National mental health report 2013

Indicator 16: Rates of post-discharge community care

Page last updated: 2013

Key messages:

  • In 2010-11, 54% of Australian admissions to state and territory acute psychiatric inpatient units were followed by community care (in the seven days after discharge). This percentage has been improving incrementally since 2005-06.
  • There is substantial variation across jurisdictions, with 2010-11 one week post-discharge follow up rates ranging from a low of 19% (in the Northern Territory) to a high of 79% (in the Australian Capital Territory).
Discharge from hospital is a critical transition point in the delivery of mental health care. People leaving hospital after an admission for an episode of mental illness have heightened levels of vulnerability and, without adequate follow up, may relapse or be readmitted. The post-discharge period is also a period of great stress and uncertainty for families and carers.

Evidence gathered in recent years from a number of consultations around Australia suggests that the transition from hospital to home is often not well managed. The inclusion of this indicator as a measure of progress of the Fourth National Mental Health Plan targeted the performance of the overall health system in providing continuity of care, recognising the need for substantial improvement in this area. The standard underlying the measure is that continuity of care involves prompt community follow up in the vulnerable period following discharge from hospital.

Figure 62 shows that in 2010-11, 54% of hospital episodes were followed by community care in the week after discharge. This percentage has been improving incrementally since 2005-06, when it was 45%.

Equivalent figures are provided for each state and territory in Part 4. They reveal substantial variation across jurisdictions, with 2010-11 one week post-discharge follow up rates ranging from a low of 19% (in the Northern Territory) to a high of 79% (in the Australian Capital Territory). For most jurisdictions, follow up rates show gradual but small improvement over the six years for which data are available, although greater improvement is evident in two jurisdictions with relatively low baseline rates (Tasmania and South Australia).

Work undertaken as part of the Australian Government-funded National Mental Health Benchmarking Project provided insights about the reasons organisations and jurisdictions may vary on seven day post-discharge follow up rates.62 Accuracy of information systems in tracking the movement of people between hospital and community care, particularly across organisations, is critical. For example, two jurisdictions (Tasmania and South Australia) can only confidently determine whether community care was provided in the same area as the hospital from which the consumer was discharged. This is likely to lead to an undercount, because some people may receive community care from elsewhere once they are discharged. Lower follow up rates may also be the result of some consumers being managed outside the state and territory public system (for example, by general practitioners, private psychiatrists or, in the Northern Territory, by Aboriginal/remote health services). These activities are not captured by existing mental health information systems.

Overall, the variation in post-discharge follow up rates suggests important differences between mental health systems in terms of their practices. An observation made by organisations engaged in the benchmarking work was that, although there may be legitimate reasons for non-follow up of some consumers in the week after discharge (for example, perhaps in circumstances where there is follow up by general practitioners, private psychiatrists, non-government organisations etc.), this group is small and routine follow up should be the norm. The implication is that the current national rate of 54% is well below what would be expected from best practice services.

Setting a national target for this indicator is expected to be explored as part of the work to be progressed under the Roadmap for Mental Health Reform,1 agreed by the Council of Australian Governments in December 2012.
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Figure 62: Percentage of discharges from state and territory acute inpatient units in which contact was provided by a community mental health team in the 7 days after discharge, 2005-06 to 2010-11

Refer to the following text for a text equivalent of Figure 62: Percentage of discharges from state and territory acute inpatient units in which contact  was provided by a community mental health team in the 7 days after discharge, 2005-06 to 2010-11

Text version of figure 62

Percentage of admissions:
  • 2005-06 - 45%
  • 2006-07 - 46%
  • 2007-08 - 47%
  • 2008-09 - 47%
  • 2009-10 - 50%
  • 2010-11 - 54%