An atlas of mental health conditions in South Australia:

Transcription

1 An atlas of mental health conditions in South Australia: Population patterns of prevalence, risk factors, service use and treatment Produced for the South Australian Department for Health and Ageing PHIDU [public health information development unit]

2 Copyright Except as otherwise noted, this work is Public Health Information Development Unit, under a Creative Commons Attribution-NonCommercial-ShareAlike 3. Australia licence. Excluded material owned by third parties may include, for example, design and layout, text or images obtained under licence from third parties and signatures. We have made all reasonable efforts to identify material owned by third parties. You may copy, distribute and build upon this work. However, you must attribute PHIDU as the copyright holder of the work in compliance with our attribution policy available at The full terms and conditions of this licence are available at This report was produced by the Public Health Information Development Unit (PHIDU) for the South Australian Department for Health and Ageing. The views expressed in this report are solely those of the authors and should not be attributed to the Government of South Australia. Suggested citation Public Health Information Development Unit (PHIDU). An atlas of mental health conditions in South Australia: population patterns of prevalence, risk factors, service use and treatment. Adelaide: PHIDU, 216. Enquiries about or comments on this publication should be addressed to: PHIDU Phone: or jglover@laureate.net.au ii

3 Contents List of Figures... iv List of Tables... iv List of Maps... v Acknowledgements... ix Introduction... 1 Re-designing the health system in South Australia... 1 What is mental health?... 1 What are the aims of the atlas?... 1 Methods... 2 Inequality measures... 4 Index of Relative Socio-economic Disadvantage (IRSD)... 4 Children in their first year of school assessed as being developmentally vulnerable... 5 Unemployment... 6 Children under 15 years living in jobless families... 7 Disability Support Pension recipients... 8 General health outcomes... 9 Estimated self-assessed health status... 9 Health risk factors... 1 Prevalence of mental health conditions Prevalence of psychological distress Clients of mental health services Emergency Department presentations for mental health conditions Presentations, by sex Presentations, by the Aboriginal population Presentations, by the non-indigenous population Presentations, by diagnosis Admissions to hospital for mental health conditions Mental health admissions Mental health services provided under the Medical Benefits Schedule Services provided under the Better Access initiative Pharmaceutical Benefits Scheme prescriptions All mental health related prescriptions Summary of mental health indicators Population Health Area (PHA) tables Statistical Local Area (SLA) tables Analysis by socioeconomic status and remoteness Socioeconomic status Remoteness Correlation analysis Introduction Findings Appendices Appendix 1: MBS schedule, selected item numbers Appendix 2: PBS classifications... 1 Appendix 3: Primary diagnoses for hospital admissions, definitions by ICD-1-AM category Key maps References iii

4 List of Figures Figure 1: Clients of community mental health services by age and sex, Figure 2: Clients of Child and Adolescent Mental Health Service by age and sex, 212/13 and 213/ Figure 3: Emergency Department presentations of people for a mental health condition, by diagnosis, as a proportion of all mental health-related presentations, 213/ Figure 4: Admissions with a primary diagnosis of mental health condition by diagnosis type, as a proportion of all mental health-related presentations in each age group, per cent, 212/13 and 213/ Figure 5: Total mental health hospital admissions by length of stay, by Local Health Network, per cent, 212/13 and 213/ Figure 6: Total mental health hospital admissions, percentage with stay of three nights or less, by diagnosis, by Local Health Network, 212/13 and 213/ Figure 7: Total mental health hospital admissions, percentage with stay of more than three nights, by diagnosis, by Local Health Network, 212/13 and 213/ Figure 7: CAMHS and community mental health services, Greater Adelaide Figure 8: Emergency Department presentations Figure 9: Hospital admissions Figure 1: Services under Better Access initiative & other services delivered by consultant psychiatrists... 8 Figure 11: Mental health related prescriptions Figure 12: CAMHS and community mental health services, Regional SA Figure 13: Emergency Department presentations Figure 14: Hospital admissions Figure 15: Services under Better Access initiative & other services delivered by consultant psychiatrists Figure 16: Mental health related prescriptions Figure 17: CAMHS and community mental health services Figure 18: Emergency Department presentations Figure 19: Hospital admissions Figure 2: Services under Better Access initiative, other services delivered by consultant psychiatrists... 9 Figure 21: Mental health related prescriptions List of Tables Table 1: Comparison table of selected indicators in Population Health Areas, Greater Adelaide Table 2: Comparison table of selected indicators in Population Health Areas, Regional South Australia... 7 Table 3: Comparison table of selected indicators in Statistical Local Areas, Greater Adelaide Table 4: Comparison table of selected indicators in Statistical Local Areas, Rest of South Australia.. 74 Table 5: Correlation matrix for PHAs in Greater Adelaide Table 6: Correlation matrix for PHAs in Regional South Australia Table 7: Correlation matrix for SLAs in Greater Adelaide Table 8: Correlation matrix for SLAs in Regional South Australia iv

