Evaluation of the mental health nurse incentive program

5.3 Program uptake

Up to Publications

prev page| TOC |next page

Analysis of the program uptake reviewed barriers to patient entry, drivers for participation of eligible organisations and mental health nurses, barriers to participation encountered by eligible organisations and mental health nurses, and reasons that registered organisations failed to commence or ceased involvement in MHNIP.

5.3.1 Patient barriers to entry
5.3.2 Eligible organisations - drivers and barriers to participation in MHNIP
5.3.3 Mental health nurse drivers and barriers to participation in MHNIP
5.3.4 Reasons eligible organisation cease to participate

5.3.1 Patient barriers to entry

Stakeholders advised that MHNIP supported patient participation through a variety of mechanisms, including access to free treatment by the mental health nurse, home visits (by some organisations), non-threatening treatment environments, and the clinic setting reduced the stigma of mental health. Nevertheless, they saw a range of barriers to program participation. The top five reasons acting as barriers to patient participation identified by medical practitioners are shown in table 5.1.

"Access is a barrier, as we have limited mental health nurse sessions, which results in waiting lists. Furthermore, suitability of appointment times is an issues as, whilst all patients are not working, they are busy with Centrelink issues, going to the chemist etc."
GP, general practice, metropolitan Victoria
Feedback from case study interviews with mental health nurses provided a different perspective on the barriers faced by patients, shown in table 5.2. They said the most common patent barrier for accessing MHNIP was not having a GP or a regular GP.

"[MHNIP] patients need to have a GP and some do not trust doctors."
Mental health nurse, Medicare Local, rural Victoria
The findings described in the two tables above roughly fall into two broad categories. Firstly, patient characteristics, such as not having a GP or stigma attached to having mental health problems. Secondly, the nature of the MHNIP program arrangements, which include the availability of mental health nurses and a lack of awareness about the program.

Detailed finding #7: barriers to patient entry into MHNIP still exist relating to:

1. patient population characteristics, such as not having a GP or experiencing stigma associated with seeking treatment; and
2. characteristics of the program operations e.g. the lack of access to mental health nurses in some areas.

The mechanisms used to manage patient demand at case study sites are summarised in table 5.3. This shows waiting lists are most commonly used. The other category contained a range of isolated responses, such as provision of short term counselling and referrals to other external services.

Detailed finding #8: participating organisations are not able to treat all suitable patients under MHNIP and use waiting lists and triaging to manage excess patient demand.Top of page

Table 5.1: Client barriers for participation in MHNIP – the views of participating medical practitioners

Barriers to participation: major themes	No. of responses	% (n=191)
There are not enough mental health nurses	79	41
Stigma associated with mental illness and accessing mental health services	18	9
I am not aware of any barriers	18	9
Lack of awareness of the program and potential benefits	16	8
Patient may be unwilling to engage with additional health professionals for the management of their mental health condition	12	6

(Source: Survey of medical practitioners)

Table 5.2: Patient barriers to participating in the MHNIP– the views of participating mental health nurses

Patient barriers (themes)	No. of responses	% (n= 28)
Patients without a GP, or a regular GP	8	28.6
Program scope eg need for a mental health care plan	7	25.0
Stigma attached to mental heath	6	21.4
Mental health nurse capacity (access)	4	14.3
Transport	4	14.3

(Source: case study interviews with mental health nurses)

Table 5.3: Mechanisms to manage patient demand for MHNIP services - the views of participating medical practitioners

Demand management approach	Medical practitioners No. of responses	Medical practitioners %	Mental health nurse No. of responses	Mental health nurse %
Waiting list	22	46.8	16	37.2
Triage	13	27.7	7	16.3
Other e.g. provision of short term counselling	12	25.5	20	46.5
Total	47	100	43	100

(Source: survey of medical practitioners and mental health nurses)

Top of page

5.3.2 Eligible organisations - drivers and barriers to participation in MHNIP

MHNIP is open to any eligible organisation that registers, using the processes described in Chapter 2. A principal of the organisations - generally a medical practitioner or the chief executive officer in the case of Medicare Locals – drove the decision to register and participate in MHNIP. Case study interviews found key drivers for participation included perceived needs of patients in the organisation's catchment area, and a close alignment of the MHNIP model with the existing multi-disciplinary care provided by the organisation. ACMHN reported that mental health nurses have also assisted in promoting the program by explaining the program and its benefits to organisations. This has resulted in a number of these organisations joining the program.

"We run a GP practice near a housing commission with lots of state mental health services clients."
GP (principal), Medicare Local, metropolitan NSW

"We received information from Medicare about MHNIP. We investigated and it seemed a good fit to our clinic's multi-disciplinary approach, and we needed a mental health nurse."
Psychiatrist (principal), private psychiatry practice, metropolitan Queensland
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.
Case study organisations reported that MHNIP was relatively easy to manage from their perspective as a service provider. However, barriers to entry still existed for organisations, shown in table 5.4. There was a range of other isolated barriers reported, not shown in this table. Examples of these included the need for the practice to be accredited, and the suspicion of the ongoing duration of MHNIP.

