2024 Public Hospital Report Card - Mental Health Edition
Download the reportPresident's Introduction
Dr Danielle McMullen
Federal AMA President
The AMA’s Public Hospital Report Card has provided Australians with a snapshot of public hospital performance for 17 years. For the past three years we have produced a mental health edition to highlight the unique challenges faced by patients seeking mental health care in our public hospitals. As a GP, I understand all too well the importance of an interconnected and well-functioning mental healthcare system.
Like many of my colleagues, I’ve sat with patients suffering an acute mental illness needing a hospital admission in my clinic — some have been able to attend hospital voluntarily, and for others I’ve needed to use the Mental Health Act to help them get the care they need. In all cases, the trip through the emergency department has been an anxiety-provoking step in the road. The staff in these departments are brilliant — but emergency departments are not designed for mental healthcare.
As we’ve shown in this report, the strain on inpatient beds is leaving patients with mental illness in emergency departments far longer than they should be. Using publicly available information from the Australian Institute of Health and Welfare, this report card looks at the capacity and performance of mental health services provided in Australia’s public hospitals for the financial year 2022–23. This report includes both national and state-by-state analysis, providing policymakers and the public with an important snapshot of how mental healthcare in our public hospitals is being managed.
Mental healthcare is complex and multi-layered. It demands involvement from across the healthcare sector, from primary care in the community through to the hospital system for the most acute cases. While it is imperative that governments invest in delivering high-quality and timely mental healthcare outside of hospitals, our public hospitals must be fully equipped to assist those requiring urgent mental healthcare.
Unfortunately, our public hospitals are under more strain than ever. Our 2024 Public Hospital Report Card, published in April, highlighted a worrying combination of record high waiting times and record low per-person bed capacity in Australia’s public hospitals. Unfortunately, these trends are replicated across our mental health wards, with the latest figure of 27 specialised mental health beds per 100,000 Australians the lowest per-person capacity figure on record.
This lack of specialised mental health beds is emblematic of the public hospital logjam and results in extended patient stays in emergency departments (ED), distressing both patients and their families.
For patients with mental-health related conditions who are eventually admitted to a public hospital bed, the length of time spent in ED was at its highest on record in 2022–23. On average, these patients spent 420 minutes, or 7 hours, in ED before being admitted to hospital. This is an increase of 37 minutes from the year before, and two hours longer than 2019–20. Devastatingly, 10 per cent of mental health patients will wait more than 23 hours before receiving a bed.
This situation is also distressing for ED staff, who are highly skilled in managing mental health crises and associated medical needs, but not supported or resourced to manage patients with complex, chronic mental health issues. Tragically, these overcrowded and stressful situations can contribute to unsafe psychosocial work environments and staff burnout, and in the worst cases, assaults on staff.
This report provides yet another piece of evidence pointing to the need for greater investment in Australia’s public hospital system. Public hospitals remain in logjam, with a shortage of beds for Australians in need. We need more beds and greater investment across the whole health system. There is work to be done to enhance the capacity of services and general practitioners to deliver mental healthcare in the community.
All levels of government and non-governmental organisations need to work cooperatively to build a mental healthcare system that is patient-centred, and needs-based, informed by evidence and research, with adequate investment and funding.
This holistic approach is needed to improve the mental health of Australians and, in turn, take the pressure off our hospital system. Without it, we will continue to see logjams in our public hospital EDs, and we will continue to see medical and health staff leave the profession due to burnout and stress.
Dr Danielle McMullen AMA President
Overview
The AMA’s Public Hospital Report Card — Mental Health Edition looks at the performance of Australia’s public hospitals when providing care to patients who have presented with mental health-related conditions. Like the AMA Public Hospital Report Card, the aim is to show trends in hospital service delivery and identify where gaps are and where improvements are needed. This edition uses publicly available data published by the Australian Institute of Health and Welfare and the Productivity Commission. See page 47 for a full list of data sources and references.
Ultimately, by publishing these report cards, the AMA wants to see policy improvements that will benefit patients, the health and medical professionals who are working in the public hospital system, and the Australian public more broadly.
This report card allows for accurate longitudinal analysis, comparing the health system’s current performance against past performance. Unfortunately, this third annual Mental Health Edition again demonstrates a worrying decline in both performance and capacity within the mental health departments of our public hospitals.
In 2021–22, the latest year for which capacity data is available, Australia saw a reduction of 244 specialised mental health beds across the country, coinciding with an overall loss of two public hospitals providing mental health services. These numbers are alarming.
Australia has witnessed a long-term decline in the number of mental health beds available per person in the past 30 years. The latest figure of 27 beds per 100,000 Australians is the lowest per-person capacity figure on record, highlighting a worrying trend of reduced system capacity at a time when the need for care is greater than ever.
The AMA is concerned by the increasing number of patients with severe, complex, and chronic conditions, where mental illness may be one of a multitude of conditions. It is essential these patients receive the appropriate support for all their health needs — be they physical health, mental health, or broader psychosocial supports.