5 List of Maps Map 1: Index of Relative Socio-economic Disadvantage, Greater Adelaide, Map 2: Index of Relative Socio-economic Disadvantage, Regional South Australia, Map 3: Children in their first year of school who are developmentally vulnerable on one or more domains under the AEDC, Greater Adelaide, Map 4: Children in their first year of school who are developmentally vulnerable on one or more domains under the AEDC, Regional South Australia, Map 5: Unemployment, per cent, Greater Adelaide, June Map 6: Unemployment, per cent, Regional South Australia, June Map 7: Children under 15 years in jobless families, per cent, Greater Adelaide, Map 8: Children under 15 years in jobless families, per cent, Regional South Australia, Map 9: Disability support pensioners, per cent, Greater Adelaide, June Map 1: Disability support pensioners, per cent, Regional South Australia, June Map 11: Estimates of self-assessed health status as fair or poor, rate per 1, Greater Adelaide, Map 12: Estimates of self-assessed health status as fair or poor, rate per 1, Regional South Australia, Map 13: Estimates of current smokers aged 18 years and over, rate per 1, Greater Adelaide, Map 14: Estimates of current smokers aged 18 years and over, rate per 1, Regional South Australia, Map 15: Estimates of the population aged 18 years and over who consume alcohol at levels considered to be high risk to health, rate per 1, Greater Adelaide, Map 16: Estimates of the population aged 18 years and over who consume alcohol at levels considered to be high risk to health, rate per 1, Regional South Australia, Map 17: Estimates of the population with a current mental and behavioural condition, rate per 1, Greater Adelaide, Map 18: Estimates of the population with a current mental and behavioural condition, rate per 1, Regional South Australia, Map 19: Estimates of males with a current mental and behavioural condition, rate per 1, Greater Adelaide, Map 2: Estimates of females with a current mental and behavioural condition, rate per 1, Greater Adelaide, Map 21: Estimates of males with a current mental and behavioural condition, rate per 1, Regional South Australia, Map 22: Estimates of females with a current mental and behavioural condition, rate per 1, Regional South Australia, Map 23: Estimates of the population with high or very high psychological distress, rate per 1, Greater Adelaide, Map 24: Estimates of the population with high or very high psychological distress, rate per 1, Regional South Australia, Map 25: Adult clients of community mental health services, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 26: Adult clients of community mental health services, rate per 1,, Regional South Australia, 212/13 and 213/ Map 27: Male adult clients of community mental health services, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 28: Female adult clients of community mental health services, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 29: Male adult clients of community mental health services, rate per 1,, Regional South Australia, 212/13 and 213/ Map 3: Female adult clients of community mental health services, rate per 1,, Regional South Australia, 212/13 and 213/ Map 31: Clients aged 2-64 years of community mental health services, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 32: Clients aged 2-64 years of community mental health services, rate per 1,, Regional South Australia, 212/13 and 213/ v

6 Map 33: Clients aged 65 years and older of community mental health services, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 34: Clients aged 65 years and older of community mental health services, rate per 1,, Regional South Australia, 212/13 and 213/ Map 35: Aboriginal clients of community mental health services, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 36: Aboriginal clients of community mental health services, rate per 1,, Regional South Australia, 212/13 and 213/ Map 37: Clients of Child and Adolescent Mental Health Service, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 38: Clients of Child and Adolescent Mental Health Service, rate per 1,, Regional South Australia, 212/13 and 213/ Map 39: Male clients of Child and Adolescent Mental Health Service, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 4: Male clients of Child and Adolescent Mental Health Service, rate per 1,, Regional South Australia, 212/13 and 213/ Map 41: Female clients of Child and Adolescent Mental Health Service, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 42: Female clients of Child and Adolescent Mental Health Service, rate per 1,, Regional South Australia, 212/13 and 213/ Map 43: Clients of Child and Adolescent Mental Health Service aged to 9, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 44: Clients of Child and Adolescent Mental Health Service aged to 9, rate per 1,, Regional South Australia, 212/13 and 213/ Map 45: Clients of Child and Adolescent Mental Health Service aged 1 to 14, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 46: Clients of Child and Adolescent Mental Health Service aged 1 to 14, rate per 1,, Regional South Australia, 212/13 and 213/ Map 47: Clients of Child and Adolescent Mental Health Service aged 15 years and over, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 48: Clients of Child and Adolescent Mental Health Service aged 15 years and over, rate per 1,, Regional South Australia, 212/13 and 213/ Map 49: Aboriginal clients of Child and Adolescent Mental Health Service, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 5: Aboriginal clients of Child and Adolescent Mental Health Service, rate per 1,, Regional South Australia, 212/13 and 213/ Map 51: Emergency Department presentations for a mental health condition, rate per 1,, Greater Adelaide, 213/ Map 52: Emergency Department presentations for a mental health condition, rate per 1,, Regional South Australia, 213/ Map 53: Emergency Department presentations of males for a mental health condition, rate per 1,, Greater Adelaide, 213/ Map 54: Emergency Department presentations of males for a mental health condition, rate per 1,, Regional South Australia, 213/ Map 55: Emergency Department presentations of females for a mental health condition, rate per 1,, Greater Adelaide, 213/ Map 56: Emergency Department presentations of females for a mental health condition, rate per 1,, Regional South Australia, 213/ Map 57: Emergency Department presentations of people aged 15 to 24 years for a mental health condition, rate per 1,, Greater Adelaide, 213/ Map 58: Emergency Department presentations of people aged 15 to 24 years for a mental health condition, rate per 1,, Regional South Australia, 213/ Map 59: Emergency Department presentations of people aged 25 to 64 years for a mental health condition, rate per 1,, Greater Adelaide, 213/ Map 6: Emergency Department presentations of people aged 25 to 64 years for a mental health condition, rate per 1,, Regional South Australia, 213/ Map 61: Emergency Department presentations of people aged 65 years and over for a mental health condition, rate per 1,, Greater Adelaide, 213/ vi

