Mental Health Workforce Study: Mental Health Workforce Planning Data Inventory

Transcription

1 Mental Health Workforce Study: Mental Health Workforce Planning Data Inventory September

2 Health Workforce Australia. This work is copyright. It may be reproduced in whole or part for study or training purposes. Subject to an acknowledgement of the source, reproduction for purposes other than those indicated above, or not in accordance with the provisions of the Copyright Act 1968, requires the written permission of Health Workforce Australia (HWA). Enquiries concerning this report and its reproduction should be directed to: Health Workforce Australia Post GPO Box 2098, Adelaide SA 5001 Telephone Internet Suggested citation: Health Workforce Australia 2013, Mental Health Workforce Planning Data Inventory, Health Workforce Australia: Adelaide 2

3 Contents Abbreviations 4 Introduction 6 Key findings 12 What data is available for the workforces in scope? 15 Primary workforces 15 Aboriginal and Torres Strait Islander health workers 16 Aboriginal mental health workers 20 General practice (GP) workforce 21 Mental health nurses 24 Mental health workers 28 Occupational therapists 30 Peer workers 33 Psychologists 35 Psychiatrists 38 Registered nurses and Enrolled nurses 41 Social workers 44 Other significant workforces 47 Dietitians 48 Pharmacists 50 Speech pathologists 53 What data is available to measure demand for workforces delivering services to mental health consumers? 56 What data is available on workforce entrants and exits? 59 Detailed data statements 61 References 81 3

4 Abbreviations AMHW ATAPS AMHSW APD ANZSCO AASW ACMHN ACRRM ABS The Census AHPRA AIHW BEACH COAG DEEWR DOHA DIAC DIICCSRTE DAA EN FTE GPET GP HWA HEP Aboriginal mental health worker Access to Allied Psychological Services Accredited Mental Health Social Worker Accredited Practising Dietitian Australian and New Zealand Standard Classification of Occupations Australian Association of Social Workers Australian College of Mental Health Nurses Australian College of Rural and Remote Medicine Australian Bureau of Statistics Australian Bureau of Statistics Census of Population and Housing Australian Health Practitioner Regulation Agency Australian Institute of Health and Welfare Bettering the Evaluation and Care of Health Council of Australian Governments Department of Education, Employment and Workplace Relations Department of Health and Ageing Department of Immigration and Citizenship Department of Industry, Innovation, Climate Change, Science, Research and Tertiary Education Dietitians Association of Australia Enrolled Nurse Full-time equivalent General Practice Education and Training General Practitioner Health Workforce Australia Higher Education Providers HESA Higher Education Support Act 2003 MTRP MBS MHE NMDS MH NGOE NMDS Medical Training Review Panel Medicare Benefits Schedule Mental Health Establishment National Minimum Dataset Mental Health Non-Government Organisation Establishments National Minimum Data Set 4

5 NCVER NHWDS NMHSPF NHMD NMDS NRAS NGO OT PHIAC PAG RN RANZCP RACGP SPA VET National Centre for Vocational Education Research Ltd National Health Workforce Data Set National Mental Health Service Planning Framework National Hospital Morbidity Database National Minimum Data Set National Registration and Accreditation Scheme Non-Government Organisation Occupational Therapist Private Health Insurance Administration Council Program Advisory Group Registered Nurse Royal Australian and New Zealand College of Psychiatrists Royal Australian College of General Practitioners Speech Pathology Australia Vocational Education and Training 5

6 Introduction The importance of mental health Mental illness describes a wide range of disorders. In general a mental illness is recognised as a health problem that significantly affects how a person feels, thinks, behaves and interacts with other people. Examples of the most common forms of mental illness include anxiety and depressive disorders 1. According to the 2007 National Survey of Mental Health and Wellbeing, almost half of all Australians experienced a mental illness or disorder during their lifetime, while one in five Australians (or 3.2 million people) aged between 16 and 85 experienced mental disorders in the 12 months prior to the survey. In addition, the Burden of Disease and Injury in Australia study found that mental disorders are one of the leading disability burdens in Australia in terms of the number of years lost due to disability. The effect of mental illness can be severe on individuals and families, and its influence is far-reaching for society as a whole. Social problems commonly associated with mental illness include poverty, unemployment or reduced productivity and homelessness. Those with mental illness often experience problems such as isolation, discrimination and stigma 2. As well as the social impact of mental illness, the economic cost of mental illness is also significant. In , almost $6.9 billion, or $309 per person, was spent on mental health related services in Australia 3, and the annual cost to employers of reduced productivity has been estimated at 30 million working days 4. For both the social and economic impacts of mental illness on the Australian community, a sustainable mental health workforce supporting the mental health system is essential. Policy context Recognising the impact of mental illness and mental disorder on the community, a collaborative approach to mental health has been taken by governments. In 1992, Australian Health Ministers endorsed a whole of government approach by endorsing the National Mental Health Strategy. This strategy consisted of the National Mental Health Policy, the National Mental Health Plan, and the Mental Health Statement of Rights and Responsibilities. The strategy has been reaffirmed on a number of occasions since Most recently the National Mental Health Policy was revised in 2008 and the Fourth National Mental Health Plan was released in Following the National Mental Health Strategy in 1992, in 1996 mental health was (and continues to be) identified as a national health priority area. This is in recognition of its significant contribution to the burden of illness and injury on the Australian community. As a national health priority area, this supports programs of collaborative action across governments, non-government organisations, service providers, clinicians, consumers and carers. Continuing the whole-of-government approach, in 2006 the Council of Australian Governments (COAG) endorsed the National Action Plan on Mental Health This targeted service improvements to mental health through measures including increased access and availability of services (the Better Access initiative), promotion and greater community awareness, and a focus on growing and building workforce capacity. In the budget, the Australian Government committed an additional $1.5 billion worth of additional funding for mental health initiatives, which when combined with previous budget commitments, equated to a record $2.2 billion worth of expenditure over a five-year period. Additionally, the Government also announced the establishment of the National Mental Health Commission, to monitor and evaluate the system as a whole by working closely with consumers, carers, stakeholders and all jurisdictions, and to seek and share knowledge and information on program and service evaluation 5. 6

7 Most recently, COAG endorsed the Roadmap for National Mental Health Reform in December The Roadmap outlines the reform directions governments will take over and reaffirms COAG s ongoing commitment and strategies to addressing mental health issues. The Roadmap also introduces new governance arrangements to ensure that governments are held to greater account for the commitments outlined in the Roadmap. Work HWA is conducting In line with the broader government commitment to mental health, and recognising the need for a national approach to develop and support a skilled and sustainable mental health workforce, HWA has established a mental health workforce program of work. The program is currently comprised of three projects: 1. Mental Health Peer Workforce project which aims to develop a better understanding of the peer workforce in Australia and barriers to their use; and to provide policy advice on training, regulatory and practice changes required to establish a career pathway for mental health peer workers into the mental health workforce. 2. Mental Health Capabilities Project which will develop mental health workforce capabilities, articulating functions across the continuum of mental health services and work roles. 3. Mental Health Workforce Study a foundation piece of work aiming to build the quantitative evidence on workforces delivering services to mental health consumers. The study is comprised of a data inventory, professionspecific supply and demand workforce projections, and potentially sector workforce planning (dependent on the release of the National Mental Health Service Planning Framework, a project funded by the Australian Government Department of Health and Ageing, and being led by the NSW Ministry of Health in partnership with Queensland Health and other jurisdictions). The Mental Health Workforce Planning Data Inventory The Mental Health Workforce Planning Data Inventory (the Inventory) is the first step in the Mental Health Workforce Study. Workforce is essential in delivering quality services to mental health consumers. The importance of, and focus on the mental health workforce is reflected in the creation of the National Mental Health Workforce Strategy and National Mental Health Workforce Plan, which were endorsed by Health Ministers in The Strategy aims to develop and support a well-led, high performing and sustainable mental health workforce that delivers quality, recovery focused mental health services, with the Plan identifying specific activities in support of the Strategy 6. In any workforce planning, the first key step is to understand the existing workforce. This encompasses both the supply and demand sides understanding the number and characteristics of the existing workforce as well as the service demand for the workforce. In mental health, services are delivered in a range of settings, and are funded through different levels of government and different government departments. This makes it difficult to develop a reliable and coherent understanding of the size and distribution of the mental health workforce 7. By identifying the current availability of quantitative data on the workforces delivering services to mental health consumers, and highlighting related data limitations and gaps, the Inventory begins to build the evidence base about the workforces involved in the care and support of people with mental illness. The Inventory is divided into the following six sections. 1. What workforces deliver services to mental health consumers? outlining the workforces in scope of the Inventory. 2. Key findings presenting the key findings from the Inventory. 3. What data is available for the workforces in scope of the Inventory? examining each workforce individually, and presenting summary information on: the role of the workforce generally, and more specifically within mental health service provision. 7

8 data available, including a snapshot of latest available data. data limitations. 4. What data is available to measure demand for workforces delivering services to mental health consumers? knowing the demand for workforces providing services to mental health consumers is important in determining how many people you need in the workforce. This section identifies information sources available to measure current service utilisation (expressed demand). 5. What data is available on workforce entrants and exits? knowing the number of people entering and exiting workforces delivering services to mental health consumers is an important component of workforce planning. This section identifies and describes information sources available on workforce inflows and outflows. 6. Detailed data statements presenting detailed data statements (where possible) for the identified data collections. These statements provide information including the scope and coverage of the collection, the frequency of collection and information on data availability. What workforces deliver services to mental health consumers? To develop the Inventory, the workforces involved in delivering services to mental health consumers needed to be identified. To do this, mental health services provided in Australia were identified, and from that, the workforces that commonly deliver those services were identified. Mental health services At its broadest, the mental health system can encompass services including: Population-based services such as mental health promotion and mental illness prevention Services targeted to individual need, such as the specialist public mental health system, private practitioners such as psychiatrists and other health professionals providing mental health services General and specialist health services that deal with co-morbidities such as drug and alcohol abuse Psychosocial rehabilitation and disability/recovery support services, such as employment and housing, used by people affected by mental illnesses Other services that deal with people with mental illnesses, for example, police. The National Mental Health Service Planning Framework (NMHSPF), one of the key initiatives in the Fourth National Mental Health Plan, is being developed to provide a population-based planning model for mental health that will better identify service demand and care packages across the sector in both inpatient and community environments 8. As part of this project, a nationally agreed taxonomy for mental health care is being developed, which will describe the full range of services in a mental health system (without specifying who delivers the services). Ideally, this taxonomy would have formed the basis for identifying mental health workforces in scope of the Inventory, however it was not publicly available during the Inventory s development. The Roadmap for National Mental Health Reform defines mental health services as: Services in which the primary function is to provide clinical treatment, rehabilitation or community support targeted towards people affected by mental illness or psychiatric disability, and/or their families and carers. For the purpose of the Inventory, HWA has adopted the definition used by the Roadmap for National Mental Health Reform , rather than take a broader approach encompassing mental health promotion, prevention, dealing with co-morbidities such as drug and alcohol abuse, and support services such as employment and housing. Focusing on mental health services targeted to individual need provides a realistic scope for this first step in the Mental Health Workforce Study. Future work may expand to encompass services across the whole mental health system. 8

9 Mental health service provision occurs via a complex set of interrelated services. Public, private and non-government service providers exist, delivering care through multiple service types and settings. Funding is provided by different levels of government and different government departments, and service delivery frameworks vary across states and territories. Figure 1 catalogues the primary methods of mental health service provision (relevant to the definition of mental health services being adopted by HWA for this Inventory). Figure 1: Mental health service types Service types Primary care and community care Private sector specialist mental health services Hospitals and other residential care General practitioner services Services provided by general practitioners to undertake early intervention, assessment and management of patients with mental illness, as well as providing referrals to other health professionals. Community based ambulatory care This includes outpatient clinics, mobile assessment and treatment teams, day programs and other services dedicated to the assessment, treatment, rehabilitation and care of people affected by mental illness or psychiatric disability who live in the community. Community based NGO services Services include accomodation outreach to support people living in their own homes, residential rehabilitation units, recreational programs, self-help and mutual support groups, carer respite services and system-wide advocacy. Private mental health services Consultation services provided by private practitioners, including psychiatrists, mental health nurses and allied mental health professionals in private practice. Services can be provided in a range of settings including hospitals, consulting rooms, home visits, over the phone and online. Emergency department Services to patients who present at an emergency department with an urgent need for medical care. Admitted patient mental health related care Services provided on admission to hospital, either public acute, public psychiatric or private hospital and can be with or without specialised psychiatric care. Ambulatory-equivalent admitted patient care Services comparable to those provided in community-based ambulatory care but provided on admission to hospital. Residential care Specialised mental health services including rehabilitation, sub-acute services, treatment or extended care, in a domesticlike environment on an overnight basis. Source: Derived from the Australian Institute of Health and Welfare, Mental Health Services in Australia, the Roadmap for national mental health reform and the National Mental Health Workforce Strategy. 9

10 Workforces delivering services to mental health consumers Workforces can work across the service types identified in Figure 1; and increasingly within the mental health sector, as well as more broadly across the health sector, services are being delivered in interprofessional multidisciplinary teams. The question was therefore raised on how far to extend the scope in including workforces in the Inventory. To this end, HWA was primarily guided by the National Mental Health Workforce Strategy and National Mental Health Workforce Plan that the mental health workforce encompasses those workforces whose primary role involves early intervention, referral, treatment, care or support to people with a mental illness, in a mental health service or other health service environment, including non-government community mental health services. The Strategy goes on to list those workforces as including: mental health nurses, psychiatrists, general registered nurses, enrolled nurses, general and other medical practitioners, occupational therapists, social workers, psychologists, Aboriginal mental health workers, Aboriginal health workers, mental health workers, consumer and carer workers. All of these workforces deliver services within the service types identified in Figure 1, and are in scope of this Inventory. HWA has also included pharmacists, dietitians and speech pathologists in the Inventory. While their primary role is not in the early intervention, referral, treatment, care or support to people with a mental illness, they can play a significant role, particularly as part of interprofessional multidisciplinary teams, in delivering services (in the described service types) to mental health consumers. Therefore they have been included in the Inventory. HWA recognise other workforces such as exercise physiologists, art therapists and music therapists can also deliver services to mental health consumers, however they have not been included at this stage of the Mental Health Workforce Study. Table 1 lists the workforces in scope of this Inventory, and the service types they generally operate within. Table 1: Workforces delivering mental health services Service type Workforce Primary care and community care Private mental health services Hospitals and other residential care Primary workforces Aboriginal mental health workers O Aboriginal and Torres Strait Islander health workers O Enrolled nurses O GPs O Mental health nurses O O O Mental health workers O O Occupational therapists O O O Peer workers O O Psychologists O O O Psychiatrists O O Registered nurses O O Social workers O O O Other significant workforces Dietitians O O O Pharmacists O O Speech pathologists O O O 10

11 Methodology The Inventory covers those workforces specified in Table 1. The Inventory is primarily limited to national, publically available data. Therefore this inventory should not be viewed as an exhaustive collation of mental health workforce data in existence, but a summary of known national data sources. To identify relevant data sources for the Inventory, desktop internet research was conducted, and extensive use was made of work previously conducted by the Mental Health Standing Committee. The draft Inventory was provided to the members of the HWA Mental Health Workforce Reform Program Advisory Group (PAG), and a representative from the Mental Health Information Strategy Sub-Committee for: Feedback on the structure and content of the Inventory. Assistance in identifying additional data sources for inclusion in the Inventory. Relevant Inventory entries were also supplied to professional bodies for review, where the professional body was not a member of the HWA Mental Health Workforce Reform PAG. 11

12 Key findings To be able to conduct workforce planning, three components need to be able to be enumerated: the existing workforce and their characteristics the demand for the workforce, and entrants to and exits from the workforce. Data sources available for each of these aspects for the workforces in scope of the Inventory were examined. Enumerating the existing workforces delivering services The data sources available to describe the workforces currently delivering services to mental health consumers were considered against five criteria to provide an indication of how suitable they are for workforce planning purposes. The five criteria were: Timeliness: has the data has been collected recently (within the last five years)? Frequency: is the data collected and published on a regular (annual, biannual) basis? Coverage: is the data representative of the national workforce? Completeness: does the data incorporate key variables required for workforce planning? Reliability: has the data been collected and sourced using appropriate methods and providers? As highlighted in the Inventory, the National Health Workforce Dataset (NHWDS) provides a strong basis for understanding the existing characteristics of the registered occupation workforces. A current limitation with the NHWDS is that it is relatively new, with limited time-series information and for one profession (occupational therapy), national information will not be available until However as the NHWDS is an annual collection, these limitations are short-term only. For non-registered occupations, the primary national source of information identified is the Australian Bureau of Statistics Census of Population and Housing. However, for workforce planning purposes, limitations associated with this include that information is self-reported, and responses provided depend on an individual s understanding and interpretation of the questions asked. For example, people who self-report as a particular occupation may not meet the occupational definition, or have appropriate qualifications. In addition, as the Census is conducted every five years, information is quickly out-of-date for workforce planning purposes. Perhaps the major limitation, regardless of data source, is identifying the amount of time a practitioner spends on mental health service provision (for those occupations where the role is not dedicated to mental health). So even having a well-enumerated workforce does not mean workforce planning can necessarily be conducted for mental health specifically, if it cannot be identified how much of a practitioner s time relates to mental health service provision. For the peer workforce, mental health workers, Aboriginal and Torres Strait Islander health workers and Aboriginal mental health workers, the lack of a nationally agreed definition means information is not currently available to reliably enumerate these workforces. Therefore for these workforces, there is no current base on which to start workforce planning. Table 2 summarises the suitability of current data sources available describing the existing workforces against the five criteria for workforce planning purposes. 12

