People living with psychotic illness 2010

14. Health service utilisation

Page last updated: November 2011

14.1 Health service use in past year
14.2 Psychiatric hospital admissions
14.3 Involuntary admissions and community treatment orders
14.4 Psychiatric emergency presentations
14.5 Mental health outpatient clinics and community services
14.6 Early intervention psychosis programs
14.7 Rehabilitation programs
14.8 Case management by mental health services and non-government organisations
14.9 Home visits by mental health service providers
14.10 Physical health services
14.11 Other services

14.1 Health service use in past year

Overall, health service use by participants for any reason was high, with 98.9% using public inpatient, emergency, or outpatient/ambulatory health services or visiting a general practitioner for any health reason in the past year. For 81.0% of participants, this was for physical health reasons and for 95.3% it was for mental health reasons (figure 14-1):
  • 43.7% reported at least one inpatient admission;
  • 41.0% had been seen in an emergency department;
  • 86.3% had used outpatient/community clinics and ambulatory health care services; and
  • 88.2% had visited a general practitioner.

Figure 14-1. Service utilisation for mental health problems and physical conditions in past year


Refer to the following table for a text equivalent of figure 14-1. Service utilisation for mental health problems and physical conditions in past year

Text version of figure 14-1

Physical health (%)Mental health (%)Any health (%)
Inpatient admission13.334.843.7
Involuntary admission020.70
Emergency department21.326.441
Outpatient/community clinic23.282.286.3
General practitioner76.349.388.2
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14.2 Psychiatric hospital admissions

One third (34.8%) of all participants had had one or more psychiatric inpatient admissions in the previous year. In contrast, 0.9% of the general population had had a psychiatric inpatient admission over the same period.8

Almost two thirds (62.9%) of these participants with any psychiatric admissions in the past year had had only one mental health-related admission, while 13.8% or 4.8% of all participants had had three or more psychiatric inpatient admissions (figure 14-2).

Almost half (47.5%) of participants who had had a psychiatric inpatient admission had spent less than four weeks in hospital. Another 43.0% had spent a total of 4-13 weeks in psychiatric inpatient care. On average they spent 40 days in inpatient care. No-one had been hospitalised for a full year (figure 14-3).

Figure 14-2. Psychiatric inpatient admissions in past year


Refer to the following list for a text equivalent of figure 14-2. Psychiatric inpatient admissions in past year

Text version of figure 14-2

Psychiatric inpatient admissions in past year:
  • One - 62.9%
  • Two - 21.5%
  • Three or more - 13.8%
  • Missing - 1.7%

Figure 14-3. Total weeks of psychiatric inpatient treatment, if any in past year


Refer to the following list for a text equivalent of figure 14-3. Total weeks of psychiatric inpatient treatment, if any in past year

Text version of figure 14-3

Total weeks of psychiatric inpatient treatment, if any in past year:
  • Less than 2 weeks - 25.4%
  • 2 to less than 4 weeks - 22.1%
  • 4 to less than 13 weeks - 43%
  • 13 to less than 26 weeks - 6.7%
  • 26 to less than 52 weeks - 2.7%
  • Full year - 0%
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14.3 Involuntary admissions and community treatment orders

One in five (20.7%) participants reported at least one involuntary admission over the past year.

A total of 19.2% had been under a community treatment order at some stage over the past year.

14.4 Psychiatric emergency presentations

A quarter of the sample (26.4%) had presented to an emergency department with a psychiatric problem in the previous year.

A number had also used a psychiatric emergency service, with 17.2% having had telephone contact with the service and 16.3% having had face-to-face contact.

14.5 Mental health outpatient clinics and community services

Four out of five (82.2%) participants had used outpatient clinics and community services for mental health problems. Three quarters (76.4%) had used outpatient clinics run by public specialised mental health services and community services.

Participants most often saw psychiatrists and other medical officers (74.0%), followed by nurses (31.8%), social workers (12.7%) and psychologists (11.3%) when attending these services.

14.6 Early intervention psychosis programs

Just 3.7% of participants had used early intervention psychosis programs in the past year and 8.4% reported ever having used them. The percentage of those who had ever accessed these programs was higher in the younger age group (16.8% of 18-34 year olds and 2.3% of 35-64 year olds) reflecting the relatively recent introduction of these intervention programs focused on young people. The proportion accessing these services is likely to be an underestimate as participants may not always be aware that the service they had received was part of an early intervention psychosis program, with a number of services running such programs under a variety of other names.