7 Map 62: Emergency Department presentations of people aged 65 years and over for a mental health condition, rate per 1,, Regional South Australia, 213/ Map 63: Emergency Department presentations of Aboriginal people for a mental health condition, rate per 1,, Greater Adelaide, 213/ Map 64: Emergency Department presentations of Aboriginal people for a mental health condition, rate per 1,, Regional South Australia, 213/ Map 65: Emergency Department presentations of non-indigenous people for a mental health condition, rate per 1,, Greater Adelaide, 213/ Map 66: Emergency Department presentations of non-indigenous people for a mental health condition, rate per 1,, Regional South Australia, 213/ Map 67: Hospital admissions with a mental health primary diagnosis, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 68: Hospital admissions with a mental health primary diagnosis, rate per 1,, Regional South Australia, 212/13 and 213/ Map 69: Male hospital admissions with a mental health primary diagnosis, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 7: Male hospital admissions with a mental health primary diagnosis, rate per 1,, Regional South Australia, 212/13 and 213/ Map 71: Female hospital admissions with a mental health primary diagnosis, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 72: Female hospital admissions with a mental health primary diagnosis, rate per 1,, Regional South Australia, 212/13 and 213/ Map 73: Hospital admissions, mental health primary diagnosis, Aboriginal people, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 74: Hospital admissions, mental health primary diagnosis, Aboriginal people, rate per 1,, Regional South Australia, 212/13 and 213/ Map 75: Hospital admissions, mental health primary diagnosis, non-indigenous people, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 76: Hospital admissions, mental health primary diagnosis, non-indigenous people, rate per 1,, Regional South Australia, 212/13 and 213/ Map 77: Hospital admissions, mental health primary diagnosis, people aged -19 years, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 78: Hospital admissions, mental health primary diagnosis, people aged -19 years, rate per 1,, Regional South Australia, 212/13 and 213/ Map 79: Hospital admissions, mental health primary diagnosis, people aged 2-64 years, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 8: Hospital admissions, mental health primary diagnosis, people aged 2-64 years, rate per 1,, Regional South Australia, 212/13 and 213/ Map 81: Hospital admissions, mental health primary diagnosis, people aged 65 years and over, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 82: Hospital admissions, mental health primary diagnosis, people aged 65 years and over, rate per 1,, Regional South Australia, 212/13 and 213/ Map 83: Hospital admissions, dementia as the primary diagnosis, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 84: Hospital admissions, dementia as the primary diagnosis, rate per 1,, Regional South Australia, 212/13 and 213/ Map 85: Hospital admissions, substance-related disorder as the primary diagnosis, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 86: Hospital admissions, substance-related disorder as the primary diagnosis, rate per 1,, Regional South Australia, 212/13 and 213/ Map 87: Hospital admissions, schizophrenia as the primary diagnosis, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 88: Hospital admissions, schizophrenia as the primary diagnosis, rate per 1,, Regional South Australia, 212/13 and 213/ Map 89: Hospital admissions, mood disorder as the primary diagnosis, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 9: Hospital admissions, mood disorder as the primary diagnosis, rate per 1,, Regional South Australia, 212/13 and 213/ vii

8 Map 91: Hospital admissions, anxiety-related disorder as the primary diagnosis, rate per 1,, Greater Adelaide, 212/13 and 213/ Map 92: Hospital admissions, anxiety-related disorder as the primary diagnosis, rate per 1,, Regional South Australia, 212/13 and 213/ Map 93: Length of stay, three nights or less, percentage of total, Greater Adelaide, 212/13 and 213/ Map 94: Length of stay, three nights or less, percentage of total, Regional South Australia, 212/13 and 213/ Map 95: Length of stay, more than three nights, percentage of total, Greater Adelaide, 212/13 and 213/ Map 96: Length of stay, more than three nights, percentage of total, Regional South Australia, 212/13 and 213/ Map 97: Services provided by GPs under the Better Access initiative, rate per 1,, Greater Adelaide, 212/ Map 98: Services provided by GPs under the Better Access initiative, rate per 1,, Regional South Australia, 212/ Map 99: Services provided by psychiatrists under the Better Access initiative, rate per 1,, Greater Adelaide, 212/ Map 1: Services provided by psychiatrists under the Better Access initiative, rate per 1,, Regional South Australia, 212/ Map 11: Services provided by clinical psychologists under the Better Access initiative, rate per 1,, Greater Adelaide, 212/ Map 12: Services provided by clinical psychologists under the Better Access initiative, rate per 1,, Regional South Australia, 212/ Map 13: Services provided by other psychologists under the Better Access initiative, rate per 1,, Greater Adelaide, 212/ Map 14: Services provided by other psychologists under the Better Access initiative, rate per 1,, Regional South Australia, 212/ Map 15: Services provided by eligible social workers and occupational therapists under the Better Access initiative, rate per 1,, Greater Adelaide, 212/ Map 16: Services provided by eligible social workers and occupational therapists under the Better Access initiative, rate per 1,, Regional South Australia, 212/ Map 17: MBS services provided by consultant psychiatrists, rate per 1,, Greater Adelaide, 212/ Map 18: MBS services provided by consultant psychiatrists, rate per 1,, Regional South Australia, 212/ Map 19: Prescriptions for mental health related medications, rate per 1,, Greater Adelaide, 212/ Map 11: Prescriptions for mental health related medications, rate per 1,, Regional South Australia, 212/ Map 111: Prescriptions for antipsychotic medications, rate per 1,, Greater Adelaide, 212/ Map 112: Prescriptions for antipsychotic medications, rate per 1,, Regional South Australia, 212/ Map 113: Prescriptions for anxiolytic medications, rate per 1,, Greater Adelaide, 212/ Map 114: Prescriptions for anxiolytic medications, rate per 1,, Regional South Australia, 212/ Map 115: Prescriptions for hypnotic and sedative medications, rate per 1,, Greater Adelaide, 212/ Map 116: Prescriptions for hypnotic and sedative medications, rate per 1,, Regional South Australia, 212/ Map 117: Prescriptions for antidepressant medications, rate per 1,, Greater Adelaide, 212/ Map 118: Prescriptions for antidepressant medications, rate per 1,, Regional South Australia, 212/ Map 119: Prescriptions for psychostimulant agents and nootropic medications, rate per 1,, Greater Adelaide, 212/ Map 12: Prescriptions for psychostimulant agents and nootropic medications, rate per 1,, Greater Adelaide, 212/ viii