13 Table 2: Evaluation of data sources identified in the Inventory Workforces Suitable for workforce modelling Timeliness Frequency Coverage Completeness Reliability Primary workforces Aboriginal mental health workers O Aboriginal and Torres Strait Islander health workers (a) O P P P P Enrolled nurses (b) O P P P P GPs (b) O P P P P Mental health nurses (c) P P P P P P Mental health workers O Occupational therapists (b) O P P P P Peer workers O Psychologists P P P P P P Psychiatrists P P P P P P Registered nurses (b) O P P P P Social workers O P Other significant workforces Dietitians O P Pharmacists (b) O P P P P Speech pathologists O P (a) The NHWDS is a suitable data source for Aboriginal and Torres Strait Islander Health Practitioners, however this workforce is only a subset of the Aboriginal and Torres Strait Islander health workforce. (b) Although the NHWDS provides a suitable data source for these workforces, it is not currently possible to quantify the contribution of this workforce to mental health service provision. (c) Using the AIHW and HWA definition that a mental health nurse is a registered nurse or enrolled nurse who reported their principal area of practice as mental health (regardless of any postgraduate qualification). 13

14 Measuring demand for workforces delivering services In terms of measuring demand for workforces delivering services to mental health consumers, an extensive number of datasets are available. However significant limitations exist in relation to measuring demand for workforce planning purposes. Firstly, there is incomplete coverage of services provided across the mental health sector specifically there is currently no national data collection for mental health service provision in the non-government organisation (NGO) sector. The NGO sector contribution to mental health service provision has increased substantially in recent years with the move to a recovery-focused service delivery approach, and the lack of information on this sector is a significant data gap. The Australian Institute of Health and Welfare (AIHW) is currently developing the Mental Health Non-Government Organisation Establishments National Minimum Data Set (MH NGOE NMDS), which once established, will allow routine, standardised collection of data relating to mental health NGOs. However the planned implementations for the MH NGOE NMDS is Incomplete coverage also refers to measuring the number of mental health services accessed. Most Medicare programs have a capped number of services per calendar year, which means not all visits to eligible mental health professionals will necessarily be captured. For example, under the Better Access initiative a consumer is eligible for a maximum of ten individual calendar sessions per year with an allied health professional. While consumers are not prevented from receiving further assistance, any further assistance given beyond the ten sessions is not captured by Medicare. Similarly, private health insurance funds have caps on the dollar amounts claimable through their policies, and once that amount is exceeded, further claims cannot be made, and any subsequent private consultations are not captured. Therefore it is likely a substantial amount of workforce activity is not captured. Finally, there is a lack of information on associating specific workforces with mental health service delivery. While some information is available from Medicare and the Private Health Insurance Administration Council (PHIAC) on which workforces are providing services, from many of the NMDS collections, it is not known what workforces deliver what services to the consumer. While the NMDS information can be used to measure an overall expressed demand for mental health services, applying this demand to individual workforces is problematic. For national workforce planning this is further complicated by the fact mental health service delivery frameworks differ across states and territories. Measuring entrants to, and exits from, workforces delivering services There are two primary streams of workforce entrants those that enter from education and those that enter through migration. Information sources exist for each of these streams. The primary limitation for workforce entrants relates to those workforces where there is not a defined or consistent education pathway through to the relevant occupation, such as Aboriginal and Torres Strait Islander health workers, Aboriginal mental health workers, peer workers and mental health workers. Workforce exits are a measure of the number of people who permanently or temporarily leave the workforce. The ability to calculate workforce exits varies between the registered and non-registered occupations because of data availability. For the registered occupations, workforce exists will be able to be derived from the Australian Health Practitioner Regulation Agency (AHPRA) registration data (upon at least two data points being available). For the non-registered occupations, measuring workforce exits is problematic because they do not have frequent, comparable data collections providing information on the number of practitioners. 14

15 What data is available for the workforces in scope? In workforce planning, the first step is to understand the existing workforce the number of workers and their characteristics, including age, gender, location and hours worked. In this section of the Inventory, each workforce listed in Table 1 is examined and summary information is presented on: The role of the workforce generally, and more specifically within mental health service provision. Data available, including a snapshot of latest available data. Data limitations. Information is presented firstly for those primary workforces identified as in scope of the Inventory, followed by the other significant workforces included in the Inventory. Primary workforces Primary workforces are those whose primary role involves early intervention, referral, treatment, care or support to people with a mental illness, in a mental health service or other health service environment, including non-government community mental health services. The following workforces were listed in the National Mental Health Strategy as primary workforces. All deliver services within the service types identified in Figure 1 in this report, and are therefore in scope of this Inventory: Aboriginal and Torres Strait Islander health workers. Aboriginal mental health workers. General practitioners. Mental health nurses. Mental health workers. Occupational therapists. Peer workers. Psychologists. Psychiatrists. Registered nurses and enrolled nurses. Social workers. 15

16 Aboriginal and Torres Strait Islander health workers The Aboriginal and Torres Strait Islander health worker workforce evolved from the need to provide health services to Aboriginal and Torres Strait Islander people whose health needs were not being met by mainstream services. With the evolvement of the role, Aboriginal and Torres Strait Islander health workers perform different tasks depending on what services are needed in their local context. This is now reflected in the wide degree of variation that exists in Aboriginal and Torres Strait Islander health worker roles, definitions, scopes of practice, education standards and career pathways 9. Commonly, Aboriginal and Torres Strait Islander health workers: perform a comprehensive primary health care role, for example, clinical assessment, monitoring and intervention activities, and health promotion provide culturally safe health care to Aboriginal and Torres Strait Islander people, such as advocating for Aboriginal and Torres Strait Islander clients to explain their cultural needs to other health professionals, and educating or advising other health professionals on the delivery of culturally safe health care adapt the roles they perform in response to local health needs and contexts 10. Eligible Aboriginal Health Workers can provide services under Medicare chronic disease management items. To be eligible, Aboriginal Health Workers need a Certificate Level III in Aboriginal and Torres Strait Islander Health from a registered training organisation (as a minimum). In the Northern Territory, Aboriginal Health Workers have been registered since This reflected the fact that Aboriginal Health Workers adapted their skills and learnt how to perform the clinical procedures that were in demand in their community. Registration was consequently introduced to protect people receiving these services 11. No other states or territory, until the introduction of the National Registration and Accreditation Scheme (NRAS) required Aboriginal Health Workers to be registered. In 2012, under the NRAS, Aboriginal and Torres Strait Islander health practitioners became a registered occupation. It should be noted that Aboriginal and Torres Strait Islander health practitioners are a subset of the Aboriginal and Torres Strait Islander health worker workforce. Under the NRAS, practitioners who are not required by their employer to use the titles Aboriginal and Torres Strait Islander health practitioner, Aboriginal health practitioner or Torres Strait Islander health practitioner, are not required to be registered, and are able to continue to work using the title Aboriginal Health Worker (unless they are practicing in the Northern Territory) 12. Upon the introduction of the NRAS, all people registered with the Northern Territory Aboriginal Health Workers Board were automatically registered as Aboriginal and Torres Strait Islander health practitioners. Recognising the complexity of the Aboriginal and Torres Strait Islander health worker workforce, and the barriers this creates for professional recognition, education and career pathways, one of the recommendations made in the HWA report Growing Our Future: the Aboriginal and Torres Strait Islander health worker Project Final Report was to: Endorse the national definition of an Aboriginal and Torres Strait Islander health worker as a person who: a. identifies as an Aboriginal and/or Torres Strait Islander and is recognised by their community as such, and b. is the holder of the minimum (or higher) qualification in Aboriginal and Torres Strait Islander primary health care, and c. has a culturally safe and holistic approach to health care. The above recommendation was noted by the Standing Council on Health, and the definition has been endorsed by the National Aboriginal Community Controlled Health Organisation, and the National Aboriginal and Torres Strait Islander Health Worker Association. 16

17 What is the role of an Aboriginal and Torres Strait Islander health worker in mental health service provision? Aboriginal and Torres Strait Islander health workers can work closely with consumers, carers and health care teams. They can undertake a range of roles in mental health service provision, including providing individual support, educating mental health workers on delivering culturally safe health care, acting as interpreters to ensure that the healthcare practitioner is clear about the patient s symptoms, medical and personal history and that the patient has a good understanding of the diagnosis, treatment and health care advice. Quantitative data available for Aboriginal and Torres Strait Islander health workers Australian Bureau of Statistics Census of Population and Housing (the Census) The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. It is conducted every five years, and its objective is to accurately measure the number and key characteristics of people who are in Australia on Census Night, and of the dwellings in which they live. From the Census, the number and characteristics of people who self-report as an Aboriginal and Torres Strait Islander health worker can be identified. In the Census, the Australian and New Zealand Standard Classification of Occupations (ANZSCO) is used to classify occupations, and in this classification, an Aboriginal and Torres Strait Islander health worker is defined as liaising with patients, clients, visitors to hospitals and other medical facilities and staff at health clinics, and works as a team member to arrange, coordinate and provide health care delivery in Aboriginal and Torres Strait Islander community health clinics. NHWDS: Aboriginal and Torres Strait Islander health practitioners Although only a subset of the Aboriginal and Torres Strait Islander health workforce, the NHWDS provides information on the number and characteristics of registered Aboriginal and Torres Strait Islander health practitioners. Characteristics of Aboriginal and Torres Strait Islander health workers Table 3 presents the latest available information from the Census on the number and characteristics of Aboriginal and Torres Strait Islander health workers (as defined by ANZSCO); and from the NHWDS on the number and characteristics of clinician Aboriginal and Torres Strait Islander health practitioners, that is, those who spent the majority of their time working on the diagnosis, care and treatment of patients. Please note, information from the Census is presented for those Aboriginal and Torres Strait Islander health workers who identified as being of Australian Aboriginal and/or Torres Strait Islander origin. 17

18 Table 3: Characteristics of the Aboriginal and Torres Strait Islander health worker workforce Characteristics Number Year Data source Headcount Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners Full-time equivalent (FTE) (a) Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners FTE rate per 100,000 Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners Average weekly hours Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners Average age Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners Per cent female Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners Per cent major cities: inner regional: outer regional: remote or very remote Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners (b) 22: 19: 23: 36 3: 4: 31: Census NHWDS Census NHWDS Census NHWDS Census NHWDS Census NHWDS Census NHWDS Census NHWDS Per cent sector (public: private) Aboriginal and Torres Strait Islander health workers 64: Census Work setting Aboriginal and Torres Strait Islander health practitioners Aboriginal health service Community healthcare services Hospital Correctional services Other government department or agency Unknown/inadequately described/not stated Workforce inflows Higher education students (c) Student commencements Student completions Vocational education students (d) Commencing course enrolments Course completions Workforce outflows Workforce vacancies n.a. n.a NHWDS DIICCSRTE DIICCSRTE NCVER NCVER n.a. not available (a) FTE calculated based on a 38 hour standard working week. (b) Calculated for all employed Aboriginal and Torres Strait Islander health practitioners. At time of publication, information was unavailable by remoteness area for clinician Aboriginal and Torres Strait Islander health practitioners. (c) Students who identified as Indigenous, in higher education courses coded to the Indigenous health field of education. (d) Where course occupation is coded to ANZSCO code Aboriginal and Torres Strait Islander health worker and student identified as Indigenous. 18

19 Data limitations While Census information is available on the number and characteristics of Aboriginal and Torres Strait Islander health workers, the ANZSCO definition used may not be representative of all Aboriginal and Torres Strait Islander health workers given the variation in roles, definitions and scopes of practice. For workforce planning purposes, limitations also exist with Census data. Information is self-reported, and responses provided depend on an individual s understanding and interpretation of the questions asked. In addition, as the Census is conducted every five years (while providing information on long-term trends), information is quickly out-of-date for workforce planning purposes. Aboriginal and Torres Strait Islander health workers conduct a substantial amount of work outside of mental health service provision. Consequently, a major limitation for workforce planning is the difficulty in measuring specific Aboriginal and Torres Strait Islander health worker mental health related activity there is no data source available for this. The Aboriginal and Torres Strait Islander health practitioner NHWDS provides information on a subset of Aboriginal and Torres Strait Islander health workers only. As noted earlier, practitioners who are not required by their employer to use the titles Aboriginal and Torres Strait Islander health practitioner, Aboriginal health practitioner or Torres Strait Islander health practitioner, are not required to be registered. Therefore coverage of the population of interest is limited. The same as Aboriginal and Torres Strait Islander health workers, Aboriginal and Torres Strait Islander health practitioners also work outside of mental health service provision. However the NHWDS survey form asks people to record the work setting of their main job, and community mental health service and residential mental health care service are options. This information could be used to identify the number of Aboriginal and Torres Strait Islander health practitioners primarily providing mental health services. Relevant to the data limitations identified in this Inventory, is a recommendation from the HWA report Growing Our Future: the Aboriginal and Torres Strait Islander health worker Project Final Report, to: Develop a national approach to collecting data on the Aboriginal and Torres Strait Islander health worker workforce to establish a consistent national dataset across employment sector. 19

20 Aboriginal mental health workers There is currently no nationally agreed definition of an Aboriginal mental health worker (AMHW), and no common expectations as to their role, required experience and/or qualifications. For example, in Queensland, the primary role of an Aboriginal and Torres Strait Islander mental health worker is described as providing cultural support and guidance to clinical staff, establishing and maintaining networks with various community organisations and providing culturally appropriate mental health and social and emotional well-being promotion and prevention programs to the Aboriginal and Torres Strait Islander Community 13. In the Northern Territory, AMHWs are described as providing a link between community, culture and practices, and government and non-government health programs, as well as working with doctors and nurses and providing support care and advice for families, individuals and groups within the community 14. The Royal Australian and New Zealand College of Psychiatrists takes a broader approach, defining Aboriginal and Torres Strait Islander mental health workers as All Aboriginal and Torres Strait Islander people who work with mental health or emotional and spiritual well-being services for Aboriginal and Torres Strait Islander people within Australia. In New South Wales, AMHWs must meet minimum qualification requirements for employment. A dedicated program also exists (the New South Wales Aboriginal Mental Health Workforce Program) to increase the supply and standing of the AMHW workforce, and increase the education, retention and representation of Aboriginal people in specialist and primary mental health service delivery 15. The lack of a nationally agreed definition is reflected in the differing levels of information and policies surrounding the AMHW workforce across jurisdictions. Some states and territories include the AMHW role under the role of Aboriginal Health Workers 16, while others have structured programs and policies specifically about AMHWs, for example the Statewide Specialist Aboriginal Mental Health Service model in Western Australia and the New South Wales Aboriginal Mental Health Workforce Program. What is the role of an Aboriginal mental health worker in mental health service provision? Despite there being no nationally agreed definition of an AMHW, role descriptions commonly refer to AMHWs working in multidisciplinary teams, and providing links between community, culture and government, and cultural support to other health workers. Services provided by AMHWs can include crisis support to community members, mental health promotion, assisting GPs and other health workers in clinical consultations, assisting people to care and primary mental health liaison and linkage with specialist acute care 17. There can be overlap between the role of an Aboriginal and Torres Strait Islander health worker and an AMHW, and the role of an AMHW can be encompassed in the broader definition of an Aboriginal and Torres Strait Islander health worker in some jurisdictions. Where a distinction is made between the two roles, the main point of difference is that an AMHWs role is specific to a mental health context, whereas this is not necessarily the case for an Aboriginal and Torres Strait Islander health worker they can work in mental health areas, however their scope of practice is generally broader. Quantitative data available for the Aboriginal mental health workforce National, publicly available information on AMHWs was not identified in the preparation of this Inventory. Unpublished data may be available from sources such as Aboriginal Medical Services. 20

