Report on Government Services 2015

Chapter 12, Volume E

Mental health management

The Mental health management chapter (chapter 12) of the Report on Government Services reports on the performance of governments in the management of mental health. Mental illness is a significant cause of morbidity and mortality in Australia and is identified by governments as a national health priority area.

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Key Facts
Indicator Framework
Indicator Results

Governments provide or fund a range of mental health management services. The key services are Medicare Benefits Schedule (MBS) subsidised mental health services; admitted patient care in hospitals; and community-based services that provide ambulatory care, residential care and support services for people with a mental illness living in the community.

Real government recurrent expenditure of around $7.3 billion was allocated to mental health services in 2012-13. State and Territory governments made the largest contribution ($4.5 billion, or 61.9 per cent), although this included some Australian Government funds under the National Health Reform Agreement. The Australian Government spent $2.8 billion or 38.1 per cent.

In 2012-13, 1.9 per cent and 7.8 per cent of the total population received State and Territory governments' specialised public mental health services (excluding Victoria, for which data were not available) and MBS subsidised mental health services, respectively.

The key broad objectives of National Mental Health Policy are to:

promote the mental health and well-being of the Australian community and, where possible, prevent the development of mental health problems and mental illness
reduce the impact of mental health problems and mental illness, including the effects of stigma on individuals, families and the community
promote recovery from mental health problems and mental illness
assure the rights of people with mental health problems and mental illness, and enable them to participate meaningfully in society.

The performance indicator framework provides information on equity, efficiency and effectiveness, and distinguishes the outputs and outcomes of mental health management. The performance indicator framework shows which data are complete and comparable in the 2015 Report.

An overview of the Mental health management performance indicator results are presented. Information to assist the interpretation of these data can be found in the indicator interpretation boxes in the Mental health management chapter and attachment tables.

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Equity — Access indicators

New client index

Most recent data for this measure are not comparable nor complete (chapter 12).

Proportion of total clients of State and Territory specialised public mental health services who are new, 2012-13.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	40.0	na	45.3	42.6	43.6	58.1	41.5	47.9	42.8

Legend: na Not available
Source: Attachment table 12A.33 and tables 12A.35-36.

Proportion of total clients of Medicare Benefits Schedule (MBS) subsidised mental health services who are new.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	35.1	33.7	37.3	38.9	34.2	36.8	38.7	48.6	35.6

Source: Attachment table 12A.33 and tables 12A.35-36.

Mental health service use by selected community groups

Most recent data for this measure are comparable (subject to caveats), but not complete (chapter 12).

Proportion (%) of the Aboriginal and Torres Strait Islander population using State and Territory specialised public mental health services, compared with the proportion for non-Indigenous population, 2012-13.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Aboriginal and Torres Strait Islander	4.9	na	4.5	5.3	5.9	1.4	6.3	4.1	4.7
Non-Indigenous	1.5	na	1.8	1.9	1.8	1.2	2.2	2.4	1.7

Legend: na Not available
Source: Attachment table 12A.33 and tables 12A.35-36.

Most recent data for this measure are comparable and complete (chapter 12).

Proportion (%) of the Aboriginal and Torres Strait Islander population using MBS and Department of Veterans' Affairs (DVA) funded mental health services, compared with the proportion for non-Indigenous population, 2012-13.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Aboriginal and Torres Strait Islander	10.7	12.0	7.1	4.0	8.2	8.8	11.4	1.4	7.7
Non-Indigenous	7.9	8.7	7.7	5.9	7.6	7.0	6.2	4.1	7.7

Legend: na Not available
Source: Attachment table 12A.33 and tables 12A.35-36.

Effectiveness — Access indicators

Mental health service use by total population

Most recent data for this indicator are comparable, but not complete (chapter 12).

Proportion (%) of the population in a State and Territory using a specialised public mental health service or a MBS-subsidised service, 2012-13.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Specialised public mental health	1.8	na	1.9	2.1	2.3	1.3	2.4	2.9	1.9
MBS and DVA subsidised service	8.0	8.8	7.8	5.9	7.8	7.1	6.3	3.4	7.8

Legend: na Not available
Source: Attachment tables 12A.41 and 12A.44.

