Examining the success of the Mental Health Nurse Incentive Program

The issue of mental health in rural areas has been in the spotlight for the past few decades, with the impact of natural disasters, climate change and isolation all contributing to the need for more support in rural communities. Recently, media coverage has focused on issues for mental health sufferers, the number of suicides annually, and potential gaps in mental health services.

In response to this, there has been a steady improvement in government funding and in provision of community mental health services, which was supported in the last Federal Budget.

Within this environment, it is timely to examine the success of the Mental Health Nurse Incentive Program (MHNIP), an initiative funded since 2008 by the Federal Government and administered by Medicare. It promotes collaboration between mental health nurses and psychiatrists and general practitioners in both metropolitan and rural community settings.

The initial aim of the program was to focus on the needs of those people in the community experiencing severe mental health issues. Eligible community-based general practices, private psychiatry services and other appropriate organisations, such as Aboriginal medical services, who appoint mental health nurses to coordinate treatment and care for people with serious mental illness and complex needs, can register with Medicare and apply for funding in the form of non-MBS incentive payments for the engagement of those mental health nurses

Medicare requires that eligible organisations would provide ‘a minimum caseload of twenty patients with a severe and persistent mental health disorder per week, averaged over three months’. Factoring in patient turnover, a full-time mental health nurse is expected to manage thirty-five patients over the course of a year, with most requiring ongoing care.

The plan of the MHNIP is to provide a flexible and accessible service that is designed to meet clients’ needs, and focuses on wellbeing and recovery. It provides doctors with clinical support, enabling them to spend more time with clients, and relevant services and programs can be used to support clients and their carers.

There are several ways that mental health nurses can work under the program (ranging from becoming an employee to working under self-funded arrangements) within a number of practice and funding models.

Julie, from Central West Gippsland in rural Victoria, joined the program as an employee when she applied for a position with a nearby division of general practice, advertised in the local paper. She had been working in public mental health for the past sixteen years and was unhappy in the job due to poor funding, not enough staff, and management that wasn’t supportive. She enthused that ‘It’s the best decision I’ve made.’

As part of the program, Julie is required to complete a Medicare form daily, with patient details and whether the contact was face to face or not. She says, ‘It only takes a couple of minutes. All Medicare wants to know is that we have contact with at least two patients in each morning and afternoon session, and that those patients have a GP mental health plan.’

The funding for Julie’s position is for at least another two years and her employer seems optimistic that it will continue. Julie is aware that, ‘Certainly the needs are there, it will leave a huge gap if withdrawn. The demand is gradually increasing and the practice will be looking at taking on new staff to cover this in the near future.’

In metropolitan South Morang in Melbourne, as a result of some unfortunate working experiences, Rosemary, a mental health nurse, decided to go it alone. After initially feeling overwhelmed, she learnt the complexities of Medicare, how to engage general practitioners, went to the tax office and got information about setting up a business. In 2008, she registering the business name, Primary Mental Health Consultancy.

Since opening that business, she says, ‘It has taken on a life of its own and I am extremely fortunate to have the opportunity to work with clients with a mental illness in a way I believe they should be treated’. She now has seven nurses working with her and is signed up with twenty practices, including general practices, private psychiatrists and community health centres, that she provides with administrative and clinical services.

The MHNIP has added other benefits since it started. It has been able to keep many people out of hospital and guide them back into productive lives, with benefits extending into the broader community.

If you are interested in knowing more, the Australian College of Mental Health Nurses can provide further information, including a toolkit available on its website, which is a good idea to read through for mental health nurses looking to establish an MHNIP practice.

By Bridget Willett.