2.4 Trends in state and territory mental health services

Key messages:

• Between 1992-93 and 2010-11, annual state and territory government spending on services provided in general hospitals and the community grew by $2.6 billion, or 283%. This was accompanied by a decrease in spending on stand-alone psychiatric hospitals of $289 million, or 35%. About two thirds of the $2.6 billion was invested in community-based services (ambulatory care services, services provided by non-government organisations or NGOs, and residential services). The remaining third was spent on increased investment in psychiatric units located in general hospitals.
• Funding to ambulatory care services increased bet ween 1992-93 and 2010-11 by 291% (from $421 million to $1.6 billion). Over the same period, the full-time equivalent direct care workforce in these services also increased, but not by the same magnitude (215%).
• The non-government community support sector's share of the mental health budget increased from 2.1% to 9.3%, with $372 million allocated to NGOs in 2010-11. Psychosocial support services account for about one third of this funding, and staffed residential mental health services accounted for about one fifth.
• Community residential support services expanded between 1992-93 and 2010-11. The number of 24 hour staffed general adult beds doubled (from 410 to 846). The number of 24 hour staffed older persons' beds was also higher in 2010-11 (682) than it was in 1992-93 (414) although it reached a peak in 1998-99 (805) and has been declining since then. The number of non-24 hour staffed beds in general adult residential services and the number of supported public housing places also increased w ith time.
• The number and mix of inpatient beds has changed during the course of the National Mental Health Strategy. There were significant decreases in beds in stand-alone psychiatric hospitals in the early years of the Strategy, particularly non-acute beds and general adult and older persons' beds. These decreases have been followed by more gradual declines in recent years. The decreases have been accompanied by commensurate increases in psychiatric beds in general hospitals, particularly acute beds. The average bed day costs in inpatient settings have increased (by 77% in stand-alone hospitals and by 51% in general hospitals).

Monitoring the progress of states and territories in the restructuring of their mental health services has been a central component of all National Mental Health Reports. Each of the four National Mental Health Plans has advocated fundamental change in the balance of services, focused on overhauling the institutional-centred systems of care that prevailed at the beginning of the 1990s.

The first National Mental Health Report documented the 'baseline' situation in 1992-93 and pointed to the scale of the task ahead. At the commencement of the Strategy:

• 73% of specialist psychiatric beds vvere located in stand-alone institutions
• only 29% of mental health resources were directed towards community-based care
• stand-alone hospitals consumed half of the total mental health spending by states and territories
• less than 2% of resources were allocated to non-government programs aimed at supporting people in the community.

Agreement on a national approach to mental health reform committed state and territory governments to expand their community-based services and devolve management from separate 'head office' administrations to the mainstream health system. In those jurisdictions where decentralisation had occurred prior to 1992-93, the First National Mental Health Plan promoted the integration of inpatient and community services into cohesive mental health programs. The Second, Third and Fourth National Mental Health Plans continued this direction, but expanded the focus of reform to additional activities to complement development of the specialist mental health system.

Previous National Mental Health Reports have provided evidence of significant change in the direction advocated by the Strategy, although this change has been variable across jurisdictions. National trends in the first five years were largely dominated by extensive structural changes in Victoria. The restructuring of services in other jurisdictions became more prominent in the early part of the Second National Mental Health Plan.

This section of the report updates information published in previous National Mental Health Reports and presents a summary of progress to 2010-11.