Private psychiatric hospital care in Australia: a descriptive analysis of casemix and outcomes

Abstract

Objective: To provide a rapid clinical update on casemix, average length of stay, and the effectiveness of Australian private psychiatric hospitals. Methods: We conducted a descriptive analysis of the publicly available patient data from the Australian Private Hospitals Association Private Psychiatric Hospitals Data Reporting and Analysis Service website, from 2015–2016 to 2019–2020. This was compared with corresponding reporting on public and private hospitals from the Australian Institute of Health and Welfare, and Australian Mental Health Outcomes and Classification Network. Results: In 2019–2020, there were 72 private psychiatric hospitals in Australia with 3582 acute beds. There were 42,942 inpatients with 1,286,470 days of care, and a mean length of stay 19.6 days (SD 13.9) for the financial year 2019–2020. The main diagnoses were major affective and other mood disorders (49%), and alcohol and other substance abuse disorders (21%). Clinician-rated outcome measures, that is, the HoNOS, showed an improvement effect size of 1.64, while the patient-rated MHQ-14 showed an improvement effect size of 1.18. Results are similar for previous years. Conclusions: Private psychiatric hospitals provide substantial, effective psychiatric care.

Clinical update on psychiatric outcome measurement: what is the purpose, what is known and what should be done about it?

“…This is important as the private and public psychiatric hospital systems provide care for complementary casemix of patients, for example, the majority of care for people with schizophrenia and bipolar disorder is within the public sector, while the majority of care of people with major depression and alcohol abuse is in the private sector. 17 Though the private hospital outcome data appear to be more complete, the improvements in HoNOS scores from admission to discharge are similar in both sectors. 17 However, there remain differences in PROM used across the Australian states/territories, 17 and there should be standardisation of the measures used.…”

Clinical update on public and private psychiatric practice shared-care partnerships – Can the twain work together?

“…Contemporary development and implementation of a partnership faces challenges through the needs for funding, cooperative planning, clinical governance and outcome evaluation. However, given the acknowledged stressors upon public mental health services, and the complementary effectiveness of private practice, 3 shared-care partnerships may enhance capacity and care in both sectors. Perhaps, with will and effort, the twain can meet.…”

“…13 Recent research has demonstrated that public and private psychiatric hospital care is complementary, and evidence may assist in building mutual understanding. 3 There will also need to be increased training of psychiatrists in private settings to improve skills and knowledge across the sectors. 13 Public-private partnerships will require psychiatrists from both sectors to lead development, implementation, and sustain effective shared-care.…”

“…2 Generic mental health services are often illprepared for the complex presentations and multiple comorbidities frequently associated with ID, and lack knowledge of how to make necessary adaptations to practice. 3 Recent recommendations have called for the implementation of specialist ID mental health (IDMH) services to support mainstream services. [4][5][6] However, there is a lack of evidence regarding the optimal design of mental health services to meet the needs of people with ID.…”

“…2 This spurs re-consideration of opportunities for public and private sectors to work collaboratively to enhance the quality of mental healthcare, particularly since recent research showing that the private psychiatric hospital sector is complementary to the public. 3 However, there remains a divide between the sectors, particularly through lack of communication between psychiatrists who are likely engaged with their respective work challenges. 4,5 Private psychiatrists, sometimes facing opposition from public sector services to cross-referral or shared-care, may be reluctant to engage with public services.…”