This annual report - Taranaki District Health Board

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ACCESS TO MENTAL HEALTH SERVICES: LATEADOLESCENCEThe following section uses the National Minimum Dataset to explore the most commonreasons for hospitalisation with a mental health diagnosis in young people aged 15–24years. In this section, the unit of analysis is the number of hospital admissions, rather thanthe number of individuals accessing services, with the coding system used to assigndiagnoses being ICD-10-AM.In addition, data from the Project for the Integration of Mental Health Data (PRIMHD) isused to explore access to mental health outpatient, community and inpatient services inyoung people with the following diagnoses: Schizophrenia and other psychotic disorders Personality disorders Depression, bipolar disorder and other mood disorders Substance-related disorders (alcohol, cannabis, and other substances).These diagnoses were selected as they were the most commonly assigned to young whowere recorded as accessing mental health services in the PRIMHD. In this second section,the units of analysis are the number of young people accessing services, and the annualnumber of contacts and inpatient bed nights per individual, with the coding system used toassign diagnoses being DSM-IV.Data Source and MethodsInformation on the Project for the Integration of Mental Health Data (PRIMHD) and the DSM-IV codes used inthis analysis is provided in the Access to Mental Health Services: Introduction section on Page 286.Note 1: Because PRIMHD data is configured in a very different way to that contained in the National MinimumDataset (hospital admissions) the reader is urged to review the methods section on Page 286, in order tobecome familiar with the strengths and limitations of PRIMHD.Note 2: The information presented in this year’s report differs from that presented in the NZCYES’ 2009Reports, because of differences in the data collections (PRIMHD vs. the Mental Health Information NationalCollection (MHINC)) and the coding systems used to code mental health diagnoses (in PRIMHD the datareceived were coded in DSM-IV, whereas in MHINC diagnoses were coded using ICD-10-AM).In addition, the section below provides additional information on the National Minimum Dataset, which hasbeen used to review mental health inpatient admissions for those aged 15–24 years.DefinitionHospital admissions for young people aged 15–24 years with an ICD-10-AM mental health diagnosisData SourceNumerator: National Minimum Dataset: Hospital admissions in young people aged 15–24 years with a primarydiagnosis of a Mental or Behavioural Disorder (ICD-10-AM F00–F99). Admissions with an EmergencyMedicine specialty code in the range M05–M08 on discharge were excluded. Specific diagnoses included ICD-10-AM F10 or Z72.1 (Mental Health Issues due to Alcohol or Alcohol Use); F12 (Mental Health Issues due toCannabis Use); F17 or Z72.0 (Mental Health Issues due to Tobacco or Tobacco Use); F11, F13, F14, F15,F16, F18, F19 or Z72.2 (Mental Health Issues due to Other Specified Drugs); F20 (Schizophrenia); F21–F29(Schizotypal/Delusional Disorders); F31 (Bipolar Affective Disorder); F32 or F33 (Depression); F30, F34, F38,or F39 (Other Mood Disorders); F40 or F41 (Anxiety Disorders); F42 (Obsessive Compulsive Disorder); F43(Stress Reaction/Adjustment Disorder); F50 (Eating Disorders); F60–F69 (Personality/Behaviour Disorders).Denominator: Statistics NZ Projected PopulationNotes on InterpretationNote 1: The limitations of the National Minimum Dataset are discussed in Appendix 3. The reader is urged toreview this Appendix before interpreting any analyses based on hospital admission data. In particular, due toinconsistent uploading of Emergency Department (ED) cases to the NMDS, all admissions with an ED healthspecialty code on discharge have been excluded (see Appendix 3 for a more detailed discussion).Note 2: Whereas the inpatient data derived from PRIMHD refers to the number of bed nights utilised by youngpeople with various mental health diagnoses, the section on mental health inpatient admissions uses hospitaladmissions as the unit of analysis (i.e. a hospital admission is counted only once, irrespective of the number ofbed nights utilised, with the same client potentially being counted several times, if they are admitted on anumber of occasions with a mental health diagnosis).Access to Mental Health Services in Young People - 396
Note 3: For hospital admission data, only the primary diagnosis has been used (vs. PRIMHD data, where aclient with more than one diagnosis may appear several times in conjunction with each of the diagnosesreceived). In addition, in the National Minimum Dataset, all mental health diagnoses were coded in ICD-10-AM,whereas PRIMHD data was provided by the Ministry with diagnoses coded in DSM-IV. Thus the two analysesare not strictly comparable.Hospital Admissions for Young People with ICD-10-AMMental Health DiagnosesNew Zealand DistributionIn New Zealand during 2007–2011, the most common reasons for hospital admissions witha mental health diagnoses in young people were for schizophrenia, followed by depressionand stress reaction/adjustment disorders. Composite categories such as schizotypal/delusional disorders and drug and alcohol-related conditions also made a significantcontribution (Table 100).Table 100. Hospital Admissions for Mental Health Conditions in Young People Aged 15–24Years by Primary Diagnosis, New Zealand 2007–2011ICD-10-AM DiagnosisNumber:Total2007−2011Young People 15–24 YearsNew ZealandNumber:AnnualAverageRate per100,000Percent ofAdmissions(%)Schizophrenia 2,640 528.0 84.80 18.5Schizotypal/Delusional Disorders 2,302 460.4 73.95 16.1Depression 2,174 434.8 69.83 15.2Alcohol/Drug Mental Health Effects 1,553 310.6 49.89 10.9Stress Reaction/Adjustment Disorder 1,248 249.6 40.09 8.7Bipolar Affective Disorder 1,145 229.0 36.78 8.0Other Mental Health Issues 999 199.8 32.09 7.0Eating Disorders 755 151.0 24.25 5.3Personality Disorders 703 140.6 22.58 4.9Other Mood Disorders 405 81.0 13.01 2.8Anxiety Disorders 292 58.4 9.38 2.0Obsessive Compulsive Disorder 47 9.4 1.51 0.3New Zealand Total 14,263 2,852.6 458.16 100.0Source: Numerator: NMDS; Denominator: Statistics NZ Projected Population; Note: ED cases removedMidland Region DistributionAmongst the DHBs in the Midland Region during 2007–2011, the commonest reasons forhospital admissions with mental health diagnoses in young people were schizophrenia,schizotypal/delusional disorders, depression, the mental health effects of drugs andalcohol and stress reaction/adjustment disorders (Table 101 and Table 102).While admission rates for a number of diagnoses differed from the New Zealand rate, suchfigures are difficult to interpret, as many mental health services are offered on anoutpatient/community basis, and thus access to inpatient mental health services may fail toaccurately reflect the true burden of disease, or access to services in an ambulatory caresetting (Note: The unit of analysis here is the number of hospital admissions, as comparedto the number of inpatient bed nights in the sections based on PRIMHD data).Access to Mental Health Services in Young People - 397
