Care for people with mental health disorders
The burden of mental illness is substantial, affecting one in two people at some point in their lives (see indicator “Mental health” in Chapter 3). Since the start of the COVID-19 crisis, levels of mental distress have increased, and the prevalence of anxiety and depression has even doubled in some countries (OECD, 2021[39]). Mental ill health drives economic costs equal to more than 4.2% of gross domestic product (GDP), which include the direct costs of treatment but also indirect costs related to lower employment rates and reduced productivity (OECD, 2021[40]). High-quality, timely care has the potential to improve outcomes and reduce suicide and excess mortality for individuals with mental disorders.
Data on quality and outcomes of care point to shortcomings in continuity of care and ongoing difficulties with improving outcomes, especially for people with severe mental health conditions. Inpatient suicide is a “never” event, which should be closely monitored as an indication of how well inpatient settings are able to keep patients safe from harm. Most countries report inpatient suicide rates below 6 per 10 000 patients, but Denmark, Belgium, Israel, and Canada are exceptions (Figure 6.28). High rates in these countries may be, in part, due to differences in case-mix (i.e. the severity of patient conditions that are treated in inpatient settings) or waiting times for ambulant treatment of patients with complex problems.
Suicide rates after hospital discharge can indicate the quality of care in the community, as well as co-ordination between inpatient and community settings. Across OECD countries, suicide rates among patients who had been hospitalised in the previous year were as low as 7 per 10 000 patients in Iceland but as high as almost 100 per 10 000 in the Netherlands (Figure 6.29).
Individuals with a psychiatric illness have a higher mortality rate than the general population. An “excess mortality” value greater than one implies that people with mental disorders face a higher risk of death than the rest of the population. Figure 6.30 shows the excess mortality values for schizophrenia and bipolar disorder, which are above two in most countries. In 2017-19, excess mortality ranged from 1.8 in Lithuania to 5.3 in Chile for people who had lived with schizophrenia.
Patient-reported metrics can help capture the quality of care provided to individuals living with mental conditions (de Bienassis et al., 2021[41]). These metrics are increasingly used in mental health care to capture people’s experience of health services and to provide their perspective on their own health status and how it may have changed over the course of treatment. Figure 6.31 shows service users perceptions of if care providers treated them with courtesy and respect, for people both in inpatient mental health settings and those using community services. While the scope of included data varies from individual sites to national surveys, this figure demonstrates increased adoption of national and subnational efforts to capture information about patient experiences with mental health care systems (de Bienassis et al., 2021[41]; OECD, forthcoming[42]).
The inpatient suicide indicator is composed of a denominator of patients discharged with a principal diagnosis or first two secondary diagnosis code of mental health and behavioural disorders (ICD-10 codes F10-F69 and F90-99) and a numerator of these patients with a discharge code of suicide (ICD-10 codes X60-X84). Data should be interpreted with caution due to a very small number of cases. Reported rates can vary over time, so where possible a three-year average has been calculated to give more stability to the indicator.
Suicide within one year of discharge is established by linking discharge following hospitalisation with a principal diagnosis or first two listed secondary diagnosis code of mental health and behavioural disorders (ICD-10 codes F10-F69 and F90-99) with suicides recorded in death registries (ICD-10 codes X60-X84).
For the excess mortality indicators, the numerator is the overall mortality rate for people aged between 15 and 74 diagnosed with schizophrenia or bipolar disorder. The denominator is the overall mortality rate for the general population in the same age group. The relatively small number of people with schizophrenia or bipolar disorder dying in any given year can cause substantial variations from year to year, so three-year averages are presented.
Mental health patient-reported experience measures (PREMs) are based on the assessment of inpatient and community mental health service users using domains recommended from the PaRIS Mental Health Working Group. Differences in data collection across reporting sites and countries may influence the calculated rates, including differences in identifying the patient populations, the total number of survey respondents, the structure and implementation of the questionnaire, and the mapping process of existing survey activities onto the identified domains (OECD, forthcoming[42]). For Australia, differences between public and private mental health services in the survey instrument, sampling methodology, patient case mix, service mix and calculation methodology may affect the overall experience scores. Direct comparison between private and public services is not recommended. In addition, direct comparison between countries should be made with caution because there is substantial variation in sample size, as well as the factors above.
Note: Three-year average except for Colombia bipolar disorder (2014). Netherlands: schizophrenia and other psychotic disorders; bipolar and other mood disorders (excluding depressive disorder).
Source: OECD Health Statistics 2021.
1. Information mapped from existing survey programme. 2. Sample size between 500-100. 3. Sample size smaller than 100. 4. Web-based survey.
Source: PaRIS Mental Health Pilot Data Collection 2020-21.