9 Acknowledgements The production of this report would have not have been possible without the support and contributions of a number of people: Ms Tina Hardin and her team from SA Health for providing data; Associate Professor Tarun Bastiampillai, Executive Director, Mental Health Strategy, SA Health for his clinical expertise and advice on service delivery; The Australian Bureau of Statistics for providing an ABS officer, Ms Annabel Cocker, to draft the report; and SA NT Datalink for providing pastoral care and office support during the transition of PHIDU. However, the responsibility for the content of the report rests wholly with PHIDU. ix

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11 Introduction Mental health and wellbeing is a fundamental component of the World Health Organization s definition of health. 1 Good mental health enables people to be the best that they can be: to cope with the normal stresses of life, develop and maintain healthy relationships, work productively, and participate in and contribute to their communities. In Australia, it is estimated that almost half (45.5%) of all adults will have experienced a mental health condition at some stage in their lifetime, with one in five experiencing a mental health condition in the previous year. 2 Mental health is therefore a priority for individuals, families, communities and governments. Re-designing the health system in South Australia The South Australian Department for Health and Ageing is undertaking a re-design of the State s healthcare system. This initiative, Transforming Health, aims to make the healthcare system one that provides the quality care, effectiveness and adaptability that South Australians expect and deserve. 3 As part of this initiative, a world-class quality healthcare system has been identified as one which is characterised by the following attributes: patient centred; safe; effective; accessible; efficient; and equitable. 3 Mental health care is an important aspect of the State healthcare system and Transforming Health will also need to address ways in which mental health care can be improved. To this end, the atlas provides information to support such improvement, through its detailed data, maps and analyses, which can assist in understanding the current state of mental health care in South Australian communities. What is mental health? Mental health is a complex and multifaceted concept. It affects how we think, feel, behave and interact with the world. 4 Therefore, mental health is more than simply the absence of a mental illness. Traditionally, mental ill health was the primary focus of interest, that is, an illness or condition that negatively affects mental health in a way that is clinically significant. More recent conceptualisations of mental health describe a spectrum, from mental wellbeing through to short-term mental health problems, to chronic and complex psychiatric conditions. This atlas focuses on mental ill health, one end of the mental health spectrum. Within the atlas, the terms mental illness, mental health condition, and psychiatric condition are used interchangeably, depending on the context and the data source. What are the aims of the atlas? The atlas aims: to describe a number of factors, using indicators that reflect key influences on mental health and mental ill health across the life span; and by mapping these indicators, to provide information in a form that will identify significant differences or inequalities across the South Australian community, and support discussion and action to remediate them. The atlas provides a broad picture of mental ill health in South Australia. It combines socioeconomic and other risk factors associated with mental health conditions with prevalence, treatment and service use data. It aims to assist communities, mental health and other practitioners, policy-makers and service planners, to understand better aspects of mental ill health at the community level. 1