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Cover Artwork: Long-tailed Blue But
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LIST OF FIGURESFigure 1. Gross Dome
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Figure 41. Number of Students Invol
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Figure 85. Proportion of Babies Bor
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Figure 127. Relationship Between th
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Table 21. Policy Documents Relevant
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Table 108. Proportion of Young Peop
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INTRODUCTION AND OVERVIEWIntroducti
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three then reviews mental health is
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Table 1. Overview of the Determinan
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Stream Indicator New Zealand Distri
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47MACROECONOMICINDICATORS
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Expenditure-based Measure of GDPThe
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Gini Coefficient: The Lorenz curve
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CHILD POVERTY AND LIVING STANDARDSI
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After Housing Costs (AHC)Relative P
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Figure 8. Proportion of Dependent C
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14 Items (Enforced Lacks) are inclu
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Local Policy Documents and Evidence
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Other Relevant New Zealand Evidence
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UNEMPLOYMENT RATESIntroductionIn th
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Figure 12. Unemployment Rates by Ag
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Unemployment Rates by Qualification
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Figure 18. Quarterly Unemployment R
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CHILDREN RELIANT ON BENEFIT RECIPIE
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Table 4. Number of Children Aged 0-
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Table 5. Number of Children Aged 0-
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YOUNG PEOPLE RELIANT ON BENEFITSInt
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Table 7. Number of Young People Age
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New Zealand Distribution by Ethnici
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Figure 25. Young People Aged 16-24
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Table 10. Number of Young People Ag
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HOUSEHOLD COMPOSITION91
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Data Source and MethodsDefinitionPr
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Figure 29. Proportion of Children A
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Robertson J, et al. 2006. Review of
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Canadian National Occupancy Standar
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Figure 33. Proportion of Children a
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Other Relevant EvidenceMarmot Revie
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108
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Note 2: The number of new school en
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Figure 36. Proportion of New Entran
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Sylva K, et al. 2004 The Effective
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Table 15. Enrolments in Māori Medi
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Table 16. Number of Students (Māor
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Local Policy Documents which Consid
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HIGHEST EDUCATIONAL ATTAINMENT AT S
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Figure 43. Highest Educational Atta
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Figure 46. Highest Educational Atta
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SENIOR SECONDARY SCHOOL RETENTION A
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Participation in Tertiary Education
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Midland Region Distribution and Tre
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The following section uses informat
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Figure 54. Age-Standardised Rates o
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Figure 56. Age-Standardised School
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TRUANCY AND UNJUSTIFIED ABSENCESInt
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Figure 60. Total Unjustified Absenc
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Figure 63. Total Unjustified Absenc
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Table 22. The National Immunisation
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Figure 64. Immunisation Coverage by
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Figure 67. Immunisation Coverage by
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Figure 71. Immunisation Coverage at
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Soares-Weiser K, et al. 2012. Vacci
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Briss PA, et al. 2000. Reviews of e
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Data Sources and MethodsIndicatorPr
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Figure 75. Proportion of New Zealan
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Proportion Receiving Core Contacts
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Figure 81. Proportion of Babies who
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The B4 School CheckThe B4 School Ch
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Other Relevant EvidenceThe Scottish
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185SUBSTANCE USE
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Notes on InterpretationNote 1: The
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Maternal Smoking at First Registrat
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Table 32. Number of Cigarettes Smok
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National Institute for Health and C
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2. Proportion of babies born to mot
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Table 37. Number of Cigarettes Smok
