Structure of Mental Health Services in Australia

Mental Health Services are subdivided into community based and hospital based care:

• Community based
• Hospital Services

Community based: 

Public community mental health services provide specialised mental health care services to patients in community settings. These include services for adults, services for children and adolescents, residential care, hospital-based services such as psychiatric outpatient services, day programs, mobile crisis treatment teams, and community mental health centres staffed by multidisciplinary teams and case managers. 

Non-government organisations also provide community-based mental health related care such as disability support services and residential mental health care (Australian Institute of Health and Welfare, 2004), With the deinstitutionalisation of mental health care in Australia, there has been increased provision for integrated community-based mental health care services. 

Hospital Services 

The public hospital system in Australia is funded by both the Commonwealth and state or territory governments, and is administered by the state and territory health departments.

 Public hospitals provide inpatient and outpatient services. As an outpatient, a person with medical problems that require urgent medical attention can go to a public hospital with no prior appointment. Patients treated as public patients in a public hospital will receive treatment by doctors and specialists nominated by the hospital, and will not be charged for most care and treatment. 

However, for non-acute conditions, such as elective surgery for chronic conditions, there may be a waiting period before treatment is available. Private hospitals usually provide a range of in-hospital services similar to those offered in public hospitals. Patients who chose to be treated in a private hospital receive treatment from doctors and specialists that they nominate. Medicare covers some of the doctor's fee, but will not cover the cost of private hospital accommodation. As such, those who intend to choose private hospital care are recommended to join a private health insurance fund (Department of Immigration and Multicultural Affairs, 2006).

 In 2002-2003, the public sector treated over 80% of identified mental-health-related conditions, and 77% of those conditions required specialised psychiatric care (Australian Institute of Health and Welfare, 2005). Specialised mental health care is provided to admitted patients in public psychiatric hospitals, and in specialised psychiatric units in public acute and private hospitals. The mix of admitted patients in hospitals varies from state to state, and also between public and private hospitals. The percentage of involuntary patients varies from state to state, and the range of diagnoses admitted varies both from state to state and between rural and urban areas. In Victoria, for example, most patients receive treatment involuntarily, and have a diagnosis of psychosis. The other states and territories meet broader needs of the community, and have more varied diagnoses admitted. In Tasmania, for example, only one-third of patients are admitted involuntarily. In all bar one state, involuntary treatment is only seen in the public sector. 

 Excluding ambulatory mental health care, overnight stays in public hospitals are most frequently for diagnoses of schizophrenia, schizotypal and delusional disorders, followed by mood disorders. For same-day services, the most common condition treated is mood disorder. In private hospitals the most frequent diagnosis for both overnight and same-day hospital care is mood disorder. 

For ambulatory mental health care, the principal diagnoses are mood disorders, and stress-related and somatoform disorders (Australian Institute of Health and Welfare, 2004). Throughout the 1980s and 1990s there was a deliberate effort to close psychiatric hospitals in Australia. However, the implementation of this policy varied from state to state. The reduction in resources to public psychiatric hospitals has been accompanied by an increase in the number of psychiatric unit beds in general public acute-care hospitals (Australian Institute of Health and Welfare, 2004). 

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