Primary mental health care for children and young people

Most recent data for this measure are comparable and complete (chapter 12).

Proportion of young people aged under 25 years who had contact with primary mental health care services subsidised through the MBS, 2013-14
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	6.1	6.9	6.1	4.7	6.3	6.2	5.6	2.2	6.1

Source: Attachment tables 12A.41 and 12A.44.

Effectiveness — Appropriateness indicators

Services reviewed against the National Standards

Most recent data for this indicator are complete, but not comparable (chapter 12).

Proportion of specialised public mental health services that had completed an external review against national standards and were assessed as meeting 'all Standards' (level 1), June 2013.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	82.6	78.3	99.7	85.8	42.1	9.2	100.0	–	80.0

Legend: – Nil or rounded to zero.
Source: Attachment tables 12A.47-49.

Services provided in the appropriate setting

Most recent data for this measure are comparable and complete (chapter 12).

Recurrent expenditure on community-based services as a proportion of total expenditure on mental health services, 2012-13.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	41.6	64.1	55.3	52.9	61.5	58.8	73.3	61.6	53.4

Source: Attachment tables 12A.47-49.

Collection of information on consumers outcomes

Most recent data for this measure are comparable, but not complete (chapter 12).

**Proportion of episodes with completed consumer outcomes measures collected for people in specialised public mental health services — ongoing community care, 2012-13.**
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	19.4	na	41.2	31.4	37.6	26.8	8.7	19.6	28.3

Legend: na Not available.
Source: Attachment tables 12A.47-49.

Effectiveness — Quality — Safety indicators

Rate of seclusion — acute inpatient units

Most recent data for this indicator are comparable and complete (chapter 12).

Number of seclusion events per 1000 bed days in specialised public mental health acute inpatient units, 2013-14.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
No.	7.4	9.2	11.1	5.0	4.5	15.2	1.1	21.6	8.0

Source: Attachment table 12A.50.

Effectiveness — Quality — Responsiveness indicators

Consumer and carer involvement in decision making

Most recent data for this measure are comparable and complete (chapter 12).

Paid consumer workers (FTE) per 1000 paid direct care, consumer and carer staff (FTE), 2012-13.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
No.	2.3	3.2	2.8	1.3	6.3	–	–	0.7	2.7

Legend: – Nil or rounded to zero.
Source: Attachment table 12A.52.

Effectiveness — Quality — Continuity indicators

Post discharge community care

Most recent data for this indicator are not comparable nor complete (chapter 12).

Community follow up for people within the first 7 days of discharge from hospital. Proportion of overnight separations from psychiatric inpatient acute services with a community mental health service contact recorded in the 7 days following separation, 2012-13.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	59.5	na	72.8	53.3	54.0	20.8	73.9	46.6	60.7

Legend: na Not available.
Source: Attachment tables 12A.53 and 12A.56.

Readmissions to hospital within 28 days of discharge

Most recent data for this indicator are complete, but not comparable (chapter 12).

Proportion of overnight separations from psychiatric inpatient acute services that were followed by a readmission to a psychiatric inpatient service within 28 days of discharge, 2012-13.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	14.7	14.7	14.3	13.4	7.7	12.7	14.4	10.7	13.9

Source: Attachment tables 12A.53 and 12A.56.

Efficiency indicators

Cost of inpatient care

Most recent data for this indicator are comparable and complete (chapter 12).

Cost per inpatient bed day, 2012-13

General mental health services (acute units).
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
$ per bed day	1013.22	843.83	921.38	1238.68	899.55	895.20	868.26	1376.80	981.17

Source: Attachment tables 12A.59, 12A.61-63.

Public acute hospital with a psychiatric unit or ward (acute units).
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
$ per bed day	1013.25	843.60	940.69	1204.42	864.21	1123.84	843.75	1376.80	975.73

Source: Attachment tables 12A.59, 12A.61-63.

