• AIHW Data Quality Statements, Standard 11/10/2018

• The National Community Mental Health Care Database (NCMHCD) contains data on service contacts provided by public sector specialised community mental health services in Australia.
• There is some variation in the types of service contacts included in the data. For example, some states or territories may include written correspondence as service contacts while others do not.
• The Indigenous status data should be interpreted with caution due to the varying quality of Indigenous identification across jurisdictions reporting to the database. While all states and territories consider the quality of Indigenous status data to be acceptable, most acknowledge that further improvement is required. Indigenous status is missing for 5.3% of contacts in the 2016–17 NCMHCD.
• Data are reported by the jurisdiction that delivered the service and therefore may include people receiving services in one jurisdiction who reside in another. These cross-border flows are particularly relevant when interpreting ACT remoteness data.
• There is variation across jurisdictions in the coverage of services providing contact data and the estimated service contact data coverage. 
• The quality of principal diagnosis data may be affected by the variability in collection and coding practices across jurisdictions.

Description

The National Community Mental Health Care Database (NCMHCD) contains data on community (also sometimes termed ‘ambulatory’) mental health service contacts provided by government-funded community mental health care services as specified by the Community mental health care (CMHC) National Minimum Data Set (NMDS) (see link). The NCMHCD includes data for each year from 2000–01 to 2016–17.

The NCMHCD includes information relating to each individual service contact provided by an in-scope mental health service. Examples of data elements included in the collection are demographic characteristics of patients, such as age and sex, clinical information, such as principal diagnosis and mental health legal status, and service provision information, such as contact duration and session type.

The CMHC NMDS is associated with the Mental Health Establishments (MHE) NMDS, which is used to collect data about the services that provide service contacts.

The Australian Institute of Health and Welfare (AIHW) is a major national agency set up by the Australian Government under the Australian Institute of Health and Welfare Act 1987 to provide reliable, regular and relevant information and statistics on Australia's health and welfare. It is an independent corporate Commonwealth Entity established in 1987, governed by a management board, and accountable to the Australian Parliament through the Health portfolio.

The AIHW aims to improve the health and wellbeing of Australians through better health and welfare information and statistics. It collects and reports information on a wide range of topics and issues, ranging from health and welfare expenditure, hospitals, disease and injury, and mental health, to ageing, homelessness, disability and child protection.

The Institute also plays a role in developing and maintaining national metadata standards. This work contributes to improving the quality and consistency of national health and welfare statistics. The Institute works closely with governments and non-government organisations to achieve greater adherence to these standards in administrative data collections to promote national consistency and comparability of data and reporting.

One of the main functions of the AIHW is to work with the states and territories to improve the quality of administrative data and, where possible, to compile national data sets based on data from each jurisdiction, to analyse these data sets and disseminate information and statistics.

The Australian Institute of Health and Welfare Act 1987, in conjunction with compliance to the Privacy Act 1988, (Cth) ensures that the data collections managed by the AIHW are kept securely and under the strictest conditions with respect to privacy and confidentiality.

For further information see the AIHW website www.aihw.gov.au.

Community mental health services may be required to provide data to states and territories through a variety of administrative arrangements, contractual requirements or legislation. States and territories use these data for service planning, monitoring and internal and public reporting. In addition, state and territory health authorities supply data for the NCMHCD under the terms of the National Health Information Agreement (see link), as specified by the CMHC NMDS (see ‘Interpretability’ section below).

Expenditure and resource information for community mental health services reporting to the NCMHCD are reported through the associated National Mental Health Establishments Database, as specified by the MHE NMDS (see link).

Data for the NCMHCD were first collected in 2000–01.

States and territories are required to supply data annually in accordance with the CMHC NMDS specifications. The reference period for this data set is 2016–17, that is, service contacts provided between 1 July 2016 and 30 June 2017. Data for the 2016–17 reference period were supplied to the AIHW at the end of January 2018.

The AIHW publishes data from the NCMHCD in Mental health services in Australia annually.