12 The circumstances of communities across the State vary in different ways. By looking at mental ill health and its determinants at a small area level, decision-makers are better able to tailor and direct specific services to those who need them most. As mental ill health cannot be understood by looking at one aspect or service alone, the ability to combine a broad range of data items with maps showing small geographic areas, allows for a more thorough understanding of mental ill health across the State, especially where severity, socioeconomic status, remoteness and access affect prevalence and service use by different groups within the population. The atlas presents data for, and maps of, the following indicators: socioeconomic variables; risk factor estimates; prevalence of mental health conditions; estimated levels of psychological distress; use of community-based mental health services; Medicare-funded mental health services, including those provided by general practitioners, psychiatrists, psychologists and others; psychiatric Emergency Department presentations; mental health admissions to hospitals; and Pharmaceutical Benefit Scheme (PBS) prescriptions for mental health conditions. Where possible, these indicators are presented by relevant demographic characteristics, including sex, age, and Indigenous status, and by diagnosed mental health condition. Methods Data Geography All data included in this atlas are for usual residents of South Australia. Clients of services in South Australia who were residents of other States, Territories or countries are excluded from the data analysis. Similarly, where address information was not provided, data have been excluded: these data made up a very small proportion of totals. Throughout the atlas, geography refers to the residential address of the population in question rather than the location of the service. For example, rates in Elizabeth East refer to people who live in Elizabeth East, even though they may have used a service in the Adelaide CBD. Population Health Areas (PHAs) are a geography designed to maximise the value of small area data, while minimising the number of areas where data need to be suppressed for privacy reasons. PHAs are based on the Australian Bureau of Statistics (ABS) Statistical Area Level 2 (SA2) geography under the Australian Statistical Geography Standard (ASGS) and were developed by PHIDU with the advice of State and Territory health departments. Regional South Australia refers to that part of the State, which is not included in Greater Adelaide as defined by the 211 Greater Capital City Statistical Areas. The MBS and PBS datasets for 212/13 are not available by SA2. Instead, the data have been mapped by Statistical Local Area (SLA), an area under the pre-june 211 Australian Standard Geographical Classification (ASGC). MBS and PBS data are not available by age and sex disaggregation at the SLA level, but have been grouped into larger areas, which include age and sex breakdowns. These are referred to as Grouped SLAs. Limitations While this atlas attempts to provide a complete picture of mental health service use in South Australia, outpatient data were not included, as they were unavailable. Outpatient mental health services play an important role in providing care for patients within the community. Future analyses 2

13 should aim to include such data in order to provide a more comprehensive overview of mental health services in the State. Modelled estimates The atlas includes a number of indicators for which the data have been derived as modelled estimates by the ABS. A modelled estimate can be interpreted as the likely value for a typical area with those characteristics. The model used for predicting small area data is determined by analysing data at a higher geographic level, in this case, for Australia. The relationship observed at the higher geographic level between the characteristic of interest and known characteristics is assumed to hold also at the small area level. The estimates are made by applying the model to data on those known characteristics that can be reliably estimated at the small area level. Rates All rates other than the unemployment rate are age-standardised. Age-standardisation is a method of adjusting a crude rate to eliminate the effect of differences in population age structures: in this atlas, to allow comparisons between geographic areas. Adjustments are undertaken for each of the populations being examined (or the study population) against a standard population: in these data, the standard is the Australian population. Where rates are age-standardised per 1 population (e.g., smoking rates), these have been referred to as percentages. Indigenous status Note that the term, Aboriginal, is used throughout this atlas to denote persons identifying as being of Aboriginal and/or Torres Strait Islander origin. Socioeconomic disadvantage In the atlas, there is a focus on socioeconomic disadvantage as a determinant of mental health and wellbeing. Here, the term socioeconomic refers to the social and economic aspects of a population where social includes information about the community and its level of education, income support, housing, employment and so forth. It is not used in the context of social as in social skills, social ability or social behaviour of community members. Therefore, an area described as having a high level of socioeconomic disadvantage does not imply that the area has low social cohesion or lacks strength as a community; rather, it identifies a relative lack of resources or opportunities that are available to a greater extent in more advantaged communities. Thus, this lack of resources leads inevitably to avoidable differences in mental health and other outcomes for communities. Identifying the communities whose residents are not faring as well as others may be perceived by some people as stigmatising. However, the purpose of the atlas is to highlight the extent of their disadvantage in order to provide evidence upon which community members and decision-makers can rely, and which can underpin advocacy for improvements in the mental healthcare system. If we avoid highlighting the most areas, we avoid providing the evidence that society is failing those who live there. Moreover, being complacent about their plight, and not publishing the evidence, makes us complicit in their poorer life outcomes. 3

14 Inequality measures Index of Relative Socio-economic Disadvantage (IRSD) Context: The IRSD represents the socioeconomic status of Australian communities and identifies areas of disadvantage. The IRSD scores each area by summarising attributes of the population, such as low income, low educational attainment, high unemployment, and jobs in relatively unskilled occupations. It reflects the overall or average level of disadvantage of the population of an area. Being an average, the score is likely to reduce apparent and actual differences between individuals in an area, and between areas. In 211, the South Australian average IRSD score of 983 was less than the Australian average of 12, indicating higher levels of relative disadvantage in the State. Overall, communities in Greater Adelaide are less than those in Regional South Australia, with average IRSD scores of 993 and 95 respectively. However, clear geographic patterns of disadvantage can be seen within both of these areas. In Greater Adelaide, there are three main clusters of PHAs with the greatest levels of disadvantage: the outer north (in Elizabeth/ Smithfield - Elizabeth North, Davoren Park, Salisbury/ Salisbury North, and Elizabeth East); the outer south (in Christie Downs/ Hackham West - Huntfield Heights); and to the north and north-west (Dry Creek - South/ Port Adelaide/ The Parks and Enfield - Blair Athol) (Map 1). The least areas are clustered to the east, south-east and north-east of Adelaide, and in the Adelaide Hills. Map 1: Index of Relative Socioeconomic Disadvantage, Greater Adelaide, 211 Map 2: Index of Relative Socio-economic Disadvantage, Regional South Australia, 211 Index of Relative Socio-economic Disadvantage Below 93; most and above; least Map 2 shows that the most PHAs in Regional South Australia cover much of the Far North of the State, with the State s lowest score by far (a score of 593), in the Anangu Pitjantjatjara Yankunytjatjara Lands (referred to here as the APY Lands both the Population Health Area of Anangu Pitjantjatjara and the Local Government Area of Anangu Pitjantjatjara (AC)). Other very low scores were recorded for many of the towns, including Renmark, Port Pirie, Murray Bridge and Wallaroo. 4