"Finding a mental health nurse initially was a barrier. The GPs too were initially concerned that the practice would have an increase in our mental health patient case load, which did not happen."
Executive Officer, general practice, metropolitan Queensland

"[There was a] financial barrier, as we had to cover the cash flow for first two months - the delay on sessional claiming."
GP (principal), general practice, metropolitan Western Australia
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.

Table 5.4: Organisational barriers to MHNIP participation - the views of participating medical practitioners

Barriers	No. of responses	% (n=17)
Recruiting appropriate mental health nurses	7	41.2
Insufficient funding	6	35.3
Cash flow timing (on commencement)	3	17.6
Physical space	3	17.6

(Note: multiple responses were permissible; the sample represents the number of organisations; Source: case study interviews of principals or CEOs

Top of page

5.3.3 Mental health nurse drivers and barriers to participation in MHNIP

Mental health nurses consulted during the cast study process reported a number of driving forces for commencing work within MHNIP, shown in table 5.5. The program design features were a key driver for engagement – the flexibility of working hours, and occupying a senior position that allowed them to use their clinical skills (equivalent seniority in the public sector requires a heavy involvement in management and administrative activities).

"With my qualifications and experience the program allows me to use all of my clinical skills. Otherwise [in the public sector], I would be a nurse unit manager or clinical nurse consultant and largely focussed on management, not clinical aspects."
Mental health nurse, general practice, metropolitan Queensland
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.
Mental health nurses still reported barriers to their engagement table 5.6 presents the most commonly reported barriers. Credentialing was seen as a necessary requirement for participating mental health nurses but was still seen as a hurdle for becoming involved. There were also concerns about remuneration levels and entitlements in comparison to public sector positions.

"Mental health nurses need experience and qualifications. Also, salary and entitlements are not as good as in the public sector. For example four weeks instead of six weeks annual leave and better access to professional development opportunities."
Mental health nurse, Medicare Local, metropolitan Victoria
These barriers fall into two categories. They reflect:

• the nature of the mental health role under the program, such as loss of clinical support and autonomy of practice (which some nurses may find confronting); and
  
  
• characteristics of the program arrangements, including the requirement for credentialing and lower remuneration compared to the public sector.

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.

Table 5.5: Drivers to participate in MHNIP - the views of participating mental health nurses

Drivers	No. of responses	% (n= 29)
Attracted to MHNIP model	13	44.8
Career change or enhancement	8	27.6
To move out of acute sector	7	24.1
Increased independence	5	17.2

Note: multiple responses were permissible; the sample represents the number of mental health nurses interviewed Source: case study interviews with mental health nurses

Table 5.6: Barriers to nurse participation in MHNIP - the views of participating mental health nurses

Barriers reported	No. of responses	% (n= 29)
Credentialing	18	62.1
Lower remuneration or salary package and entitlements	16	55.2
Insufficient Funding	4	13.8
Loss of clinical / professional support	3	10.3
Autonomy / independence	3	10.3
Job security	3	10.3

Note: multiple responses were permissible; the sample represents the number of mental health nurses interviewed; Source: case study interviews with mental health nurses

Top of page

5.3.4 Reasons eligible organisation cease to participate

Reasons why eligible organisations ceased their participation after initial registration was gauged by running an on-line survey. Seven organisations completed the survey. Table 5.7 shows financial reasons were the most common reason for an organisation to withdraw from the program, followed by difficulties in recruiting and retaining mental health nurses.

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.
Six of the seven organisations that responded to the email survey on reasons for withdrawal said they would reconsider participating in the program in the future. The main factors that would influence their reconsideration are given in table 5.8.

Table 5.7: Reasons eligible organisations ceased participation in MHNIP

Table 5.7 is presented as a list in this HTML version for accessibility reasons. It is presented as a table in the PDF version.

Number of responses for the following reasons:

• Insufficient funding - 5
• Mental health nurse recruitment & retention - 4
• Difficulties with professional relationships - 2
• Total responses - 7

Source: email survey of eligible organisations that ceased participation in MHNIP

Table 5.8: Factors that would influence an organisation to reconsider participation in MHNIP

Table 5.8 is presented as a list in this HTML version for accessibility reasons. It is presented as a table in the PDF version.

Number of responses for the following factors:

• Increase sessional payments - 5
• Mental health nurse recruitment & retention - 4
• Total responses - 7

Source: email survey of eligible organisations that had ceased participation

Top of page

prev page| TOC |next page