21 General practice (GP) workforce GPs are medical specialists who provide primary medical care meaning person-centred, continuing, comprehensive and coordinated whole person health care to individuals and families in their communities. GPs are usually the first medical specialist a person sees for health care in Australia. GPs scope of practice is broad, spanning prevention, health promotion, early intervention, and the management of acute, chronic and complex conditions within the practice population whether in the home, practice, health service, outreach clinic, hospital or community 18. What is the role of a GP in mental health service provision? GPs are often the first health professional a person sees when seeking assistance for mental illness. GPs can undertake early intervention, assessment and management of patients with mental illness, including prescribing medication, and referring patients to other specialists, health professionals and support groups. Quantitative data available for the GP workforce NHWDS: Medical Practitioners (2010 onwards) The NHWDS combines data from the NRAS with survey data collected on each of the registered health professions at the time of annual registration renewal. It provides information on counts of medical practitioners by type of specialist (including GPs), and includes demographic and employment information. AIHW Medical Labour Force Survey (pre-2010) This was the primary data collection on registered medical practitioners prior to the NHWDS, providing information on the demographics and employment status of registered doctors. Information was collected through questionnaires administered annually by the state and territory registration boards. Information was collected on primary care practitioners, which was mostly comprised of GPs. GP Workforce Statistics Department of Health and Ageing (DOHA) DOHA GP statistics provide the number of GPs by headcount, FTE and full-time workload equivalent annually. Counted are all GPs who provided at least one Medicare Service during the reference period and had at least one claim for Medicare service processed during the same reference period. The Census The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. It is conducted every five years, and its objective is to accurately measure the number and key characteristics of people who are in Australia on Census Night, and of the dwellings in which they live. From the Census, the number and detailed characteristics (including labour force status, age, gender, hours worked and country of birth) of people who self-report as a general medical practitioner can be identified. 21

22 Characteristics of the GP workforce Table 4 presents the latest available information from the NHWDS and other sources on the GP workforce. Information presented from the NHWDS relates to employed GPs only. Table 4: Characteristics of the GP workforce Characteristics Number Year Data source Headcount 25, NHWDS FTE (a) 24,492 Full-time workload equivalent (b) 21, NHWDS DOHA FTE per 100, NHWDS Average weekly hours NHWDS Average age NHWDS Per cent female NHWDS Per cent major cities: inner regional: outer regional: remote or very remote 70: 19: 8: NHWDS Work setting Private practice Aboriginal health service Community healthcare services Hospital Residential healthcare services Commercial/business services Education facility Correctional services Defence force Other government department or agency Other Workforce inflows Vocational training positions/trainees Advanced (RACGP/ACRRM) New fellows (RACGP/ACRRM) Immigration (c) Temporary visa grants Permanent visa grants Workforce outflows Workforce vacancies 22, / / n.a. n.a NHWDS MTRP MTRP DIAC DIAC n.a. not available (a) FTE calculated based on a 40 hour standard working week. (b) Full-time workload equivalent takes into account differing working patterns of doctors, and is calculated by dividing each doctor s Medicare billing by the average billing of full-time doctors for the year. (c) For ANZSCO code General Medical Practitioner. 22

23 Data limitations The medical practitioner NHWDS provides extensive information on the demographic and employment status of GPs for workforce planning purposes. However this has only been collected Australia-wide from Caution should be used when making comparisons with historical information from the AIHW medical labour force survey due to differences in survey methodology; definitions (in the AIHW survey, information was collected on primary care practitioners, which while mostly comprised of GPs, also included other doctors providing primary care); and information collected in the AIHW survey is subject to uneven and low response rates. The GP statistics provided by DOHA includes several thousand medical practitioners who provide only small numbers of services through Medicare each year, who may not be counted in other collections. The primary limitation with GP workforce data for mental health is the difficultly in measuring a GP s specific mental health related activity. Two sources of information exist that may be useful in measuring this. Firstly, the Bettering the Evaluation and Care of Health collection, which provides information on the consultation (for example date, type of consultation), the patient s presenting problems (for example diagnoses, status of each problem), and the management for each problem (for example treatment provided, prescriptions, referrals). Secondly, through the Better Access initiative, new item numbers were added to the Medicare Benefits Schedule (MBS) to provide a rebate for selected mental health services provided by GPs and other health professionals. Therefore Medicare data, and the measurement of these MBS items may provide a guide on the amount of a GP s activity that is mental health specific. 23

24 Mental health nurses Mental health nursing is an area of nursing that focuses on meeting the mental health needs of consumers in partnership with family, significant others and the community. Mental health nurses provide care to consumers with mental illness, disorder and dysfunction such as schizophrenia, bipolar disorders, psychosis, depression and those experiencing emotional difficulties, distress and crisis in health 19. The Australian College of Mental Health Nurses (ACMHN) defines a mental health nurse as a registered nurse who holds a specialist qualification in mental health nursing. The approach adopted by the AIHW, and HWA in their publication Health Workforce 2025 Doctors, Nurses and Midwives is to classify all registered nurses and enrolled nurses who report their principal area of practice as mental health (regardless of any postgraduate qualification) as mental health nurses. This approach enables the identification of the total mental health nursing workforce. Prior to the NRAS, some jurisdictions had additional endorsements or authorisations for mental health nurses through the state and territory nursing and midwifery regulatory authorities. This is no longer the case, and completion of postgraduate qualifications in mental health nursing are not separately recognised on a nurse s registration. Despite there being no formal regulatory requirement, a postgraduate qualification is often a condition of employment for mental health nurses. Registered nurses can become credentialed mental health nurses. Credentialing is conducted through the ACMHN, and recognises the skills, expertise and experience of nurses who are practising as specialist mental health nurses. Applicants must provide evidence of a combination of postgraduate qualifications and experience as a registered nurse in a mental health setting to become credentialed 20. Credentialed mental health nurses are able to provide some Medicare services in mental health, and are also eligible for the Mental Health Nurse Incentive Program a program that helps appropriate organisations engage mental health nurses to assist in providing coordinated clinical care for people with severe mental health disorders. What is the role of a mental health nurse in mental health service provision? Mental health nurses work in hospitals, community mental health services, residential mental healthcare services, welfare and aged care facilities, correctional services and the community. The role of a mental health nurse spans the full continuum of care, ranging from the promotion of mental health through to the treatment and ongoing management and maintenance of mental illness. Quantitative data available for the mental health nurse workforce NHWDS: nurses and midwives (2011 onwards) The NHWDS combines data from the NRAS with nursing and midwifery workforce survey data collected at the time of annual registration renewal. From the NHWDS the number and characteristics (demographic and employment characteristics) of registered nurses and enrolled nurses who reported their principal area of practice as mental health are available. Information is not available on nurses with postgraduate qualifications in mental health. 24

25 AIHW Nursing and Midwifery Labour Force Survey (pre-2010) This was the primary data collection on nurses prior to the NHWDS, providing information on the demographics and employment status of respondents. Information was collected through questionnaires administered by the state and territory nursing and midwifery regulatory authorities. The last collection was in It provides a count of registered nurses and enrolled nurses who recorded their principal area of practice as mental health, and their characteristics. ACMHN data The ACMHN have a database containing information on approximately 3000 members. Information is provided by members on a voluntary basis and may include the following details; Gender Date of birth Employer practice setting Employer practice place Employee work focus Employer region Professional qualifications. The Census The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. It is conducted every five years, and its objective is to accurately measure the number and key characteristics of people who are in Australia on Census Night, and of the dwellings in which they live. From the Census, the number and characteristics of people who self-report as a registered nurse in mental health can be identified. In the Census, ANZSCO is used to classify occupations, and in this classification, a registered nurse (mental health) is defined as providing nursing care to patients with mental illness, disorder and dysfunction, and those experiencing emotional difficulties, distress and crisis in health, welfare and aged care facilities, correctional services and the community. State and Territory Nursing and Midwifery Boards (pre-2010) Prior to the introduction of the NRAS, some jurisdictions had additional endorsements or authorisations for mental health nurses through the state and territory nursing and midwifery regulatory authorities. Historical information on those with endorsements or authorisations may be available from the former boards of Queensland, South Australia, the Australian Capital Territory, Victoria and Tasmania. 25

26 Characteristics of the mental health nurse workforce Table 5 presents the latest available data from the NHWDS on employed clinical (mainly involved in care and treatment of patients, as well as supervision and management of clinical nurses) registered nurses and enrolled nurses reporting their principal area of practice as mental health. Table 5: Characteristics of the mental health nurse workforce Characteristics Registered nurses Enrolled nurses Year Data source Headcount 13, NHWDS Per cent of clinical nurses NHWDS FTE (a) 12, NHWDS FTE rate per 100, NHWDS Average weekly hours NHWDS Average age NHWDS Per cent female NHWDS Per cent major cities: inner regional: outer regional: remote or very remote 73: 20: 6: 1 73: 23 :4: < NHWDS Work setting Private practice Aboriginal health service Community healthcare service Hospital Residential healthcare services Commercial/business services Education facility Correctional services Defence force Other government department or agency Other Unknown/inadequately described/not stated NHWDS 26

27 Table 5: Characteristics of the mental health nurse workforce continued Characteristics Number Year Data source Workforce inflows: Students (b) Student commencements Bachelor Postgraduate Student completions Bachelor Postgraduate Immigration (c) Temporary visa grants Permanent visa grants Workforce outflows Workforce vacancies n.a. not available (a) FTE calculated based on a 38 hour standard working week. (b) Unpublished DIICCSRTE data, where field of education coded to mental health nursing. (c) For ANZSCO code Registered nurses (mental health) n.a. n.a DIICCSRTE DIICCSRTE DIICCSRTE DIICCSRTE DIAC DIAC Data limitations In relation to workforce stock, there is extensive data from the nursing and midwifery NHWDS and the AIHW nursing and midwifery labour force survey on the number and characteristics of registered nurses and enrolled nurses who report their principal area of practice as mental health. However within this, there is no distinction between those with mental health qualifications, and nurses without qualifications providing mental health care. Information from the nursing and midwifery NHWDS was collected nationally for the first time in 2011, meaning timeseries information is limited. Caution should also be used when making comparisons with historical information from the AIHW nursing and midwifery labour force survey due to differences in survey methodology; and information collected in the AIHW survey is subject to uneven and low response rates. While the ACMHN is a useful source of information on the number of credentialed mental health nurses, not all mental health nurses are (or need to be) credentialed. Therefore it is an incomplete data source. Also, information on data items used for workforce planning (such as hours worked) is not currently collected by the ACMHN. Any information available from former State and Territory Nursing and Midwifery Boards on endorsed or authorised mental health nurses is out-of-date for current workforce planning purposes. In relation to workforce inflows, while information is available on registered nurse graduates, and some information is available on the number of nurses obtaining postgraduate mental health qualifications, the number of nurses specifically entering mental health is unknown. In Health Workforce 2025 Doctors, Nurses and Midwives, the workforce projections for nurses by area of practice (including mental health) were based on the assumption of apportioning new graduates across areas of practice in accordance with their workforce proportion. This is a recognised limitation, however the approach was taken due to the absence of any other data. 27

28 Mental health workers Mental health worker is a generic term used to encompass a broad range of job roles and titles, but most often is used when referring to vocational education and training (VET) qualified workers. Mental health workers are usually located in the community NGO sector 21. The Certificate IV in Mental Health (first introduced into the Community Services Training Package in 1999) has been endorsed as a voluntary entry-level qualification by Community Mental Health Australia and the community managed mental health sector 22. Other qualifications relevant to career pathways for the advanced practitioner mental health worker is the Diploma in Community Services (Mental Health) and the Diploma in Community Services (Alcohol, Other Drugs and Mental Health). Occupation titles used by those completing the Certificate IV vocational training include community rehabilitation and support worker, community support worker, mental health outreach worker, mental health rehabilitation support worker and mental health support worker 23. What is the role of a mental health worker in mental health service provision? Reflecting the fact the term mental health worker is a generic description encompassing a broad range of job roles and titles, there is no common description of the role of a mental health worker. The Community Services and Health Industry Skills Council (CSHISC) describe the Certificate IV in Mental Health as focusing on rehabilitation and support for people affected by mental illness and psychiatric disability, implementing community based activities focusing on mental health, mental illness and psychiatric disability, and mental health promotion work. They further describe working in mental health as being work that may focus on engaging people with mental illness in community participation, working to prevent relapses and promoting recovery through programs such as residential rehabilitation, work in clinical settings, home based outreach and centre-based programs delivered by community based NGOs. This work may also involve supported employment and programmed respite care 24. Quantitative data available for the mental health worker workforce Routine quantitative data is not available on mental health workers, given it is a generic term that encompasses a range of roles and job titles, and there is an absence of routine data collections for community sector mental health work roles/ settings. Information is available on the number of people who have completed relevant vocational qualifications, and is presented in Table 6 for information. Table 6: Number of qualifications completed, 2010 and 2011 Course Per cent increase Certificate IV in Mental Health Males Females Persons Diploma of Community Services (Mental Health) Males 0 15 Females Persons Diploma of Community Services (Alcohol, Other Drugs and Mental Health) Males Females Persons Source: VocStats, NCVER 28

29 Data limitations The lack of any national data collected consistently, using a standard definition for mental health workers is a major data gap. More broadly, the lack of information on the mental health NGO sector (whose contribution to mental health service provision has increased substantially over the last decade) is a significant data gap in understanding the mental health sector, and the mental health workforce. In 2009 and 2010 the Mental Health Non-Government Organisation (NGO) Workforce Project 25 was conducted, which aimed to: Test a methodology and approach to workforce data collection for the Mental Health NGOs. Use the pilot process to provide a degree of greater understanding of the sector and its workforce. One of the recommendations from this pilot was: The development of agreed national definitions and a data dictionary which includes a list of standard classifications for organisation, service, workforce and other related categories to describe the work of the Mental Health NGO sector. From this pilot, the AIHW is currently developing the MH NGOE NMDS. Once established, the MH NGOE NMDS will allow routine, standardised collection of data relating to mental health NGOs, including some information on the workforce delivering services. Given the focus of other NMDS collections is to provide a picture of the establishments and services provided (refer What information is available to measure demand for workforces providing mental health services? ), it is likely only limited information on the workforces delivering NGO services will be collected. In relation to NCVER data on numbers of qualifying vocationally-trained workers, the limitation of this information is that it is only collected from publicly-funded Registered Training Organisations (RTOs). A number of private RTOs deliver VET training, for example the Mental Health Coordinating Council delivers the Certificate IV in Mental Health (with 156 course completions in ) 26. This information is not currently included in NCVER data, therefore complete information on those obtaining qualifications is not currently available. NCVER have advised that non-publicly funded RTO information will be included in their data collections from

30 Occupational therapists Occupational therapists (OTs) work with people of all ages with a variety of conditions caused by injury, illness, psychological or emotional difficulties, developmental delay, or the effects of ageing. Their goal is to assist individuals to improve their everyday functional abilities in order to allow greater independence, well-being, participation and quality of life 27. OTs can provide services under the Better Access to Mental Health Care Initiative. Under this initiative, Medicare rebates are available to patients for selected mental health services provided by GPs, psychiatrists, psychologists (clinical and registered), eligible social workers and OTs. OTs providing services under this initiative must apply through Occupational Therapy Australia. To be eligible, OTs must: Be registered with the Occupational Therapy Board of Australia and have no limitations of provisions attached to their registration. Have a Medicare Australia provider number. Have a minimum of 2 years of supervised practice as an OT working in mental health. Be a full-time or part-time member of Occupational Therapy Australia (or pay an application assessment fee). Satisfy all units of competency as set out in the Australian Competencies for Occupational Therapists in Mental Health (1999) 28. What is the role of an occupational therapist in mental health service provision? In the field of mental health, OTs specialise in assessing how an individual s mental illness impacts on their ability to function in their everyday occupations and roles. Mental health OTs provide individual and group assessment and intervention in hospital, community, home and work environments. A mental health OT assists people to better understand their mental health condition and take an active part in their wellness. They assist people with mental illness to develop skills to live more independently in the community 29. Quantitative data available for the occupational therapy workforce NHWDS: Occupational Therapists (2012 onwards) The NHWDS combines data from the NRAS with OT workforce survey data collected at the time of annual registration renewal. From the NHWDS the number and characteristics (demographic and employment characteristics) of OTs is available. AIHW Occupational Therapy Labour Force Survey (pre-2010) The AIHW Occupational Labour Force Survey was conducted infrequently the most recent collection was and 1998 prior to that. This survey provided information on the demographics and employment status of OTs. In survey collection methods varied across jurisdictions due to the different governance structures that existed prior to national registration. In the Northern Territory, South Australia and Queensland the survey was conducted by the relevant state and territory registration bodies. In Western Australia, Tasmania and the Australian Capital Territory, the national office of Occupational Therapy Australia sent surveys to its members. In Victoria and New South Wales the relevant Occupational Therapy Australia state office was responsible for conducting the survey. Mental Health Establishment National Minimum Dataset (MHE NMDS) The MHE NMDS collects information from all specialised mental health services that are managed or funded by state and territory health authorities annually. Data reported includes the number of FTE OTs. 30

