Darrel Phillip Doessel

Accuracy of official suicide mortality data in Queensland

Objective: The purpose is to answer the following research question: are the time-series data published by the Australian Bureau of Statistics for Queensland statistically the same as those of the Queensland Suicide Register? Method: This question was answered by first modelling statistically, for males and females, the time series suicide data from these two sources for the period of data availability, 1994 to 2007 (14 observations). Fitted values were then derived from the ‘best fit’ equations, after rigorous diagnostic testing. The outliers in these data sets were addressed with pulse dummy variables. Finally, by applying the Wald test to determine whether or not the fitted values are the same, we determined whether, for males and females, these two data sets are the same or different. Results: The study showed that the Queensland suicide rate, based on Queensland Suicide Register data, was greater than that based on Australian Bureau of Statistics data. Further statistical testing showed that the differences between the two data sets are statistically significant for 24 of the 28 pair-wise comparisons. Conclusions: The quality of Australias official suicide data is affected by various practices in data collection. This study provides a unique test of the accuracy of published suicide data by the Australian Bureau of Statistics. The Queensland Suicide Registers definition of suicide applies a more suicidological, or medical/health, conception of suicide, and applies different practices of coding suicide cases, timing of data collection processes, etc. The study shows that ‘difference’ between the two data sets predominates, and is statistically significant; thus the extent of the under-reporting of suicide is not trivial. Given that official suicide data are used for many purposes, including policy evaluation of suicide prevention programmes, it is suggested that the system used in Queensland should be adopted by the rest of Australia too.

Uptake of Medicare Benefits Schedule Items by Psychologists and Other Mental Health Practitioners.

Abstract This paper provides a background to the mental health policy changes introduced by the Council of Australian Governments (COAG) in 2006. It then considers a major Australian Government COAG reform, the revision of the Medicare Benefits Schedule (MBS), by analysing the month-by-month utilisation of the available time-series data for the 17-month period (1 November 2006–31 March 2008) when new items for psychologists, social workers and occupational therapists were introduced. There are a number of unique problems associated with monthly time-series data. Essentially, there is a problem of heterogeneity that arises from the non-uniformity of the temporal unit of a ‘month’. Second, there is an issue of the population covered by Medicare altering through time. Both of these problems are addressed in the present analysis of the time-series data. The two groups of psychologists created by the MBS changes dominate the provision of the new services, providing 96.4% of the new services. Psychologists, who...

Policy-appropriate measurement of suicide: headcount vs. potential years of life lost, Australia, 1907-2005.

We reconsider conventional suicide measurement. First, a headcount of suicide is examined relative to some other causes of death (circulatory diseases, cancer, and motor vehicle accidents). We then construct a time-series data set of an alternative measure of suicide, the potential years of life lost (PYLL) for males and females. Suicide PYLLs average 4.57% of all male PYLLs and 2.44% of female PYLLs for 1907–2005. The comparable “count” percentages are 1.85 and 0.65, respectively. These differences are widening through time. In 2005, suicide represented 3.25% of all male deaths and 0.90% of female deaths using the count measure and, using PYLLs, 11.0% and 4.96%, respectively. The two measures produce quite different indications of suicide.

A central dilemma in the mental health sector: Structural imbalance

Mental health services provision is persistently criticised regarding resource inadequacy. Services are also subject to another dilemma, “structural imbalance”. This study demonstrates the dimensions of structural imbalance in Australias mental health sector by recourse to the 1997 Australian Bureau of Statistics national survey of mental health and wellbeing. This study also examines the concept by reference to the Australian Governments announced COAG initiatives (April 2006), and State government responses (July 2006). The two dimensions of structural imbalance are, first, that some people with no clinical mental illness consume mental health services and, second, that other people have clinical manifestations of mental illness and (for various reasons) do not consume mental health services; the present study shows how the situations coexist. “Throwing more money” at the pre-existing structures may do nothing to address the structural imbalance problem. Remedies are discussed by reference to the reforms undertaken in the British National Health Service in recent years.

Australia's National Mental Health Strategy and deinstitutionalization: some empirical results

Objective: To determine the role of the National Mental Health Strategy in the deinstitutionalization of patients in psychiatric hospitals in Queensland. Method: Regression analysis (using themaximumlikelihood method) has been applied to relevant time-series datasets on public psychiatric institutions in Queensland. In particular, data on both patients and admissions per 10 000 population are analysed in detail from 1953–54 to the present, although data are presented from 1883–84. Results: These Queensland data indicate that deinstitutionalization was a continuing process from the 1950s to the present. However, it is clear that the experience varied from period to period. For example, the fastest change (in both patients and admissions) took place in the period 1953–54 to 1973–74, followed by the period 1974–75 to 1984–85. Conclusions: In large part, the two policies associated with deinstitutionalization, namely a discharge policy (‘opening the back door’) and an admission policy (‘closing the front door’) had been implemented before the advent of the National Mental Health Strategy in January 1993. Deinstitutionalization was most rapid in the 30-year period to the early 1980s: the process continued in the 1990s, but at amuch slower rate. Deinstitutionalization was, in large part, over before the Strategy was developed and implemented.

