National mental health report 2013

Indicator 15: Rates of pre-admission community care

Page last updated: 2013

Key messages:

  • In 2010-11, 47% of admissions to state and territory acute inpatient psychiatric units were preceded by community care in the seven days before the admission. This figure represents a small improvement over recent years.
  • There is considerable cross-jurisdictional variability. The Australian Capital Territory is the only jurisdiction to have achieved rates above 70%, with 76% of its acute inpatient admissions in 2010-11 being preceded by community care in the seven days prior to admission.
  • The 2010-11 figures for the other states and territories range from 27% in the Northern Territory to 63% in Western Australia.
Much of the reform effort in the early years of the National Mental Health Strategy was aimed at creating integrated public sector mental health services, in which hospital and community-based services operate as a single service characterised by continuity of care, particularly when consumers move between treatment settings. Continuity of care has special relevance for the mental health sector because the enduring nature of many mental illnesses often means that care needs to be provided on an ongoing basis or intermittently over a considerable period of a person's life.

This indicator focuses on one aspect of continuity of care and looks at the extent to which consumers who require admission for inpatient care receive community care by clinical teams in the seven days leading up to the hospital admission. The indicator is complemented by Indicator 16 which looks at continuity of care following discharge from hospital.

Monitoring pre-admission community care rates is based on the fact that many consumers who are admitted to an acute inpatient unit are known to the local community mental health service, and the expectation that, where the person is a registered consumer of the service, community teams should be involved in their care in the period prior to admission. Contact by the community team is appropriate to assess the consumer's situation and ensure that admission is the most appropriate treatment option. Community mental health teams that have established a good relationship with the consumer are Iikely to be able to identify signs of deterioration in his or her condition, and, where required, smooth the way to an inpatient admission.

Figure 61 shows that in 2010-11, 47% of admissions were preceded by community care. Although this represents a small improvement over recent years, the contact rate remains relatively low.

Equivalent figures are provided for each state and territory in Part 4. The Australian Capital Territory had the highest pre-admission contact rates, with 76% of all its acute inpatient admissions in 2010-11 being preceded by community care, compared with 60% in 2005-06. The Australian Capital Territory is the only jurisdiction with rates above 70%; the 2010-11 figures for the other states and territories range from 27% in the Northern Territory to 63% in Western Australia.

Estimates from some jurisdictions are more likely to reflect the true picture than those from others. This is because some states and territories (notably Tasmania and South Australia) only have the capacity to determine whether an individual received pre-admission community care from the community team within the inpatient unit's catchment. Some people may receive community care from elsewhere and be referred from there to the inpatient unit, which means the rates in these jurisdictions may represent an undercount.

As a measure of performance this indicator cannot be looked at in isolation from other services (including non-government services or general practitioners). If people receive care from these services or providers prior to an admission, this will not be reflected in the above figures.

As with other related indicators, deciding on an appropriate target for pre-admission community contact rates remains a challenge for all governments. While 100% is not feasible, given that a proportion of admissions to hospital will continue to be unexpected and accounted for by
people not known to the local community mental health team, the current national rate of 47% falls short of reasonable expectations. The Roadmap for Mental Health Reform,1 agreed by the Council of Australian Governments in December 2012, foreshadows the development of targets in this area. Top of page

Figure 61: Percentage of admissions to state and territory acute inpatient units where contact was provided by a community mental health team in the 7 days prior to admission, 2005-06 to 2010-11

Refer to the following text for a text equivalent of Figure 61: Percentage of admissions to state and territory acute inpatient units where contact was provided by a community mental health team in the 7 days prior to admission, 2005-06 to 2010-11

Text version of figure 61

Percentage of admissions:
  • 2005-06 - 43%
  • 2006-07 - 45%
  • 2007-08 - 43%
  • 2008-09 - 43%
  • 2009-10 - 45%
  • 2010-11 - 47%