National mental health report 2013

System-level indicators of mental health reform in Australia, 1993 to 2011

Page last updated: 2013

National spending on mental health
National workforce trends
Trends in state and territory mental health services
Trends in private sector mental health services
Consumer and carer participation in mental health care

National spending on mental health

  • The original commitment made by all governments to protect mental health resources under the National Mental Health Strategy has been met. Total government expenditure on mental health increased by 178% in real terms between 1992-93 and 2010-11. In 2010-11, Australia spent $4.2 billion more of public funds on mental health services than it did at the commencement of the Strategy in 1992-93.
  • Until recently, growth in mental health spending mirrored overall health expenditure trends for most of the 18 year period since the Strategy began. In the most recent year (2010-11), mental health increased its position in terms of relative spending within the broader health sector.
  • Australian Government spending has increased by 245% compared to an increase of 151% by state and territory governments. This increased the Australian Government share of total national spending on mental health from 28% in 1992-93 to 35% in 2010-11. Most of the increase in Australian Government spending in the first ten years of the Strategy was driven by increased outlays on psychiatric medicines subsidised through the Pharmaceutical Benefits Scheme, but more recently other activities have taken over as the main drivers of increased mental health spending.
  • The considerable variation in funding between the states and territories that existed at the beginning of the Strategy is still evident 18 years later, mid-way through the Fourth National Mental Health Plan. The gap between the highest spending and the lowest spending jurisdiction increased over the 1992-93 to 2010-11 period. The disparity between the states and territories points to wide variation in the level of mental health services available to their populations.
  • Despite claims to the contrary, there are no reliable international benchmarks by which to judge Australia's relative investment in mental health. These await international collaboration on costing standards to ensure 'like with like' comparisons. Top of page

National workforce trends

  • The direct care workforce employed in state and territory mental health services increased by 72%, from 14,084 full-time equivalent (FTE) in 1992-93 to 24,292 FTE in 2010-11
  • On a per capita basis, this equates to an increase from 80 FTE per 100,000 in the former period to 108 FTE per 100,000 in 2010-11, or an increase of 35%. New South Wales reported the most growth (52%), followed by Tasmania (47%) and Queensland (43%).
  • Nationally, the absolute increase in the direct care workforce size of 72% was lower than the increase in recurrent expenditure on state and territory inpatient and community-based services (119%). Factors such as rising labour costs and increases in overhead and infrastructure costs may contribute to this discrepancy.
  • At a conservative estimate, 3,119 full-time equivalent mental health professionals provided services through Australian Government funded primary mental health care initiatives in 2010-11. The majority of these (1,928 or 62%) were psychologists. The next largest professional group was psychiatrists (817 or 26%).
  • In total, 1,517 full-time equivalent mental health professionals were employed in private hospitals in 2010-11. The workforce mix mainly comprised nurses (1,165, 77%) and allied health professionals (310, 20%). Medical practitioner services provided to consumers treated in private hospitals are delivered primarily through the Medicare Benefits Schedule rather than direct employment arrangements. Top of page

Trends in state and territory mental health services

  • 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 w as 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 with 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). Top of page

Trends in private sector mental health services

  • There was significant growth in mental health care activity in private hospitals between 1992-93 and 2010-11. Bed numbers in specialist psychiatric units in private hospitals increased by 40%, the number of patient days increased by 106%, and the number of full-time equivalent staff increased by 87%. Expenditure by private hospital psychiatric units grew by 142% between 1992-93 and 2010-11.
  • Medicare Benefits Schedule (MBS) expenditure on mental health services increased significantly with the introduction of the Better Access program. Better Access provided a rebate on the M BS for selected services provided by general practitioners, psychiatrists, psychologists, social workers and occupational therapists. In 2006-07, MBS expenditure on mental health services had reached a low of $474 million. In 2007-08, the first full year of Better Access, there was a sharp increase to $583 million, and by 2010-11 the overall MBS mental health specific expenditure figure rose to $852 million, accounting for 35% of overall Australian Government mental health spending.
  • In 1992-93, services provided by psychiatrists and genera I practitioners accounted for all of the MBS expenditure on mental health services. By 2010-11, MBS-subsidised services provided by medical practitioners were complemented by services delivered by clinical psychologists, registered psychologists and other allied health professionals who accounted for 41% of MBS mental health specific expenditure.
  • In 2011-12, 1.6 million people received mental health services subsidised by the Medicare system, some from several providers. In total, 7.9 million mental health services were provided in that year. Top of page

Consumer and carer participation in mental health care

  • In 2010-11, about half of Australia's state and territory mental health services had either appointed a person to represent the interests of mental health consumers on their organisational management committees or had a specific Mental Health Consumer/ Carer Advisory Group established to advise on all aspects of service delivery. However, one quarter had no structural arrangements in place for consumer and carer participation.
  • Significant proportions of state and territory mental health services also had some other arrangements in place for consumer and carer participation, although the extent to which organisations had established particular initiatives varied. Mechanisms for carer participation have been less developed than those for consumer participation, but the gap is closing.
  • In 2010-11, there were 4.6 consumer and carer workers employed for every 1,000 full-time equivalent staff in the mental health workforce. This figure has risen by 33% since 2002-03, when it was 3.5 per 1,000.
  • In recent times, there have been a number of consumer and carer developments that have had an increased emphasis on social inclusion and recovery. For example, the recently established National Mental Health Commission has produced its first Report Card, identifying and reporting on several areas that are important to consumers' ability to lead a contributing life. Moves are also underway to establish a new national mental health consumer organisation, auspiced by the Mental Health Council of Australia, that will ensure that a strong and consolidated consumer voice can contribute to more responsive and accountable mental health reform.