31 The Census The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. It is conducted every five years, and its objective is to accurately measure the number and key characteristics of people who are in Australia on Census Night, and of the dwellings in which they live. From the Census, the number and characteristics (including labour force status, age, gender, hours worked and country of birth) of people who self-report as an OT can be identified. Characteristics of the OT workforce Table 7 presents the latest available information from the NHWDS and other sources on the OT workforce. Information presented from the NHWDS relates to employed clinical OTs only those who spent the majority of their time working on the diagnosis, care and treatment (including preventative action) of patients or clients. NHWDS information is for New South Wales, Victoria, Tasmania, the Australian Capital Territory and the Northern Territory only. Due to transitional arrangements for NRAS, many OTs in Queensland, South Australia and Western Australia were not required to renew their registrations and therefore did not complete workforce surveys in Table 7: Characteristics of the OT workforce Characteristics Number Year Data source Headcount NHWDS FTE (a) NHWDS FTE per 100, NHWDS Average weekly hours NHWDS Average age NHWDS Per cent female NHWDS Per cent major cities: inner regional: outer regional: remote or very remote 76: 19: 4: < NHWDS Work setting Private practice Aboriginal health service Community healthcare service Hospital Residential healthcare services Commercial/business services Education facility Correctional services Defence force Other government department or agency Other Unknown/inadequately described/not stated Workforce inflows Students (b) Student commencements Student completions Immigration (c) Temporary visa grants Permanent visa grants Workforce outflows n.a NHWDS DIICCSRTE DIICCSRTE DIAC DIAC 31

32 Table 7: Characteristics of the OT workforce continued Characteristics State Number Year Data source Workforce vacancies: Current labour market ratings NSW VIC QLD SA WA TAS NT ACT: Recruitment difficulty Metropolitan recruitment difficulty, regional shortage Regional Shortage No shortage Recruitment difficulty Recruitment difficulty Recruitment difficulty Shortage Apr 2012 Apr 2012 Mar 2012 Jan 2012 Mar 2012 Feb 2012 Mar/Apr 2012 Feb 2012 DEEWR n.a. not available (a) FTE calculated based on a 38 hour standard working week. (b) In tertiary courses coded to the occupational therapy field of education. May include students in a course that does not lead to registration as an occupational therapist. (c) For ANZSCO code 2524 Occupational Therapist. Data limitations For the first time, the OT NHWDS will provide extensive information on the demographic and employment status of OTs for workforce planning purposes on an annual basis. However, the 2012 OT NHWDS does not contain national information. This is because some practitioners transitioned to the national scheme from local boards with different registration renewal cycles, and it will be from 2013 that registration renewal dates will align nationally. This means 2013 will be the first year the OT NHWDS offers a comprehensive national data collection. There is limited historical information on the OT workforce, with the exception of Census information. However concerns with Census information for workforce planning purposes include the fact information is self-reported, and as the Census is conducted every five-years, information is quickly out-of-date for workforce planning purposes. In looking forward, even with the NHWDS, the primary limitation with OT workforce data for mental health is the difficultly in measuring OT specific mental health related activity. Medicare data can provide some information on mental health services provided by OTs (as OTs have specific MBS item numbers under the Better Access initiative), however this is likely to represent only a small percentage of OT mental health specific service provision. 32

33 Peer workers Peer workers are a relatively new and evolving workforce. Peer work had its origin in self-help and mutual support movements that were volunteer in nature 30. People came together to help one another, often meeting in groups for support, or to advocate for better services. Recently, peer work has evolved into more formalised approaches, and people can be employed as peer workers in varying roles. Definitions of peer workers vary. Peer work requires that lived experience of mental illness and recovery is an essential criterion of job descriptions, although job titles and related tasks vary 31. Peer support, which is one element of peer work, is based on the belief that people who have faced, endured and overcome adversity can offer useful support, encouragement, hope, and mentorship to others facing similar situations 32. Peer workers may work in a paid or volunteer capacity. Many different position titles are used when referring to a peer worker including consumer companion, consumer support worker, peer support worker, peer educator, carer support worker, consumer worker or carer worker. HWA is conducting the Mental Health Peer Workforce project, which aims to develop a better understanding of the peer workforce in Australia and barriers to their use; and to provide policy advice on training, regulatory and practice changes required to establish a career pathway for peer workers into the mental health workforce. For the purpose of the HWA s peer workforce project, and consequently for the purpose of this Inventory, peer workers are defined as people who are employed in roles that require them to identify as being, or having been a mental health consumer or carer. Peer work requires that lived experience of mental illness is an essential criterion of job descriptions, although job titles and related tasks vary. What is the role of a peer worker in mental health service provision? Peer workers can work as members of a multidisciplinary support team, working alongside clinical and other team members. Peer workers undertake a range of roles in different mental health service settings. They may, for example, provide individual support, deliver education programs for mental health workers, provide support for housing and employment, advocate for systemic improvements, or run groups or activities. Quantitative data available for the peer worker workforce There is no quantitative information available on peer workers that specifically use the peer worker definition adopted by HWA. Even considering broader titles and definitions used to describe peer workers, there is limited quantitative information available. Information identified in developing this Inventory that relates to broader titles commonly used to describe peer workers is presented here for information, and to highlight the lack of information available: The 2010 National Mental Health Report reported in 2008 that across the 221 public mental health service organisations nationally, only 64 consumers and 27 carers (FTE) were employed in this capacity. The AIHW reported there were 68.5 FTE consumer workers and 43.4 FTE carer workers employed in specialised mental health care facilities in , and that between and there was an average annual increase of 4.7 percent in consumer workers and 17.1 percent in carer workers 33. The Department of Families, Housing, Community Services and Indigenous Affairs advised that as at 30 June 2013, the Personal Helpers and Mentors (PHaMs) initiative included 217 peer workers nationally. The PHaMs program supports participants in their recovery journey, building long-term relationships, providing holistic support and ensuring services access by participants are coordinated, integrated and complementary to other services in the community

34 Also, in 2012 a Certificate IV in Mental Health Peer Work was endorsed. In the future, information will be available on the number of people commencing and completing this qualification. Data limitations The lack of any national data collected consistently, using a standard definition for peer workers is a major data gap. More broadly, the lack of information on the mental health NGO sector (whose contribution to mental health service provision has increased substantially over the last decade) is a significant data gap in understanding the mental health sector, and the mental health workforce. In 2009 and 2010 the Mental Health Non-Government Organisation (NGO) Workforce Project 35 was conducted, which aimed to: Test a methodology and approach to workforce data collection for the Mental Health NGOs. Use the pilot process to provide a degree of greater understanding of the sector and its workforce. From this pilot, the AIHW is currently developing the MH NGOE NMDS. Once established, the MH NGOE NMDS will allow routine, standardised collection of data relating to mental health NGOs, including some information on the workforce delivering services. The planned implementation for the MH NGOE NMDS is

35 Psychologists Psychologists are experts in human behaviour. They use scientific methods to study the factors that influence the way that people think, feel and learn, and use evidence-based strategies and interventions to help people to overcome challenges and improve their lives 36. What is the role of a psychologist in mental health service provision? Psychology is a broad profession and individuals can focus on a wide range of areas and workplaces. Many psychologists work directly with those experiencing difficulties, such as mental health disorders including anxiety and depression. Common settings in which psychologists work to assess, diagnose, treat or prevent problems include schools, hospitals, courts, community health services, prisons, the defence forces and private practice 37. Under NRAS, psychologists with additional qualifications or advanced supervised practice can obtain an endorsement on their registration. Nine areas of endorsement are available to psychologists clinical psychology, counselling psychology, forensic psychology, clinical neuropsychology, organisational psychology, sport and exercise psychology, educational and developmental psychology, health psychology and community psychology. Quantitative data available for the psychology workforce NHWDS: Psychologists (2011 onwards) The NHWDS: Psychologists combines data from the NRAS with psychology workforce survey data collected at the time of annual registration renewal. From the NHWDS the number, demographic and employment characteristics of psychologists is available. The NHWDS: Psychologists also provides information on the number and characteristics of psychologists within each area of endorsement. National Psychology Workforce Survey This was conducted in 2008 by the Council of Psychologists Registration Boards (the forerunner to the Psychology Board of Australia) in collaboration with the Australian Psychological Society. The aim of the survey was to collect information about the psychology workforce to inform workforce planning, with information collected including work setting, role, service location and client type. MHE NMDS The MHE NMDS collects information from all specialised mental health services that are managed or funded by state and territory health authorities annually. Data reported includes the number of FTE psychologists. The Census The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. It is conducted every five years, and its objective is to accurately measure the number and key characteristics of people who are in Australia on Census Night, and of the dwellings in which they live. From the Census, the number and characteristics (including labour force status, age, gender, hours worked and country of birth) of people who self-report as psychologist can be identified. AIHW Psychology Labour Force Survey 2003 This report was released by the AIHW in 2006 and presents statistics on the size and growth of registered psychologists in Australia. Data were collected from a number of sources including a 2003 survey of psychologists conducted in New South Wales, Victoria, Queensland, South Australia and the Australian Capital Territory, administrative records from the state and territory psychology registration board, and the Australian Bureau of Statistics Labour Force Survey. 35

36 Characteristics of the psychology workforce Table 8 presents the latest available information from the NHWDS and other sources on the psychology workforce. Information presented from the NHWDS relates to employed psychologists (regardless of their area of endorsement). Table 8: Characteristics of the psychology workforce Characteristics Number Year Data source Headcount Headcount by area of endorsement Clinical psychology Counselling psychology Forensic psychology Clinical neuropsychology Organisational psychology Health psychology Community psychology Educational and developmental psychology Sport and exercise psychology 22, NHWDS FTE (a) 19, NHWDS FTE per 100, NHWDS Average weekly hours NHWDS Average age NHWDS Per cent female NHWDS Per cent major cities: inner regional: outer regional: remote or very remote 82: 12: 5: NHWDS Work setting Private practice Aboriginal health service Community healthcare service Hospital Residential healthcare services Commercial/business services Education facility Correctional services Defence force Other government department or agency Other Unknown/inadequately described/not stated Workforce inflows Provisional Registrations (b) Immigration (c) Temporary visa grants Permanent visa grants NHWDS NHWDS DIAC DIAC 36

37 Table 8: Characteristics of the psychology workforce continued Characteristics Number Year Data source Workforce outflows Workforce vacancies Current labour market rating Suitable applicants per vacancy Vacancies filled within six weeks of advertising n.a. No shortage per cent Feb DEEWR DEEWR DEEWR n.a. not available (a) FTE calculated based on a 38 hour standard working week. (b) Graduates of approved programs of study must complete a period of supervised practice to be eligible for general registration as a psychologist. Provisional registration is granted for the supervised practice period. (c) For ANZSCO code 2723 Psychologist. Data limitations The psychology NHWDS provides extensive information on the demographic and employment status of psychologists for workforce planning purposes on an annual basis. The primary limitation with this collection is its current limited ability to provide time-series information, given it has only been collected Australia-wide from There is limited historical information on the psychology workforce aside from one-off or infrequent collections. Particular concerns exist with the 2003 AIHW Psychology Labour Force Survey, where the definition of clinical psychology used in the survey (regarded as the assessment, diagnosis and treatment of psychological problems and mental illness by a registered psychologist) did not align with the clinical psychologist role defined by the Australian Psychological Society College of Clinical Psychologists ( psychologists with a minimum of six years university training, including approved postgraduate clinical studies and placements in psychiatric settings ) 38. While information from Census provides long-term times-series information, the ANZSCO definition of a psychologist (at its broadest level) includes psychotherapists, and at the detailed level, the ANZSCO categories (of clinical psychologist, educational psychologist, organisational psychologist, psychotherapist and psychologists not elsewhere classified) do not align with the registration areas of endorsement. This means comparisons at a detailed level across data collections is not possible. 37

38 Psychiatrists A psychiatrist is a qualified medical doctor who has obtained additional qualifications to become a specialist in the diagnosis, treatment and prevention of mental illness and emotional problems. Psychiatrists are trained to recognise and treat the effects of emotional disturbances on the body as a whole, and the effects of physical conditions on the mind 39. What is the role of a psychiatrist in mental health service provision? Psychiatrists are one of few professions whose entire clinical activity is dedicated to mental health. Psychiatrists work in a variety of settings, including general and psychiatric hospitals, universities, community mental health services and public and private clinics. Many psychiatrists have a predominantly private practice. Others work mainly in hospitals or in prisons, or in a variety of public health facilities. Some work in more than one area, such as combining work in a public hospital with a private practice. Psychiatrists can also focus on areas of practice such as child and adolescent, aged or forensic psychiatry 40. Quantitative data available for the psychiatry workforce NHWDS: Medical Practitioners (2010 onwards) The NHWDS combines data from the NRAS with survey data collected on each of the registered health professions at the time of annual registration renewal. It provides information on counts of medical practitioners by type of specialist (including psychiatrists), and includes demographic and employment information. AIHW Medical Labour Force Survey (pre-2010) This was the primary data collection on registered medical practitioners prior to the NHWDS, providing information on the demographics and employment status of registered doctors. Information was collected through questionnaires administered by the state and territory registration boards. Information was collected on medical specialists, which included psychiatrists. MHE NMDS The MHE NMDS collects information from all specialised mental health services that are managed or funded by state and territory health authorities annually. Data reported includes numbers of FTE staff, including for the categories of consultant psychiatrists and psychiatrists. The Royal Australian New Zealand College of Psychiatrists (RANZCP) RANZCP is responsible for training, educating and representing psychiatrists in Australia and New Zealand. RANZCP conducted an online survey of fellows and affiliates in 2008, with limited results published online. The results are available at the following location: The Census The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. It is conducted every five years, and its objective is to accurately measure the number and key characteristics of people who are in Australia on Census Night, and of the dwellings in which they live. From the Census, the number and detailed characteristics (including labour force status, age, gender, hours worked and country of birth) of people who self-report as a psychiatrist can be identified. 38

39 Characteristics of the psychiatry workforce Table 9 presents the latest available information from the NHWDS and other sources on the psychiatry workforce. Information presented from the NHWDS relates to employed clinical psychiatrists only those who spent the majority of their time working on the diagnosis, care and treatment (including preventative action) of patients or clients. Table 9: Characteristics of the psychiatry workforce Characteristics Number Year Data source Headcount NHWDS FTE (a) NHWDS FTE per 100, NHWDS Average weekly hours NHWDS Average age NHWDS Per cent female NHWDS Per cent major cities: inner regional: outer regional: remote or very remote 87: 9: 2: NHWDS Work setting Private practice Aboriginal health service Community healthcare service Hospital Residential healthcare services Commercial/business services Education facility Correctional services Defence force Other government department or agency Other Unknown/inadequately described/not stated Workforce inflows Basic trainees Advanced trainees New fellows Immigration (b) Temporary visa grants Permanent visa grants Workforce outflows Workforce vacancies n.a. n.a NHWDS MTRP MTRP MTRP DIAC DIAC n.a. not available (a) FTE calculated based on a 40 hour standard working week. (b) For ANZSCO code 2534 Psychiatrists. 39

40 Data limitations For workforce planning purposes, the medical practitioner NHWDS provides extensive information on the demographic and employment status of psychiatrists. The primary limitation with this collection is its current limited ability to provide time-series information, given it has only been collected Australia-wide from Caution should be used when making comparisons with historical information from the AIHW medical labour force survey due to differences in survey methodology; and information collected in the AIHW survey is subject to uneven and low response rates. The MHE NMDS provides only partial coverage of mental health services it does not cover the non-clinical sector and NGOs, or services that are not funded by state or territory governments. The dataset also only provides limited information on psychiatrists, as the purpose of the dataset is to provide a picture of mental health establishments, not staffing. Only limited information is publicly available from the survey run by the RANZCP. It also appears to be a one-off collection from 2008, which is not current compared with the medical practitioner NHWDS. While time-series information on psychiatrists is available from the Census, information is self-reported, and responses provided depend on an individual s understanding and interpretation of the questions asked. For example, people who self-report as a psychiatrist may not have appropriate qualifications or registration. In addition, being conducted every five years (while providing information on long-term trends) means information is quickly out-of-date for workforce planning purposes. 40

41 Registered nurses and Enrolled nurses A registered nurse (RN) is qualified to assess, plan, provide and evaluate preventative, curative and rehabilitative care to people in their homes, private and public hospitals, aged care facilities, general practices and other health and community organisations. RNs practise independently and interdependently, assuming accountability and responsibility for their own actions and delegation of care to other healthcare workers. RNs have completed as a minimum, a threeyear bachelor degree. Enrolled nurses (ENs) usually work with registered nurses to provide patients with basic nursing care, doing less complex procedures than RNs. ENs must have completed an appropriate VET course or equivalent, lasting between 1 and 2 years, providing a theoretical base as well as supervised clinical experience. What is the role of RNs and ENs in mental health service provision? It should be noted this Inventory entry is not for RNs and ENs who are mental health nurses defined by HWA (and the AIHW) as an RN or EN who reported their principal area of practice as mental health in the nursing and midwifery NHWDS (refer to the Mental Health Nurse data inventory entry). RNs and ENs generalist roles, particularly in primary and community care based settings, can be involved in mental health service provision, assisting consumers and carers. Quantitative data available for RNs and ENs NHWDS: nurses and midwives (2011 onwards) The NHWDS combines data from the NRAS with nursing and midwifery workforce survey data collected at the time of annual registration renewal. From the NHWDS the number and characteristics (demographic and employment characteristics) of all RNs and ENs are available. AIHW Nursing and Midwifery Labour Force Survey (pre-2010) This was the primary data collection on nurses prior to the NHWDS, providing information on the demographics and employment status of respondents. Information was collected through questionnaires administered by the state and territory nursing and midwifery regulatory authorities. The last collection was in It provides a count of all RNs and ENs. The Census The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. It is conducted every five years, and its objective is to accurately measure the number and key characteristics of people who are in Australia on Census Night, and of the dwellings in which they live. From the Census, the number and characteristics of people who self-report as a RN or EN can be identified. Characteristics of the RN and EN workforces Table 10 presents the latest available data from the NHWDS on all clinical RNs and ENs except those that reported their principal area of work as being in a mental health setting (which are included in the Mental Health Nurse entry in this inventory). 41

