Additional training essential for mental health nursing: opinion

There is an accelerating need for a skilled mental health workforce in Australia given the growing recognition of mental illness. However, developing an informed, flexible and skilled nursing workforce in hospital, community mental health and non-traditional settings is a challenge. The critical ingredients appear to be a mix of supported practice, particularly in the transition from graduate nurse to specialist, relevant postgraduate education and clinical supervision.

Nurses form the largest occupational group who work in mental health services in Australia. Nurses work in acute settings such as emergency departments in which people frequently present with mental health problems. Indeed in 2016, 276,954 presentations to emergency departments were classified as mental health related and the majority of presentations to general practitioners are thought to be related to mental health problems.^[1]

In the same year, Australians had over 8.9 million contacts with community mental health workers, and 258,302 discharges from state mental health inpatient services. However, despite the pressing need for highly skilled nurses, the majority of those who work in mental health settings are not trained mental health nurses (MHNS) and it is widely recognised that nursing graduates are poorly equipped for working in the mental health field on graduation.

Since the loss of state registration and endorsement by nursing boards and councils, the only way to achieve recognition for mental health nurses is through the Australian College of Mental Health Nurses Credentialing program. To be eligible, registered nurses must have completed at least a postgraduate diploma in the specialty and met further practice and supervision requirements. Increasingly, these credentials are required for advancement for nurses in the mental health field – and rightly so. The public deserve to receive mental health nursing services from appropriately skilled people.

As funding of mental health programs increases, demand for skilled nurses will rise. In the 2019 Federal budget, the government provided $736.6 million for mental health and suicide prevention initiatives over seven years. Big measures include $373 million for additional services through headspace. Much of this funding will be channelled via the Primary Health Networks (PHN).

Credentialed MHNs have been previously able to work in primary care settings under what was known as the Mental Health Nurse Incentive Program (MHNIP). MHNs working in the program were found to be able to deliver and adapt complex evidence based psychotherapies to people with the most complex mental health needs.^[2] The funding for this program has now been devolved to the PHN ‘flexible funding pool’, which is charged with commissioning services not funded or accessible to people via the Medicare Benefits Schedule (MBS). MHNs will be sought after and are in short supply, especially to address the needs of people with complex mental health needs.

In 2017, there were 22,159 nurses employed in the mental health workforce, compared to 3,369 psychiatrists and 26,311 psychologists (not all work in mental health), according to data from the Australian Institute of Health and Welfare (AIHW).^[3] The total number of nurses working in mental health jumped 48 per cent from 14,959 in 2007. Yet the AIHW, like much of the general public, is mistaken in calling these nurses MHNs. Whilst there may be a higher number of eligible nurses, the number of Credentialed Mental Health Nurses in Australia stands at just 1166^[4].

MHNs require highly specialist skills and attitudes, including strong communication and interpersonal skills to communicate with patients and their families. MHNs require and have generally acquired the skills in psychotherapy and the capacity to form alliances and engage psychotherapeutically with people in extreme states of distress or with complex illness. Arguably, all nurses who work in mental health should have these skills but often fall short. As a consequence of MHNs being confused with nurses who work in mental health, the skill set of MHNs is often under-recognised and patients are excluded from accessing rebates for services by MHNs under Medicare as they might for accessing services from allied health professionals. It is imperative for the survival of the specialty for a greater percentage of the nursing workforce to be skilled and appropriately credentialed and recognised.

Postgraduate education is essential for nurses to meet the credentialing requirements to become MHNs.^[5] An educated nursing workforce can also have benefits for service users, the service system and individual nurses. Nurses have a pivotal role in the leadership of healthcare organisations, and postgraduate education can strengthen a nurse’s leadership and management skills so that they can positively influence workplace culture, translate the best available evidence into practice, and recognise and respond to ethical problems as they arise.

Educated, and expert nurses are needed to contribute to discussion and decisions about reform and change in mental health services. Postgraduate education can also unlock opportunities for employment in many specialist mental health roles such as consultation liaison, court liaison, early intervention, intensive treatment and recovery services, community case management, perinatal-mental health programmes and many as yet unimagined services.

In addition to opening up career opportunities by delivering specialist skills, postgraduate study can also increase nurses’ salary potential in a variety of professionally satisfying roles. A Deloitte Access Economics Report released last year revealed that workers with postgraduate qualifications in nursing occupations were earning an average of $95,391 in 2016–17. Ignoring demographics and experience, those nurses earned 45 per cent more than the average of nurses without postgraduate education. This difference significantly affects an individual’s lifelong remuneration. That is a very healthy payoff for pursuing further tertiary education.

By gaining such credentials, mental health nurses will be advancing not only their own careers, but helping to drive better health outcomes.

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.

References

[1] Australian Institute of Health and Welfare.  Mental health services in Australia: in brief 2018

[2] Lakeman, R. (2013). Mental health nurses in primary care: Qualitative outcomes of the Mental Health Nurse Incentive Program. International Journal of Mental Health Nursing, 22(5), 391-398.

[3] https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/mental-health-workforce

[4] Personal Communication with the ACMHN on the 9/10/2019

[5] http://www.acmhn.org/about-us/about-mh-nursing

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