The Role of Knowledge Accumulation in Health and Longevity: The Puzzling Case of Suicide

Abstract Many Western countries have experienced the ‘rectangularisation of the [demographic] survival curve’, leading to a rise in life expectancy. This process is the result of falling death rates, which leads to increasing longevity. In this article, suicide is placed within the general perspective of declining All Causes mortality. It is shown that suicide is atypical when compared with other causes of death. Which ever way it is measured, whether by an unweighted headcount measure or a weighted Potential Years of Life Lost measure, the suicide rate is not subject to secular decline. In fact, it has become (numerically) a relatively more important cause of death. This article puts some emphasis on the arguments by Joel Mokyr, an economic historian, about the importance of knowledge accumulation. It is argued that, in the case of suicide, there is a deficiency in knowledge of the causes of suicide and the prevention of suicide.

Private psychiatry and Medicare: Regional equality of access in Australia?

Background: Private psychiatric services are produced and consumed on a fee-for-service (FFS) basis in Australia. The Commonwealth Government subsidises these (and all) medical services via Medicare, a universal, comprehensive, tax-financed medical and hospital financing mechanism. A key purpose of Medicare is to improve equality of access to medical services. Aims: To measure the distribution of “access”, as measured by utilization, to private FFS psychiatric services at a regional level; and to determine the temporal trend in equality in regional access to these services during the Medicare period. Method: Conventional measures of statistical dispersion and economic inequality (the coefficient of variation, Gini coefficient and the Atkinson measure) are applied to quarterly time-series data on quantities of private psychiatric services for Australias regions since 1984. Equations are modelled statistically on the distributional data generated by applying these measures. Lorenz curves are also constructed. Results: The negative sign on the slope coefficients in all estimated equations, i.e., for each measure of the distribution, is statistically significant, but the slope coefficients are nearly zero. Conclusions: These preliminary results suggest relatively intractable movement in alleviating inequality in the private psychiatric services produced and consumed in Australia, at the broad level of the region, during two decades of Medicare subsidies.

Some economic dimensions of the mental health jigsaw in Australia

Purpose – The purpose of this paper is to demonstrate that, although there are some unique features associated with mental illness, such special features do not preclude economic analysis. Design/methodology/approach – As a mechanism for understanding how individual economic studies fit into the mental health sector, a conceptual framework of the components of mental health service provision is outlined. Emphasis is placed on, not simply institutional and market resources, but also on the services provided by relatives, self-help groups, etc. Findings – Australian data on parts of the mental health sector are employed to illustrate that some (and different) economic analyses can be undertaken in mental health. First, time-series data on public psychiatric hospitals are employed to demonstrate trends associated with deinstitutionalisation. Other data (for Queensland alone) indicate that there are state-based differences in the provision of such services. Second, attention is then directed to the analysis of time-series data on private fee-for-service psychiatric services. Various concepts and measures from industrial economics are applied to analyse the relative size of this service industry, the pricing behaviour of the profession, the service-mix of “the psychiatry firms” operating in Australia. In addition, the analysis also sheds some light on the distributional implications of Australias national (and uniform) system of health funding, Medicare. Originality/value – Apart from demonstrating that economic analyses can be undertaken in the difficult area of mental health, this paper indicates a number of puzzles (e.g. various regional variations within a unified profession and a uniform national funding scheme) that invite further investigation

The Use of Touch-Screen Technology for Health-Related Information in Indigenous Communities: Some Economic Issues

Abstract The low health status of indigenous communities in Australia, and other countries, has been a continuing societal problem. One way to improve health status involves the provision of health‐related information. Computer‐based systems offer new ways to provide such information: thus their application can be seen as process innovations. This paper describes the use of touch‐screen technology to present health information in a culturally relevant fashion for Aboriginal and Torres Strait Islanders in Queensland, Australia. Touch‐screen kiosks incorporate both computer hardware and software. The paper also outlines some of the key economic concepts relevant to an economic analysis of an information system employing touch‐screen technology. It is shown that the economic analysis involves a two‐stage process, and it is somewhat more complex than setting up an Internet website.

Changes in Private Sector Electroconvulsive Treatment in Australia

Objectives: This paper reports on changes, over time and between states, in the use of electroconvulsive therapy (ECT) in the private psychiatric sector in Australia between 1984 and 2004. Method: Data for ECT services, and all specialist psychiatry services provided under the Medicare system, have been analysed in absolute numbers and as utilization rates. Results: Changes in the use of ECT over time are different from other services provided by private psychiatrists. As in other countries, the use of ECT initially declined in period studied but has increased in recent years. In addition, there is a clear pattern of differential use of ECT between the states and territories. Conclusions: This descriptive study cannot ‘explain’ the results obtained: other data, incorporated into an explanatory model using regression analysis, are needed to determine the factors underlying the utilization patterns obtained in this study. Thus, further work is needed. Furthermore, it is important to analyse data at a lower level of geographical aggregation than that of the state/territory: this (state/territory) aggregation conceals differences in utilization between metropolitan, minor city, rural and remote regions of the country.