Evaluation of the mental health nurse incentive program
5.2 Summary of findings: effectiveness
Table of contents
The key findings of the evaluation of MHNIP in relation to effectiveness are summarised below:
- Key Finding 9: patients being supported under MHNIP are benefiting from improved levels of care in the form of greater continuity of care, greater follow-up, timely access to support, and increased compliance with treatment plans.
- Key Finding 10: examination of a sample of MHNIP patients in the evaluation cost analysis showed a downward trend in their HoNOS scores, a measure of mental health and social functioning. This statistically validates qualitative perceptions that the treatment and support provided by mental health nurses improves the mental health and wellbeing of patients receiving support under the program.
- Key Finding 11: based on an examination of a sample of MHNIP patients, the HoNOS score of patients using state and territory mental health services were on average at similar levels to the scores of MHNIP patients, affirming that the program is providing support to people with severe mental illness.
- Key Finding 12: quantitative evaluation evidence showed overall mental health hospital admissions decreased by 13.3% for a sample of MHNIP patients in the 12 months following their involvement in the program. This was not true for all conditions: bipolar disorders showed a slight increase in the number of admissions.
- Key Finding 13: for the same sample of patients, when they were admitted to hospital following their engagement in MHNIP, there was on average a reduction in their total number of admission days by 58% and the average length of stay fell from 37.2 days to 17.7 days.
- Key Finding 14: there was some evidence of increased patient employment by MHNIP patients.
- Key Finding 15: MHNIP has encouraged and facilitated patient's increased involvement in social and educational activities.
- Key Finding 16: MHNIP has had positive flow on benefits to some carers of MHNIP patients.
- Key Finding 17: MHNIP has had other positive impacts on patients, including improved family interactions and reductions in the number of emergency department presentations.
- Key Finding 18: MHNIP has had a positive impact on medical practitioner workloads by increasing their time available to treat other patients and improve patient throughput.Top of page
- Detailed finding #7: barriers to patient entry into MHNIP still exist relating to:
- patient population characteristics, such as not having a GP or experiencing stigma associated with seeking treatment; and
- characteristics of the program operations e.g. the lack of access to mental health nurses in some areas.
- Detailed finding #8: participating organisations are not able to treat all suitable clients under MHNIP and use waiting lists and triaging to manage excess patient demand.
- Detailed finding #9: eligible organisation's decision to participate in MHNIP was driven by perceived needs of the catchment area where they operate and the synergies of the MHNIP model with an organisation's existing approach to care, which was generally accepting of a multi-disciplinary approach.
- Detailed finding #10: barriers to entry into MHNIP for organisations included the need to recruit suitable mental health nurses, perceptions that subsidy levels were insufficient, and difficulties with cash flow management on commencing the program.
- Detailed finding #11: mental health nurses participating in the program were attracted to the MHNIP model because it allows them to occupy a senior clinical position with flexible hours but also has a degree of autonomy and independence.
- Detailed finding #12: barriers to program entry for mental health nurses include the requirement for credentialing and the associated processes, and perceptions that remuneration was relatively low compared to what was available in public sector positions.
- Detailed finding #13: there was evidence that a number of eligible organisations ceased their involvement in MHNIP due to concerns about insufficient funding and difficulty in recruiting a mental health nurse.
- Detailed finding #14: there is scope for ensuring greater consistency in processes of patient care by strengthening the Program Guidelines and enhancing clinical governance requirements.
- Detailed finding #15: the majority of medical practitioners select patients to participate in the MHNIP based on the criteria specified in the Program Guidelines.
- Detailed finding #16: there was evidence that MHNIP organisations are completing GP mental health care plans for patients. However, there is also evidence that not all plans are completed in a way that conforms with all the requirements of the MBS item.
- Detailed finding #17: there was anecdotal evidence that MHNIP patients received treatment over a period between 12 to 24 months.
- Detailed finding #18: scope exists to strengthen clinical governance arrangements to improve the quality of services by providing resources and tools to support: improved case management processes; more systematic approaches to risk management; patient and carer complaint mechanisms; and more uniform access to the program at a population level within a particular geography.
- Detailed finding #19: there was evidence of increased participation in voluntary work by MHNIP patients.
- Detailed finding #20: MHNIP guidelines are easily accessible and have been used by the majority of medical practitioners and mental health nurses however some suggestions were made regarding improving the guidelines.
- Detailed finding #21: MHNIP has enabled an expansion in the roles and responsibilities of mental health nurses in the primary health sector.
- Detailed finding #22: the establishment payment was considered appropriate in terms of size and application process.
- Detailed finding #23: MHNIP organisations are unhappy with the current claims process for sessional payments, suggesting it needs reengineering.
- Detailed finding #24: participating MHNIP organisations no longer view the sessional fee as an incentive for involvement in the programTop of page
- Detailed finding #25: medical practitioners take responsibility for assessing patient eligibility for MHNIP treatment.
- Detailed finding #26: there was some evidence of variability in mean HoNOS scores on patient entry to the program, suggesting there is scope for promoting a more consistent approach to assessing eligibility across sites. Clinical governance processes, including cross-site case review processes, could be used to promote this greater uniformity.
- Detailed finding #27: the majority of mental health nurses comply with the employment conditions in the Guidelines around the maximum number of sessions per week.
- Detailed finding #28: consideration could be given to expanding the current mental health nurse employment conditions allowing them to provide greater than 10 sessions per week to enable eligible organisations to offer MHNIP services out of hours and on weekends.
- Detailed finding #29: mental health nurses comply with caseload requirement of at least two individual services to patients per session.
- Detailed finding #30: compliance around completing the claim form could be improved to capture data on all mental health nurse patient activity.
- Detailed finding #31: mental health nurses are meeting the compliance requirements relating to the minimum caseload (number of individual patients) per week and over the year.
- Detailed finding #32: mental health nurses are, on average, allocating 25 hours per week to clinical contact, consistent with the requirements of the Program Guidelines.
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