Trends in Primary Mental Health Care Service Use and Subsequent Self-Harm in Western Sydney Australia: Policy and Workforce Implications.

Sithum Munasinghe,Sandro Sperandei,Haider Mannan,Vlasios Brakoulias,Shahana Ferdousi,Andrew Page,Pankaj Gaur

doi:10.3390/ijerph19063382

Abstract

Background: This study investigated the trends in primary mental health care (PMHC) service use and hospital-treated self-harm in Western Sydney (Australia). Methods: A data linkage study and descriptive ecological study of PMHC referrals investigated the trends in referrals, treatment attendance, hospital-treated self-harm, and health care practitioners (HCPs) for the period of 2013−2018 (n = 19,437). Results: There was a substantial increase in referrals from 2016. The majority of referrals were females (60.9%), those aged <45 years (71.3%), and those presenting with anxiety or affective disorders (78.9%). Referrals of those at risk of suicide increased from 9.7% in 2013 to 17.8% in 2018. There were 264 (2.2%) cases of subsequent hospital-treated self-harm, with higher rates among those at risk of suicide and those who attended <6 sessions. The number of HCPs per referral also increased from 2013, as did waiting times for treatment initiation. Conclusion: Individuals presenting to PMHC services at risk of suicide, and who subsequently presented to a hospital setting following self-harm, were more likely to either not attend services following a referral or to attend fewer services. This trend occurred in the context of an increase in the number of clients per HCP, suggesting workforce capacity has not kept pace with demand.

Highlights

Introduction published maps and institutional affilThe Australian government has made significant investments in mental health services over the last two decades by introducing initiatives for those who experience mental disorders to receive mental health services at no cost or low cost [1,2]
There was a sharp increase in the number of primary mental health care (PMHC) service referrals in the period after the establishment of PHNs in 2016, including an increase in the proportion of referred clients who were at risk of suicide
The trends in subsequent hospital-treated self-harm during the same period did not change substantially. Those who were at risk of suicide and who subsequently presented to a hospital setting following self-harm were more likely to either not attend PMHC services following a referral or to attend fewer services

Summary

Introduction

Introduction published maps and institutional affilThe Australian government has made significant investments in mental health services over the last two decades by introducing initiatives for those who experience mental disorders to receive mental health services at no cost or low cost [1,2]. Methods: A data linkage study and descriptive ecological study of PMHC referrals investigated the trends in referrals, treatment attendance, hospital-treated self-harm, and health care practitioners (HCPs) for the period of 2013−2018 (n = 19,437). Conclusion: Individuals presenting to PMHC services at risk of suicide, and who subsequently presented to a hospital setting following self-harm, were more likely to either not attend services following a referral or to attend fewer services. This trend occurred in the context of an increase in the number of clients per HCP, suggesting workforce capacity has not kept pace with demand

Methods

Results

Discussion

Conclusion