4327.0 - National Survey of Mental Health and Wellbeing: Users' Guide, 2007  
Latest ISSUE Released at 11:30 AM (CANBERRA TIME) 11/02/2009   
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HEALTH SERVICE UTILISATION


OVERVIEW

This chapter provides information about the range of data collected on health service utilisation and the perceived need for help. Within each of the mental disorder modules, the survey collected broad information on people's consultations with health professionals and any overnight hospital admissions. Information was also collected through separate service utilisation and medication modules, which contained the following topics:


Health service utilisation relates to services used for mental health problems in the 12 months prior to interview. While people were asked whether their use of health services related to a mental health problem, it is not possible to directly link this with specific mental disorders. A mental health problem in this context, may relate to stress, worry, sadness, or to any issue identified by the person, regardless of whether or not they met criteria for a mental disorder. Also, the treatment sought and/or received may relate to a mental disorder not collected in the survey, such as an eating disorder. Therefore, while it is possible to analyse the use of health services by people with a mental disorder, it is not possible to directly link service use with specific mental disorders.


CONSULTATIONS FOR SPECIFIC MENTAL DISORDERS

For each specific mental disorder (eg depression), information was collected about the type of treatment sought and received. People were asked whether they had ever talked to a medical doctor or other professional about symptoms previously identified (eg sadness, discouragement, lack of interest). The types of professionals include:
  • psychologists;
  • social workers;
  • counsellors;
  • herbalists;
  • acupuncturists; and
  • other healing professionals.

People were asked to provide their age in years for the first time they ever talked to a professional about their symptoms. For people who had talked to a professional during their lifetime, they were asked whether they had ever received treatment for their symptoms which they considered to be helpful or effective. People who had received helpful/effective treatment were then asked to:
  • provide their age (in years) for the first time they ever received helpful treatment; and
  • nominate how many professionals they had ever talked to (about their symptoms), up to and including the first time they received helpful treatment.

People who had sought treatment, but had not received treatment they considered to be helpful/effective were also asked how many professionals they had ever talked to about their symptoms.

People who had received treatment during their lifetime were also asked:
  • whether they had received treatment for their symptoms at any time in the 12 months prior to interview; and
  • whether they had ever been hospitalised overnight for their symptoms, and if so, the age when this first occurred.


COMPARISON WITH THE 1997 SURVEY

The 1997 survey contained one question on treatment seeking behaviour for each mental disorder. People were asked whether they had told a doctor about the symptoms or problems they had been experiencing. Some of these questions specifically referred to the 12 months prior to interview, but for others this was inferred through the scope of the survey. Additionally, at the end of each mental disorder module (eg Anxiety disorders) people were asked how many times they had seen a doctor or other health professional for their symptoms or problems (eg unusually strong fears, avoidance, feeling worried, etc) in the four weeks prior to interview.


SERVICES USED FOR MENTAL HEALTH PROBLEMS

This section provides information on the following types of service use:

CONSULTATIONS WITH HEALTH PROFESSIONALS

Information was collected on whether people had ever had consultations with the following types of health professionals (apart from any occurring during hospital admissions):
  • general practitioner (GP);
  • psychiatrist;
  • psychologist;
  • mental health nurse;
  • other professional providing specialist mental health services, including social worker, counsellor or occupational therapist;
  • specialist doctor or surgeon, including cardiologist, gynaecologist or urologist;
  • other professional providing general services, including social worker, occupational therapist or counsellor; and
  • complementary/alternative therapist such as a herbalist or naturopath.

People who endorsed that they had seen a health professional for problems with their mental health were asked the first time (age in years) they ever saw that type of health professional for their mental health.

People who reported they had consultations with health professionals (including GPs) were asked to identify for the 12 months prior to interview:
  • the number of consultations for physical and/or mental health;
  • the average length of time (in minutes) for these consultation/s;
  • the method of payment for the consultation/s;
  • their 'out of pocket' expenses; and
  • whether they had received a referral from a GP for the consultation.

People who did not know or were unable to provide information on the number of consultations they had in the 12 months prior to interview were asked about health consultations in their lifetime. They were asked whether they had ever seen a health professional for problems with their mental health.

Cost of consultations

People who saw a GP were asked to provide the average cost, not including any money refunded by Medicare or private health insurance, of a typical consultation. This was recorded as an 'out of pocket' expense. People may not have had any of these expenses, as they may have had their consultations bulk billed.