14.7 Rehabilitation programs

Rehabilitation programs for people with a mental illness are designed to promote recovery, improve independent functioning and reduce disability through education, support and individual recovery plans.

Just over one third (36.5%) of people had participated in community rehabilitation or day programs within public mental health services and/or non-government organisations in the past year (table 14-1). More participants were involved in rehabilitation programs in the non-government sector (22.4%) than in the public mental health sector (14.5%).

The majority of participants using these programs found the program useful, with 87.5% of those using public specialised mental health services and 90.0% using non-government community rehabilitation programs reporting that they were somewhat or very satisfied.

The percentage with an individual rehabilitation or recovery plan was 28.9%.

Table 14-1. Community rehabilitation programs in past year by sector

Public specialised mental health services
(%)
Non-government organisations
(%)
Attended community rehabilitation program*
14.5
22.4
Type of program - for those accessing a community rehabilitation program
Group
13.6
46.5
Individual
72.0
29.1
Combination of both
13.3
24.4
Not known
1.1
-
Total
100.0
100.0
Usefulness of program
Very helpful
54.9
62.6
Somewhat helpful
32.6
27.4

* Some participants used rehabilitation programs in both sectors

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14.8 Case management by mental health services and non-government organisations

Seven out of ten (69.2%) participants reported having a case manager in the past year: 61.6% of the total sample had a case manager provided by public specialised mental health services and 20.2% had one provided by a non-government organisation, with 12.7% having one provided by each sector at some stage over the past year (table 14-2).

Satisfaction with case management from both sectors was high, with 85.0% of participants with public specialised mental health service case managers and 89.4% of those with non-government case manager being very or somewhat satisfied with their case managers.

Three quarters of participants reported being happy with the frequency of contact with their case manager. Most of the remainder would have preferred more contact: 13.5% of people with a case manager provided by public specialised mental health services and 16.3% of people with one provided by a non-government organisation.

Table 14-2. Case management by sector if case managed in past year

Public mental health services (%)Non-government organisation (%)
Case manager*
61.6
20.2
For those with a case manager - contact with case manager is as often as preferred
76.5
77.8
Frequency of contact - once a week or more
28.1
64.0
Frequency of contact - less than once a week, but at least once every 4 weeks
54.4
30.4
Satisfaction with case manager - very satisfied
62.2
69.6
Satisfaction with case manager - somewhat satisfied
22.8
19.8

* Some participants had case managers in both sectors over the past year

14.9 Home visits by mental health service providers

Half (52.4%) of participants said they had had at least one home visit in the past year, with 45.4% of participants reporting this was someone from public specialised mental health services and 15.9% of participants reporting this was someone from a non-government organisation.

The main reason for visits by public specialised mental health services was routine care, with 40.3% of participants reporting one or more visits for routine care. However, 15.1% of participants had had one or more visits from these services for crisis care.

Very few (8.8%) had assertive community treatment, where their main mental health care was provided in their home.

14.10 Physical health services

Over the past year 13.3% of participants had been admitted to hospital for a physical condition in comparisons with 8.4% of the general population.8

One in five (21.3%) had attended an emergency department and almost one quarter (23.2%) had used outpatient or community health clinics for a physical rather than mental health reasons.

14.11 Other services

14.11.1 Non-government organisations funded to provide mental health services

One in three (29.8%) participants had used services provided by non-government organisations funded to support people with a mental illness in the past year.

More detailed information on who and what services were used is provided in Chapter 16.

14.11.2 Drug and alcohol services and programs

Just over one in eight (12.9%) participants had used drug and alcohol services and programs in the past year.

14.11.3 Complementary/Alternative therapist services

A small proportion of participants (3.2%) had seen a complementary/alternative therapist for their mental health.

14.11.4 Other community organisations

Participants had also used a variety of other community services in the past year. These included:
  • community organisations providing material or financial aid (for example Salvation Army and St Vincent de Paul), which were used by 21.7%;
  • religious or spiritual groups used by 14.7%;
  • legal aid services used by 8.4%;
  • community telephone services for mental health (for example SANE Australia and Lifeline) used by 8.2%; and
  • community counselling services (for example Relationships Australia) used by 4.7%.

14.11.5 Internet

The proportion using the internet to access information about mental health was 17.3%.