15 Children in their first year of school assessed as being developmentally vulnerable Context: The quality of a child s earliest environments and the availability of appropriate experiences at the right stages of development are crucial determinants of health and wellbeing, including emotional wellbeing and mental health. Supportive communities that promote optimal early childhood development greatly increase children s chances of a successful transition to school, good learning outcomes and better education, employment, and physical and mental health and wellbeing in adulthood. The Australian Early Development Census (AEDC) is a census of children's health and development in their first year of full-time schooling. 5 Five domains of early childhood development are assessed: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (schools-based), and communication skills and general knowledge. 5 Children who are placed in the bottom 1% in a domain are classified as being developmentally vulnerable in that domain. A higher proportion of children in Regional South Australia were assessed as being developmentally vulnerable on one or more domains of the AEDC than was the case in Greater Adelaide (25.4% and 23.2%, respectively). Again, strong geographic patterns of disadvantage are evident. In Greater Adelaide, the highest percentages of children who were assessed as being developmentally vulnerable under this index are found in the outer north (in Elizabeth/ Smithfield - Smithfield North (45.9%), Davoren Park (42.4%), Elizabeth East (41.2%), and Salisbury/ Salisbury North (38.1%)); in Adelaide (36.2%), and to the north, in Enfield/ Blair Athol (34.%); and in the outer south, in Christie Downs/ Hackham West - Huntfield Heights (33.5%). Percentages are generally lower in more advantaged areas to the east, north-east and south-east of the city (Map 3). Map 3: Children in their first year of school who are developmentally vulnerable on one or more domains under the AEDC, Greater Adelaide, 212 Map 4: Children in their first year of school who are developmentally vulnerable on one or more domains under the AEDC, Regional South Australia, 212 Per cent 35. and above and below 5

16 The APY Lands has by far the highest proportion of children who are developmentally vulnerable on one or more domains under the AEDC in the State, with 8.% of children in this category, almost double the proportion of the next highest PHA of Coober Pedy/Outback, with a proportion of 46.4%. Towns in Regional South Australia with above-average percentages of children who are developmentally vulnerable, were Wallaroo (37.9%), Murray Bridge (33.%), Port Pirie (32.2%) and Roxby Downs (3.7%). Mannum/ Murray Bridge Region and Flinders Ranges/ Port Augusta also had over one third of their children in this category. Unemployment Context: A connection between labour market status and mental health has long been recognised, although the exact nature of the interrelationships between labour market experience and mental health remains unclear. Unemployment is consistently associated with poorer mental health, anxiety, depression, suicide and parasuicide, and less consistently associated with cardiovascular disease, respiratory disease and musculoskeletal conditions. 6 There are also higher rates of behavioural and physiological risk factors for poor health among people who are unemployed. 7 The unemployment rate for June 214 in Greater Adelaide was 6.8% and for Regional South Australia, it was 7.4%, notably above the national average of 5.9% for the June quarter, 214. The highest levels of unemployment are found in the north-west, outer north and outer south of Adelaide. Map 5 also shows that the lowest levels of unemployment are in the eastern suburbs of Greater Adelaide. In Greater Adelaide, the highest unemployment rate was estimated for Elizabeth/ Smithfield - Elizabeth North (28.3%, and nearly four times the Greater Adelaide average), and Davoren Park (19.5%) in the outer north; and Christie Downs/ Hackham West - Huntfield Heights (18.9%) and Christies Beach/ Lonsdale (15.5%), in the outer south. Many other areas had unemployment rates above the Greater Adelaide average. Unemployment was lower in areas to the east, north-east and south-east of the city. Map 5: Unemployment, per cent, Greater Adelaide, June 214 Map 6: Unemployment, per cent, Regional South Australia, June 214 In Regional South Australia, the APY Lands had the highest unemployment rate (38.5%), followed by Wallaroo (14.5%) and Port Pirie (13.8%). The lowest proportions of unemployment were in Roxby Downs (.7%), Naracoorte Region (1.6%), and in Kimba - Cleve - Franklin Harbour (2.4%). 6 Per cent 1. and above and below

17 Children under 15 years living in jobless families Context: Children living without an employed parent are more likely to experience financial hardship and poorer health and wellbeing outcomes. 8 The relationship between living in a jobless family and disadvantage is multifaceted. Children living in families either solely or largely dependent on government for their incomes have the least access to material resources, and may face lower achievement in education and have poorer emotional wellbeing than their more advantaged peers. 9 South Australia has a higher percentage of children aged under 15 living in jobless families (15.2%) than the Australian average (13.9%). The percentage was slightly lower in Greater Adelaide (14.8%) than in Regional South Australia (15.2%). The distribution across Greater Adelaide of children living in jobless families emphasises the social segregation seen in the earlier maps, with substantial differences in concentrations between the most and the least areas (Map 7). Elizabeth/ Smithfield - Elizabeth North had the highest rate in the State, of 49.7%. That one in every two children under 15 years of age lives in a family without a parent in employment is of concern, as these families, in general, have few financial and other resources with which to cope with the pressures of living and raising a family. Other PHAs with rates substantially above the Greater Adelaide average include Davoren Park (41.1%), Elizabeth East (32.9%), and Salisbury/ Salisbury North (3.8%) in the outer north; Christie Downs/ Hackham West - Huntfield Heights (32.7%) in the outer south; Enfield - Blair Athol (28.37%) and Dry Creek - South/ Port Adelaide/ The Parks (26.7%) in the north and north-west; and in the city, in Adelaide (27.%). Map 7: Children under 15 years in jobless families, per cent, Greater Adelaide, 211 Map 8: Children under 15 years in jobless families, per cent, Regional South Australia, 211 Per cent 2. and above Below 5. In Regional South Australia, the APY Lands has the highest percentage of children under 15 years living in jobless families (41.6%) (Map 8). The next highest rates in Regional South Australia are for the towns of Port Pirie (28.%) and Wallaroo (26.3%). 7