42 Table 10: Characteristics of the Registered Nurse and Enrolled Nurse workforces Characteristics Registered nurses Enrolled nurses Year Data source Headcount 161,471 37, NHWDS FTE (a) 137,675 30, NHWDS FTE rate per 100, NHWDS Average weekly hours NHWDS Average age NHWDS Per cent female NHWDS Per cent major cities: inner regional: outer regional: remote or very remote 71: 18: 8: 2 59: 25: 13: NHWDS Work setting Private practice Aboriginal health service Community healthcare service Hospital Residential healthcare services Commercial/business services Education facility Correctional services Defence force Other government department or agency Other Unknown/inadequately described/not stated , ,970 16, ,999 11, NHWDS 42

43 Table 10: Characteristics of the Registered Nurse and Enrolled Nurse workforces continued Characteristics Number Year Data source Workforce inflows: Student commencements Registered (b) Enrolled (c) Student Completions Registered (b) Enrolled (c) Immigration Registered (d) Temporary visa grants Permanent visa grants Enrolled (c) Temporary visa grants Permanent visa grants Workforce outflows Workforce vacancies Registered Enrolled 17,790 12,546 10, n.a. Recruitment difficulty for senior positions and those requiring specialist experience Shortage DIICCSRTE NCVER DIICCSRTE NCVER DIAC DIAC DIAC DIAC DEEWR DEEWR n.a. not available. (a) FTE calculated based on a 38 hour standard working week. (b) Students completing a general nursing course required for initial registration. (c) For ANZSCO code 4114 Enrolled and Mothercraft Nurses. (d) For ANZSCO codes to , and to (all Registered nurse ANZSCO codes except Registered nurse mental health). Data limitations The same as for mental health nurses, there is extensive information available from the nursing and midwifery NHWDS and the AIHW nursing and midwifery labour force survey on the number and characteristics of RNs and ENs. However unlike mental health nurses, whose entire clinical activity is dedicated to mental health, RNs and ENs conduct a substantial amount of work outside of mental health service provision. Consequently, a major limitation for workforce planning is the difficulty in measuring specific RN and EN mental health related activity (separate to mental health nurse activity) there are currently no data sources available to do this. 43

44 Social workers Social Workers apply knowledge and skills from the social and behavioural sciences to enable individuals, families, groups and communities to solve problems and achieve good health and wellbeing. The focus of social work practice is the social context and social consequences of illness, disability and social disadvantage. Social workers are committed to facilitating people to achieve social justice. Social work interventions are directed not just at individuals but will engage aspects of the individual s environment to achieve structural and community changes. The Australian Association of Social Workers (AASW) is the lead national association of professional social workers in Australia. Eligibility and/or membership of the AASW is often a condition of employment for social workers. To be eligible for membership of the AASW, an individual must hold either an AASW approved social work degree from an Australian tertiary institution, or a comparable international qualification. Social workers are engaged in many fields of practice in the public, non-government and private sectors. Social workers can specialise in areas such as the use of evidence-based interpersonal therapies, community work, social policy development, management and in research. In a health setting, including mental health, social workers often operate as members of a multidisciplinary care team. Interventions provided by social workers in health and mental health care include individual and family counselling/therapy, mediation, group education, arranging social, financial or other support and referral advice, depending upon the person s needs. Social workers in private practice can become Accredited Mental Health Social Workers (AMHSW) by acquiring additional training and skills in assisting people with diagnosed mental health conditions. AMHSWs are eligible for a Medicare provider number and work with people referred by GPs under Commonwealth-funded programs including ATAPS and Better Access to Mental Health Care. What is the role of a social worker in mental health service provision? Social workers are involved in mental health service provision in public and non-government services, and in a private capacity, for example as an AMHSW. Social workers roles are influenced by the service type and setting, for example, whether they are part of an acute inpatient or outreach program, a sub-acute residential facility, a tailored rehabilitation program or a case management service. AMHSWs in the private sector tend to provide services to people with high prevalence mental illnesses and disorders of moderate to severe intensity. The role of an AMHSW can be described as a therapist who uses a suite of interventions prescribed under Focussed Psychological Strategies in the Commonwealth Government s Better Access and ATAPS programs. The common themes to social work practice in all mental health settings are: A comprehensive psychosocial assessment with the person and where appropriate, their family. Developing a person-centred approach and using evidenced based therapeutic skills to motivate change toward recovery. Engaging personal and situational strength to promote and sustain recovery in people with mental illness. Where there are non-medical issues affecting mental health, connecting the person (and their family) to external services and resources to assist in achieving identified health and related outcomes. Quantitative data available for the social worker workforce The Census The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. It is conducted every five years, and its objective is to accurately measure the number and key characteristics of people who are in 44

45 (including labour force status, age, gender, hours worked and country of birth) of people who self-report as a social worker can be identified. AASW data The AASW maintain a register of all its members. Information may be available through this source into the future. MHE NMDS The MHE NMDS collects information from all specialised mental health services that are managed or funded by state and territory health authorities annually. Data reported includes the number of FTE social workers. Characteristics of the social worker workforce Table 11 presents the latest available information from the Census and other selected sources on social workers. Information presented from the Census relates to those people who reported their occupation as a social worker, and their highest level of education as a bachelor or postgraduate qualification in social work. Table 11: Characteristics of the social worker workforce Characteristics Number Year Data source Headcount: Total social workers AMHSWs 10, Census AASW 42 FTE (a) Census FTE per 100, Census Average weekly hours Census Average age Census Per cent female Census Per cent major cities: inner regional: outer regional: remote or very remote 75: 16: 7: Census Sector (public: private) 57: Census Workforce inflows Students (b) Commencements Completions Immigration (c) Temporary visa grants Permanent visa grants Workforce outflows Workforce vacancies Current labour market rating Suitable applicants per vacancy Vacancies filled within six weeks of advertising n.a. No shortage per cent Feb DIICCSRTE DIICCSRTE DIAC DIAC DEEWR DEEWR DEEWR n.a. not available (a) FTE calculated based on a 38 hour standard working week. (b) In tertiary courses coded to the social work field of education. Includes students in courses not accredited by the AASW. (c) For ANZSCO code 2725 Social Worker. 45

46 Data limitations While several information sources exist to describe the social worker workforce, each has limitations for workforce planning purposes: The Census Information from the Census is self-reported, and responses provided depend on an individual s understanding and interpretation of the questions asked. For example, people who self-report as a social worker may not meet the occupational definition of a social worker, or have appropriate qualifications or experience. Some refinement of Census data can better identify the target workforce (as in the table above, where information is presented for those people who reported their occupation as a social worker, and their highest level of education as a bachelor or postgraduate qualification in social work), however for workforce planning purposes, Census information is also quickly out-of-date. AASW Membership of the AASW is voluntary, so information available is unlikely to be representative of all social workers. The MHE NDS The MHE NDS does not provide coverage of all mental health services it covers specialised mental health services that are managed or funded by state and territory health authorities, and does not cover the non-clinical sector and NGOs, or services not funded by state or territory governments. The purpose of the dataset is to provide a picture of mental health establishments, so information available on the characteristics of social workers (beyond FTE) is limited. Social workers conduct work outside of mental health service provision. A consequent limitation for workforce planning is the difficulty in measuring specific social worker mental health related activity. While the MHE NMDS measures mental health service activity (through items such as number of separations and number of episodes of residential care), as well as the number of FTE social workers (and other workers), service activity is not allocated across the mental health workforces. This means it is not known how much activity conducted in establishments in scope of the MHE NMDS collection, is conducted by social workers. Medicare data can provide some information on mental health services provided AMHSWs (as AMHSWs have specific MBS item numbers), however this is likely to represent only a small percentage of social workers mental health specific service provision. 46

47 Other significant workforces In addition to those workforces whose primary role is in the early intervention, referral, treatment, care or support to people with a mental illness, other workforces can also have significant role in delivering services to mental health consumers, particularly as part of interprofessional multidisciplinary teams. For this reason, the following workforces were identified as in scope of the Inventory: Dietitians. Pharmacists. Speech pathologists. The following Inventory entries provide summary information on: The role of each of these workforces generally, and more specifically within mental health service provision. Data available, including a snapshot of latest available data. Data limitations. 47

48 Dietitians Dietitians contribute to health promotion and the prevention and treatment of illness by optimising the nutrition of communities and individuals. Dietetics uses scientific principles and methods in the study of nutrition and applies these to influencing the wider environment affecting food intakes and eating behaviours. Accredited Practising Dietitians (APDs) have the qualifications and skills to modify diets and to treat diseases and conditions such as diabetes, obesity, cancer, heart disease, renal disease, gastro-intestinal diseases and food allergies. In Australia, dietitians who have graduated from a university course accredited by the Dietitians Association of Australia (DAA) are eligible to apply for the APD credential. Eligibility for APD status, current APD status or eligibility for full DAA membership is often a prerequisite of many dietetic positions in Australia. APD status is required for a Medicare or Department of Veterans Affairs provider number, and for provider status with many private health insurers 43. What is the role of a dietitian in mental health service provision? A number of mental illnesses either the illness itself or the medication taken for the illness can affect appetite and food eaten. Dietitians can have significant involvement with mental health issues through clinical community and food services roles, working intensely with mental illnesses such as eating disorders, and more broadly with other health conditions that have mental illness as a co-morbidity 44. In particular, APDs identify, assess and monitor the mental and physical health risks associated with food and nutrition, and plan and manage the nutrition and dietetic care, lifestyle and well-being of people with mental illness 45. Activities dietitians working in a mental health service setting commonly engage in include: group education professional development, advocacy and resource provision for mental health professionals food service menu planning and training for food service staff consultation and involvement in mental and physical health promotion activities. Quantitative data available for the dietitian workforce The Census The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. It is conducted every five years, and its objective is to accurately measure the number and key characteristics of people who are in Australia on Census Night, and of the dwellings in which they live. From the Census, the number and characteristics (including labour force status, age, gender, hours worked and country of birth) of people who self-report as a dietitian can be identified. DAA The DAA is the peak body of dietetic and nutrition professionals in Australia. The DAA collects data on its members, and membership is open to all dietitians who have successfully completed a DAA accredited course or successfully passed the dietetics examination for overseas-trained dietitians. Information on the workforce characteristics of DAA members may be available on request. 48

49 Characteristics of the dietitian workforce workforce Table 12 presents the latest available information from the Census and other selected sources on dietitians. Please note, information from the Census is presented for those people who reported their occupation as a dietitian, and their highest level of education as a bachelor or postgraduate qualification in nutrition and dietetics. Table 12: Characteristics of the dietitian workforce Characteristics Number Year Data source Headcount Census FTE (a) Census FTE per 100, Census Average weekly hours Census Average age Census Per cent female Census Per cent major cities: inner regional: outer regional: remote or very remote 79: 13: 6: Census Per cent sector (public: private) 53: Census Workforce inflows Students (b) Student commencements Student completions Immigration Temporary visa grants Permanent visa grants Workforce outflows Workforce vacancies n.a. n.a DIICCSRTE DIICCSRTE DIAC DIAC n.a. not available (a) FTE calculated based on a 38 hour standard working week. (b) Student commencements and completions from University courses accredited or provisionally accredited by the DAA (as at 28 June 2013). Data limitations The Census is the primary data source available providing detailed national information on the dietitian workforce. For workforce planning purposes, the primary limitations with census data are that information is self-reported, and responses provided depend on an individual s understanding and interpretation of the questions asked. For example, people who self-report as a dietitian may not meet the occupational definition of a dietitian, or have appropriate qualifications. Some refinement of Census data can better identify the target workforce (as in the table above, where information is presented for those people who reported their occupation as a dietitian, and their highest level of education as a bachelor or postgraduate qualification in nutrition and dietetics), however for workforce planning purposes, Census information is also quickly out-of-date. Dietitians conduct a substantial amount of work outside of mental health service provision. Consequently, a major limitation for workforce planning is the difficulty in measuring specific dietitian mental health related activity there are currently no data sources available to do this. 49

50 Pharmacists The role of a pharmacist encompasses counselling patients on the best use of medications, providing advice on symptoms, the management of common ailments, preparing and formulating medications, preventing possible and resolving actual drug interactions, medication side-effects and adverse events, and providing health education. The practice of pharmacy includes the custody, preparation, dispensing and provision of medicines, together with systems and information to assure quality of use. Pharmacists provide primary health care including education and advice to promote good health and to reduce the incidence of illness 46. What is the role of a pharmacist in mental health service provision? Medication is a significant form of treatment for many mental illnesses, with 31.1 million mental health-related prescriptions in Australia in (which comprised 11 percent of all medications subsidised under the Pharmaceutical Benefits Scheme) 47. Pharmacists often work as part of a multidisciplinary team, including specialised community mental health care teams, to ensure the safe and effective use of medications, and due to their accessibility to consumers and carers, community pharmacists are frequently consulted for advice on psychotropic (mood-altering) medications 48. Accredited pharmacists can also conduct medicine reviews, which aim to increase quality use of medicines and reduce adverse medicine events. Quantitative data available for the Pharmacy workforce NHWDS: Pharmacists (2011 onwards) The NHWDS combines data from the NRAS with pharmacy workforce survey data collected at the time of annual registration renewal. From the NHWDS: Pharmacists the number, demographic and employment characteristics of pharmacists is available. AIHW Pharmacy Labour Force Survey (pre-2010) National pharmacist labour force collections were conducted in 1994, 1995, 1996 and 1999, with results from all collections published in the AIHW report Pharmacy labour force to 2001 (released in 2003). The report presents demographic and labour force information on pharmacists in Australia for the selected years. The last survey in 1999 was conducted with the assistance of state and territory registration boards, where each pharmacy board sent a survey questionnaire to pharmacists as part of the annual registration renewal process. The Census The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. It is conducted every five years, and its objective is to accurately measure the number and key characteristics of people who are in Australia on Census Night, and of the dwellings in which they live. From the Census, the number and characteristics (including labour force status, age, gender, hours worked and country of birth) of people who self-report as a pharmacist can be identified. The Pharmacy Guild of Australia: Guild Digest The Pharmacy Guild of Australia (the Guild) conducts an annual survey of its members and publishes the results through the Guild Digest. The Guild Digest provides a snapshot of pharmacy operations over a financial year and generates a comprehensive analysis of pharmacy demographics. 50

51 The Pharmacy Guild of Australia e-census The Guild have also conducted two major Census collections the first in 2006 and the second in The Census consists of 40 detailed questions, which aim to explore the demographics of, and range of services provided by, community pharmacists. Results from the e-census inform publicly searchable sites such as au, which provides information on the location and ranges of services provided by community pharmacists. Characteristics of the pharmacy workforce Table 13 presents the latest available information from the pharmacy NHWDS and other sources on the pharmacy workforce. Information presented from the pharmacy NHWDS relates to employed clinical pharmacists only, which includes those pharmacists conducting medication reviews and managers also providing clinical services. Table 13: Characteristics of the pharmacy workforce Characteristics Number Year Data source Headcount 17, NHWDS FTE (a) 16, NHWDS FTE per 100, NHWDS Average weekly hours NHWDS Average age NHWDS Per cent female NHWDS Per cent major cities: inner regional: outer regional: remote or very remote 75: 16: 7: NHWDS Work setting Private practice Aboriginal health service Community healthcare services Hospital Residential healthcare services Commercial/business services Education facility Correctional services Defence force Other government department or agency Other Unknown/inadequately described/not stated Workforce inflows Students (b) Student commencements Student completions Provisional registrations (c) Immigration (d) Temporary visa grants Permanent visa grants , NHWDS DIICCSRTE DIICCSRTE NHWDS DIAC DIAC 51

52 Table 13: Characteristics of the pharmacy workforce continued Characteristics Number Year Data source Workforce outflows Workforce vacancies (e) Current labour market rating Suitable applicants per vacancy Vacancies filled within six weeks of advertising n.a. No shortage per cent Feb DEEWR DEEWR DEEWR n.a. not available (a) FTE calculated based on a 38 hour standard working week. (b) In tertiary courses coded to the pharmacy field of education. May include students in courses that do not lead to registration as a pharmacist. (c) Graduates of approved programs of study must complete a period of supervised practice to be eligible for general registration as a pharmacist. Provisional registration is granted for the supervised practice period. (d) For ANZSCO code 2515 Pharmacist. (e) For ANZSCO code Hospital Pharmacist and Retail Pharmacist. Data limitations For workforce planning purposes the pharmacy NHWDS provides extensive information on the demographic and employment status of pharmacists from The primary limitation with this collection for mental health workforce planning is that a pharmacist s specific mental health related activity is not known. Potentially, the number of mental health related prescriptions may provide may provide some information to measure pharmacists mental health care activity. There is also limited historical information on the pharmacy workforce. The last AIHW pharmacy labour force survey was conducted in 1999, with results released in 2003, and while Census information provides long-term time series information, concerns with Census information for workforce planning purposes include the fact information is selfreported, and is quickly out-of-date. This limitation will not apply in the short-term future as the pharmacy NHWDS is conducted annually. In relation to information collected by the Guild, this does not take into account pharmacists practising outside of a community or retail setting, it does not necessarily include all community pharmacists (as membership of the Guild is voluntary, and survey responses are voluntary), and workforce information describing the demographics of the community pharmacy workforce is not publicly available. 52

