IHPA has developed a new classification for mental health, known as the Australian Mental Health Care Classification (AMHCC). The new classification will improve the clinical meaningfulness of the way that mental health care services can be classified.
On 25 February 2016, the Pricing Authority approved the AMHCC Version 1.0. The AMHCC will be implemented on a best endeavours basis from 1 July 2016 ahead of pricing from 1 July 2017.
The AMHCC Version 1.0 covers the admitted and community settings. At this stage, there is not enough data to develop the residential arm of the classification – IHPA will undertake work over the coming year to determine the best approach to classifying residential mental health care.
The classification has six major splitting variables. The first three variables are categorical variables, and the remaining variables are complexity variables.
The classification is illustrated at Figures 1 and 2 and described below.
Figure 1: AMHCC Version 1.0 admitted setting structure
Figure 2: AMHCC Version 1.0 community setting structure
NB: These charts describe the six major splitting variables that comprise the AMHCC. They do not represent a clinical decision-making process.
Variables used within the AMHCC
The classification splits by setting: admitted and community.
The admitted setting includes consumers that are admitted for mental health care. The consumer may be admitted to a general ward or a designated psychiatric unit in a general hospital or a psychiatric hospital.
The community setting (also known as ambulatory) includes specialised and non-specialised mental health care services delivered to consumers who are not admitted to an inpatient facility or reside in a residential mental health care facility.
Mental health phase of care
There are five possible phases of care: assessment only, acute, functional gain, intensive extended and consolidating gain. The classification also provides for ‘unknown phase’.
Mental health phase of care is defined as the “primary goal of care that is reflected in the consumer’s mental health treatment plan at the time of collection, for the next stage in the patient’s care”. It reflects the prospective assessment of the primary goal of care, rather than a retrospective assessment.
Mental health phase of care is a clinical decision. It is independent of both the treatment setting and the designation of the treating service, and does not reflect service unit type. Mental health phase of care is assessed at the commencement of an episode of care and reviewed where there is a significant change to the consumer’s symptoms and/or psychosocial functioning requiring a clinical review and a change to the mental health treatment plan.
There are three consumer age groups 0‑17 years, 18‑64 years, and 65+ years.
Mental health legal status
Applies to: admitted setting only, acute phase only, 18-64 years age group only
In the admitted, acute, 18-64 years age group only, there is a split based on the mental health legal status (MHLS) of the consumer (involuntary or voluntary).
MHLS is an indicator of whether mental health care is being provided under the state or territory mental health legislation. An involuntary patient may be detained in hospital under mental health legislation for the purpose of assessment or provision of appropriate treatment or care.
There is a HoNOS complexity split (high or moderate). The split is based on the weighted sum of each mental health phase of care’s HoNOS scores. The weighted HoNOS scores are assessed against a threshold and classified as ‘high’ if greater than or equal to the threshold, and ‘moderate’ if less than the threshold. The weightings are detailed at Appendix B.
The HoNOS is a clinical outcomes measure that captures the symptoms and functioning of the consumer at key points within an episode of mental health care. It is a clinician-rated measure that consists of 12 items that collectively cover the sorts of problems that may be experienced by people with a mental illness.
The HoNOSCA instrument is used for the 0-17 year age group, the HoNOS instrument is used for 18-64 years age group, and the HoNOS 65+ instrument is used for persons aged 65 years and above.
Applies to: community setting only, 18-64 years age group only, moderate HoNOS complexity only
In the community setting, consumers aged 18-64 years with a moderate HoNOS complexity are also classified by assessing the sum of their LSP-16 question scores against a threshold, which classifies the score as high or moderate accordingly.
The LSP-16 is a clinical outcomes measure that is designed to measure the level of functioning and adaptation of people with a mental illness living in the community. It consists of 16 items that address issues faced when adapting to life in the community. Each item is rated on a four-point scale ranging from 0 to 3 with high scores indicating higher disability, resulting in an individual item scores, subscale scores and a total score. The LSP-16 thresholds are listed at Appendix B.
More information about the HoNOS and LSP-16 is available on the Australian Mental Health Outcomes Collection Network website.
Number of end classes
The final AMHCC has 91 end classes, of which 60 are completely classified and 31 are a result of unknown phase of care or HoNOS. In the admitted setting, there are 45 end classes in total, of which 29 are completely classified and 16 are a result of unknown phase of care or HoNOS. In the community setting, there are 46 end classes in total, of which 31 are completely classified and 15 are a result of unknown phase of care or HoNOS. It is anticipated that the unknown phase of care and HoNOS classes will be eliminated over time as reporting improves.
Mental health classification in ICD-10-AM and AR-DRGs
AR-DRGs – comprise of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, Australian Modification (ICD-10-AM), the Australian Classification of Health Interventions (ACHI) and the Australian Coding Standards.
AR-DRGs will be the source of mental health diagnosis data in the AMHCC.
Activity Based Funding Mental Health Care Data Set Specifications
Activity Based Funding Mental Health Care NBEDS 2017-18 (Metadata Online Registry)
|Overview v1||ABF MHC NBEDS 2017-18 Overview v1||ABF MHC NBEDS 2017-18 Overview v1|
|Technical Specifications v1||ABF MHC NBEDS 2017-18 Technical Specifications v1||ABF MHC NBEDS 2017-18 Technical Specifications v1|
Activity based funding: Mental health care DSS 2016-17 (Metadata Online Registry)
|Overview V1.0 (2)|
|Technical Specs V1.0|
Activity based funding: Mental health care DSS 2015-16 (Metadata Online Registry)