National Mental Health Report 2010 – Highlights The National Mental Health Report 2010 is the eleventh in the National Mental Health Report series and is the final edition to be published in this format. Future reports will be redesigned according to the specifications outlined in the Fourth National Mental Health Plan, and will incorporate independent commentaries. The report incorporates the most recently available data, covering 2007-08. The focus of the report is on progress of the National Mental Health Strategy (the Strategy) across the period 1993 to 2008, covered by the First, Second and Third National Mental Health Plans. As such, it completes 15 years of reporting on progress of the Strategy. The Report series draws on a number of sources. State and territory information is collected through the National Minimum Data Set Mental Health Establishments collection, which covers all specialised mental health services managed or funded by the state and territory health administrations. Information collected includes expenditure, service mix, workforce, activity levels including patients treated, and arrangements for consumer and carer participation. Data is also collated from other Australian Government program sources (including DoHA program outlays, the Medicare Benefits Schedule (MBS), the Pharmaceutical Benefits Scheme (PBS), the Department of Families, Housing and Community Services and Indigenous Affairs and the Department of Veterans’ Affairs). The findings of the 2010 Report include: Government Spending •
Total mental health spending by governments and private health insurers in 2007-08 was $5.32 billion, 10% higher in real terms than the previous year, the largest annual increase since the commencement of the Strategy. Australian Government spending was $1.92 billion, state and territory spending was $3.22 billion and private health insurers spending was $185 million.
•
Mental health accounted for 7.0% of total expenditure on health care and 7.5% of government health spending in 2007-08. These proportions have remained relatively stable over the course of the National Mental Health Strategy.
•
Total spending by governments on mental health increased by 137% between 1993 and 2008. Australian Government spending increased by 201%, equivalent to $1.3 billion, while state and territory spending increased by 110% or $1.7 billion.
•
This growth has kept mental health in step with expenditure increases in the overall health sector. The implication is that the mental health sector has maintained its relative position in the health industry rather than significantly increasing its share of the health dollar.
•
Growth at the national level masks differences between the states and territories. The gap between the highest spending jurisdiction (Western Australia, $181 per capita) and the lowest (Queensland, $142 per capita) increased over the 1993-2008 period.
•
Expenditure on psychiatric medicines subsidised through the PBS was the main driver of growth in the first ten years of the Strategy, accounting for nearly two thirds of the growth in Australian Government spending in that period. Over the course of the Strategy, expenditure on psychiatric medicines has increased more than six-fold (645%), three and a half times the growth rate of overall PBS expenditure (183%) in the period. 1
•
The impact of psychiatric medicines on Australian Government mental health spending growth reduced markedly between 2003 and 2008, caused by lower costs of antidepressant drugs as they came off patent.
•
Substantial increases have occurred in outlays on MBS services (Better Access component) and new programs funded under the COAG National Action Plan on Mental Health 2006-2011.
Community Based Care •
Annual spending by states and territories on community based mental health services increased by 272% or $1.2 billion between 1993 and 2008. All states and territories have expanded services, but to varying degrees.
•
Ambulatory services accounted for three quarters of the growth in community based mental health care over the 1993-2008 period. Annual spending on ambulatory care services increased by 258%, or $914 million.
•
Nationally, the number of clinical staff providing ambulatory mental health care increased by 175% between 1993 and 2008. Growth in the clinical workforce has not kept up with growth in spending.
•
Funding to non government organisations to provide mental health services has increased more than seven fold since the start of the Strategy, equivalent to $232 million growth in annual spending. Most of this growth occurred between 2003 and 2008. NGOs accounted for 8.3% of state and territory mental health spending in 2007-08.
Level & Mix of Psychiatric Beds •
Extensive reductions in the size of stand alone psychiatric hospitals occurred in the 30 years preceding the Strategy, decreasing the number of beds by about 22,000.
•
Reductions in the size of stand alone hospitals continued under the Strategy, with the number of beds decreasing by 63% between 1993 and 2008.
•
Spending on stand alone psychiatric hospitals in 2008 was $301 million less than in 1993. These savings have been more than matched by a $1.9 billion increase in spending on alternative community based and general hospital services.
Overall number of psychiatric inpatient beds •
Overall bed numbers continued to decline between 1993 and 2003 (from 7,991 to 6,073). In contrast, the overall number of acute inpatient beds increased by 478 between 2003 and 2008, although this simply kept up with population growth.
•
The Strategy committed states and territories to the replacement of most acute inpatient services previously provided in stand alone psychiatric hospitals with units located in general hospitals.
•
The number of psychiatric beds located in general hospitals doubled between 1993 and 2008 (2,206 additional beds). By June 2008, 86% of acute psychiatric beds were located in general hospitals compared with 55% in June 1993.
Community Residential Services •
An impact of the reductions has been the loss of about half of the non acute beds (2,144 beds) that were available in stand alone hospitals in 1993. The role of these beds was to provide longer term care to people with severe and persistent mental illness. 2
•
Development of specialised mental health residential services in the community has not progressed at the same pace as the reductions. These services provide longer-term care and fulfil the role previously provided by stand alone hospitals.
•
24 hour staffed residential beds have increased by 71% (745 beds) since 1993, equivalent to one third of the reduction in long stay hospital beds. Up to 2005, the growth was mainly the result of initiatives taken by Victoria but more recently, staffed community-based residential services have begun to increase in most other jurisdictions.
•
When inpatient and residential services are considered together, major disparities are evident between states and territories in the level and mix of psychiatric beds provided for their populations. At June 2008, there was a three-fold difference across the jurisdictions in the number of available inpatient and 24 hour staffed residential beds.
Consumer & Carer Participation •
The Strategy advocates the participation of consumers and carers in planning, delivery and evaluation of mental health services. In 2008, approximately two-thirds of state and territory mental health service organisations reported that they had consumers represented on local decision-making and advisory bodies compared with one-third in 1994.
•
Growth of consumers and carers employed in state and territory mental health services has been slow, with little overall progress made between 2003 and 2008.
Quality and Outcome Measures in Mental Health Care •
The National Standards for Mental Health Services were agreed in 1996 as a basis for assessing service quality and continuous quality improvements. All states and territories agreed in 1998 to implement the Standards, but progress was slower than expected. By June 2008, 86% of public sector services had completed the review process against the Standards.
•
Consumer outcome measures were introduced into all services during the Second National Mental Health Plan. By June 2008, 98% of state and territory services had begun collecting and reporting consumer outcomes information.
3