53 Speech pathologists Speech pathologists diagnose, treat and provide management services to people of all ages with communication disorders, including speech, language, voice, fluency and literacy difficulties, or people who have physical problems with eating or swallowing 49. Speech pathologists can provide individual therapy, work in small groups, work within a classroom, become involved in home-based programs, provide resources and information, and give advice and direction to clients, their carers and other professionals 50. Speech pathologists work in a variety of settings, including early intervention, schools, hospitals, community and rehabilitation centres, aged care facilities, mental health services, specialist centres, disability services and in private practice 51. Certified Practising Speech Pathologist status can be earned by speech pathologists who meet the requirements of Speech Pathology Australia s Professional Self-Regulation program. What is the role of a speech pathologist in mental health service provision? Speech pathologists have the capacity to enhance the health, well-being and participation of people with, or at risk of, mental health conditions through prevention, early detection and treatment of communication and swallowing disorders 52. Speech pathologists can form an important part of multidisciplinary mental health teams, contributing to differential diagnosis, identifying communication difficulties, and developing appropriate treatment targets. Speech pathologists work with client groups who have mental health issues including working within Child and Adolescent (Youth) Mental Health Services, Adult Mental Health Services, Community Health and in youth justice settings. Quantitative data available for the speech pathology workforce The Census The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. It is conducted every five years, and its objective is to accurately measure the number and key characteristics of people who are in Australia on Census Night, and of the dwellings in which they live. From the Census, the number and characteristics (including labour force status, age, gender, hours worked and country of birth) of people who self-report as a speech pathologist can be identified. Speech Pathology Australia (SPA) SPA is the national peak body for the speech pathology profession in Australia, with two primary sources of workforce information: Membership database SPA maintains an ongoing database of its members which records demographic and practice details, including age, gender, location, country of first qualification, employment sector and area of specialty, as well as information on student membership. General membership survey conducted in 2001, 2002 and These surveys aimed to collect detailed data on demographic, training and workforce characteristics, including age, gender, country of birth, practice location, employment status and field of employment. SPA identified a number of other data collections, however these were not national and have not been included in this Inventory. Information on these collections can be accessed at: per cent20pathology per cent20australia per cent20data per cent20inventory per cent pdf. 53

54 SPA advised they have the capacity to conduct targeted member surveys, and could feasibly collect data on speech pathologists working in mental health settings, capturing information on items such as setting, scope of practice, hours worked and activity type. Characteristics of the speech pathology workforce Table 14 presents the latest available information from the Census and other selected sources on speech pathologists. Information presented from the Census relates to employed speech pathologists only. Table 14: Characteristics of the speech pathology workforce Characteristics Number Year Data source Headcount Census FTE(a) Census FTE per 100, Census Average weekly hours Census Average age n.a Census Per cent female Census Per cent major cities: inner regional: outer regional: remote or very remote 77: 16: 6: Census Per cent sector (public: private) 43: Census Workforce inflows Students(b) Student commencements Student completions Immigration(c) Temporary visa grants Permanent visa grants Workforce outflows Workforce vacancies: Current labour market ratings NSW VIC QLD SA WA TAS NT ACT Recruitment difficulty (metropolitan) Recruitment difficulty No shortage No shortage No shortage Shortage Shortage No shortage n.a Apr 2012 Apr 2012 Feb 2012 Feb 2012 May 2012 May 2012 Mar/Apr 2012 Mar 2012 DIICCSRTE DIICCSRTE DIAC DIAC DEEWR n.a. not available (a) FTE calculated based on a 38 hour standard working week. (b) In tertiary courses coded to the speech pathology field of education. (c) For ANZSCO code Speech Pathologist. 54

55 Data limitations The Census is the primary data source available providing detailed national information on the speech pathology workforce. For workforce planning purposes, the primary limitations with census data are that information is selfreported, and responses provided depend on an individual s understanding and interpretation of the questions asked. For example, people who self-report as a speech pathologist may not meet the occupational definition of a speech pathologist, or have appropriate qualifications. In addition, being conducted every five years (while providing information on long-term trends) means information is quickly out-of-date for workforce planning purposes. Although membership information from SPA is more timely than Census information, it is not mandatory for speech pathologists to be members of SPA to practice speech pathology in Australia (SPA estimates that its membership captures approximately seventy percent of practising speech pathologists in Australia) 53. Additionally, not all data items needed for workforce planning purposes are available. Speech pathologists conduct a substantial amount of work outside of mental health service provision. Consequently, a major limitation for workforce planning is the difficulty in measuring specific speech pathologist mental health related activity there are currently no data sources available to do this. 55

56 What data is available to measure demand for workforces delivering services to mental health consumers? As highlighted in the introduction to this Inventory, the first key step in workforce planning is to understand the existing workforce both the number and characteristics of the existing workforce, as well as the service demand for the workforce. The section above described the different national information sources available to understand the number and characteristics of the workforces primarily responsible for delivering services to mental health consumers. For measuring and projecting workforce demand, HWA employs the utilisation method. This method measures expressed demand and is based on service utilisation patterns as they currently exist (making no assumptions about potential or unmet demand). The utilisation method for measuring workforce demand uses service utilisation data, and in mental health there are many datasets available measuring different aspects of mental health service utilisation. A list and brief description of these datasets is provided in this section. Quantitative data available to measure expressed demand Community Mental Health Care NMDS This NMDS contains information on client contacts with government-operated specialised community mental health care services and hospital-based ambulatory care services, such as outpatient and day clinics. Variables included are year of collection, sex, age group, mental health legal status and principal diagnosis. Residential Mental Health Care NMDS This NMDS contains information on client episodes in government-operated residential mental health care services. Variables included are year of collection, sex, age group, mental health legal status and principal diagnosis. Mental Health Establishments NMDS This NMDS collects information from all specialised mental health services that are managed or funded by state and territory health authorities. The AIHW define specialised mental health services as those with a primary function to provide treatment, rehabilitation or community health support targeted towards people with a mental disorder or psychiatric disability. This NMDS provides a wide range of data including revenue, grants to NGOs, indirect expenditure, salary and non-salary expenditure, and numbers of FTE staff. Items collected relevant to measuring expressed demand includes episodes of residential care and available beds. National Hospital Morbidity database (NHMD) The NHMD is compiled from data supplied by the state and territory health authorities. It is a collection of electronic confidentialised summary records for separations (that is, episodes of care) in public and private hospitals in Australia. Information on principal diagnosis for admission is collected (based on the ICD-10-AM disease classification) with mental and behavioural disorders being separately identified. The NHMD provides the source data for the Admitted Patient Mental Health Care NMDS, which contains information on patients admitted to hospital who receive specialised psychiatric care, that is, those who are in a public psychiatric hospital or a psychiatric unit of an acute care hospital or who had a mental health-related principal diagnosis. 56

57 Medicare data Data on the activity of all providers making claims through the MBS is collected. Information includes the type of service provided (MBS item number) and the benefit paid by Medicare for the service. MBS item numbers specific to mental health service provision can be identified and used to measure changes in expressed demand. Examples of programs with specific mental health MBS item numbers are: ATAPS ATAPS enables GPs to refer consumers to mental health professionals who deliver focussed psychological strategies services, including psychologists, social workers, mental health nurses, OTs and Aboriginal and Torres Strait Islander health workers with specific mental health qualifications. Through ATAPS, patients are eligible for a number of group or individual sessions with the listed mental health professionals. Better Access initiative Through the Better Access initiative, new MBS item numbers were added to provide a rebate for selected mental health services provided by GPs, psychiatrists, psychologists, eligible social workers and OTs. PHIAC data People with private health insurance can make claims for some medical services not covered by Medicare through their health fund. PHIAC is a statutory authority that regulates the private health insurance industry and collects and disseminates information regarding private health funds, including information on number of services. PHIAC data can be used as a measure of expressed demand for private providers of mental health services such as psychiatrists. National Health Survey (NHS) The ABS conducted the Australian Health Survey from March 2011 to Within this, there was a NHS component, which collected a range of information on: the health status of the population; health-related aspects of peoples lifestyles; and the use of health services, including consultations with health practitioners. This last item is of particular relevance to measuring expressed demand, and the NHS collected information on consultations with a number of occupations in scope of this Inventory, including GPs, Aboriginal Health Workers, dietitians/nutritionists, nurses, OTs, speech therapists/pathologists, psychologists, and social workers/welfare workers. Data limitations While an extensive number of datasets are available to build a picture of expressed demand for mental health services, there are two key limitations: 1. Incomplete coverage While there is substantial national coverage of mental health services provided in government-operated facilities, there is currently no national data collection for the NGO sector. The NGO sector contribution to mental health service provision has increased substantially in recent years with the move to a recovery-focused service delivery approach, and the lack of information on this sector is a significant data gap. Incomplete coverage also refers to measuring the number of mental health services accessed. Most Medicare programs have a capped number of services per calendar year, which means not all visits to eligible mental health professionals will necessarily be captured. For example, under the Better Access initiative an individual is eligible for a maximum of ten individual calendar sessions per year with an allied health professional. While consumers are not prevented from receiving further assistance, any further assistance given beyond the ten sessions is not captured by Medicare. Similarly, private health insurance funds have caps on the dollar amounts claimable through their policies, and once that amount is exceeded, further claims cannot be made, and any subsequent private consultations are not captured. While the NHS provides information on the type of health professional consulted in the previous 12 months to the survey, it does not capture how many times that professional was consulted, or the nature of the visit, which is relevant for those workforces who provide services outside of mental health. 57

58 2. Lack of information associating specific workforces with mental health service delivery. While some information is available from Medicare and PHIAC on which workforces are providing mental health services, from many of the NMDS datasets, it is not known what workforces deliver what services to the consumer. While the NMDS information can be used to measure an overall expressed demand for mental health services, applying this demand to individual workforces is problematic. For national workforce planning, this is further complicated by the fact mental health service delivery frameworks differ across states and territories. Needs-based demand While HWA currently employs the utilisation method for measuring and projecting workforce demand, another method is the burden of disease, or needs-based method. This method examines the burden of disease on the community. It measures the health of the community, not just those seeking services, and requires information on the incidence, prevalence and disability states for virtually all diseases and conditions. For mental health, the 2007 National Survey of Mental Health and Wellbeing is the most recent national collection providing information on the prevalence of selected lifetime mental disorders and mental disorders reported in the 12-months prior to the survey for three major disorder groups: anxiety disorders, affective disorders and substance use disorders. The AIHW report The Burden of Disease and Injury in Australia also provides information on the health status of Australians. The NMHSPF, which is aiming to provide an Australian average estimate of need, demand and resources for the range of agreed mental health services, is a needs-based planning model and will be using estimates drawn from this report as an input. 58

59 What data is available on workforce entrants and exits? As well as understanding the existing workforce stock, and knowing the demand for workforces delivering services to mental health consumers, the final component required for workforce planning is knowing how many people are entering the relevant workforces (workforce entrants), and how many people are leaving (workforce exits). This section provides a brief description of information sources available measuring workforce entrants and exits. Quantitative data available for workforce entrants and exits Workforce entrants There are two primary streams of workforce entrants those that enter from education and those that enter through migration. Information sources available for each of these streams are described below. Education stream For education, there are three primary sources of quantitative information available to measure the number of graduates. 1. Department of Industry, Innovation, Climate Change Science, Research and Tertiary Education (DIICCSRTE) Higher Education Statistics Collection The Higher Education Statistics Collection provides a range of information on the provision of higher education in all Australian universities. Of particular relevance to workforce planning purposes is the number of student commencements and student completions by field of education. 2. Medical colleges GPs and psychiatrists are specialist medical practitioners who have completed vocational training beyond their initial Bachelor degree to qualify to practice as a GP or psychiatrist. For GPs, vocational training is provided through the General Practice Education and Training Limited (GPET) and the Australian College of Rural and Remote Medicine (ACRRM), while RANZCP provides psychiatry vocational training. Information from GPET, ACRRM and RANZCP on the number of doctors in vocational training, and the number of new fellows, is published annually in the Medical Training Review Panel (MTRP). 3. The National Centre for Vocational Education Research (NCVER) NCVER conduct the VET provider collection (also known as the Students and Courses collection). This is an administrative collection of information on students, the courses they undertake and their achievement in the VET sector. The information is sourced from student enrolment records and it is an annual national collection. The scope of the collection has progressively widened over time and broadly covers the public VET system. Immigration stream For immigration, there are two primary sources of quantitative information available that can be used to obtain information on the number of people entering the workforce through migration. 1. Department of Immigration and Citizenship (DIAC) administrative data For occupations that are eligible for migration under the skilled independent pathway and the sponsored migration streams, information is available from DIAC on the number of visas granted by visa type, along with demographic information on the visa applicant including gender and country of citizenship. 2. Overseas assessment information from relevant assessing bodies For occupations on the skilled occupation list, applicants need to undergo a skills assessment to ensure their qualification, skills and abilities are comparable with an Australian-trained practitioner. The assessing bodies, such as the Australian Medical Council for doctors, and DAA for dietitians, can provide information on the number of applicants and assessment outcomes. 59

60 Data limitations While information on graduates is available, this does not necessarily equate to the number of new workforce entrants, and there is limited information on the number of graduates who go on to obtain employment in the relevant occupation. Additionally, for some workforces (such as peer workers and mental health workers) there is currently no formal qualification requirement prior to workforce entry. While information is available on the number of people completing vocational training (through publicly-funded RTOs) relevant to these roles, as this is not a formal workforce entry requirements the magnitude of total workforce entrants is unknown. Some specific limitations in relation to the DIICCSRTE data include: For registered or accredited occupations, DIICCSRTE data can include courses allocated to a particular field of education that do not lead to registration or accreditation in that particular occupation. That is, it may include students in non-accredited courses. The accuracy of coding courses to field of education is the responsibility of each university, and is subject to the knowledge of those allocating the codes. For NCVER data, the primary limitation is that information is not obtained from all private VET RTOs, so complete coverage of those providing training, and consequently complete information on those obtaining qualifications, is not available. The magnitude of this issue on VET is not known. However the scope of the NCVER VET provider collection is expanding to encompass non-publicly funded RTOs from 2016, which will remove this limitation. For immigration, people granted a visa under the skilled independent or state and territory sponsored pathways for a particular occupation have no obligation to obtain employment in that occupation. Therefore similar to education, it is not known how many of those people granted a visa goes on to obtain employment (and become a workforce entrant) in the relevant occupation. Workforce exits Workforce exits are a measure of the number of people permanently or temporarily leave the workforce. The ability to calculate workforce exits varies between the registered and non-registered occupations because of data availability. For the registered occupations of GPs, psychiatrists, psychologists, OTs and Aboriginal and Torres Strait Islander health practitioners, workforce exits will be able to be derived from AHPRA registration data (upon at least two data points being available). This is because each registered practitioner has a unique ID that they retain. AHPRA registration data is therefore longitudinal in nature, and allows for a highly specific calculation of the number of practitioners leaving the relevant workforce. For the non-registered occupations, measuring workforce exits is problematic. This is not necessarily because they do not have longitudinal datasets available, but because they do not have regular, comparable data collections providing information on the number of practitioners (as identified through this Inventory). For example, at the time HWA produced Health Workforce 2025 Doctors, Nurses and Midwives, AHPRA longitudinal data was not available. However exit rates were calculated by measuring the net change to the workforce between AIHW medical and nursing and midwifery labour force survey years, taking account of graduate and migrant inflows. The non-registered occupations in this Inventory do not have similar ongoing, comparable surveys so a similar calculation is not readily possible. A measure of workforce exits may be able to be derived from Census information for the non-registered occupations measuring the change in the number of people employed in the relevant occupation between Census years and taking account of graduates and migrants. However there would be substantial concerns on the accuracy of such a measure given the Census is conducted every five years. Additionally, this would not be possible for some of the non-registered occupations in this Inventory (such as peer workers), which do not have a specific occupation code under ANZSCO (which is used to classify occupations in the Census), and also do not have defined education pathways to be able to measure graduate inflows to the workforce. 60

