S.TRUEMAN PhD THESIS 2016

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Without specialist psychiatric care: A separation is classified as ‘without specialist psychiatric care’ if the patient did not receive any days of care in a specialist psychiatric unit or ward. Despite this, these separations are classified as mental health-related because the reported principal diagnosis for the separation is either one that falls within the mental and behaviours disorders chapter (Chapter 5) of the ICD-10 manual classification (codes F00-F99). 2.10 Hospital-Based Mental Healthcare Service Provision By Remoteness In cases of hospital separation, upon discharge, remote mental health patients have the lowest rates of follow-up specialist psychiatric care. Rates of these types of separations in metropolitan areas are almost double those in remote areas, and when the discharge of ambulatory remote patients occurs without specialist psychiatric care, it is at a rate of one thirteenth of that in metropolitan areas. A plausible reason for this is the lack of specialised mental practitioners and clinicians working remotely (see Chapter 1) and the lack of remote mental health resources and facilities. Certainly, these types of separations add to the workload and burden of remote nurses delivering mental healthcare. An opposite trend can be observed for separations without specialist psychiatric care after discharge (see Figure 2.2 and Table 2.12). Remote areas have the highest rates in both categories (ambulatory and non-ambulatory), with both being more than double the rates of similar discharges in metropolitan areas. Again, the rates of these types of discharges without specialist psychiatric care add to the workload and burden of remote generalist nurses.