The sorry state of support for mental health nurses

Australia’s mental health crisis is not improving. The National Mental Health Commission (NMHC) tells us so in its summary of 2023, highlighting no “improvement in mental health and wellbeing” for 10 years, with many suffering through “a decline in whole of life outcomes”.

We clearly need all the help we can get. Yet mental health nurses – both individually and as a “category” of the broader nursing workforce – are underutilised, and even excluded from initiatives that could lead to improvements.

The issues at play are many.

There’s persistent non-recognition of the role of a mental health nurse, and a widespread, outdated perception that nursing is a generic, one-size-fits all job, beholden to others, which it is not.

Better Access to Mental Health Care, the largest Medicare fund for mental health services in primary care, doesn’t include mental health nurses. If mental health nurses were eligible providers, considerable needs in the community would be better-met.

Unfortunately, this isn’t a new problem, but it’s not being addressed, to the detriment of the community.

In 2018, the NHMC, in a submission to the government on Medicare benefits, said mental health nurses should be included and remunerated in line with others, including GPs, who have “arguably less specialist training in mental health”.

As it stands, if a GP refers a patient for treatment, many, many health professionals can bill for it – including social workers and occupational therapists – but mental health nurses cannot, despite credentials and postgraduate training.

At the same time, the Victorian government is actively trying to recruit and retain mental health nurses.

A simple search of jobs online shows mental health nurses are in demand, with more than 5000 available positions nationally in acute and community mental health services.

These jobs might be in assessment, case management, counselling, and therapy, a variety of hospital settings such as emergency departments, specialised roles in prisons, in alcohol and drug work, plus non-government organisations. All are trying to competitively attract nurses to work in mental health.

A new National Nursing Workforce Strategy has started to address issues on the ground. As yet it hasn’t looked at specialist mental health nurses or their employers, instead grouping all nurses together.

The Nursing and Midwifery Board of Australia (NMBA) also doesn’t recognise speciality nursing, because they say speciality registration of nurses doesn’t improve patient safety. However, there are arguments that undergraduate nursing students are inadequately prepared to work in mental health upon graduation, which is a safety issue for them and their patients.

Midwives are another way to look at this. A pregnant woman would never be expected to attend a birthing suite and be supported by a nurse with no midwifery qualifications. Yet government agencies think people with mental health needs don’t deserve to be cared for by nurses with mental health qualifications.

Credentialing for mental health nurses is provided by the Australian College of Mental Health Nurses, but many don’t obtain the credential. The incentive fell away when the government removed the requirement for it to work in a primary health network. A considerable decline followed, from 2016. Now, there’s little government incentive for registered nurses to do specialist mental health postgraduate studies.

Between those times, and only briefly, credentialed mental health nurses could be funded by Medicare, but as soon as the program ended, so did the opportunity.

Why is all this happening?

We’re in the middle of a general nursing shortage, and a mental health crisis, but it may be that there’s an unspoken policy to keep nurses as nurses, and keep them in the public system.

It may also be a case of the federal and state/territory governments not being on the same page, and not using the same metrics – with one the funder and the other the employer.

Because of the general nursing shortage, there’s no requirement for those in mental health to have specialty qualifications, which means the existing specialists are kept from practising to their full scope even though mental health nurses have postgraduate qualifications. Those in more senior or advanced roles are few and far between.

Added to this, clear data on the sector is hard to find because these nurses aren’t properly accounted for – federal government numbers released this month, on nurses and midwives, doesn’t detail them beyond “nurse” or “midwife”.

Australian Institute of Health and Wellbeing data says there are 25,000 mental health nurses in Australia, but this includes those with a speciality mental health nursing qualification and those without. Meanwhile, a separate federal government document, Health Workforce Data, has 218,372 registered nurses working in mental health.

What to do? Plenty.

First, future mental health nursing workforce data should identify those with postgraduate qualifications in the field. If nursing organisations want to understand this better, we would be pleased to partner.

Governments should start engaging with the Australian College of Mental Health Nurses about how to use mental health nurses to their full scope of practice, and add credentialed mental health nurses to Medicare’s Better Access to Mental Health Care initiative.

Then, the Nursing and Midwifery Board of Australia should collect better data, including completed postgraduate education.

Lastly, the Commonwealth’s Ministerial Council of state and territory health ministers should implement mental health nursing as an area of endorsed practice – trends in the mental health nursing workforce can be effectively monitored and used as a method of attracting and recognising mental health nurses.

These things would bring mental health nursing into line with other professions in the wider mental health field – and, more importantly, help patients in their recovery and keep them safe.