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Figure 93. Proportion of Year 10 St
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Figure 95. Proportion of Year 10 St
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TOBACCO USE IN YOUNG PEOPLEIntroduc
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Figure 96. Daily Smoking Rates in Y
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2009 New Zealand Tobacco Use Survey
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Source of Tobacco in the Last Month
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Carson KV, et al. 2011. Community i
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Other Relevant PublicationsMāori A
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Other Cochrane Systematic Reviews o
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ALCOHOL-RELATED HOSPITAL ADMISSIONS
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Figure 100. Alcohol-Related Hospita
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Table 45. Listed External Causes of
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Shults RA, et al. 2009. Effectivene
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Mortality from conditions with a so
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Table 50. Mortality from Conditions
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Figure 105. Hospital Admissions for
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Table 55. Hospital Admissions for C
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Table 57. Hospital Admissions for C
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Midland Region Distribution by Caus
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INFANT MORTALITY AND SUDDEN UNEXPEC
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New Zealand Distribution and Trends
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Figure 111. Total Infant Mortality,
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Table 62. Neonatal and Post Neonata
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Table 65. Neonatal and Post Neonata
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Distribution by Ethnicity, NZ Depri
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Figure 116. Sudden Unexpected Death
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Vennemann M, et al. 2007. Do immuni
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with a review of interventions aime
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deprivation in some parts of the wo
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who delay a second pregnancy by two
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Family ViolenceDefinitions and New
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need for multidisciplinary interven
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6 days to determine gestational age
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In New Zealand, information on fact
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post intervention. Engagement in ed
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antenatal care, including two nutri
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throughout pregnancy, birth and the
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Alcohol and Other DrugsNational and
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Zealand had a number of specialist
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in one Cochrane review [274] (see p
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interventions to treat antenatal de
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In ConclusionWhile it is hoped that
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Data Source and MethodsDefinition1.
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Other Systematic ReviewsLouwers ECF
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INJURIES ARISING FROM ASSAULT IN YO
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New Zealand Distribution by Age and
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Flood M & Fergus L. 2008. An Assaul
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Note 2: The numbers in this section
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Table 78. Number of Notifications t
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Table 80. Outcome of Assessment for
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Table 82. Number of Notifications R
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Table 84. Outcome of Assessment for
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Data Source and MethodsDefinition1.
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Family Violence Investigations Wher
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Table 90. Local Policy Documents an
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Page 352 and 353: oader contextual influences on the
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Page 356 and 357: Williams SB, et al. 2009. Screening
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Page 400 and 401: Numbers Accessing Services by Diagn
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Page 414 and 415: Local Policy Documents and Evidence
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Page 420 and 421: Figure 138. Mortality from Suicide
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Figure 142. Police Area Boundaries
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3. The condition exhibits a socioec
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REFERENCES1. Children's Commissione
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33. Mackay R. 2005. The Impact of F
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71. Ministry of Health. 2011. Immun
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107. ASH New Zealand. 2011. Nationa
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141. Child and Youth Mortality Revi
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175. Pihama L. 2011. Overview of M
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208. King-Hele S, Webb RT, Mortense
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244. Nelson Marlborough District He
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274. Ramsay J, Carter Y, Davidson L
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306. Jewkes R. 2002. Intimate partn
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347. Heflinger CA, Hinshaw SP. 2010
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376. Ministry of Education. 2012. W
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410. Ministry of Health. 2001. New
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443. Zeanah PD, Bailey LO, Berry S.
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480. Weinberg MK, Olson KL, Beeghly
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