The AIHW produces the annual series Mental health services in Australia, primarily as an online publication (see link). This includes pdf documents of all sections in the publication, as well as data workbooks and an interactive data portal. In addition, a companion hard copy 'In brief' summary document is produced and is available via the Mental health reports page.

Metadata information for the CMHC NMDS is published in the AIHW’s online metadata repository—METeOR.

METeOR can be accessed on the AIHW website:

http://meteor.aihw.gov.au

Data published annually in Mental health services in Australia include additional important caveat information to ensure appropriate interpretation of the analyses presented by the AIHW. Readers are advised to take note of footnotes and caveats specific to individual data tables that influence interpretability of specific data.

The purpose of the NCMHCD is to collect information on all mental health service contacts provided by community mental health care services, as specified by the CMHC NMDS. The scope for this collection is all government-funded and operated community mental health care services in Australia.

A mental health service contact, for the purposes of this collection, is defined as the provision of a clinically significant service by a specialised mental health service provider for patients/clients, other than those admitted to psychiatric hospitals or designated psychiatric units in acute care hospitals and those resident in 24-hour staffed specialised residential mental health services, where the nature of the service would normally warrant a dated entry in the clinical record of the patient/client in question. Any one patient can have one or more service contacts over the reporting period (that is, 2016–17). Service contacts are not restricted to face-to-face communication but can include telephone, video link or other forms of direct communication. Service contacts can also be either with the patient or with a third party, such as a carer or family member, or other professional or mental health workers or other service providers.

States and territories are primarily responsible for the quality of the data they provide. However, the AIHW undertakes extensive validations on receipt of data. Data are checked for valid values, logical consistency and historical consistency. Potential errors are queried with jurisdictions, and corrections and resubmissions may be made by them in response to these queries. The AIHW does not adjust data to account for possible data errors or missing or incorrect values.

All states estimate that 75–100% of in-scope community mental health care services provided contact data to the collection. Overall service contact data coverage for most jurisdictions was estimated to be between 86–100%. Most states reported small collection gaps that are being addressed.

Victoria reported that industrial action from May 2016 resulted in slight under-reporting of service contacts and reduced data coverage.

New South Wales reported that the introduction of a new system in the Justice Health Network has resulted in under-reporting of service contacts and reduced data coverage.

Tasmania stated that forensic community mental health contacts are not reported due to ongoing challenges with the information system for the forensic service unit.

Indigenous status

Data from the NCMHCD on Indigenous status should be interpreted with caution. Jurisdictional advice is that the data quality and completeness of Indigenous identification varies. The methodology for the identification of Indigenous status varies both between jurisdictions and between services within a jurisdiction. Subsequently, the identification process may result in a different status being recorded among multiple service contacts or between service providers. Indigenous status is missing for 5.3% of contacts in the 2016–17 NCMHCD.

States and territories provided additional information on the quality of the Indigenous status data for 2016–17 as follows:

·        New South Wales reported the quality of the Indigenous status data acceptable and consistent with previous years, reporting that there are always opportunities for improvement.

·         Victoria reported the quality of the Indigenous status data to be acceptable but that there continue to be areas for improvement based on the National best practice guidelines for collecting Indigenous status in health data sets.

·         Queensland reported that the quality of Indigenous status data was acceptable, with continued improvement on reporting from earlier years. The percentage of registered contact records with an unknown/not stated Indigenous status in 2016–17 is the same as in 2015–16. Further work to improve future collections is ongoing.

·         Western Australia reported that the quality of Indigenous status data was acceptable with plans to introduce a new data quality process in 2017–18, which will target records with missing or unknown Indigenous status. WA also acknowledged the importance of continuing work to improve data collection in areas including improved cultural education and training in data capture at the point of collection and analysis and action regarding clients who change their Indigenous status between contacts.

·         South Australia reported that the quality of Indigenous status data was acceptable, but that further investigation and follow-up was required for services with high rates of unknown/not stated Indigenous status.

·         Tasmania reported the quality of the Indigenous status data acceptable, requiring some improvement.

