Mental health care

Mental health care is care in which the primary clinical purpose or treatment goal is improvement in the symptoms and/or psychosocial, environmental and physical functioning related to a patient’s mental disorder.

Mental health care:

  • is delivered under the management of, or regularly informed by, a clinician with specialised expertise in mental health;
  • is evidenced by an individualised formal mental health assessment and the implementation of a documented mental health plan; and
  • may include significant psychosocial components, including family and carer support.

Australian Mental Health Care Classification

IHACPA has developed a classification for mental health, known as the Australian Mental Health Care Classification (AMHCC). The AMHCC aims to improve the clinical meaningfulness of the way that mental health care services can be classified. 

On 25 February 2016, the Pricing Authority approved the AMHCC Version 1.0. The AMHCC was implemented on a best endeavours basis from 1 July 2016 and used to price admitted mental health from 1 July 2022.

The AMHCC Version 1.0 covers the admitted and community settings. At this stage, there is insufficient data to develop the residential setting of the classification. IHACPA will review the development when more robust data becomes available.

AMHCC Version 1.1

In December 2023, IHACPA released AMHCC Version 1.1, a modest refinement of AMHCC Version 1.0. The classification structure and variables remain the same with 6 variables being utilised to determine an end class: 

  1. Episode setting
  2. Mental Health Phase of Care (MHPoC)
  3. Age group
  4. Mental Health Legal Status (MHLS)
  5. Health of the Nation Outcome Scale (HoNOS)
  6. Abbreviated Life Skills Profile (LSP-16). 

The key changes for AMHCC Version 1.1 include the recalibration of the complexity model by updating HoNOS weights and thresholds, and LSP-16 thresholds. In addition, phases with up to 2 missing HoNOS items attract a valid complexity score in AMHCC Version 1.1, in line with the National Outcomes and Casemix Collection rules.

Further information on IHACPA’s development of the classification refinement is available in the Final Report. Guidance on its application is also available in the AMHCC User Manual and Reference to Changes

Education materials 

In December 2022, the IHACPA released the AMHCC and MHPoC education materials to assist jurisdictions and mental health services with further understanding the AMHCC and consistent application of MHPoC. Additional information and resources can be found in the AMHCC education materials.

The classification has for AMHCC Version 1.0 and AMHCC Version 1.1 is illustrated for the admitted setting in Figure 1 and the community setting in Figure 2. There are no changes to the classification structure between AMHCC versions.

Diagram of the AMHCC classification structure for admitted setting
Figure 1: AMHCC Version 1.0 admitted setting structure

There are 45 end-classes for admitted setting phases of care.  
Acute: 0-17 years for HoNOS complexity - high, moderate, unknown; 18-64 years, mental health legal status for voluntary or involuntary, for HoNOS complexity high, moderate, unknown; 65+ years for HoNOS compexity  high, moderate, unknown.
Functional gain: 0-17, 18-64, 65+ years of age for HoNOS complexity high, moderate, unknown. 
Intensive extended: 0-17, 18-64, 65+ years of age for HoNOS complexity high, moderate, unknown.
Consolidating gain: 0-17, 18-64, 65+ years of age for HoNOS complexity high, moderate, unknown.
Unknown: 0-17, 18-64, 65+ years of age.

Diagram of the AMHCC classification structure for admitted setting
Figure 2: AMHCC Version 1.0 community setting structure

There are 46 end-classes for community admitted setting phases of care.  
Acute (0-17, 18-64, 65+ years of age), functional gain (0-17, 18-64, 65+ years of age), intensive extended (0-17, 18-64, 65+ years of age) with HoNOS complexity high, moderate (LSP-16 complexity, high or moderate, 18-64 years only) or unknown.
Consolidating gain: 0-17, 18-64, 65+ years of age.
Unknown: 0-17, 18-64, 65+ years of age.
Assessment only: 0-17, 18-64, 65+ years of age.

The classification has 6 major splitting variables. The first 3 variables are categorical variables, and the remaining variables are complexity variables.

Setting

The classification splits by setting into admitted and community.

The admitted setting includes consumers who are admitted for mental health care. The consumer may be admitted to a general ward or a designated psychiatric unit in a general hospital or a psychiatric hospital.

The community setting, also known as ambulatory, includes specialised and non-specialised mental health care services delivered to consumers who are not admitted to an inpatient facility.

Mental health phase of care

There are 4 phases of care: 

  • acute
  • functional gain
  • intensive extended
  • consolidating gain. 

Mental health phase of care is assessed by a healthcare professional directly involved in a consumer’s care. It is the primary goal of care that is reflected in the consumer's mental health treatment plan. The mental health phase of care reflects a prospective assessment of the primary goal of care at the time of collection, rather than a retrospective assessment.

The mental health phase of care concept is an attempt to bring together two related concepts – the ‘consumer’s needs’ and ‘goal of care’. Each phase of care involves providing resources that meet individual consumer needs.

The mental health phase of care is a simple tool designed to qualify a complex concept. Consumers may move between any of the phases of care in any particular order. Identification of the mental health phase of care is aligned to the contemporary recovery-orientated mental health practice. This is where the goals of care are collaboratively generated and are responsive to the particular needs of the consumer at the time.

Age group

There are 3 consumer age groups: 

  • child and adolescents (0 to 17 years) 
  • adults (18 to 64 years) 
  • older persons (65+ years).

Mental health legal status

Only applies to admitted setting with acute phase for 18 to 64 year age group.

The mental health legal status (MHLS) is categorised as voluntary or involuntary.

MHLS is an indicator of whether mental health care is being provided under the state or territory mental health legislation. An involuntary patient may be detained in hospital under mental health legislation for the purpose of assessment or provision of appropriate treatment or care.

