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INTRODUCTION

The World Health Organization states that “there is no health without mental health”, highlighting the association between mental and physical health [1]. People living with mental illness have poorer physical health and higher rates of mortality, compared with people with good mental health [2].

Understanding the interplay between mental and physical health is important when considering mortality outcomes of people with poor mental health. Poor mental health is a risk factor for chronic physical health conditions, while conversely, people with chronic physical health conditions are at risk of poor mental health [3]. Given this interplay, there are a variety of reasons that may lead a person to access mental health-related treatments. The particular option(s) a person follows may be influenced by a range of factors, such as their diagnosis, the type and/or severity of their condition(s), availability and costs of treatment options as well as personal preference.

Australia’s mental health system comprises different treatment paths and options. The Australian Government funds a range of mental health-related services through the Medicare Benefits Schedule (MBS), the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS). The Australian Government also funds a range of programs and services which provide support for people with mental illness (such as income support and disability services) [4]. Additionally, state and territory governments fund and deliver public sector mental health services that provide specialist care for people with severe mental illness, such as specialised mental health care delivered in public hospitals, community mental health care services, and residential mental health care services [4]. Also available are a range of mental health-related services provided by non-government sector organisations such as crisis support services.

Data in this publication are sourced from the Mental Health Services-Census-Mortality Integrated Dataset which includes information about MBS subsidised mental health-related services and/or PBS subsidised mental health-related prescription medications, mortality information and 2011 Census of Population and Housing (Census) information. The cohort of persons who accessed these services or medications during the calendar year 2011 was linked to death records for the 13-month period following the 2011 Census to enable analysis of the characteristics and mortality outcomes of these persons. Given persons aged 75 years and over account for the majority of deaths in Australia, information on mortality for the total population (that is, all ages) may mask results for younger age groups. Data in this publication are therefore presented for persons aged 15-74 years as well as persons of all ages.

MBS subsidised mental health-related services are those provided by psychiatrists, general practitioners (GPs), clinical psychologists, other psychologists and other allied health professionals. PBS subsidised mental health-related prescription medications comprise antipsychotics, anxiolytics, hypnotics and sedatives, antidepressants, and psychostimulants, agents used for ADHD and nootropics. For brevity, the term ‘mental health-related treatments’ is frequently used in this publication to refer to these services and medications. See Appendix 1 and Appendix 2 for more detail about mental health-related services and prescription medications listed on the MBS and PBS.

KEY FINDINGS

Characteristics of deaths of persons who accessed mental health-related treatments in 2011

Persons of all ages

• There were 3.2 million persons who accessed MBS and/or PBS subsidised mental health-related services or prescription medications (‘mental health-related treatments’) in 2011.
• There were 153,451 deaths registered in Australia in the period 10 August 2011 to 27 September 2012.
• Persons who accessed mental health-related treatments accounted for 49.4% of all deaths in this period (75,858 deaths).
• The standardised death rate for persons who accessed mental health-related treatments in 2011 was almost twice (1.9 times) that of the standardised death rate for the total Australian population (11.4 deaths per 1,000 population compared with 6.1 deaths per 1,000 population respectively).
• Males who accessed mental health-related treatments in 2011 had a standardised death rate 2.3 times higher than that of all males in Australia (16.4 deaths per 1,000 population compared with 7.3 deaths per 1,000 population respectively).
• Females who accessed mental health-related treatments in 2011 had a standardised death rate 1.7 times higher than that of all females in Australia (8.6 deaths per 1,000 population compared with 5.1 deaths per 1,000 population respectively).
• The standardised death rate for males who accessed mental health-related treatments in 2011 was almost twice (1.9 times) that of females who accessed mental health-related treatments in 2011 (16.4 deaths per 1,000 population compared with 8.6 deaths per 1,000 population respectively).
• Consistently higher rates of mortality amongst persons who accessed mental health-related treatments in 2011 were evident across a range of other socio-demographic characteristics such as age, geography, socio-economic status and cause of death when compared with the total Australian population.