·         Tasmania considered the data captured by one service (accounting for approximately 6% of the state-wide contacts) as generally being of a lower quality than other teams, due to the nature of how they record data via telephone. The Australian Capital Territory considered the quality of the Indigenous status data to be satisfactory.

·         The Northern Territory considered the quality of Indigenous status data to be satisfactory. The Northern Territory reported that an aim for future collections is to improve user data collection compliance in regards to aspects of contact details, like contact duration and client participation.

Remoteness area and socioeconomic status

Numerators for remoteness area and socioeconomic status are based on the reported area of usual residence of the patient, regardless of the location or jurisdiction of the service provider. This may be relevant if significant numbers of one jurisdiction’s residents are treated in another jurisdiction. Therefore, comparisons of service contact rates for jurisdictions require consideration of cross-border flows, particularly for the Australian Capital Territory.

Mental health legal status

Data on involuntary treatment of consumers is collected in the NCMHCD, however the quality of the data is unknown and should be treated with caution. Reporting of service events with a mental health legal status of involuntary will differ from reporting of treatment orders in the community by state and territory Chief Psychiatrists due to differences in statistical unit, collection scope and jurisdictional data systems.

Legislation governing the use of treatment orders differs between jurisdictions and comparisons should be made with caution.

Metadata specified in the CMHC NMDS may change from year to year. The following definitional changes occurred to the 2016–17 metadata specifications:

• The current classification scheme changed to the 9^th Edition of the International Statistical Classification of Diseases and Relate Health Problems, Tenth Revision, Australian Modification.
• The data element Mental health service contact – service duration was updated to include additional guidance on the reporting of service contacts where care delivery is reviewed such as case conferences and multidisciplinary reviews.
• The data element Mental health service contact – session type was updated to include guidance on the definition of a group session and assignment of session type for service contacts where care delivery is reviewed and the patient/client is absent.

There are variations across jurisdictions in the scope and definition of a service contact. For example, most jurisdictions may include telephone and/or written correspondence as service contacts while the Northern Territory does not. Data on contacts with unregistered clients are not included by all jurisdictions. Unregistered client contacts refer to those mental health service contacts for which a person identifier was not recorded. Queensland and the Northern Territory do not have any unregistered clients.

Principal diagnosis

The quality of principal diagnosis data in the NCMHCD may be affected by the variability in collection and coding practices across jurisdictions. In particular, there are:

1. Differences among states and territories in the classification used as follows:

·        Victoria and the Northern Territory report that data are submitted in accordance with the ICD-10-AM 10th edition.

·         New South Wales, Queensland, Western Australia, Tasmania and the Australian Capital Territory report that data are submitted in accordance with the ICD-10-AM 9th edition.

·         South Australia used a combination of ICD-10-AM 9th Edition, ICD-10-AM 4th Edition and ICD-10-AM Mental Health Manual 1st Edition.

2. Differences according to the size of the facility (for example, large versus small) in the ability to accurately code principal diagnosis.

3. Differences in the availability of appropriately qualified clinicians to assign principal diagnoses (diagnoses are generally to be made by psychiatrists, whereas service contacts are mainly provided by non-psychiatrists).

4. Differences according to whether the principal diagnosis is applied to an individual service contact or to a period of care.

New South Wales and Victoria report the current diagnosis for each service contact rather than a principal diagnosis for a longer period of care. The remaining jurisdictions report principal diagnosis as applying to a longer period of care.

Comparability over time

Comparability of NCMHCD data over time can be variable. Changes to reporting practices, upgrades to information systems and revisions to data mean comparison between years should be made with caution.

For 2016–17, New South Wales reported reduced data coverage due to the introduction of a new system in the Justice Health network.

For 2016–17, Victoria reported that industrial action from May 2016 resulted in under reporting of contacts, due to reduced coverage of in-scope services supplying data for some of the collection period.

The Northern Territory noted improvement is required in the collection of service contact information but acknowledged this was challenging given the limitations of the current information systems. For 2016–17, The Northern Territory reported a reduction in data coverage and are currently investigating reasons behind the decrease in service contacts compared to 2015–16.