Report on Government Services 2023

Mental health relates to an individual’s ability to negotiate the daily challenges and social interactions of life without experiencing undue emotional or behavioural incapacity (DHAC 1999). The World Health Organization describes positive mental health as:

… a state of wellbeing in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community (WHO 2001).

Mental illness is a term that describes a diverse range of behavioural and psychological conditions. These conditions can affect an individual’s mental health, functioning and quality of life. Each mental illness is unique in its incidence across the lifespan, causal factors and treatments.

There are a range of services provided or funded by Australian, State and Territory governments that are specifically designed to meet the needs of people with mental health issues; the key services are:

• MBS subsidised mental health specific services that are partially or fully funded under Medicare on a fee-for-service basis and are provided by GPs, psychiatrists, psychologists or other allied health professionals under specific mental health items.
• State and Territory government specialised mental health services (treating mostly low prevalence, but severe, mental illnesses), which include:
• Admitted patient care in public hospitals — specialised services provided to inpatients in stand-alone psychiatric hospitals or psychiatric units in general acute hospitals¹. (Data on emergency department presentations for mental health related care needs are reported where available in table 13A.19.)
• Community-based public mental health services, comprising:
• ambulatory care services and other services dedicated to assessment, treatment, rehabilitation and care, and
• residential services that provide beds in the community, staffed onsite by mental health professionals.
• Not for profit, non-government organisation (NGO) services, funded by the Australian, State and Territory governments focused on providing wellbeing, support and assistance to people who live with a mental illness. These include crisis, support and information services such as Beyond Blue, Lifeline, Kids Helpline, and ReachOut.
• The National Disability Insurance Scheme (NDIS), which began full roll out in July 2016². People with a psychiatric disability who have significant and permanent functional impairment are eligible to access funding through the NDIS. In addition, people with a disability other than a psychiatric disability, may also be eligible for funding for mental health-related services and support if required.
• The Australian, State and Territory governments also share a focus on prevention and early intervention through suicide prevention programs and investment to reduce gaps in care (including emphasising a whole of system approach and the role of social determinants of health on people’s mental health and wellbeing).

1. While not a State and Territory government specialised mental health service, this section also reports on emergency department presentations for mental health related care needs (where data are available). Locate Footnote 1 above
2. For further information on the NDIS and its implementation see https://www.ndis.gov.au. Locate Footnote 2 above

State and Territory governments are responsible for funding, delivering and/or managing specialised services for mental health including inpatient/admitted care in hospitals, community-based ambulatory care and community-based residential care.

The Australian Government is responsible for overseeing and funding of a range of services for mental health and programs that are primarily provided or delivered by private practitioners or NGOs. These services and programs include MBS subsidised services provided by GPs (under both general and specific mental health items), private psychiatrists and other allied mental health professionals, Pharmaceutical Benefits Scheme (PBS) funded mental health-related medications and other programs designed to prevent suicide or increase the level of social support and community-based care for people with a mental illness and their carers. The Australian Government also funds State and Territory governments for health services, most recently through the approaches specified in the National Mental Health and Suicide Prevention Agreement and the National Health Reform Agreement (NHRA) which includes a mental health component.

A number of national initiatives and nationally agreed strategies and plans underpin the delivery and monitoring of services for mental health in Australia including:

• the Mental Health Statement of Rights and Responsibilities (Australian Health Ministers 1991)
• the National Mental Health Policy 2008 (DoH 2009)
• the National Mental Health Strategy (DoH 2014)
• five-yearly National Mental Health Plans, with the most recent ― the Fifth National Mental Health and Suicide Prevention Plan — endorsed in August 2017 (COAG 2017).

Under the National Mental Health and Suicide Prevention Agreement ³, the Australian, State and Territory governments are jointly responsible for a number of areas including:

• mental health workforce planning, training and accreditation
• mental health promotion, prevention, early intervention and social and emotional wellbeing programs, suicide prevention, stigma reduction
• help and crisis hotlines
• psychosocial support services for people who are not supported through the NDIS
• contributions to the National Agreement on Closing the Gap (reducing suicide of Aboriginal and Torres Strait Islander peoples towards zero, ensuring all services funded by Australian governments are culturally safe and responsive, and building a strong, sustainable community-controlled sector).

3. National Mental Health and Suicide Prevention Agreement, 2022 https://federalfinancialrelations.gov.au/sites/federalfinancialrelations.gov.au/files/2022-03/nmh_suicide_prevention_agreement.pdf Locate Footnote 3 above

Nationally in 2020-21, around $10.9 billion in real government recurrent expenditure was allocated to services for mental health, equivalent to $425.86 per person in the population (table 13A.1 and figure 13.1). State and Territory governments made the largest contribution ($7.0 billion or 63.5 per cent, which includes Australian Government funding under the NHRA), with Australian Government expenditure of $4.0 billion (table 13A.1).

Expenditure on MBS subsidised services was the largest component of Australian Government expenditure on services for mental health in 2020-21 ($1.6 billion or 39.1 per cent) (table 13A.2). This comprised MBS payments for psychologists and other allied health professionals (19.8 per cent), consultant psychiatrists (10.6 per cent) and GP services (8.6 per cent) (table 13A.2). The Australian Government also spent $607.0 million in 2020-21 on mental health related medications under the PBS (table 13A.2).

Nationally in 2020-21, expenditure on admitted patient services was the largest component of State and Territory governments’ expenditure on specialised mental health services ($3.0 billion or 42.8 per cent), followed by expenditure on community-based ambulatory services ($2.7 billion or 38.6 per cent) (table 13A.3). State and Territory governments’ expenditure on specialised mental health services, by source of funds and depreciation (which is excluded from reporting) are in tables 13A.4 and 13A.5 respectively.

In 2021-22, 11.2 per cent of the total population received MBS/DVA services, with 1.9 per cent of the total population receiving State and Territory government specialised mental health services in 2020-21 (the most recent data available) (figure 13.2). While the proportion of the population using State and Territory government specialised mental health services has remained relatively constant, the proportion using MBS/DVA services has increased steadily over time from 7.8 per cent in 2012-13 to 11.2 per cent in 2021‑22 (table 13A.7). Growth in service use has been relatively consistent across GPs, clinical psychologists and other allied health services, followed by psychiatrists, although GPs remain the most commonly accessed service provider (table 13A.7).

Information on the proportion of new consumers who accessed State and Territory governments’ specialised and MBS subsidised services for mental health are available in tables 13A.8–9.

For the first time, the 2021 Census collected information on diagnosed long-term health conditions. Over two million people reported having a diagnosed long-term mental health condition (2 231 543) (ABS 2022).

MBS subsidised services for mental health

In 2021‑22, 13.6 million MBS subsidised services for mental health were provided by; psychologists (clinical and other services) (6.7 million), psychiatrists (2.6 million) and other allied health professionals (0.6 million). GPs provided a further 3.7 million MBS subsidised specific services for mental health. Service usage rates varied across states and territories (table 13A.10).

GPs are often the first service accessed by people seeking help when suffering from a mental illness (AIHW 2021). They can diagnose, manage and treat mental illnesses and refer patients to more specialised service providers. According to a 2022 report by the Royal Australian College of General Practitioners, mental health issues were the single most common reason patients visited their GP for the sixth year in a row (RACGP 2022).

State and Territory governments’ specialised mental health services

Across states and territories, the mix of admitted patient and community-based services and care types differ. As the unit of activity varies across these three service types, service mix differences can be partly understood by considering items which have comparable measurement such as expenditure (table 13A.3), numbers of full time equivalent (FTE) direct care staff (table 13A.11), accrued mental health patient days (table 13A.13) and mental health beds (table 13A.14).

Additional data are also available on the most common principal diagnosis for admitted patients, community-based ambulatory contacts by age group and specialised mental health care by Indigenous status in Mental Health Services in Australia (AIHW 2022).

Crisis and support organisations

Crisis, support and information services such as Beyond Blue, Lifeline and Kids Helpline are provided to support Australians experiencing mental health issues. In 2021-22:

• Lifeline received 1 142 234 calls and answered 990 076 calls.
• Kids Helpline received 350 812 answerable contact attempts (call, webchat and email) with 146 545 contacts answered.
• Beyond Blue received 317 904 contacts and responded to 242 327 contacts (unpublished AIHW).

National Disability Insurance Scheme

The National Disability Insurance Scheme (NDIS) provides support to people with a significant and enduring primary psychosocial disability. In 2021-22, there were 56 559 active NDIS participants with a psychosocial disability (10.6 per cent of all participants) (NDIA 2022), receiving approximately $3.1 billion in payments (table 13A.15).

‘Mental health service use by selected equity groups’ is an indicator of governments’ objective to provide services in an equitable manner.

‘Mental health service use by selected equity groups’ is defined by two measures:

• the proportion of the population in a selected equity group using the service, compared to the proportion of the population outside the selected equity group, for each of:
  • State and Territory governments’ specialised public mental health services
  • MBS/DVA subsidised mental health services.

The selected equity groups reported are Aboriginal and Torres Strait Islander people, people from outer regional, remote and very remote locations and people residing in low socioeconomic areas (Socio Economic Indexes for Areas (SEIFA) quintiles 1 and 2).