• Differences in mortality rates between persons who accessed mental health-related treatments in 2011 and the total Australian population were even greater for persons aged 15-74 years, compared with persons of all ages.
• The standardised death rate for persons aged 15-74 years who accessed mental health-related treatments was 2.4 times higher than the standardised death rate for the total Australian population of the same age (7.4 deaths per 1,000 population compared with 3.0 deaths per 1,000 population respectively).
• The standardised death rate for males aged 15-74 years who accessed mental health-related treatments in 2011 was almost three times (2.9) higher than that of all males of the same age in the total Australian population (11.2 deaths per 1,000 population compared with 3.8 deaths per 1,000 population).
• The standardised death rate for females aged 15-74 years who accessed mental health-related treatments in 2011 was 2.2 times higher than that of all females of the same age in the total Australian population (5.1 deaths per 1,000 population compared with 2.3 deaths per 1,000 population).
• The standardised death rate for males aged 15-74 years who accessed mental health-related treatments in 2011 was more than twice (2.2 times) that of females of the same age who accessed mental health-related treatments in 2011 (11.2 deaths per 1,000 population compared with 5.1 deaths per 1,000 population respectively).

• The leading cause of death for persons of all ages who accessed mental health-related treatments in 2011 was Ischaemic heart disease (12.3% of all deaths of persons who accessed mental health-related treatments) followed by Lung cancer (6.7%). Amongst the total Australian population, Ischaemic heart disease was also the leading cause of death (14.1%) while Lung cancer was the fourth leading cause of death (5.9%).
• The standardised death rate for Ischaemic heart disease for persons who accessed mental health-related treatments was 122.2 deaths per 100,000 population, one and a half times higher than that of the total Australian population (84.0 deaths per 100,000 population).
• For persons aged 15-74 years who accessed mental health-related treatments in 2011, the leading cause of death was Lung cancer (11.1% of all deaths of persons aged 15-74 years who accessed mental health-related treatments) followed by Ischaemic heart disease (7.5%).
• The standardised death rate for Lung cancer for persons aged 15-74 years who accessed mental health-related treatments was 74.8 deaths per 100,000 population, more than two and a half times (2.6) greater than that of the total Australian population of the same age (29.1 deaths per 100,000 population).
• Of the 3.4 million persons in Australia aged 15-74 years and over who reported having a mental or behavioural condition in 2014-15, almost one quarter (23.9%) smoked currently, compared with 16.3% of all persons aged 15-74 years (National Health Survey, 2014-15).
• The standardised death rate for Intentional self-harm for persons who accessed mental health-related treatments was more than three times (3.3) higher than the standardised death rate for Intentional self-harm amongst the total Australian population (34.4 deaths per 100,000 population compared with 10.5 deaths per 100,000 population respectively).

	Persons who accessed mental health-related treatments in 2011(a)				Total Australian population
	Deaths(b) no.	Population no.	Death rate(c) rate		Deaths(b) no.	Population(d) no.	Death rate(c) rate	Rate ratio(e) ratio
Persons of all ages
nnnMales	35 457	1 229 566	16.4		78 428	10 634 012	7.3	2.3
nnnFemales	40 401	1 961 281	8.6		75 023	10 873 706	5.1	1.7
nnnPersons	75 858	3 190 847	11.4		153 451	21 507 719	6.1	1.9
Persons aged 15-74 years
nnnMales	14 790	973 753	11.2		32 897	7 925 847	3.8	2.9
nnnFemales	11 584	1 591 138	5.1		20 391	8 052 975	2.3	2.2
nnnPersons	26 375	2 564 891	7.4		53 289	15 978 819	3.0	2.4
(a) Persons who accessed MBS subsidised mental health-related services and/or PBS subsidised mental health-related prescription medications in 2011. (b) Deaths registered between 10 August 2011 and 27 September 2012 inclusive. (c) Deaths per 1,000 population, age standardised to the 2001 Australian population. (d) 2011 Census counts. (e) Ratio calculated as death rate for persons who accessed mental health-related treatments divided by death rate for total Australian population.