Mental health services provided in emergency departments Print this page

Rates of mental health-related emergency department presentations vary by age group and sex. In 2022–23, among women, the highest rate was for those aged 85 years and over (212 per 10,000 population), followed by 18–24 years (199) and 12–17 years (186). Among men, the highest rate was also for those aged 85 years and over (234) followed by 35–44 years (163) and 25–34 years (160) (Figure ED.1.2). These differences are likely to be influenced by differences in prevalence and age of onset of different mental disorders (WHO 2019).

Between 2014–15 to 2022–23, while most age groups among women had relatively stable rates of presentation, those aged 18–24 years and 12–17 years peaked in 2020–21, before returning to the long-term trend. Among women aged 85 years and over, the rate consistently climbed over this time, from 139 per 10,000 population to 212, which is an increase of about 50% during this period (Figure ED.1.1). Similarly, for men aged 85 years and over, rates of presentation consistently climbed during this period, increasing by about 50%, from 158 to 234 (Figure ED.1.1).

In total, males in 2022–23 had a slightly higher rate of mental-health related emergency department presentations than females (111 presentations per 10,000 population compared with 107). Females have had a higher rate of presentations compared with males almost every year since 2014–2015 (Figure ED.1.2). 

Aboriginal and Torres Strait Islander (First Nations) people are proportionally overrepresented in terms of mental health-related ED presentations, making up about 3% of the Australian population (ABS 2022) but accounting for 14% of presentations. The age-standardised rate of mental health-related ED presentations for First Nations Australians in 2022–23 was more than 5 times that of non-Indigenous Australians (491 per 10,000 population compared with 94; Figure ED.1). For First Nations Australians this rate has also increased by about 50% over the past 9 years (from 329 to 491), whereas for non-Indigenous Australians, it has remained comparatively stable (Figure ED.1.2). 

In 2022–23, people living in Remote and Very remote areas had the highest rate of mental health-related ED presentations at 239 people per 10,000 population. This is more than double the rate for people in Major cities, who had the lowest rate of 97 (Figure ED.1.2). Since 2014–15, the rate of mental health-related ED presentations among people living in Remote and Very remote areas has increased by 85% (from 129 to 239). People living in Remote and Very remote areas have consistently had the highest rate of mental health-related ED presentations over this time and people living in Major cities have consistently had the lowest (Figure ED.1.2). 

Rates of mental health-related ED presentations for SEIFA Quintile 1 (most disadvantaged) in 2022–23 were double that for Quintile 5 (least disadvantaged) with 144 presentations per 10,000 population compared with 74 (Figure ED.1). While data by SEIFA quintiles between 2014–15 and 2022–23 show rates have been largely stable within individual quintiles, they also show that mental health-related ED presentations increase as socio-economic disadvantage increases (Figure ED1.2).

The arrival mode records the way in which a person arrives at the ED. Just over half of mental health-related ED presentations in 2022–23 arrived via ambulance, air ambulance or helicopter rescue service (52%), which is double the proportion for all ED presentations (26%). About 8% arrived by police or correctional service vehicles, whereas about 1% arrived by this mode across all ED presentations.

When presenting to an ED, patients are clinically assessed to determine their priority for care (i.e. triaged) and an appropriate triage category is assigned. For example, patients triaged as Emergency category require care within 10 minutes (ACEM 2013). However, due to a range of factors, care may or may not be received within the designated time frames. Compared with across all ED presentations, mental health-related ED presentations in 2022–23 had higher proportions of presentations classified as Urgent (52% compared with 40%) Emergency (20% compared with 16%) and Resuscitation (2% compared with 1%), and lower proportions of presentations classed as Semi-urgent (23% compared with 36%) and Non-urgent (3% compared with 7%) (Figure ED.3). 

Waiting time is the time from presentation to clinical care commencement. The median waiting time to be seen for mental health-related ED presentations in 2022–23 was 22 minutes, with 59% of presentations seen on time according to their triage category, compared to 65% across all ED presentations (AIHW 2023). Ten per cent of mental health-related presentations had a waiting time longer than 2h:26min.  

