Evaluation of the mental health nurse incentive program
4.5 Aggregate program demand
As noted in section 3.3.1, actual expenditure under MHNIP grew by an average of 29% per annum over the last two financial years, 2010-11 and 2011-12. This growth was higher than anticipated during the budget process, as illustrated by actual expenditure for MHNIP when compared to the Budget Papers budget allocation. (See table 4.5)
The inability to project expenditure accurately reflects the supply-side driven nature of demand (until the application of session caps in May 2012) ie demand was driven by the number of eligible providers and credentialed nurses. While there is a large cohort of people with a severe mental illness that meet the entry requirements for MHNIP, until the application of the cap it was the number of eligible organisations and credentialed nurses that drove the expenditure of the program.
The number of nurses credentialed by the ACHN rose from 352 at the beginning of July 2009, immediately prior to introduction of the need for mandatory credentialing, to 923 by the end of June 2011, an average increase of 25 nurses per month. Figure 4.2 shows the number of nurses credentialed by month and the total number of nurses at years end.
This graph shows a consistent increase in the total number of credentialed MHNs. The exception was in February and March 2010 where there was a large upward 'spike' linked to the change in the Guidelines that required nurses participating in the MHNIP program to lodge their application to become credentialed by the ACMHN by 31 December 2009.
Medical practitioners participating in MHNIP commented on their perceptions of growing demand during the case study process.
"The demand was always there but there was no service. Increased knowledge of the service increases demand"
GP, private practice, regional New South Wales
"Demand was there as it's a gap in the public system. Nurse availability has enabled increased referrals."
Private psychiatrist, metropolitan Queensland
"Yes, demand is increasing. Patients from other practices are presenting for mental health care. Patient word of mouth is spreading."
GP, private practice, metropolitan Victoria
Although the underlying model of care is strong (as demonstrated by the findings in section 4.4), the supply driven design characteristic of MHNIP is problematic. The levels of unplanned growth are not sustainable in a period of budget restraint and significant resource allocation to new programs in the mental health area.
Key Finding 7: Until the application of session caps in May 2012, realised demand under MHNIP was driven by supply-side factors –the number of eligible providers and credentialed nurses. These program design features are not sustainable in a period of budget restraint.Top of page
Table 4.5: MHNIP: actual program expenditure compared to budget allocation
| 2010-11 | 2011-12 | |
|---|---|---|
| Budget allocation $m | 23.5 | 26.3 |
| Actual expenditure $m | 27.2 | 35.6 |
| Change | 15.7% | 35.4% |
Source: DoHA
Figure 4.2: Nurses credentialed by month and total number of nurses at month end, July 2009 to June 2011
Data source: ACMHN
Nurses credentialed by month contains both newly credentialed and re-credentialed nurses. Data on the number of newly credentialed mental health nurses was not available.
Text version of figure 4.2
Nurses credentialed per month:- Jul-09 - 19
- Aug-09 - 20
- Sep-09 - 30
- Oct-09 - 26
- Nov-09 - 37
- Dec-09 - 37
- Jan-10 - 33
- Feb-10 - 51
- Mar-10 - 71
- Apr-10 - 32
- May-10 34
- Jun-10 - 36
- Jul-10 - 33
- Aug-10 - 35
- Sep-10 - 33
- Oct-10 - 27
- Nov-10 - 32
- Dec-10 - 19
- Jan-11 - 26
- Feb-11 - 23
- Mar-11 - 27
- Apr-11 - 26
- May-11 - 33
- Jun-11 - 31
- at the end of the 2008-2009 financial year was approximately 320;
- at the end of the 2009-2010 financial year was approximately 700; and
- at the end of the 2010-2011 financial year was approximately 920.