Cost of community based residential care

Most recent data for this indicator are comparable and complete (chapter 12).

Average recurrent cost per patient day for community residential services. General adult units — 24-hour staffed units, 2012-13.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
$ per patient day	183.97	514.54	..	408.18	456.02	641.44	671.96	353.46	468.79

Legend: .. Not applicable
Source: Attachment tables 12A.59, 12A.61-63.

Cost of ambulatory care

Most recent data for this indicator are not comparable nor complete (chapter 12).

Average cost per treatment day of ambulatory care, 2012-13.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
$ per episode	223.84	na	362.05	428.58	332.35	665.90	234.40	439.27	303.28

Legend: na Not available
Source: Attachment tables 12A.59, 12A.61-63.

Outcome indicators

Rates of licit and illicit drug use

Most recent data for this indicator are comparable and complete (chapter 12).

Proportion of people aged 14 years or over who used any illicit drug in the preceding 12 months, 2013.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	11.4	11.0	12.6	13.7	12.5	13.3	12.4	19.0	12.0

Source: Attachment tables 12A.66, 12A.75, 12A.81, 12A.85, 12A.87 and 12A.94.

Prevalence of mental illness

Most recent data for this indicator are comparable and complete (chapter 12).

Proportion of people with a lifetime mental disorders among adults aged 16-85 years, 2007.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	20.1 ±2.2	20.7 ±2.3	19.2 ±2.6	21.4 ±4.1	19.1 ±3.4	14.1 ±5.4	np	np	20.0 ±1.1

Legend: np Not published.
Source: Attachment tables 12A.66, 12A.75, 12A.81, 12A.85, 12A.87 and 12A.94.

Mortality due to suicide

Most recent data for this indicator are comparable and complete (chapter 12).

Suicide rate per 100 000 people, 2008-2012.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
	8.9	9.7	13.0	13.5	11.8	14.1	9.1	18.1	10.8

Source: Attachment tables 12A.66, 12A.75, 12A.81, 12A.85, 12A.87 and 12A.94.

Physical health outcomes of people with mental illness

Most recent data for this indicator are comparable and complete (chapter 12).

Proportion of people with a mental illness (compared to the proportion for people without a mental illness) who were daily smokers, 2011-12 (per cent).
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
People with mental illness	23.6 ±4.5	28.9 ±6.4	25.7 ±4.6	26.0 ±5.8	26.7 ±4.9	32.4 ±5.7	20.0 ±5.6	29.1 ±10.1	26.1 ±2.4
People without mental illness	13.4 ±1.5	14.7 ±1.7	15.8 ±2.1	15.0 ±1.9	15.5 ±2.1	21.5 ±2.3	11.7 ±2.7	21.8 ±3.0	14.7 ±0.8

Source: Attachment tables 12A.66, 12A.75, 12A.81, 12A.85, 12A.87 and 12A.94.

Social and economic inclusion of people with mental illness

Most recent data for this indicator are comparable and complete (chapter 12).

Proportion of people aged 16-64 years with mental or behavioural problems who are employed, 2011-12 .
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	65.2 ±7.7	59.4 ±6.4	57.7 ±6.7	65.0 ±5.9	61.2 ±7.2	51.6 ±8.7	72.5 ±8.2	63.2 ±10.3	61.7 ±3.1

Source: Attachment tables 12A.66, 12A.75, 12A.81, 12A.85, 12A.87 and 12A.94.

Mental health outcomes of consumers of specialised public mental health services

Most recent data for this indicator are not comparable nor complete (chapter 12).

Proportion of people discharged from a State or Territory public hospital psychiatric inpatient unit who had a significant improvement in their clinical mental health outcomes, 2012-13.
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	70.0	na	72.7	74.3	72.6	76.4	np	77.3	72.1

Legend: na Not available; np Not published.
Source: Attachment tables 12A.66, 12A.75, 12A.81, 12A.85, 12A.87 and 12A.94.

Some results reported here include 95 per cent confidence intervals (for example, 80 per cent ± 2.7 per cent).