Length of emergency department stay refers to the elapsed time from presentation to physical departure from the ED unit. Nationally, in 2022–23 the median length of stay for all mental health-related ED presentations was 4h:55m. Ten per cent of presentations had a length of stay longer than 18h:09m, longer than the same measure for across all ED presentations (10h:32m) (AIHW 2023).

For mental health-related presentations ending in admission, the median length of stay was 7h:00m whereas the median length of stay for presentations not ending in admission was 4h:03m. 

National Non-Admitted Patient Emergency Department Care Database 

All state and territory health authorities collect a core set of nationally comparable information on emergency department (ED) presentations (including mental health-related ED presentations) in public hospitals within their jurisdiction. The AIHW compiles this data annually to form the National Non-Admitted Patient Emergency Department Care Database (NNAPEDCD). In 2022–23, 293 of Australia’s public hospital emergency departments reported emergency department presentations to the NNAPEDCD (AIHW 2023a).

Prior to 2014–15, diagnosis-related information was not included in the NNAPEDCD and states and territories provided the AIHW with a bespoke analysis of mental health-related ED presentations. Diagnosis-related data has subsequently been included in the NNAPEDCD. In this report, data from 2014–15 to 2022–23 are sourced from the NNAPEDCD. 

Definition of mental health-related emergency department presentations

Mental health-related ED presentations in this report are defined as presentations in public hospital EDs that have a principal diagnosis of Mental and behavioural disorders (that is, codes F00–F99) in ICD-10-AM or the equivalent codes in other coding schemas. It does not include codes for self-harm or poisoning.

For 2022–23, principal diagnoses information is reported for the NNAPEDCD using ICD-10-AM (11th Ed)Principal Diagnosis Short List, developed by the Independent Health and Aged Care Hospital Pricing Authority (IHACPA) from the full version of ICD-10-AM. Further information is available in Emergency department care 2022–23 Appendixes (AIHW 2023a).

The Mental and behavioural disorders principal diagnosis codes may not fully capture all mental health-related presentations to EDs, such as presentations for self-harm. Diagnosis codes for intentional self-harm are not part of the Mental and behavioural disorders chapter and are not in-scope for the principal diagnosis variable for the NNAPEDCD. Additionally, a presentation for self-harm may have a principal diagnosis relating to the injury, for example Open wound to wrist and hand. These presentations cannot be identified as mental health-related presentations in the NNAPEDCD and are not included in this report.

Further information on the NNAPEDCD is available on METEOR, the AIHW’s Metadata Online Registry. 

Response to COVID-19

From February 2020, Australian governments introduced a range of restrictions on travel, business, social interaction and border control in response to the COVID-19 pandemic. From October 2020, Australia was at the end of the second wave of the pandemic, leading to relaxation of those restrictions. Over the pandemic period to present, the total number of ED presentations and mental health-related ED presentations have been impacted by a range of factors which may have influenced an individual seeking mental health care or other care in the ED setting. These include changes to the accessibility of mental health care through general practice with the introduction of telehealth and increases in the number of Medicare-subsidised services which could be delivered by psychologists. ED presentations in 2020–21 increased by 7% from 2019–20 and remained stable in both 2021–22 and 2022–23 (AIHW 2023). In contrast, the number of mental health-related ED presentations increased in 2019–20 but decreased in both 2020–21 and 2021–22.

ABS (Australian Bureau of Statistics) (2022) Census of Population and Housing – Counts of Aboriginal and Torres Strait Islander Australians 2021, ABS, accessed 18 April 2023.

ACEM (Australasian College for Emergency Medicine) (2013). Policy on the Australasian Triage Scale (P06), ACEM, accessed  February 2024. 

AIHW (Australian Institute of Health and Welfare) (2023) Emergency department care, AIHW, accessed 15 February 2024. 

AIHW (Australian Institute of Health and Welfare) (2023a). Hospitals info & downloads: About the data, AIHW, accessed 15 February 2024. 

AIHW (2024) Health of veterans: Health status, AIHW, accessed 15 February 2024.

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World Health Organization (WHO) (2019) Adolescent mental health, WHO, accessed 6 May 2022.