People who saw a health professional, other than a GP, were asked to nominate how they paid for their consultation from the following list:
  • public hospital outpatient or public community health/mental health services;
  • Medicare (bulk billed);
  • private health insurance;
  • by a friend or family member (with or without any refunds); or
  • some other type of payment.

They were also asked whether there were any 'out of pocket' expenses incurred by them, their friend/s or family member/s in paying for the consultations.

Health consultations with a GP

People who had more than one consultation with a GP for their mental health in the 12 months prior to interview, were asked about their continuity of care, including:
  • whether they saw the same GP;
  • the number of different GPs;
  • whether the GPs worked at the same clinic; and
  • how many different clinics were visited.

People who reported consultations with a GP in the 12 months prior to interview were also asked whether any of their consultations were:
  • at home; or
  • as a hospital outpatient or in the Emergency Department.


HOSPITAL ADMISSIONS

People were asked whether they had ever been admitted to hospital for any reason, excluding routine childbirth. If a person endorsed that they had been admitted overnight they were asked how many times this had ever occurred and their age (in years) the first time they were admitted.

For the 12 months prior to interview, people were asked about hospital admissions relating to their physical and/or mental health problems. Mental health problems included, but were not restricted to, things such as stress, anxiety, depression, or dependence on alcohol or drugs. They were asked to provide:
  • the number of overnight admissions;
  • the total number of nights admitted; and
  • whether they were a public or private patient.

Most recent hospital admission

People were asked the reason/s for their most recent hospital admission for physical and/or mental health problems. From a list provided, they were asked to nominate the main reason for admission. People were able to nominate more than one reason. The lists of reasons varied between physical and mental health problems.

Admission to treat physical health problems
  • injury or the results of injury;
  • asthma or chronic bronchitis;
  • diabetes;
  • arthritis;
  • heart attack;
  • angina or high blood pressure;
  • cancer;
  • stroke;
  • stomach or duodenal ulcer;
  • gall bladder or liver trouble;
  • complications of pregnancy or childbirth (females only); or
  • some other reason.

Admission to treat mental health problems
  • psychosis, including schizophrenia;
  • anxiety;
  • depression;
  • bipolar disorder;
  • drug-related problems;
  • alcohol-related problems;
  • personality disorder; or
  • some other reason.


SELF-MANAGEMENT STRATEGIES

Apart from the consultations with health professionals outlined previously, people were asked about any self-management strategies they may have used for their mental health problems. Information was collected about the use of:
  • Internet support groups or chat rooms;
  • self-help groups (a group of people who meet to improve their health through discussion and special activities); or
  • telephone counselling services (eg Lifeline).

For each of these, people were asked whether their use occurred in their lifetime, in the 12 months prior to the survey and if so, how many times they used this type of help and the average length of time for the help sessions.

People were also asked about other types of strategies they may have used for their mental health, including:
  • obtaining information on mental illness, its treatment and available services from a list of possible sources (eg Internet, book, newspaper, television, radio, brochure, etc);
  • increasing their level of exercise or physical activity;
  • doing more things they enjoyed;
  • seeking support from family or friends;
  • using alcohol or drugs;
  • cutting out alcohol or drugs; or
  • obtaining prescription medication.


COMPARISON WITH THE 1997 SURVEY

Consultations with health professionals

Apart from the overall differences in the two surveys, in 1997 people were asked if they saw a doctor or health professional for their health, including check-ups or scripts, from a much broader list of options. Other specific health professionals that may have been identified include:
  • radiologist;
  • pathologist;
  • welfare officer;
  • drug and alcohol counsellor;
  • nurse;
  • mental health team;
  • chemist for professional advice; and
  • ambulance officer.

Additionally, in 1997 people were not specifically asked if they saw a mental health nurse, occupational therapist, cardiologist, or complementary/alternative therapist.

People were asked to identify the number of consultations with each group of professionals, as well as where the consultations mainly took place. In 1997, there were three additional categories to select from:
  • in a health professional's rooms (eg surgery, clinic or shop);
  • at a community health clinic; and
  • at a drug or alcohol service.

Hospital admissions

In 1997, people were asked about the number of admissions to general hospitals and the number of admissions for nerves or mental problems. People were also asked about the number of admissions to psychiatric hospitals and to drug and alcohol rehabilitation centres. For each type of admission, people were asked to identify whether they were in a public or private bed and the total number of nights spent in the hospital or unit.

Self-management strategies

The 1997 survey did not collect information on self-management strategies.