61 Detailed data statements Where possible, detailed data statements have been created for the data collections identified in the Inventory. The data statements provide information on a range of factors for the identified datasets, to indicate their fitness for purpose for workforce planning. Data quality is generally accepted as fitness for purpose. Fitness for purpose implies an assessment of an output, with specific reference to its intended objectives or aims. Quality is not a single dimension, only concerned with the accuracy of data. It also includes other aspects such as accessibility (ease of access to the data) and timeliness (for example the frequency of the data collection and the delay between the collection and release of data). National Health Workforce Data Set: medical practitioners Organisation The NHWDS medical practitioners is jointly owned by HWA and the AIHW. Description The NHWDS is comprised of registration and workforce survey data from AHPRA. This dataset only contains data for medical practitioners who completed the workforce survey. The data has been weighted to represent the total number of people who are registered with AHPRA for each profession. Scope and Coverage All medical practitioners who wish to practice in Australia are required to register with AHPRA each year. Practitioners are required to renew their registration each year (in September) and are asked to voluntarily complete a workforce survey at this time. Practitioners who are registering in the profession for the first time are not asked to complete a workforce survey. For 2010, data is not available for Queensland and Western Australia. The registration dates for medical practitioners in 2010 in those states were different from the rest of Australia during the transition to the NRAS. Frequency of Collection Annual (from 2010) Geography Data for the practitioner s place of practice is collected at the postcode level in the workforce survey (if completed). Postcode data is then concorded to other geographical boundaries including the 2011 Australian Standard Geographical Classification, Medicare Locals and Integrated Regional Clinical Training Networks. Method of Collection Practitioners can either renew their registration online via the AHPRA website or using a paper form provided by AHPRA. For initial registration, practitioners must use a paper form and provide supplementary supporting documentation. Registration data collected include demographic information such as age, sex, country of birth; and details of health qualification(s) and registration status. 61

62 When practitioners renew their registration online they are also asked to complete an online version of the Workforce Survey. The questionnaire collects information on the employment characteristics, work locations and work activity of practitioners. When practitioners renew their registration on a paper form they are also asked to complete a paper version of the Workforce Survey. Data collected during registration and on the workforce survey is sent by AHPRA to AIHW, where the data are merged to create the NHWDS. The data provided to AIHW is de-identified. Accuracy Medical practitioner survey response rate, by state and territory Response rate NSW Vic Qld SA WA Tas NT ACT Aust (b) 2010 (a) (a) No 2010 data for Queensland and Western Australia is included due to their registration period closing after the national registration deadline of 30 Sept (b) The national figures include the Not stated response category and employed medical practitioners resident overseas. Data Availability Aggregated data from the NHWDS is published by the AIHW and is available on their website ( Selected data from the NHWDS is also available on the HWA website ( where users are able to derive their own tables. Data Items Year, age, gender, Indigenous status, workforce status, hours worked, primary specialty, geographical area (location of main job), principal role, principal area, principal setting, years worked and years intended to work. National Health Workforce Data Set: nurses and midwives Organisation The NHWDS: nurses and midwives is jointly owned by HWA Australia and the AIHW Description The NHWDS is comprised of registration and workforce survey data from AHPRA. This dataset only contains data for nurses and midwives who completed the workforce survey. The data has been weighted to represent the total number of people who are registered with AHPRA for each profession. Scope and Coverage All nurses and midwives who wish to practice in Australia are required to register with AHPRA each year. They are required to renew their registration each year (in May) and are asked to voluntarily complete a workforce survey at this time. Practitioners who are registering in the profession for the first time are not asked to complete a workforce survey. In 2011, persons registered as both a Nurse and Midwife were only asked to complete the nursing survey form. From 2012, persons with dual registrations were asked to complete the relevant workforce questions for both nursing and midwifery. 62

63 Frequency of Collection Annual (from 2011) Geography Data for the practitioner s place of practice is collected at the postcode level in the workforce survey (if completed). Postcode data is then concorded to other geographical boundaries including the 2011 Australian Standard Geographical Classification, Medicare Locals and Integrated Regional Clinical Training Networks. Method of Collection Nurses and midwives can either renew their registration online via the AHPRA website or using a paper form provided by AHPRA. For initial registration, they must use a paper form and provide supplementary supporting documentation. Registration data collected include demographic information such as age, sex, country of birth; and details of health qualification(s) and registration status. When practitioners renew their registration online they are also asked to complete an online version of the Workforce Survey. The questionnaire collects information on the employment characteristics, work locations and work activity of practitioners. When nurses and midwives renew their registration on a paper form they are also asked to complete a paper version of the Workforce Survey. Data collected during registration and on the workforce survey is sent by AHPRA to AIHW, where the data are merged to create the NHWDS. The data provided to AIHW is de-identified. Accuracy Nurses and midwives survey response rate, by state and territory Response rate NSW Vic Qld SA WA Tas NT ACT Aust Data Availability Aggregated data from the NHWDS is published by the AIHW and is available on their website ( Data from the NHWDS is also available on the HWA website ( where users are able to derive their own tables. Data Items Year, profession, age, gender, Indigenous status, workforce status, hours worked, geographical area (location of main job), principal role, principal area, principal setting, years worked and years intended to work. 63

64 National Health Workforce Data Set: occupational therapy Organisation This data is jointly owned by HWA and the AIHW. Description The NHWDS is comprised of registration and workforce survey data from AHPRA. This dataset only contains data for OTs who completed the workforce survey. The data has been weighted to represent the total number of people who are registered with AHPRA for each profession. Scope and Coverage All OTs who wish to practice in Australia are required to register with AHPRA each year. Practitioners are required to renew their registration each year (in November) and are asked to voluntarily complete a workforce survey at this time. Practitioners who are registering in the profession for the first time are not asked to complete a workforce survey was the first year that occupational therapists were registered under NRAS. Most of the registration details were migrated from individual state-based systems and updated at the time of registration renewal (where necessary). Due to transitional arrangements, many occupational therapists in Queensland, South Australia and Western Australia were not required to renew their registrations and as a result did not complete a workforce survey. Data for these states for 2012 are excluded. Frequency of Collection Annual (from 2012) Geography Data for the practitioner s place of practice is collected at the postcode level in the workforce survey (if completed). Postcode data is then concorded to other geographical boundaries including the 2011 Australian Standard Geographical Classification, 2011 Local Government Areas, Medicare Locals and Integrated Regional Clinical Training Networks. Method of Collection Practitioners can either renew their registration online via the AHPRA website or using a paper form provided by AHPRA. For initial registration, practitioners must use a paper form and provide supplementary supporting documentation. Registration data collected includes demographic information such as age, sex, country of birth; and details of health qualification(s) and registration status. When practitioners renew their registration online they are also asked to complete an online version of the Workforce Survey. The questionnaire collects information on the employment characteristics, work locations and work activity of practitioners. When practitioners renew their registration on a paper form they are asked to complete a paper version of the Workforce Survey. Data collected during registration and on the workforce survey is sent by AHPRA to AIHW, where the data are merged to create the NHWDS. The data provided by AHPRA to AIHW is de-identified. 64

65 Accuracy Occupational therapists survey response rate, by state and territory of principal practice Response rate NSW Vic Qld SA WA Tas NT ACT Aust n.a. n.a. n.a Data Availability Aggregated data from the NHWDS is published by the AIHW and is available on their website ( Data from the NHWDS is also available on the HWA website ( where users are able to derive their own tables. Data Items Year, age, gender, Indigenous status, country of initial qualification, workforce status, hours worked, geographical area (location of main job), public/private sector, principal role, principal setting, years worked and years intended to work. National Health Workforce Data Set: pharmacy Organisation This data is jointly owned by HWA and the AIHW. Description The NHWDS is comprised of registration and workforce survey data from AHPRA. This dataset only contains data for pharmacists who completed the workforce survey. The data has been weighted to represent the total number of people who are registered with AHPRA for each profession. Scope and Coverage All pharmacists who wish to practice in Australia are required to register with AHPRA each year. Practitioners are required to renew their registration each year (in November) and are asked to voluntarily complete a workforce survey at this time. Practitioners who are registering in the profession for the first time are not asked to complete a workforce survey. Frequency of Collection Annual (from 2011) Geography Data for the practitioner s place of practice is collected at the postcode level in the workforce survey (if completed). Postcode data is then concorded to other geographical boundaries including the 2011 Australian Standard Geographical Classification, 2011 Local Government Areas, Medicare Locals and Integrated Regional Clinical Training Networks. 65

66 Method of Collection Practitioners can either renew their registration online via the AHPRA website or using a paper form provided by AHPRA. For initial registration, practitioners must use a paper form and provide supplementary supporting documentation. Registration data collected includes demographic information such as age, sex, country of birth; and details of health qualification(s) and registration status. When practitioners renew their registration online they are also asked to complete an online version of the Workforce Survey. The questionnaire collects information on the employment characteristics, work locations and work activity of practitioners. When practitioners renew their registration on a paper form they are asked to complete a paper version of the Workforce Survey. Data collected during registration and on the workforce survey is sent by AHPRA to AIHW, where the data are merged to create the NHWDS. The data provided by AHPRA to AIHW is de-identified. Accuracy Pharmacy survey response rate, by state and territory of principal practice Response rate NSW Vic Qld SA WA Tas NT ACT Aust Data Availability Aggregated data from the NHWDS is published by the AIHW and is available on their website ( Data from the NHWDS is also available on the HWA website ( where users are able to derive their own tables. Data Items Year, age, gender, Indigenous status, country of initial qualification, workforce status, hours worked, geographical area (location of main job), public/private sector, principal role, principal setting, principal setting, years worked and years intended to work. National Health Workforce Data Set: psychologists Organisation This data is jointly owned by HWA and the AIHW. Description The NHWDS is comprised of registration and workforce survey data from AHPRA. This dataset only contains data for psychologists who completed the workforce survey. The data has been weighted to represent the total number of people who are registered with AHPRA for each profession. 66

67 Scope and Coverage All psychologists who wish to practice in Australia are required to register with AHPRA each year. Practitioners are required to renew their registration each year (in November) and are asked to voluntarily complete a workforce survey at this time. Practitioners who are registering in the profession for the first time are not asked to complete a workforce survey. Frequency of Collection Annual (from 2011) Geography Data for the practitioner s place of practice is collected at the postcode level in the workforce survey (if completed). Postcode data is then concorded to other geographical boundaries including the 2011 Australian Standard Geographical Classification, 2011 Local Government Areas, Medicare Locals and Integrated Regional Clinical Training Networks. Method of Collection Practitioners can either renew their registration online via the AHPRA website or using a paper form provided by AHPRA. For initial registration, practitioners must use a paper form and provide supplementary supporting documentation. Registration data collected includes demographic information such as age, sex, country of birth; and details of health qualification(s) and registration status. When practitioners renew their registration online they are also asked to complete an online version of the Workforce Survey. The questionnaire collects information on the employment characteristics, work locations and work activity of practitioners. When practitioners renew their registration on a paper form they are asked to complete a paper version of the Workforce Survey. Data collected during registration and on the workforce survey is sent by AHPRA to AIHW, where the data are merged to create the National Health Workforce Dataset. The data provided by AHPRA to AIHW is de-identified. Accuracy Psychologists survey response rate, by state and territory of principal practice Response rate NSW Vic Qld SA WA Tas NT ACT Aust Data Availability Aggregated data from the NHWDS is published by the AIHW and is available on their website ( Data from the NHWDS is also available on the HWA website ( where users are able to derive their own tables. Data Items Year, age, gender, Indigenous status, country of initial qualification, workforce status, hours worked, geographical area (location of main job), public/private sector, principal role, principal setting, years worked and years intended to work. 67

68 National Health Workforce Data Set: Aboriginal and Torres Strait Islander health practitioners Organisation This data is jointly owned by HWA and the AIHW. Description The NHWDS is comprised of registration and workforce survey data from AHPRA. This dataset only contains data for Aboriginal and Torres Strait Islander health practitioners who completed the workforce survey. The data has been weighted to represent the total number of people who are registered with AHPRA for each profession. Scope and Coverage All Aboriginal and Torres Strait Islander health practitioners who wish to practice in Australia are required to register with AHPRA each year. Practitioners are required to renew their registration each year (in November) and are asked to voluntarily complete a workforce survey at this time. Practitioners who are registering in the profession for the first time are not asked to complete a workforce survey. In order to register, applicants must provide evidence that they are an Aboriginal and/or Torres Strait Islander person, identify as an Aboriginal and/or Torres Strait Islander person and are accepted as an Aboriginal and/or Torres Strait Islander person in the community in which they live or have lived. Frequency of Collection Annual (from 2012) Method of Collection Practitioners can either renew their registration online via the AHPRA website or using a paper form provided by AHPRA. For initial registration, practitioners must use a paper form and provide supplementary supporting documentation. Registration data collected includes demographic information such as age, sex, country of birth; and details of health qualification(s) and registration status. When practitioners renew their registration online they are also asked to complete an online version of the Workforce Survey. The questionnaire collects information on the employment characteristics, work locations and work activity of practitioners. When practitioners renew their registration on a paper form they are asked to complete a paper version of the Workforce Survey. Data collected during registration and on the workforce survey is sent by AHPRA to AIHW, where the data are merged to create the National Health Workforce Dataset. The data provided by AHPRA to AIHW is de-identified. Accuracy Aboriginal and Torres Strait Islander health practitioners survey response rate, by state and territory of principal practice Response rate NSW Vic Qld SA WA Tas NT ACT Aust Data Availability Aggregated data from the NHWDS is published by the AIHW and is available on their website ( 68

69 Data Items Year, age, gender, workforce status, hours worked, workforce status, geographical area (location of main job), public/ private sector, principal role, principal setting, years worked and years intended to work. AIHW Medical Labour Force Survey (ceased in 2009) Organisation The AIHW Description This survey collected information on the demographic and employment characteristics of medical practitioners in Australia who are registered at the time of the survey. This survey was last conducted by AIHW in respect of From 2010, the information is collected by AHPRA, through the NHWDS: medical practitioners. Scope and Coverage The scope of the survey included all medical practitioners in states and territories who were registered at the time of the survey. Frequency of Collection Annual Geography Australia, states and territories. Method of Collection The survey was distributed to all registered medical practitioners in Australia as a mail-back questionnaire. Accuracy The overall response rate for 2009 survey was estimated to be 53.1 per cent. The national rate gradually declined over time from the 83.1 per cent response rate achieved in Estimates for some jurisdictions should be interpreted with caution, due to relatively low response rates to the survey and very large declines in the response rate between 2008 and 2009 for Victoria, Queensland, Western Australia, Tasmania and the Northern Territory, as well as low response rates for particular age groups in Queensland. Data Availability Data from the Medical Labour Force Survey is available on the AIHW website: Data Items Demographic characteristics: age, gender, Indigenous/non-Indigenous. Work characteristics: clinical/non- clinical, work setting, average hours worked. Regional distribution: place of practice. 69

70 AIHW Nursing and Midwifery Labour Force Survey (ceased in 2009) Organisation The AIHW Description This survey collected information on the demographic and employment characteristics of registered nurses, enrolled nurses and midwives who were registered in Australia at the time of the survey. This survey was last conducted by AIHW in respect of From 2010, the information is collected by AHPRA, through the NHWDS: nurses and midwives. Scope and Coverage The scope of the survey included all registered nurses, enrolled nurses and midwives in states and territories. Frequency of Collection Annual Geography Australia, states and territories. Method of Collection This survey form was distributed to all registered nurses, enrolled nurses and midwives in Australia as a mail-back questionnaire. Accuracy The overall response rate to the 2009 survey was estimated to be 44.4 per cent. The national rate declined over time, from the 77.3 per cent response rate achieved in Estimates for some jurisdictions for some years should be interpreted with caution, due to the relatively low response rate to the survey. In particular Western Australia and the Northern Territory had very low response rates in 2005 (26.9 per cent and 13.7 per cent, respectively). Estimates for the Northern Territory for 2005 are not separately published, due to the very low response rate to the survey in that jurisdiction (13.7 per cent). Because survey data for Victoria were not available in 2005, the 2006 Victorian survey responses were weighted to 2005 benchmarks. Interpretation of responses for the Northern Territory is made difficult, due to the high turnover of nurses moving to and from that jurisdiction. Data Availability Data from the Nursing and Midwifery Labour Force Survey is available on the AIHW website; Data Items Demographic characteristics: age, gender, Indigenous/non-Indigenous, country of first nursing and midwifery qualification. Work characteristics: work setting, area of nursing or midwifery, role in nursing and midwifery, average hours worked. Regional distribution: place of practice 70

71 Australian Bureau of Statistics Census of Population and Housing Organisation Australian Bureau of Statistics Description The Census is the largest statistical operation undertaken by the Australian Bureau of Statistics. It aims to accurately measure the number of people in Australian on Census night, their key characteristics, and the dwellings in which they live. It collects information on people s education and employment characteristics and provides data for small geographic areas and for small population groups. Scope and Coverage The Census includes all people, except foreign diplomats and their families, who are in Australia and its internal and external territories on Census night. Frequency of Collection 5 yearly Geography Data are available from the collection district level (approximately 250 households), through to state/territory and national levels. Method of Collection The Census of Population and Housing is a self-enumerated collection. A collector leaves the questionnaire to be filled in by a respondent on behalf of the household, and returns to collect the form at a later date. Another method of collection is the internet based Census form, introduced for the first time in Accuracy The ABS releases extensive information on the quality of each data items from the Census. Please refer to the ABS Census Dictionary (cat. no ) for further information. Data Items The Census collects a large amount of socio-economic information on the characteristics of people and dwellings. A full list of variables is available in the Census Dictionary (cat. no ) 71

