Mental health nurses are still not 'all in this together'

The lack of recognition of the specialist skills of mental health nurses (MHNs) by the Australian Government in the Budget and the failure to address the mental health needs of the Australian population should be of great concern to nurses everywhere.

Early in the COVID-19 pandemic, it was anticipated that the associated mental health impacts would be far reaching. Indeed, in Australia the burden of mental health-related problems associated with isolation, job losses, delayed or inappropriate treatment and grief may come to exceed the associated physical health problems and health costs of managing COVID-19 itself.

The primary treatment for most mental health problems is psychotherapy, or some combination of focused ‘talking treatment’ and medicine. The Australian Government response to the pending mental health crisis was to double the number of subsidised sessions of the Medicare Benefit Schedule (MBS) program called ‘Better Access’.

Many MHNs were ready, willing, exceptionally well qualified and able to respond to the emerging mental health crisis with advanced psychotherapeutic skills, but were effectively locked out — and remain so — from providing subsidised services under the MBS program. A consequence of the federal government’s response is that waiting lists and costs for psychotherapeutic services are greater than ever, and highly skilled MHNs are unable to offer subsidised services to those in greatest need.

Yet mental health nursing is the oldest regulated mental health professional group in Australia next to medicine (by decades), and the practice of psychotherapy and its adaptation to those with complex needs has been part of the training and practice of MHNs since at least the 1950s. The pathway to being credentialed as an MHN in Australia is one of the most arduous post-registration processes of all allied health professions. The Australian College of Mental Health Nurses requires a minimum qualification of a postgraduate diploma and two years’ supervised specialist practice.

Reflecting the level of skill needed, those MHNs with an interest in psychotherapy have been found to generally hold more qualifications specifically in psychotherapy (the majority with Masters degrees). Other health professionals can gain eligibility to provide ‘Better Access’ services, which is really ‘psychotherapy lite’ with a few days of training in some instances. Eligibility also enables access to other item numbers such as those to treat eating disorders.

MHNs with appropriate qualifications have always been able to provide the capped alternative to those who can’t afford Better Access (largely because of the extra fees charged by practitioners), which was called ‘Access to Allied Psychological Services’ (ATAPs). This has also been devolved to primary health networks (PHN) who by and large commission this service from existing providers of Better Access (MHNs are locked out again). Those people who can’t afford the ‘gap fee’ for allied health professionals can often get a referral via the PHN to bridge that gap. This is quite a brazen example of price fixing. If the price of petrol or a litre of milk was manipulated in this way there would be a public outcry. Better Access is the lowest clinical tier of the stepped care model and all practitioners are meant to be doing the same thing (but paid differently and nurses not at all).

The Royal Commission into the Victorian Mental Health System, like the dozens of public and statutory inquiries before them, has noted our ‘system is flawed’ and has advocated for interdisciplinary community mental health responses to address systemic problems. Nurses are apparently meant to be part of the solution. However, the best and most pragmatic response is to treat MHNs as professionals, with parity with others and enable equitable access to the MBS.

Please visit https://working4recovery.com/MHN/ and consider signing the petition which already has 4000 signatures. You will also find a wealth of information on the psychotherapeutic potential of MHNs.

Dr Richard Lakeman is the course coordinator for the Master of Mental Health and Master of Mental Health Nursing programs, and a Senior Lecturer at Southern Cross University’s internationally recognised School of Health and Human Sciences. He has 30 years’ experience working in the mental health field as a mental health nurse, psychotherapist, researcher and teacher in New Zealand, Ireland and Australia. Clinically he has focused on working with people with complex mental health needs.

Image credit: ©stock.adobe.com/au/Monkey Business