18 Disability Support Pension recipients Context: Disability support payments provide an income to people of working age whose capacity for work is restricted by physical and/or psychological disability. There is a strong relationship between disabling conditions and mental ill health. In 212 in Australia, 18.5% of all people with any sort of disability had a psychological disability, that is, a mental health condition that causes restrictions in everyday activities. 1 The percentage of the population aged between 16 and 64 years, who received a Disability Support Pension in 214, was higher in Regional South Australia than in Greater Adelaide (8.6% and 6.4%, respectively). In Greater Adelaide, the highest percentages of the population receiving a Disability Support Pension were in Elizabeth/ Smithfield - Elizabeth North (18.7%), Christie Downs/ Hackham West - Huntfield Heights (17.4%), and Davoren Park (13.4%). The lowest percentages were in areas to the east, southeast and north-east of Adelaide. In Regional South Australia, the highest percentages of the population receiving a Disability Support Pension were in Port Pirie (15.2%) and Wallaroo (15.1%). People living in Naracoorte Region had the lowest proportion of the population receiving a Disability Support Pension (2.8%). Map 9: Disability support pensioners, per cent, Greater Adelaide, June 214 Map 1: Disability support pensioners, per cent, Regional South Australia, June 214 Per cent 1. and above Below 4. 8

19 General health outcomes Estimated self-assessed health status Context: An increasing body of research demonstrates that physical health and mental health are interrelated dimensions of overall health, rather than separate ones. Wellness or illness, in either dimension, is likely to affect the other; and the links between physical health and mental health are complex. Self-assessed health status is commonly used as a proxy measure for actual health status; and how people rate their health overall is strongly related to their experience of illness and disability. 11,12 Subjective assessments are as important as objective ones when determining levels of mental health and wellbeing. The estimated proportion of the population who assessed their health as fair or poor (on a scale from fair or poor, through to good, very good or excellent ), was higher in South Australia than for the whole of Australia (15.6% and 14.6%, respectively). Greater Adelaide had a lower percentage than Regional South Australia, with 15.3% compared to 16.6%, respectively. In Greater Adelaide, the patterns of people reporting fair or poor health are highly consistent with the pattern of relative socioeconomic disadvantage, with areas with higher disadvantage having higher levels of poor self-assessed health. The highest percentages of the population with fair or poor health were estimated for Elizabeth/ Smithfield - Elizabeth North (25.9%), Dry Creek - South/ Port Adelaide/ The Parks (23.3%), Davoren Park (23.2%), Salisbury/ Salisbury North (22.5%), Elizabeth East (19.4%) and Parafield/ Parafield Gardens/ Paralowie (19.%), in the outer north; Dry Creek - South/ Port Adelaide/ The Parks (23.3%), Enfield - Blair Athol (2.5%) and Charles Sturt - North-West (2.2%), in the north and north-west; and Christie Downs/ Hackham West - Huntfield Heights (21.7%), in the outer south. Map 11: Estimates of self-assessed health status as fair or poor, rate per 1, Greater Adelaide, Map 12: Estimates of self-assessed health status as fair or poor, rate per 1, Regional South Australia, Rate per and above and below 9

20 The lowest levels were in Aldgate - Stirling/ Uraidla - Summertown (9.3%), Glenside - Beaumont/ Toorak Gardens (9.6%), Belair/ Bellevue Heights/ Blackwood (9.8%), and Hahndorf - Echunga/ Mount Barker Region/ Nairne (12.1%). In Regional South Australia, the highest levels of fair to poor self-assessed health were estimated to be in Wallaroo (21.9%), Renmark (2.9%), Port Pirie (2.8%) and Murray Bridge (19.1%). The lowest percentages were estimated for people in Roxby Downs (9.7%) and Naracoorte Region (11.5%). Note that estimates were not produced for most of the PHAs in the Far North, as Very Remote areas, Aboriginal communities, or areas with a population of less than 1,, were excluded from the estimates. Health risk factors Smoking Context: Tobacco smoking is recognised as the largest single preventable cause of death and disease in Australia, and carries an increased risk of heart disease, stroke, cancer, emphysema, bronchitis, asthma, renal disease and eye disease. 13,14 Smoking has also been associated with a range of mental health conditions including schizophrenia, anxiety disorders and depression. 15 People with mental illness have high rates of morbidity and mortality from smoking-related conditions, such as cardiovascular disease, respiratory disease and cancer. 15 Rates of smoking are generally higher in regional areas compared to Greater Capital City areas. This is true for South Australia, where it is estimated that 22.2% of people who live in Regional South Australia are smokers, compared to 17.7% for Greater Adelaide. Geographic patterns of smoking are similar to geographic patterns of socioeconomic disadvantage, with marked differences in Greater Adelaide between areas estimated to have high, and those with low, rates. The highest proportions, all with over one quarter of the population estimated to be current smokers, were in Elizabeth/ Smithfield - Elizabeth North (32.8%), Davoren Park (29.2%), Elizabeth East (25.4%), and Salisbury/ Salisbury North (24.6%), in the outer north; and in Christie Downs/ Hackham West - Huntfield Heights (28.%), and in Christies Beach/ Lonsdale (25.%), in the outer south. It is of note that, whereas smoking rates for males were in almost all cases higher than for females, the differences in Elizabeth/ Smithfield - Elizabeth North and Davoren Park were substantial, with the rates for males around 5% higher than those for females. Smoking rates in Regional South Australia are relatively high for all PHAs for which estimates were made. In particular, high rates were estimated for Port Pirie and Wallaroo (both 27.%), Flinders Ranges/ Port Augusta (26.6%), Murray Bridge (25.8%), Renmark (25.7%) and Whyalla/ Whyalla - North (24.9%). The lowest rate was estimated for Roxby Downs (15.1%), well below the next lowest rates in Naracoorte Region and Naracoorte (18.7% and 18.9%, respectively). 1

