“I don’t want to be assessed. I want to be assisted.” – The role of the Mental Health Nurse Practitioner

Advocacy is an important aspect of nursing, and particularly in mental health nursing. People with mental health conditions are often stigmatised and marginalised in our communities. Mental Health Nurse Practitioners (MHNP) can help to improve accessibility and affordability of quality mental health care, which can be challenging and confusing for those affected.

MHNP undertake master’s level qualifications and have extensions on their scope of practice traditionally reserved for those practising medicine. They use a mix of counselling and psychotherapy skills complemented by the ability to prescribe, or deprescribe as is often the case, order and interpret investigations, diagnose illness and disease and refer to specialist when required. ⁸

Mental Health Nurse Practitioners can offer a range of short-term psychological interventions through to longer-term complex care coordination. This may include anxiety, depression, bipolar disorder, personality disorders, schizophrenia, substance abuse and eating disorders. As with all areas of nursing, mental health nursing is evidence-based, and takes a holistic approach.  Mental Health nurses consider the mental, physical, emotional, social and cultural needs⁷.

Patients don’t need a referral to see a MHNP and can access Medicare rebates⁷.  People can book an appointment to see a MHNP without a referral from their GP. Both psychiatrists and mental health nurses are allotted 45 minutes session under Medicare scheme but not GPs who are often the frontline for these people⁶.   A MHNP can conduct an initial assessment, and then link patient to the most suitable service. This can include a letter to take to a GP to organise a Mental Health Care Plan for up to 10 sessions per year.

Unfortunately, mental health nurses and NP are not adequately supported in Australia.

There are many barriers for nurses working in primary care and private practice, not just those practising in the area of mental health.  Credentialed mental health nurses and mental health NP are not able to see people under mental health care plans funded through Medicare.  These mental health plans are provided by the GP and make provision for the person to have 10 sessions with a psychologist⁵. The GP may believe a credentialed mental health nurse or NP is the best clinician for their patient, but if cost is a barrier, which it often is, the patient will be reliant upon the “free” sessions afforded by the Medicare mental health plan⁷.

ACHM Board Director Tom Ryan agrees: “There’s a widespread and tragically incorrect belief that psychotherapy is the sole province of psychologists. Unfortunately, that influences organisations such as PHNs and many other providers, to the detriment of the consumer. Mental health nurses often bring a more eclectic blend of psychotherapy and counselling skills to the workforce than other disciplines.  Nurses have a holistic approach and an ability to look at physical as well as psychological aspects of patient’s presentation. We are generally also familiar with and skilled in managing the more severe and complex presentations.  This has actually been quite well recognised but is inadequately supported,” said Mr Ryan⁷.

Nurses are trusted health professionals who are experts at coordination of care, but also treat the physical and mental of their patients. 

The Year of the Nurse is 2020. What a great opportunity to drive some dynamic and major changes that enable the community to access the expertise of our mental health credentialed nurses and NP taking much needed strain off of our GPs but most importantly improving accessibility and affordability of quality mental health care.

References

1. http://www.acmhn.org/resources-mhnpsig


2. https://www.ranzcp.org/practice-education/guidelines-and-resources-for-practice


3. https://www1.racgp.org.au/newsgp/professional/gp-mental-health-consultations-continuing-to-rise


4. https://www1.racgp.org.au/newsgp/professional/mental-health-of-the-nation-productivity-commissio


5. https://www.healthdirect.gov.au/talking-to-your-doctor-gp-about-mental-health


6. https://www1.health.gov.au/internet/main/publishing.nsf/Content/work-nurse-prac


7. Health Times, September 2019 p. 18-20


8. https://www.altaira.com.au/news/nurse-practitioners-integral-to-mental-health-outcomes


9.  

Odd Sock Day is on the 4th October 2019 and is a light-hearted approach to reminding people that anyone can have an odd day. Stigma is undoubtedly still one of the biggest barriers to people seeking help and recovery from mental illness.