72 Bettering the Evaluation and Care of Health (BEACH) Organisation University of Sydney, Australian GP Statistics and Classification Centre (collaborating unit of the AIHW). Description BEACH is a continuous national study of GP activity. It was established in 1998 to collect information about the care provided in general practice. Scope and Coverage GPs are randomly sampled from a frame of all GPs who claimed at least 375 GP Medicare items of service in the previous 3 months. Each year, BEACH involves a random sample of about 1,000 GPs. Frequency of Collection On-going Geography Australia Method of Collection BEACH is a continuous survey of GP activity. Approximately 1,000 GPs participate each year, at a rate of approximately 20 per week. The GP sample is ever changing. GPs are approached by letter and followed up by telephone recruitment. Each participating GP records details of 100 consecutive patient encounters. Encounter details are recorded by the GP at the time of the encounter on structured paper forms. Accuracy Approximately 1,000 GPs are recruited each year, providing details for 100,000 patient encounters per year. In , 4,355 GPs were approached for participation in the survey, resulting in a response rate of approximately 22 per cent. The sample of GPs is weighted to the GP frame according to GP characteristics (age-sex) and individual GP activity level (as measured by the number of A1 Medicare items claimed in the previous 3 months) The final annual encounter dataset is tested for reliability. Each year the age-sex distribution of patients at BEACH encounters is compared with the age-sex distribution of the total A1 Medicare claims for that year. Data availability Reports are available through the University of Sydney s website or for individual purchase Data Items GP characteristics: age, gender, years in practice, hours worked, education details. Practice characteristics: postcode, number of gps working at practice. Patient demographics: age, gender, postcode, indigenous status, nesb, patient reasons for encounter, treatments received, medications, referrals, investigations, other treatments. 72

73 Community Mental Health Care National Minimum Data Set (NMDS) Organisation AIHW Description This NMDS collects information about care provided by specialised mental health services, other than those services reported in the Admitted Patient Care NMDS and the Residential Mental Health Care NMDS. Scope and coverage Patient-level data. Data required for reporting by specialised psychiatric services that deliver ambulatory services, in both institutional and community settings. It does not extend to services provided to patients who are in general (non-specialised) care who may be receiving treatment or rehabilitation for psychiatric conditions. Frequency of Collection Annual Geography Australia, states and territories. Method of Collection State and Territory Health authorities provide the data to the AIHW. Data Availability Data obtained by request (some data publicly available through AIHW website). Data Items Episode of Care: principal diagnosis. Establishment: sector. Mental Health Service Contact: service contact duration. Person: area of usual residence, date of birth, Indigenous status, gender. 73

74 Residential Mental Health Care National Minimum Data Set (NMDS) Organisation AIHW Description This NMDS collects information on care in government-funded residential mental health care services in Australia, relating to episodes of care, establishment and person characteristics. Scope and Coverage Episodes of residential care in all government-funded residential mental health care services in Australia, except those that are in receipt of funding under the Aged Care Act and subject to Commonwealth reporting requirements i.e. report to the system for the payment of Aged Residential Care (SPARC) collection. Includes government-operated services that employ mental health trained staff on-site 24 hours per day. Includes government-funded, non-government operated services and non 24-hour staffed services (optional). For non-24-hour staffed services to be included they must employ mental health-trained staff on-site at least 50 hours per week with at least six hours staffing on any single day. Excludes admitted care patient services that may meet the definition of a residential mental health Frequency of Collection Annual Geography Australia. States and territories are not specified in the data set specification, although data is collected and provided to DoHA and AIHW by jurisdictional health authorities. Method of Collection Data are collected at each service from resident administrative and care related record systems. Services forward data to the relevant state or territory health authority on a regular basis. State and territory health authorities provide the data to the AIHW for national collection annually. Data Availability Data obtained by request Data Items Episode of care: principal diagnosis, additional diagnosis. Episode of residential care: episode start date, episode end date, episode start mode, episode end mode. Establishment: sector. Person: area of usual residence, date of birth, Indigenous status, sex. Residential stay: episode start date. 74

75 Mental Health Establishments National Minimum Data Set Organisation AIHW Description The MHE NMDS collects information from all specialised mental health services that are managed or funded by state and territory health authorities. The MHE NMDS provides a national picture of mental health establishments and allows for state and territory comparisons. Scope and Coverage Specialised mental health services are defined as services that have a primary role of providing treatment, rehabilitation or community health support targeted towards people with a mental disorder or psychiatric disability. A service is not defined as a specialised mental health service solely because its clients include people affected by a mental illness or psychiatric disability. The definition excludes specialist drug and alcohol services for people with intellectual disabilities, except where they are established to assist people affected by a mental disorder who also have drug and alcohol related disorders or intellectual disability. Frequency of Collection Annual Geography Australia. States and territories are not specified in the data set specification, although data is collected and provided to DoHA and AIHW by jurisdictional health authorities. Method of Collection Data are collected at each service from resident administrative and care related record systems. Services forward data to the relevant state or territory health authority on a regular basis. State and territory health authorities provide the data to the AIHW for national collection annually. Data Availability Data available through AIHW website. Data Items Episode of Care: principal diagnosis, additional diagnosis. Episode of residential care: episode start date, episode end date, episode start mode, episode end mode. Establishment: sector. Person: area of usual residence, date of birth, Indigenous status, sex. Residential stay: episode start date (no episode end date listed in DSS). 75

76 National Hospital Morbidity Database Organisation AIHW Description The National Hospital Morbidity Database is a collection of electronic confidentialised summary records for separations (that is, episodes of care) in public and private hospitals in Australia. Scope and Coverage The scope of the database is admitted patients treated in Australian hospitals. The database contains data relating to admitted patients in almost all hospitals, including public acute hospitals, public psychiatric hospitals, private acute hospitals, private psychiatric hospitals and private free-standing day hospital facilities. Public sector hospitals that are not within the jurisdiction of a state or territory health authority are excluded (e.g. hospitals operated by the Department of Defence or correctional authorities and hospitals located in offshore territories). Frequency of Collection Annual Geography Australia Method of Collection Data is supplied to the AIHW by state and territory health authorities. Data Items The data items include demographic, administrative and length of stay data, as well as data on the diagnoses of the patients, the procedures they underwent in hospital and external causes of injury and poisoning. The counting unit for the NHMD is the separation. Separation is the term used to refer to the episode of admitted patient care, which can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay beginning or ending in a change of type of care (for example, from acute care to rehabilitation). 76

77 Visa grants Organisation DIAC Type of organisation Australian Government Authority / Legislation The department s key objectives are to: Manage the lawful and orderly entry and stay of people in Australia, including through effective border security. Promote a society which values Australian citizenship, appreciates cultural diversity and enables migrants to participate equitably. Description Overseas residents who wish to work in Australia may apply for either permanent residency, or temporary residency. Permanent visa categories are broadly categorised under either the General Skilled Migration Program or Employer Sponsored. The General Skilled Migration Program (GSM) is for professionals and other skilled migrants who are not sponsored by an employer and who have skills in particular occupations required in Australia. There is a range of visa options under the General Skilled Migration program. These include options for skilled people applying as an independent migrant as well as those sponsored by a relative, or nominated by a State or Territory government. The Employer Sponsored permanent visas include the Employer Nomination Scheme and Regional Sponsored Migration Scheme. Visa subclass 457 is the most commonly used program for employers to sponsor overseas workers to work in Australia on a temporary basis. This visa is for employers who would like to employ overseas workers to fill nominated skilled positions in Australia. With this visa, businesses can employ overseas workers for a period of between one day and four years. Scope and Coverage Visa grant data only refers to the occupation of primary applicants. The data represents a visa grant, and does not necessarily indicate the arrival of a person in Australia. There are a large number of unknown in Intended Residence for GSM as applicants are not obliged to advise and, indeed, may not even have an intended residence at time of the visa grant. Last Visa held is applicable only to Onshore Applicants. Frequency of Collection Annual Geography Australia. State of intended residence. 77

78 Method of Collection From visa application and grant process. Applicants can apply from within Australia (on-shore) or outside of Australia (off-shore). Data Items Visa subclass, age, sex, occupation, state of intended residence, country of citizenship, on-shore/off-shore, birth country and last visa held. Accuracy Includes all visas granted in a financial year. Dissemination Summary visa grant statistics are available from the DIAC website: Higher Education Student Statistics Collection Organisation DIICCSRTE Description DIICCSRTE, with the cooperation of the Australian Bureau of Statistics, is responsible for the collection and dissemination of statistics relating to the provision of higher education in all Australian universities. The Department manages a comprehensive set of statistics collection referred to as the Higher Education Statistics Collection. The Higher Education Student Statistics Collection is one part of this. Scope and Coverage Higher Education Providers (HEPs) approved under the Higher Education Support Act 2003 must report data for all domestic and overseas students enrolled or undertaking a course of study leading to a higher education award at the institution. The student statistics collection encompasses three files; Student enrolment. Student load liability. Commonwealth assisted students. Frequency of Collection Annual Geography Australia, States and Territories, HEPs 78

79 Method of Collection Institutions receive detailed documentation about what information is required. Universities design and produce their own statistical information (Enrolment) forms to collect the required information from students. DIICCSRTE provides institutions with suggested wording for questions relating to Indigenous status, language spoken at home and disability. Institutions submit data online using software provided by DIICCSRTE. Accuracy The accuracy of coding courses to field of education is the responsibility of each university, and is subject to the knowledge of those allocating the codes. HEPs are able to revise the enrolment data previously reported. Some of the data elements such as date of birth and gender can only be revised by contacting DIICSRTE. Other elements can be revised through an update of the student details in a subsequent reporting period. Data Availability Data from DIICCSRTE is available through the higher education section of their website; Vocational Education and Training statistics Organisation NCVER Description The purpose of the VET provider collection is to provide data on publicly funded training programs delivered by government funded and privately operated training providers. Scope and Coverage Information is collected from training providers, which include TAFE institutes, some universities, secondary schools offering VET, industry organisations, Adult Migrant Education Scheme providers, private enterprises in receipt of government funding for training, agricultural colleges, community education providers and other government providers. The collection broadly covers the public VET system. Frequency of Collection Annual Geography Australia, States and Territories, VET Providers Method of Collection Training providers submit data for a calendar year to state training authorities, who validate and compile the data into standardised files; these are then submitted to NCVER by the end of March of the following year. Data submissions are reviewed for quality and signed off by jurisdictions by the end of April. Statistics for the calendar year are released publicly at the beginning of July. 79

80 Data Availability Publicly available through NCVER website; Additional data also available upon request (may incur an access fee). Data Items There are many data items available from the NCVER collection. The main items include student commencements, student enrolments, student completions, institution, course code, gender, age and state/territory. Department of Health and Ageing - General Practice Workforce Statistics Organisation Department of Health and Ageing (DoHA) Description The GP Workforce statistics provide information on the number of GPs by headcount, FTE and full-time workload equivalent. Scope and Coverage GPs who have provided at least one Medicare Service during the reference period and who have had at least one claim for Medicare Service processed during the same reference period are included as part of the headcount. Frequency of Collection Annual Geography Data in this collection is presented nationally, by state/territory and by remoteness area. Method of Collection Medicare administrative data is provided to DoHA for calculation. Full-time workload is calculated by dividing each doctor s Medicare billing by the average billing of full-time doctors for the reference period. Data Availability Publicly available through the DoHA website; Data Items Gender, age, place of basic qualification, number of services provided, place of service provided, looking for work and hours worked. 80

81 References 1 The Department of Health and Ageing website; F BF8ECA2572ED001C4CB4/$File/whatmen.pdf. Accessed 3 April The Australian Institute of Health and Welfare (AIHW) website: Accessed 2 April Ibid 4 Mental Health Workforce Advisory Committee The National Mental Health Workforce Strategy. 5 National Mental Health Commission; Accessed 8 April Mental Health Workforce Advisory Committee. National Mental Health Workforce Strategy. Accessed at: and Mental Health Workforce Advisory Committee. National Mental Health Workforce Plan. Accessed at: publishing.nsf/content/0783fe44ca0c9ec0ca257a5d0009ca04/$file/plan.pdf 7 Ibid 8 The Department of Health and Ageing website: Accessed 26 June Health Workforce Australia, Growing Our Future: the Aboriginal and Torres Strait Islander health worker Project Final Report. Adelaide 10 Ibid 11 Ibid 12 Aboriginal and Torres Strait Islander Board of Australia website: Guidelines/FAQ/Registration-and-how-to-apply.aspx 13 Queensland Health website: Accessed 9 July Northern Territory Department of Health and Community Services website: scripts/objectifymedia.aspx?file=pdf/9/83.pdf&siteid=1&str_title=aboriginal%20mental%20health%20worker%20 Career%20Factsheet.pdf. Accessed 9 July NSW Health, NSW Health Aboriginal Health Worker Project: Phase 1 Report- Analysis of current NSW Aboriginal Health Worker environment. Accessed at: awe_phase_1.pdf. Accessed on 9 July Aboriginal Health Workers Board of the Northern Territory, Submission to Support National Regulation of Aboriginal Health Workers in Australia Accessed at: Accreditation/Partially%20Regulated%20Professions/Aboriginal%20Health%20Workers%20Board%20of%20the%20 Northern%20Territory.pdf. Accessed on: 9 July Beyond Blue website: aboriginal-mental-health-worker-program-phase-1. Accessed 9 July

82 18 Royal Australian College of General Practitioners website: what-is-general-practice. Accessed 9 July Hazelton, M. Mental Health Nursing. Accessed at: C88A8F732ED31670CA2571FF001FC989/$File/lrn51.pdf. Accessed 27 May Australian College of Mental Health Nurses Inc. Guidelines for Credentialing. Accessed at images/stories/credentialing/application_guidelines_march_2011_v8.pdf. Accessed 27 March Mental Health Workforce Advisory Committee. National Mental Health Workforce Strategy Accessed at Accessed on 9 July Mental health coalition of South Australia website: Accessed 9 July Training.gov.au website: Accessed 9 July Community Service and Health Industry Skills Council website: Accessed 9 July National Health Workforce Planning and Research Collaboration 2011: Mental Health Non-Government Organisation Workforce Project Final Report. 26 Personal communication, Tina Smith, Mental Health Coordinating Council, July Queensland Health factsheet. Accessed at: Accessed on 9 July Occupational Therapy Australia website: Accessed 1 July Department of Veteran s Affairs Factsheet. Mental%20Health%20Occupational%20Therapy%20Services.htm. Accessed 1 July Davidson, L, Chinman, M; Sells, David and Row, M Peer Support among Adults with Serious Mental Illness: A report from the field in Schizophrenia Bulletin vol 32 no.3 pp Mental Health Coordinating Council, Final Report on the National Mental Health Peer Workforce Forum May 2011, 32 Davidson, L, Chinman, M; Sells, David and Row, M Peer Support among Adults with Serious Mental Illness: A report from the field in Schizophrenia Bulletin vol 32 no.3 pp AIHW. Mental Health Services in Australia. Specialised mental health care facilities. 34 Department of Families, Housing, Community Services and Indigenous Affairs website: our-responsibilities/mental-health/programs-services/personal-helpers-and-mentors. Accessed 17 August National Health Workforce Planning and Research Collaboration 2011: Mental Health Non-Government Organisation Workforce Project Final Report. 82

83 36 Australian Psychological Society website: Accessed 2 July Ibid 38 Australian Institute of Health and Welfare Psychology labour force AIHW cat. no. HWL 34. Canberra: AIHW (National Health Labour Force Series no. 33). 39 Royal Australian and New Zealand College of Psychiatrists website: Accessed 9 July Ibid 42 Australian Association of Social Workers. Submission to Medicare Australia and Minister for Mental Health and Ageing to review MBS Schedule Fees for Social Workers under the Better Access initiative. Accessed at 43 Department of Immigration and Citizenship website Accessed 5 October Dietitians Association of Australia, Role statement for accredited practicing dietitians practicing in the are of mental health Accessed 23 July National Competency Standards Framework for Pharmacists in Australia Accessed at download/standards/competency-standards-complete.pdf. Accessed 1 March Australian Institute of Health and Welfare. Mental health services - in brief HSE 125. Canberra: AIHW Pharmaceutical Society of Australia. Mental care project A framework for pharmacists as partners in mental health care. February The Job Guide Website: Accessed 27 June Speech Pathology Australia website: Accessed 9 July Speech Pathology Australia website: Accessed 9 July Speech Pathology Australia. Position Statement: Speech Pathology Services in Mental Health Accessed at: Services.pdf. Accessed 9 July Speech Pathology Australia, Data Inventory for the Speech Pathology Profession Accessed at Profession Inventory% pdf. Accessed 9 July

84 Enquiries concerning this report and its reproduction should be directed to: Health Workforce Australia Post GPO Box 2098, Adelaide SA 5001 Telephone Internet Health Workforce Australia 2013 HWA13IAP010 Published August 2013 ISBN: