychiatrists, mental health nurses, general practitioners (GPs), social workers, counsellors and peer workers. Available registered and employed workforce data for some of these professions indicate that in Australia in 2019 there were:

  • 28,400 registered psychologists
  • 24,100 mental health nurses
  • 3,600 psychiatrists.

In 2019–20, there were about 35,686 full-time equivalent (FTE) staff employed in state and territory specialised mental health care services.

See Mental health workforce for more information.

Safety and quality

Safety and quality is important in all areas of the health system. A safe and high-quality health system provides the most appropriate and best-value care, while keeping patients safe from preventable harm. Data are available that can be used to measure aspects of safety and quality in the Australian mental health care system – including use of restrictive practices, consumer perspectives of care, and change in mental health consumers’ clinical outcomes.

Seclusion and restraint

Use of seclusion and restraint are examples of restrictive practices and are included in the Key Performance Indicators for Australian Public Mental Health Services (NMHPC). Seclusion is defined as the confinement of a patient 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 (RANZCP 2021).

Seclusion events in specialised acute public hospital mental health services over the past decade have fallen from 13.9 seclusion events per 1,000 bed days in 2009–10 to 8.1 events per 1,000 bed days in 2019–20 (Figure 1).

Mechanical restraint events fell from 1.7 events per 1,000 bed days of patient care in 2015–16 to 0.7 in 2019–20. The use of physical restraint has remained relatively stable, since reporting began in 2015–16, varying between 10 to 12 events per 1,000 bed days of patient care (Figure 1).

Figure 1: Rate of seclusion and restraint events, public sector acute mental health hospital services, 2009–10 to 2019–20

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 2019-20 (8.1), with the largest changes occurring  between 2009–10 and 2013–14. There has been a decline in mechanical restraint between 2015–16 (1.7 events per 1,000 bed days) and 2019-20 (0.7 events per 1,000 bed days). Physical restraint has varied between around 10 and 11 events per 1,000 bed days over this same period.

See Restrictive practices for more information.

Patient-reported experiences of care

Patient-reported experience measures collect patients’ views and observations on aspects of the care they have received. Monitoring mental health consumer and carer experiences of service has been a long-term goal of the National Mental Health Strategy (Commonwealth of Australia 2009 and CHC 2017) and patient-reported measures have attracted increasing national focus for their potential to support health service improvement. One such measure – the Your Experience of Service (YES) survey – has been implemented in New South Wales, Victoria and Queensland specialised mental health services. Each state has a method of administration that best suits local needs and, therefore, comparisons between jurisdictions with different methods should be made with caution.

In 2019–20, more than 25,600 YES survey responses were collected across 68 mental health service organisations across New South Wales and Queensland. Victoria did not conduct the survey during 2019–20 due to the COVID-19 pandemic. In 2019–20 it is estimated that:

  • 70% of respondents in New South Wales and 50% in Queensland reported a positive experience of admitted care services
  • 80% of respondents in New South Wales and 81% in Queensland and reported a positive experience of ambulatory (non-admitted) care services
  • 80% of respondents in Queensland residential care reported a positive experience of service.

See Consumer perspectives of mental health care for more information.

Consumer outcomes of care

Clinical measures that capture information about the health and wellbeing of people during mental health service use can be used to report on whether consumers improve after receiving mental health care. The National Outcomes and Casemix Collection (NOCC) encourages the routine use of outcome measures in all publicly funded or managed mental health services and provides data for reporting one of the Key Performance Indicators for Australian Public Mental Health Services (NMHPC).

See Consumer outcomes in mental health care for more information.

COVID-19 impact on mental health

The potential for COVID-19 to impact mental health and wellbeing was recognised early in the pandemic (WHO 2020). In addition to concerns around contracting the SARS-CoV-2 virus itself, some of the measures necessary to contain its spread were also likely to negatively impact mental health (NMHC 2020).

Medicare-subsidised mental health-specific services

The Australian Government introduced additions to the MBS to support provision of health care via telehealth (telephone and videoconference) to reduce the risk of community transmission of COVID-19. These MBS items include mental health services provided by GPs, psychiatrists, psychologists and other allied health workers.

Between 16 March 2020 and 9 January 2022, there were 25 million MBS-subsidised mental health-related services processed and $2.8 billion in benefits paid. About 7.3 million (29.2%) of these services were delivered via telehealth.

Pharmaceutical Benefits Scheme prescriptions

In March 2020, the Australian Government temporarily expanded existing Continued Dispensing arrangements through the Continued Dispensing (Emergency Measures) for most PBS and RPBS medicines supplied through community pharmacies  to support Australians’ continued access to PBS medicines in response to the pandemic (Department of Health 2022; Services Australia 2021).

Key trends include:

  • A spike in PBS prescriptions, including all mental health-related prescriptions, was observed in March 2020 during the first wave of the pandemic and the nationwide lockdown in 2020.
  • An 18.6% increase in the number of mental health-related prescriptions dispensed in the 4 weeks to 29 March 2020 compared with the 4 weeks to 31 March 2019
  • In the 4 weeks to 28 November 2021, there was a 3.9% increase compared with the 4 weeks to 29 November 2020. Prescriptions for antidepressants increased by 5.0% between these periods.

National use of crisis and support organisations

There are a range of crisis, support and information services available to support Australians experiencing mental health issues, such as Lifeline, Kids Helpline and Beyond Blue.

These crisis support services reported an increased demand for their services in March 2020 and have recorded fluctuations in activity during the course of the pandemic. Total demand for crisis and support organisations trended upward from June 2021 to early September 2021, with Lifeline reaching record call demand in September 2021. Direct comparisons between organisations are not meaningful due to differences in populations being serviced, service models, funding envelopes, workforce availability and information systems.

See COVID-19 impact on mental health services for more information, including state and territory breakdowns.

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