Since 2010–11, the number of Australians presenting to ED with a mental illness triaged as “emergency” has more than doubled from 9 to 21 per 10,000 people, while the number of “urgent” presentations has grown from 37 to 57 per 10,000 people.
In 2022–23, more than half (52 per cent) of mental health-related presentations came via an emergency services vehicle, compared to 26 per cent of all emergency department presentations.
These numbers clearly highlight the fact that the needs of patients with severe mental illness are increasingly unmet by the community and primary care system, leading them to an ED as a last resort, when the situation is critical.
Despite the best efforts of hospital staff, a lack of inpatient beds and insufficient resourcing continues to create access block in our public hospitals. This means that highly distressed patients suffering from severe mental health problems must wait, on average, seven hours in a crowded ED before they are admitted to hospital. Even more worryingly, the 90th percentile length of stay for mental health presentation admissions has risen to 1392 minutes, or more than 23 hours. In other words, 10 per cent of mental health patients who are eventually admitted to hospital are waiting almost an entire day in ED.
Despite the amazing knowledge, effort and care provided by Australia’s medical and healthcare professionals working in the public hospital system, EDs are not appropriate environments for sustained, in-depth care of patients with mental illness. Unfortunately, the physical design of most public hospital EDs is often not conducive to quality mental healthcare. The result is ED clinical staff are placed under increasing pressure, leading to stress, burnout, and the emergence of their own mental health issues.
Once admitted to hospital, mental healthcare patients stay on average for much longer than non-mental health patients due to the complexity and fragility of their health at the point of admission. In 2022–23, the average length of stay for mental health patients was 14.3 days, compared to 5.3 days for non-mental health admissions.
With our hospitals stuck in logjam, it is clear investment in community and primary mental healthcare will pay dividends by reducing the number and severity of admissions to our mental health wards.
One positive sign is the increasing proportion of patients receiving follow up care in the community post-discharge from specialised mental healthcare in our public hospitals. Patients can be particularly vulnerable in the post-discharge period, with the likelihood of readmission or relapse greatly reduced if patients are provided with community care in the aftermath of a hospital stay.
Across Australia, the rate of patients being provided with community follow-up cases has been increasing in both major cities and remote areas, with 81 per cent of patients located in a remote part of Australia receiving community follow up within 7 days post-separation in 2021–22. This represents the best figure on record, and significant improvement from the less that 60 per cent of remote patients receiving community follow up in 2013–14.
Unfortunately, this positive trend stands alone among a crowd of worrying long-term trends pointing to either stagnant or reduction in performance and/or capacity within Australia’s public hospitals. Australia’s population is aging, with Australians aged over 85 presenting to ED with mental health-related illnesses at a rate 48 per cent higher in 2022–23 than in 2014–15.
The data is clear. Australia’s public hospitals require significant investment in capacity, workforce and resourcing to ensure our world-class medical and healthcare professionals are equipped to keep up with the growing complexity and demand of Australia’s healthcare needs.
AMA solutions for a healthier hospital system
This report card highlights the underlying issues facing Australia’s mental health system; growing wait times, decreased capacity, and an increase in severity of illness for those presenting to ED.
Australia’s population is growing, ageing, and developing more complex health needs. Without a change of approach from all layers of government, the worrying trends highlighted within this report card are bound to continue heading in the wrong direction.
It is clear the current funding model for our health system is not fit-for-purpose. It’s only focused on the number of procedures hospitals provide. Nor does it provide enough funding to keep people out of hospital through preventative and community care.
The four points of the AMA plan to deal with our struggling, logjammed hospitals is:
1.Improve performance
Reintroduce funding for performance improvement — for example, improvement in elective surgery and emergency department waiting times — to reverse the decline in public hospital performance.
2.Expand capacity
Give public hospitals additional funding for extra beds (along with the staff) and support them to expand capacity to meet community demand, surge when required, improve treatment times, and put an end to ambulance ramping.
3.Addressing demand for out-of-hospital alternatives
Fund alternatives for out-of-hospital care, so those whose needs can be better met in the community can be treated outside hospital. Programs that work with general practitioners to address avoidable admissions and readmissions should be prioritised.
4.Increase funding and remove funding cap
Increase the federal government’s contribution for activity, allowing states and territories to reinvest the ‘freed-up’ funds to improve performance, capacity and innovation. Remove the artificial cap on funding growth that is shared between states and territories, so funding can meet community health needs based on realities on the ground.
We acknowledge the significant offer of increased funding and a more generous growth cap announced by the federal government last December . However, until a new National Health Reform Agreement is signed this funding, along with the needed additional funding from states and territories, will not yet to flow to our public hospitals.
For more information or to share your story, visit www.ama.com.au/clear-the-hospital-logjam
National Public Hospital Mental Health Performance
An available bed is the most fundamental prerequisite to receiving care in a public hospital. Although the number of hospital beds is not necessarily an indication of the quality of mental healthcare provided, it is an indicator of the capacity of the system to provide acute care for those patients who need it.
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