HoNOS complexity

The HoNOS (Health of the Nation Outcome Scales) is a clinical outcomes measure that captures the symptoms and functioning of the consumer at key points within an episode of mental health care. It is a clinician-rated measure that consists of 12 items that assess the various aspects of consumers’ mental health.

The HoNOS complexity is based on the weighted sum of each mental health phase of care’s HoNOS scores. The weighted HoNOS scores are assessed against a threshold and classified as ‘high’ if greater than or equal to the threshold, and ‘moderate’ if less than the threshold. 

The HoNOS is adapted as the Health of the Nation Outcome Scales – Children and Adolescents (HoNOSCA) for the 0 to 17 years age group and the Health of the Nation Outcome Scale 65+ (HoNOS 65+) for persons aged 65 years and above.

LSP-16 complexity

LSP-16 only applies to the community setting for 18 to 64 years age group with moderate HoNOS complexity.

The LSP-16 is a clinical outcomes measure that assess the level of functioning for mental health consumers living in the community. It consists of 16 items that address issues faced when adapting to life in the community. Each item is rated on a four-point scale ranging from 0 to 3 with high scores indicating higher severity, resulting in an individual item scores, subscale scores and a total score. 

The overall LSP-16 complexity is classified as high or moderate.

More information about the HoNOS and LSP-16 is available on the Australian Mental Health Outcomes and Classification Network website.

Number of end classes

AMHCC Version 1.0 has 91 end classes, of which 60 are completely classified and 31 are a result of unknown phase of care or HoNOS. This consists of the admitted setting with 45 total end classes, of which 29 are completely classified and 16 are a result of unknown phase of care or HoNOS. The remainder are from the community setting with a total of 46 end classes, of which 31 are completely classified and 15 are a result of unknown phase of care or HoNOS. 

AMHCC Version 1.1 has 89 end classes as 2 end classes from Version 1.0 have been made inactive. Details of the change can be found in the AMHCC Version 1.1 Final Report.

The Activity Based Funding Mental Health Care National Best Endeavours Data Set (ABF MHC NBEDS) defines information about consumers receiving mental health care within the activity based funding scope.  

Additional information on the ABF MHC NBEDS can be found in the ABF MHC NBEDS Technical Specifications.

2023–24

Activity based funding: Mental health care NBEDS 2023–24 (Metadata Online Registry)

Document PDF Word
Technical Specifications Version 1.0 ABF MHC NBEDS 2023–24 Technical Specifications Version 1.0 ABF MHC NBEDS 2023–24 Technical Specifications Version 1.0

2022–23

Activity Based Funding Mental Health Care NBEDS 2022–23 (Metadata Online Registry)

Document PDF Word
Technical Specifications Version 1.0 ABF MHC NBEDS 2022–23 Technical Specifications Version 1.0 ABF MHC NBEDS 2022–23 Technical Specifications Version 1.0

2021–22

Activity Based Funding Mental Health Care NBEDS 2021–22 (Metadata Online Registry)

Document PDF Word
Technical Specifications Version 1.0 ABF MHC NBEDS 2021–22 Technical Specifications Version 1.0 ABF MHC NBEDS 2021–22 Technical Specifications Version 1.0

2020–21

Activity Based Funding Mental Health Care NBEDS 2020–21 (Metadata Online Registry)

Document PDF Word
Overview Version 1.0 ABF MHC NBEDS 2020–21 Overview Version 1.0 ABF MHC NBEDS 2020–21 Overview Version 1.0
Technical Specifications Version 1.0 ABF MHC NBEDS 2020-21 Technical Specifications Version1.0 ABF MHC NBEDS 2020–21 Technical Specifications Version 1.0

Five steps to a mental health care classification

In the healthcare system we use classifications to describe the care people receive.

At present there’s no single classification for mental health services in Australia.

Having one will allow us to group like with like, to help people make more informed decisions about resources, giving the sector the data it needs to manage, measure and deliver services more effectively and more efficiently, providing a clearer picture about what’s going on for consumers like Adam.

But how do we develop this classification so we can understand the care that Adam receives, and how it’s delivered?

A classification that encourages transparency and more insightful decision making.

IHPA is putting together the first Australian Mental Health Care Classification, or the AMHCC as we like to call it. It will provide more useful and consistent data about the services Adam receives in the community, in hospitals or other places.

We’re taking 5 clearly defined steps. Each of these will improve the way that mental health care services can be classified, counted and costed.

Firstly, we’ve defined the types of mental health care to be included in the classification.

Adam has schizophrenia, but his diagnosis shouldn’t be the only thing we consider. 

It’s important to look at how Adam’s illness affects his everyday life. This gives us a more informed view of the care he requires. 

We want to understand both the services and the cost of care to identify the cost drivers. For mental health care, a comprehensive analysis must take place.

So, we’ve included literature reviews, data analysis and stakeholder consultations. 

This enables us to consider the various factors that contribute to Adam’s care such as the intensity of support he’s receiving in the community, the medication he’s taking and the programs he takes part in.

Next, we undertook a costing study with health services. This helped us understand more about what drives costs in mental health services. This study enabled us to develop the AMHCC. 

Step 4 involves the planning, design and testing of the classification. It also includes a pilot of the AMHCC along with a series of public consultations on its structure.

The development and refinement of the classification is an ongoing process. This is important as mental health care is evolving and changing all the time.

IHPA will regularly review and update the system to ensure it’s as accurate as possible. 

It will receive ongoing input from clinicians, consumers, carers, community organisations, as well as collecting cost and activity data that will support the refinement of the classification.

This can allow for more informed decisions about resources, giving the sector the data it needs to effectively manage, measure and efficiently deliver services.

This will ensure Adam receives the most effective form of care.

For more information visit ihacpa.gov.au/amhcc

Is this page useful?