21 Map 13: Estimates of current smokers aged 18 years and over, rate per 1, Greater Adelaide, Map 14: Estimates of current smokers aged 18 years and over, rate per 1, Regional South Australia, Rate per and above and below Alcohol use at levels risky to health Context: Excessive alcohol consumption is a major risk factor for morbidity and mortality; and the harmful use of alcohol is the third largest risk factor for disease burden globally. 16,17 Harm can also be caused to those people around the drinker, as a significant proportion of the disease burden attributable to harmful drinking arises from unintentional and intentional injuries, including those due to road traffic accidents, violence, and suicide. There is significant comorbidity between high levels of alcohol consumption and mental health conditions. 17 The estimated percentage of the population engaged in risky alcohol consumption is higher in Regional South Australia than in Greater Adelaide (4.4% and 4.% respectively). However, these rates are below the Australian average of 4.7%. The pattern of risky alcohol consumption in Greater Adelaide is generally similar to that shown by the IRSD, although not all of the most areas are mapped in the high-risk ranges. The highest estimates of risky alcohol consumption at the PHA level in Greater Adelaide were in Elizabeth/ Smithfield - Elizabeth North (5.%), and Davoren Park and Elizabeth East (both 4.7%), in the outer north; Christies Beach/ Lonsdale (4.8%), and Morphett Vale - East/ Morphett Vale - West (4.6%), in the outer south; and Largs Bay - Semaphore/ North Haven (4.7%), in the north-west. The lowest percentages were estimated for PHAs in the eastern suburbs. There was little variation in Regional South Australia, with the highest estimated percentages in Port Pirie (4.9%), and Wakefield - Barunga West (4.7%); and the lowest in Barossa - Angaston/ Lyndoch (3.9%). Several towns and rural areas were estimated to have 4.6% of their populations as being at risk to their health from their level of alcohol consumption. 11

22 Map 15: Estimates of the population aged 18 years and over who consume alcohol at levels considered to be high risk to health, rate per 1, Greater Adelaide, Map 16: Estimates of the population aged 18 years and over who consume alcohol at levels considered to be high risk to health, rate per 1, Regional South Australia, Rate per and above and below Prevalence of mental health conditions Prevalence of mental and behavioural conditions Context: Anxiety disorders, mood disorders (such as depression) and substance abuse disorders are the most common mental and behavioural conditions reported in the population. In , there were an estimated 4. million Australians (17.5%) who reported having a mental and behavioural condition. 18 Anxiety-related conditions were most frequently reported (2.6 million people or 11.2% of the population) followed by mood (affective) disorders, which include depression (2.1 million people or 9.3%). 18 Around one in twenty Australians (5.1%) reported having both an anxietyrelated condition and a mood (affective) disorder. 18 Mental and behavioural conditions continue to be more common amongst women than men (19.2% compared with 15.8%, respectively). 18 The estimated percentage of the population who had a current mental and behavioural condition is slightly lower in Greater Adelaide than in Regional South Australia (14.5% and 15.4%, respectively). In Greater Adelaide, the highest percentages of mental and behavioural conditions were estimated for people in Elizabeth/ Smithfield - Elizabeth North and Davoren Park (both 19.8%), and Elizabeth East (17.7%), in the outer north; in Adelaide (19.2%), and to the north of the city centre in Enfield - Blair Athol (18.6%); in Christies Beach/ Lonsdale (18.1%), Christie Downs/ Hackham West - Huntfield Heights (17.8%), Aldinga (16.9%), and Morphett Vale - East/ Morphett Vale - West (16.8%), in the outer south; and in the south-west, in Mitchell Park/Warradale (17.1%). The lowest percentages were estimated to be in PHAs in the east and south-east, in Aldgate - Stirling/ Uraidla - Summertown (12.%) and Hahndorf - Echunga/ Mount Barker Region/ Nairne (12.4%). The highest percentages of the population estimated to have mental and behavioural conditions in Regional South Australia were in Wallaroo (19.%), Port Pirie (17.6%), Murray Bridge (17.2%), 12