MEDICATIONS

People were asked about the types of medications they had used for their mental health in the two weeks prior to interview. Up to five types of medication could be recorded. Medications include those used for preventive health purposes, as well as those used for mental disorders. Medications may have included:
  • vitamins or mineral supplements;
  • herbal or natural treatments/remedies; and
  • pharmaceutical medications.

People were also asked to report:
  • the number of medications taken for their mental health;
  • the length of time they had been taking the medication; and
  • whether they usually took the medication according to the recommended dose.

Most of the reported medications were automatically categorised through a Computer-Assisted Coding system (CAC). The CAC incorporates the names of medications readily available in Australia and commonly used for the nominated conditions. People were encouraged to refer to the medication packet, bottle, etc when reporting, but may have reported from memory or may have reported medications by their brand, trade or generic names. A small number of medications, which could not be identified by the CAC were manually categorised by ABS staff.

The medications reported for this survey were classified by generic type using a classification system developed by the ABS for the National Health Survey (cat. no. 4364.0). The classification system is based on the World Health Organization's (WHO) Anatomical Therapeutic Chemical (ATC) Classification and the framework (based on organ system and therapeutic drug class) underlying the listing of medications in the Australian Medicines Handbook.

For more information on the classification of medications, refer to the National Health Survey: Users' Guide - Electronic Publication, 2004-05 (cat. no. 4363.0.55.001).


COMPARISON WITH THE 1997 SURVEY

The 1997 survey did not collect information on medications.


PERCEIVED NEED FOR HELP

TYPES OF ASSISTANCE

Whether people had a perceived need for help was assessed in relation to five types of assistance:
  • information (about mental illness, its treatment and available services);
  • medication;
  • counselling (psychotherapy, cognitive behaviour therapy or counselling);
  • social intervention (help to sort out housing or money problems or to meet people for support or company); and
  • skills training (help to improve their ability to work, to use their time, to look after themselves or their home).


WHETHER PERCEIVED NEED WAS MET

Responses to the perceived need for help questions were classified as:
  • no need - people who were not receiving help and felt that they had no need for it;
  • need fully met - people who were receiving help and felt that it was adequate;
  • need partially met - people who were receiving help, but not as much as they felt they needed; and
  • need not met - people who were not receiving help, but felt that they needed it.


WHETHER PEOPLE USED SERVICES

People who used services for mental health problems (ie consulted a health professional or were admitted to hospital overnight) in the 12 months prior to interview were asked to identify the help they received from a list of five types of assistance (see 'Types of assistance'). For each type of assistance, they were asked if they received as much help as they needed and if not, the main reason this was not received.

People who did not use services for mental health problems, but who had symptoms that indicated a potential mental disorder (eg feeling sad or uninterested, excitable or irritable, worried or anxious, problems with alcohol use or drugs, etc) were asked whether they felt they needed any help from a list of five types of assistance (see 'Types of assistance'). For each type of assistance identified, people were asked the main reason they did not seek help.

The following list provides the selection of main reasons:
  • they preferred to manage themself;
  • they didn't think anything (more) could help;
  • they didn't know (how or) where to get (more) help;
  • they were afraid to ask for (more) help, or of what others would think if they did;
  • they couldn't afford the money;
  • they asked but didn't get the help; or
  • they got help from another source.

Where a person said they preferred to manage their own mental health, they were asked to choose a main reason why they did not seek help from health professionals from the following list:
  • they didn't think the health professional knew how to help;
  • they were uncomfortable talking about these problems;
  • they relied on faith and spirituality;
  • they relied on family and friends;
  • they felt they would be treated differently if people thought they had a mental illness;
  • they didn't think it was fair to expect it;
  • they didn't feel ready to seek help; or
  • they couldn't get this kind of help where they lived.

If a person had seen more than one type of health professional for their mental health problems in the 12 months prior to interview, they were asked to select who was most involved in providing them with the type of assistance they needed (eg information, medication, etc) from the following list:
  • general practitioner (GP);
  • psychiatrist;
  • psychologist;
  • mental health nurse;
  • other mental health professional;
  • other specialist doctor;
  • other health professional; or
  • complementary or alternative therapist.

If a person had seen only one type of health professional then this was recorded as the response.


COMPARISON WITH THE 1997 SURVEY

The 1997 survey asked about people's perceived need for help and whether their need was met in relation to the use of services for mental health problems. A new question was added in 2007 for people who indicated that they preferred to manage their own mental health. They were asked to choose a main reason why they did not seek help from health professionals.