Results for this indicator should be interpreted with caution. Variation in use could be due to variation in access but could also be a result of differences in the prevalence of mental illness. This indicator does not provide information on whether the services are appropriate for the needs of the people receiving them, or correctly targeted to those most in need.

A higher proportion of the population access MBS/DVA subsidised mental health services than State and Territory governments’ specialised public mental health services (table 13A.7). However, the pattern of service use differs across the selected equity groups.

In 2020-21, for State and Territory governments’ specialised public mental health services, a higher proportion of Aboriginal and Torres Strait Islander people accessed these services than non-Indigenous people (figure 13.3). People residing in lower socioeconomic areas (SEIFA quintiles 1 and 2) had greater use of mental health services compared to people residing in higher socioeconomic areas (SEIFA quintiles 4 and 5) and people in outer regional, remote and very remote areas had greater use of mental health services compared to inner regional and major cities.

Nationally in 2021-22, the proportion of people who accessed MBS/DVA services was lower for people in lower socioeconomic areas compared to higher socioeconomic areas (table 13A.16) and lower for people in outer regional, remote and very remote areas compared to inner regional and major cities (table 13A.18), though results varied across jurisdictions.

Data on the use of private hospital mental health services are available in tables 13A.7 and 13A.16–18.

‘Timely access to mental health care’ is an indicator of governments’ objective to provide services in a timely manner.

‘Timely access to mental health care’ is defined as the proportion of people who present to an emergency department with a mental health related care need (principal diagnosis of F00–F99) seen within clinically recommended waiting times.

The proportion of people seen within clinically recommended waiting times is defined as the proportion of patients seen within the benchmarks set by the Australasian Triage Scale. The Australasian Triage Scale is a scale for rating clinical urgency, designed for use in hospital-based emergency services in Australia and New Zealand. The benchmarks, set according to triage category, are as follows:

• triage category 1: need for resuscitation — patients seen immediately
• triage category 2: emergency — patients seen within 10 minutes
• triage category 3: urgent — patients seen within 30 minutes
• triage category 4: semi urgent — patients seen within 60 minutes
• triage category 5: non urgent — patients seen within 120 minutes.

High or increasing proportions of patients seen within the recommended waiting times is desirable. Contextual data for all presentations (not just those with a mental health related care need) is reported in section 12.

This is a partial measure for this indicator as emergency departments are only one of many services that provide access to mental health care. Future reporting will focus on timely access to State and Territory governments’ specialised public mental health services and MBS subsidised services for mental health.

Nationally in 2020-21, 63.8 per cent of people who presented to an emergency department with a mental health related care need were seen within clinically recommended waiting times (figure 13.4).

‘Affordability of mental health care’ is an indicator of governments’ objective to provide services that are affordable.

‘Affordability of mental health care’ is defined by three measures:

• The proportion of people who delayed seeing or did not see a GP for their mental health due to cost
• The proportion of people who delayed seeing or did not see a psychologist, psychiatrist or other mental health professional for their mental health due to cost
• The proportion of people who delayed filling or did not fill a prescription for their mental health due to cost.

A low or decreasing proportion for each measure is desirable.

Data are not available for measure 3.

Nationally in 2021-22, 16.7 per cent of all respondents delayed seeing any mental health professional in the last 12 months due to cost, an increase from 12.0 per cent in 2020-21. Respondents were more likely to report delaying mental health care due to cost for psychologists, psychiatrists and other mental health professionals (21.7 per cent) than for GPs (6.8 per cent) (figure 13.5). Survey respondents who self-reported as having a mental health condition were more likely to delay seeking mental health care across all mental health care providers, except GPs, than people who did not self-report having a mental health condition (but who still reported delaying mental health care due to cost).

‘Mental health service use estimates’ is an indicator of governments’ objective to provide services that are readily available to those who need them.

‘Mental health service use estimates’ is defined as the estimated proportion of the population with a mental health condition receiving a mental health service.

A high or increasing proportion of the population with a mental health condition receiving services for mental health suggests greater access to treatment. However, not all people with a mental health condition will want or need treatment. Furthermore, accessing a service does not guarantee that the service will be effective.

An agreed method for reporting against this indicator is not yet available.

‘Primary mental health care for children and young people’ is an indicator of governments’ objective to facilitate early detection of mental health issues and mental illness, followed by appropriate intervention.

‘Primary mental health care for children and young people’ is defined as the proportion of young people aged under 25 years who received an MBS subsidised mental health care service from a GP, psychologist or other allied health professional.

High or increasing proportions of young people who had contact with MBS subsidised primary mental health care services are desirable.

Results for this indicator should be interpreted with caution. Variations in use could be due to variations in access but could also be a result of differences in the prevalence of mental illness. This indicator does not provide information on whether services are appropriate for the needs of young people receiving them, or correctly targeted to young people most in need. Further, some primary mental health services for children and young people are excluded from these data; for example, community health centres, school and university counsellors and nurses and some mental health care provided by State and Territory governments’ specialised mental health services (NMHPSC 2011a).

The proportion of all children and young people who received MBS subsidised primary mental health care services increased over the past 10 years, from 5.6 per cent in 2012-13 to 10.0 per cent in 2021-22. MBS mental health service use increases with age. Nationally, 17.7 per cent of young people aged 18–24 years received MBS subsidised primary health care in 2021-22 (figure 13.6).

Disaggregation by telehealth and face-to-face is reported for the first year. Since the introduction of MBS telehealth services in 2019-20, the proportion of people under 25 accessing telehealth consultations has increased annually from less than a quarter of all subsidised primary mental health care consultations in 2019-20 (2.1 per cent compared to 9.2 per cent in person) to around one third of all subsidised primary mental health care consultations in 2021-22 (3.5 per cent compared 9.3 per cent) (13A.22 and figure 13.6).

Proportions of young people accessing MBS subsidised mental health care are higher for females compared to males and higher for young people in major cities and inner regional areas compared to other areas (table 13A.22). Data by Aboriginal and Torres Strait Islander status and service type is available in tables 13A.22–23.

‘Consumer and carer involvement in decision making’ is an indicator of governments’ objective to provide universal access to services that are responsive to consumer and carer goals.

‘Consumer and carer involvement in decision making’ is defined by two measures, the number of paid FTE:

• consumer workers per 1000 FTE direct care staff
• carer workers per 1000 FTE direct care staff.

High or increasing proportions of paid FTE direct care staff who are consumer or carer workers implies better opportunities for consumers and carers to influence the services received.

Nationally in 2020-21 there were 10.5 paid FTE consumer workers per 1000 paid FTE direct care staff (figure 13.7a)

Nationally in 2020-21, there were 3.3 paid FTE carer workers per 1000 paid FTE direct care staff (figure 13.7b).

‘Services reviewed against the National Standards’ is an indicator of governments’ objective to provide universal access to services that are high quality.

‘Services reviewed against the National Standards’ is defined as the proportion of expenditure on State and Territory governments’ specialised public mental health services that had completed a review by an external accreditation agency against the National Standards for Mental Health Services (NSMHS) and met ‘all standards’ (level 1). The assessment levels are defined in the ‘Key terms and references’ tab.

A high or increasing proportion of expenditure on specialised mental health services that had completed a review by an external accreditation agency and had been assessed against the NSMHS as level 1 is desirable.

This is a process indicator of quality, reflecting progress made in meeting the NSMHS. It does not provide information on whether the standards or assessment process are appropriate. In addition, services that had not been assessed do not necessarily deliver services of lower quality. Some services that had not completed an external review included those that were undergoing a review and those that had booked for review and were engaged in self-assessment preparation.

Nationally at 30 June 2021, 92.4 per cent of expenditure on specialised public mental health services was on services that had completed an external review against the NSMHS and met ‘all standards’ (level 1) (figure 13.8).

‘Adverse events’ is an indicator of governments’ objective to provide services that promote recovery, and are high quality, safe and responsive to consumer and carer goals.

‘Adverse events’ is defined by seven measures:

• Measure 1: Restrictive practices:
  • Seclusion, defined as the number of seclusion events per 1000 bed days in State and Territory governments’ specialised mental health acute inpatient units
  • Restraint, defined as:
    • the number of mechanical restraint events per 1000 bed days in State and Territory governments’ specialised mental health acute inpatient units
    • the number of physical restraint events per 1000 bed days in State and Territory governments’ specialised mental health acute inpatient units
    • the number of chemical restraint events. (Measurement of this concept is under development.)
• Measure 2: Suicide in an inpatient facility
  • Suicide in an inpatient facility, defined as suspected suicide of a patient in an acute psychiatric unit or acute psychiatric ward, reported as a number, by jurisdiction.
• Measure 3: Self-harm in an in-patient facility
  • Self-harm is defined as deliberately injuring or hurting oneself, with or without the intention of dying. (Measurement of this concept is under development.)
• Measure 4: Assault in an inpatient facility
  • Assault is defined as physical or sexual assault of a patient in an inpatient facility. (Measurement of this concept is under development.)
• Measure 5: Medical errors in an inpatient facility
  • Medical errors are defined as the administration of an incorrect diagnosis, intervention, or medication, or delay in administration resulting in harm or deterioration. (Measurement of this concept is under development.)
• Measure 6: Abscondment from an inpatient facility
  • Abscondment is defined as leaving or not returning to an admitted healthcare facility without prior agreement. (Measurement of this concept is under development.)
• Measure 7: Falls in an inpatient facility
  • Falls is defined as a loss of balance resulting in serious harm. (Measurement of this concept is under development.)

Restrictive practices

Seclusion involves confining a person at any time of the day or night alone in a room or area from which he or she cannot leave (the ‘Explanatory material’ tab provides further details on seclusion and ‘seclusion events’). Legislation or mandatory policy governs the use of seclusion in each state and territory and may result in exceptions to the definition of a seclusion event and variations in the data collected across jurisdictions (NMHPSC 2011b).

Supporting data on the duration of seclusion events is provided in table 13A.26. These data, when considered with the rate of seclusion, provide information on the use and management of seclusion across jurisdictions.

A low or decreasing rate of seclusion events combined with shorter average durations is desirable.

Restraint involves restricting a person's freedom of movement by physical or mechanical means. The ‘Explanatory material’ tab provides further details on mechanical and physical restraint.

A low or decreasing rate of restraint events per 1000 bed days in specialised public mental health inpatient units is desirable.

Nationally in 2021-22, the rate of seclusion was 6.6 events per 1000 bed days (figure 13.9a).

For both seclusion and restraint, results varied across target populations. In 2021-22, the lowest seclusion, physical and mechanical restraint rates were in Older persons units and the highest were in Forensic units (tables 13A.27 and 13A.29).

Nationally in 2021-22, the rate of physical restraint was 10.3 events per 1000 bed days, and for mechanical restraint was 0.9 events per 1000 bed days (figure 13.9b and table 13A.28).

Suicide in an inpatient facility

A suspected suicide of a patient in an acute psychiatric unit or acute psychiatric ward is known as a ‘sentinel event’. Sentinel events are adverse events that occur because of hospital system and process deficiencies, and which result in the death of, or serious harm to, a patient.

Australian health ministers agreed version 2 of the Australian sentinel events list in December 2018. All jurisdictions implemented these categories on 1 July 2019. 'Suspected suicide of a patient in an acute psychiatric unit or acute psychiatric ward' is one of ten sentinel events in the Australian sentinel events list. Further details are available in section 12.

A low or decreasing number of suspected suicides of patients in acute psychiatric units or acute psychiatric wards is desirable.

Nationally in 2020-21, there were 18 suspected suicides in psychiatric inpatient facilities, an increase on the number of inpatient suicides in 2019-20 (table 13.1 and table 13A.30).

‘Consumer and carer experiences of mental health services’ is an indicator of governments’ objective to provide access to services that are responsive to consumer and carer goals.

‘Consumer and carer experiences of mental health services’ is defined by two measures:

• the proportion of mental health service consumers reporting positive experiences of mental health services
• the proportion of carers of mental health service consumers reporting positive experiences of mental health services.

A high or increasing proportion of mental health consumers and carers with positive experiences of service is desirable. Data are reported by service delivery setting (residential care, admitted care and ambulatory care — see ‘Explanatory material’ tab for definitions).

In 2020-21, for jurisdictions where data are available, a higher proportion of consumers reported positive experiences of service in residential and ambulatory care (non-admitted care) than in admitted care (table 13.2).

‘Community follow-up after psychiatric admission/hospitalisation’ is an indicator of governments’ objective to provide services that are coordinated and provide continuity of care.

‘Community follow-up after psychiatric admission/hospitalisation’ is defined as the proportion of State and Territory governments’ specialised public admitted patient overnight acute separations from psychiatric units for which a community-based ambulatory contact was recorded in the seven days following separation.

A high or increasing rate of community follow-up within the first seven days of discharge from hospital is desirable.

This indicator does not measure the frequency of contacts recorded in the seven days following separation. Neither does it distinguish between the mode of contact. Only follow-up contacts made by State and Territory governments’ specialised public mental health services are included.

Nationally, the rate of community follow-up for people within the first seven days of discharge from an acute inpatient psychiatric unit was 76.0 per cent in 2020-21, an increase from 75.1 per cent in 2019-20 (figure 13.10).

Community follow-up rates by Indigenous status, remoteness areas, SEIFA, age groups and sex are in tables 13A.32-33.

‘Readmissions to hospital within 28 days of discharge’ is an indicator of governments’ objective to provide services that are coordinated and provide continuity of care.

‘Readmissions to hospital within 28 days of discharge’ is defined as the proportion of State and Territory governments’ admitted patient overnight separations from psychiatric acute inpatient units that were followed by readmission to the same type of unit within 28 days of discharge.

A low or decreasing rate of readmissions to hospital within 28 days of discharge is desirable.

While readmissions can indicate that inpatient treatment was either incomplete or ineffective, or that follow-up care was inadequate, they can also reflect the cyclic and episodic nature of some illnesses.

Nationally in 2020-21, the rate of readmission to hospital acute psychiatric units within 28 days of discharge was 14.7 per cent, similar to 2019-20 (14.8 per cent) (figure 13.11).

Data by Indigenous status, remoteness areas, SEIFA, age group and sex are in table 13A.35.

‘Workforce sustainability’ is an indicator of governments’ objective to provide sustainable services.

‘Workforce sustainability’ reports age profiles for the mental health workforce. It shows the proportion of full time equivalent (FTE) medical practitioners (including psychiatrists), mental health nurses, registered psychologists and other allied mental health practitioners in ten year age brackets, by jurisdiction.

High or increasing proportions of the workforce that are new entrants and/or low or decreasing proportions of the workforce that are close to retirement are desirable.

Health workforce sustainability relates to the capacity of the health workforce to meet current and projected service demand. These measures are not a substitute for a full workforce analysis that allows for migration, trends in full-time work and expected demand increases. They can, however, indicate that further attention should be given to workforce sustainability for mental health services.

Nationally in 2021, allied mental health practitioners had the highest proportion of FTEs who were aged less than 30 years, followed by nurses, psychologists and medical practitioners (including psychiatrists). The medical practitioner (including psychiatrist) workforce had the highest proportion of FTEs aged 60 years or over (figure 13.12).

‘Cost of care’ is an indicator of governments’ objective to provide services in an efficient manner.

‘Cost of care’ has three measures.

• Measure 1: ‘Cost of inpatient care’, defined by two sub measures:
  • ‘Cost per inpatient bed day’, defined as expenditure on inpatient services divided by the number of inpatient bed days — data are disaggregated by hospital type (psychiatric and general hospitals) and care type (acute and non-acute units) and by inpatient target population (acute units only)
  • ‘Average length of stay’, defined as the number of inpatient patient days divided by the number of separations in the reference period — data are disaggregated by inpatient target population (acute units only). Patient days for consumers who separated in the reference period (2020-21) that were admitted during the previous period (2019-20) are excluded. Patient days for consumers who remain in hospital (and therefore are not included in the separations data) are included. Data for this sub measure are not yet reported.

  These sub measures are considered together for the inpatient acute units by target population to provide a ‘proxy’ measure to improve understanding of service efficiency. Average inpatient bed day costs can be reduced with longer lengths of stay because the costs of admission, discharge and more intensive treatment early in a stay are spread over more days of care. Data for forensic services are included for costs per inpatient bed day only, as the length of stay is dependent on factors outside the control of these services.

• Measure 2: ‘Cost of community-based residential care’ is defined as the average cost per patient day. Data are reported for both the care of general adult and older person services.
• Measure 3: ‘Cost of ambulatory care’ is defined by two sub measures:
  • average cost per treatment day
  • average number of treatment days per episode – this measure is provided, along with average costs, as frequency of servicing is the main driver of variation in care costs.

For each measure, a low or decreasing cost per input is desirable as this might indicate more efficient service delivery. However, efficiency data needs to be interpreted with care as it does not provide information on service quality or patient outcomes.

Mainstreaming (that is, providing mental health care in general health care settings rather than psychiatric settings) has occurred at different rates across states and territories, with some jurisdictions treating a greater proportion of consumers with severe mental illnesses in community-based services than other jurisdictions (see ‘Explanatory material’ tab for a definition of mainstreaming). This can create differences across states and territories in the mix of consumers, and therefore the costs, within service types.

Nationally in 2020-21, the average cost per inpatient bed day was higher in acute than non-acute units (figure 13.13a). Older persons units have lower costs per inpatient day (table 13A.39) but have considerably longer lengths of stay than general adult or child and adolescent units (table 13A.41). Data on the average cost per inpatient bed day by target population for all care types are reported in tables 13A.39–40.

Nationally in 2020-21, the average cost for 24 hour staffed residential care is higher for general adult units ($705.55 per patient day) compared to older persons care units ($614.39 per patient day) (figure 13.13b). Nationally, the average recurrent cost per patient day for general adult units staffed 24 hours a day was over two and a half times the cost of those that were not staffed 24 hours a day (table 13A.42).

Nationally in 2020-21, the average recurrent cost per treatment day of ambulatory care was $365.71 (figure 13.13c), and the average number of treatment days per episode of ambulatory care was 6.7 days (figure 13.13d).

‘Prevalence of mental illness’ is an indicator of governments’ objective to, where possible, prevent the development of mental health problems, mental illness and suicide.

‘Prevalence of mental illness’ is defined as the proportion of the total population who have a mental illness.

A low or decreasing prevalence of mental illness can indicate that measures to prevent mental illness have been effective.

Many of the risk and protective factors that can affect the development of mental health problems and mental illness are outside the scope of the mental health system. These include environmental, sociocultural and economic factors, some of which can increase the risk of mental illness while others can support good mental health.

Not all mental illnesses are preventable and a reduction in the effect of symptoms and an improved quality of life will be a positive outcome for many people with a mental illness.

Due to COVID-related difficulties with in-person data collection during 2021, the National Study of Mental Health and Wellbeing (NSMHW) was conducted in two parts from 2020 to 2022. As a result, only national totals are available for reporting in 2023. These data should not be compared to the 2007 survey due to a smaller sample size in 2020-2021. State and territory data are expected to be available for the 2024 Report.

Nationally in 2020-21, more than one in five Australians (21.4 per cent) aged 16 to 85 years reported a mental health disorder with symptoms in the previous 12 months (table 13.3). National data by disorder, age and sex are reported in tables 13A.44–46.

The prevalence of mental illness among children and young people aged 4–17 years was an estimated 13.9 per cent in 2013-14 (Lawrence et al. 2015). Attention deficit/hyperactivity disorder (ADHD) was the most common mental illness for this age group (7.4 per cent) followed by anxiety disorders (6.9 per cent) (Lawrence et al 2015).

A proxy measure of the overall mental health and wellbeing of the population is the Kessler 10 (K10) psychological distress scale. Very high levels of psychological distress may signify a need for professional help and provide an estimate of the need for mental health services (ABS 2012).

Nationally in 2017-18, the age standardised proportion of adults with high/very high levels of psychological distress was 13.0 per cent (table 13A.48), and of those 4.0 per cent had very high levels (table 13A.47). Proportions were higher for:

• females compared to males (table 13A.47)
• people with disability compared to people without (tables 13A.48–49)
• people in lower compared to higher socioeconomic areas (tables 13A.48–49)
• Aboriginal and Torres Strait Islander people (2018-19) compared to non-Indigenous people (2017-18) (table 13A.50).

High rates of substance use and abuse can contribute to the onset of, and poor recovery from, mental illness. Information on rates of licit and illicit drug use can be found in tables 13A.51–53 and the National Drug Strategy Household Survey (AIHW 2020).

‘Mortality due to suicide’ is an indicator of governments’ objective to, where possible, prevent the development of mental health problems, mental illness and suicide.

‘Mortality due to suicide’ is defined as the suicide rate per 100 000 people. Deaths from suicide are defined as causes of death with the International Classification of Diseases (ICD) 10 codes X60–X84 and Y87.0.

A low or decreasing suicide rate per 100 000 people is desirable.

While services for mental health contribute to reducing suicides, other services also have a significant role including public mental health programs and suicide prevention programs (addressed through the initiatives of other government agencies, NGOs and other special interest groups).

Many factors outside the control of services for mental health can affect suicide risk. These include environmental, sociocultural and economic risk factors. Often a combination of these factors can increase the risk of suicidal behaviour.

People with a mental illness are at a higher risk of suicide compared to the general population. For the period 2017–2021, there were 16 136 suicides recorded in Australia — equivalent to 12.6 deaths per 100 000 people (table 13A.54). The rate for people aged 5–17 years was 2.5 deaths per 100 000 population and the rate for Aboriginal and Torres Strait Islander people was 26.4 deaths per 100 000 population (figure 13.14).

Nationally, suicide rates per 100 000 population for 2021 show that rates are lower for females compared to males (6.1 deaths compared to 18.2 deaths) (ABS 2022), lower in capital cities compared to other areas (9.8 deaths compared to 16.7 deaths) (table 13A.56) and (for 2017–2021) lower for non-Indigenous compared to Aboriginal and Torres Strait Islander people (12.4 deaths compared to 26.4 deaths) (table 13A.57).

‘Physical health outcomes for people with a mental illness’ is an indicator of governments’ objective to promote recovery and physical health and encourage meaningful participation in society.

‘Physical health outcomes for people with a mental illness’ is defined as the proportion of adults with a mental illness (compared to those without a mental illness) who experienced a long-term physical health condition: cancer, diabetes, arthritis, cardiovascular disease and asthma.

Low or decreasing proportions of people with a mental illness who experience a long-term physical health condition are desirable.

People with a mental illness have poorer physical health outcomes than people without mental illness (Happell et al. 2015; Lawrence, Hancock and Kisely 2013), but the relationship between the two is complex. Poor physical health can exacerbate mental health problems and poor mental health can lead to poor physical health. In addition, some psychiatric medications prescribed to treat mental health conditions may lead to poorer physical health.

Greater exposure to particular health risk factors can also contribute to poorer physical health. Information on selected risk factors by mental illness status can be found in table 13A.58.

A higher proportion of adults with a mental illness had long-term health conditions compared to adults without a mental illness. Nationally in 2017-18, the age standardised proportions of adults with a mental illness who had arthritis (25.9 per cent) and asthma (18.4 per cent) were higher than those without a mental illness (15.3 per cent and 9.5 per cent respectively) (figure 13.15 and table 13A.59).

‘Social and economic inclusion of people with a mental illness’ is an indicator of governments’ objective to promote recovery and physical health and encourage meaningful participation in society.

‘Social and economic inclusion of people with a mental illness’ is defined by two measures, with the proportion of people:

• aged 16–64 years with a mental illness who are employed
• aged 15 years or over with a mental illness who had face-to-face contact with family or friends living outside the household in the past week

High or increasing proportions of people with a mental illness who are employed, or who had face-to-face contact with family or friends, are desirable.

This indicator does not provide information on whether the employment, education or social activities were appropriate or meaningful. It also does not provide information on why people who were not employed were not looking for work (for example, those outside the labour force).

Nationally in 2017-18, the age-standardised proportion of 16–64 year olds with a mental illness who were employed was 63.9 per cent (figure 13.16).

Information on the proportion of people aged 16–30 years with a mental illness who were employed and/or are enrolled for study in a formal secondary or tertiary qualification can be found in table 13A.60.

Nationally in 2020, the proportion of people aged 15 years or over with a mental illness who had face-to-face contact with family or friends living outside the household in the last week was 40.6 per cent (Table 13.4).

‘Mental health outcomes of consumers of specialised public mental health services’ is an indicator of governments’ objective to promote recovery and physical health and encourage meaningful participation in society.

‘Mental health outcomes of consumers of specialised public mental health services’ is defined as the proportion of people receiving care who had a significant improvement in their clinical mental health outcomes, by service type. The ‘Explanatory material’ tab provides information on how the consumer outcomes average score is derived.

Outcomes are calculated for the following consumer groups:

• Group A: Consumers separated from hospital. People who received a discrete episode of inpatient care within a State/Territory designated psychiatric inpatient unit during the reference year. The defining characteristic of the group is that the episode of care commenced, and was completed, within the year.
• Group B: Consumers discharged from community‑based ambulatory care. People who received relatively short-term community care from a State/Territory mental health service during the reference year. The defining characteristic of the group is that the episode of care commenced, and was completed, within the year.
• Group C: Consumers in ongoing community‑based ambulatory care. People receiving relatively long-term community care from a State/Territory mental health service. It includes people who were receiving care for the whole of the reference year, and those who commenced community care sometime after 1 July who continued under care for the rest of the year. The defining characteristic of the group is that all remained in ongoing care when the year ended (30 June).

A high or increasing proportion of people receiving care in State and Territory governments’ specialised public mental health services who had a significant improvement in their clinical mental health outcomes is desirable.

Supplementary data are reported on the proportion of people receiving care who experienced no significant change or a significant deterioration in their mental health outcomes. Information on the proportion of episodes for which completed outcomes data are available is in table 13A.63.

This indicator has a number of issues:

• The outcome measurement tool is imprecise as a single ‘average score’ does not reflect the complex service system in which services are delivered across multiple settings and provided as both discrete, short-term episodes of care and prolonged care over indefinite periods (AHMC 2012).
• The approach separates a consumer’s care into segments (hospital versus the community) rather than tracking his or her overall outcome across treatment settings.
• A consumer’s outcomes are measured from a clinician’s perspective rather than the consumer’s.

Nationally in 2020-21, 72.1 per cent of people discharged from a hospital psychiatric inpatient unit, 50.3 per cent of people discharged from community-based ambulatory care and 26.9 per cent of people in ongoing community-based ambulatory care showed a significant improvement in their clinical mental health outcomes (figure 13.17).

Over the 10 years of data in this Report, for those in ongoing community-based ambulatory care, younger people aged 0–17 years had the highest proportion of people who showed a significant improvement compared to other age groups (table 13A.64).

‘Stigma and discrimination experienced by people living with mental health problems or mental illness’ is an indicator of governments’ objective to reduce the impact of mental illness (including the effects of stigma and discrimination).

‘Stigma and discrimination experienced by people with a mental health condition’ is defined by two measures:

• the proportion of people with a mental health condition who have experienced discrimination or been treated unfairly
• the proportion of people with a mental health condition who have experienced discrimination or been treated unfairly because of their mental health condition.

A low or decreasing proportion of people experiencing discrimination or being treated unfairly is desirable.

In 2020, 20.8 per cent of people with a mental illness reported experiencing discrimination or being treated unfairly (table 13.5). Data are not available on whether the discrimination was perceived to be due to a person’s mental illness.