Better health and ageing for all Australians

Evaluation of the mental health nurse incentive program

5.9 Payment structure

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5.9.1 Establishment payment
5.9.2 Sessional payment
Employed mental health nurses
Mental health nurses engaged under contract
Comparison with NSW public health system nurses' and midwives state award

5.9.1 Establishment payment

Organisations were comfortable with the process for claiming the establishment payment. They considered the payment useful and deployed it in a variety of ways, such as:
  • furnishing an office space for the mental health nurse, including computers and phones;
  • covering cash flow at commencement, as there is a time lag between starting service delivery and receiving the first sessional payment; and
  • developing policies and process to govern MHNIP activities.
Case study organisations did not raise any concerns around the rules governing the allocation of whether they received $5,000 or $10,000.

Detailed finding #22: the establishment payment was considered appropriate in terms of size and application process.
There was also minor feedback that infrastructure purchased using the establishment payment needs to be replaced over time. For example, organisations that have been participating since commencement of MHNIP have already replaced computers, but there is no process for recovering such an expense.

5.9.2 Sessional payment

Case study organisations consistently reported issues around the claims process for sessional payments and the sessional payment amount.
  1. Process. Claim forms must either be faxed or posted to DHS. Organisations had concerns with this process:
    • this is old technology, whilst all other dealings with DHS are online;

    • faxing a large quantity of claim forms at once can result in the recipient running out of paper, being engaged for extended time periods, or paper jams;

    • rejections are often difficult to follow up as DHS tends to post them back to an organisation, resulting in long time lags before processing actually occurred.

      Detailed finding # 23: MHNIP organisations are unhappy with the current claims process for sessional payments, suggesting it needs reengineering.

  2. Fee size. The fee level for sessional payments has not changed since the commencement of MHNIP in July 2007. Organisations that have been participating for a number of years strongly advised that the fee level no longer provided an incentive to participate in the program. The lack of indexation means organisations have experienced a real decrease in the sessional fee value and mental health nurse salaries have increased over time.

    The impact of indexing the sessional fee since commencement is shown in table 5.25. It reveals the differential between the current fee ($240) and the indexed fee for 2012-13 ($276) would be 15%.

    Some sites also suggested that other recent changes to the MBS fee structure for mental health management plans have also reduced the overall income associated with management of eligible MHNIP patients. It is now more difficult to cross subsidise the true cost of MHNIP through other income generating activities.

    Detailed finding # 24: participating MHNIP organisations no longer view the sessional fee as an incentive for involvement in the program.
Indicative analysis of the sessional fee size is presented below in relation to mental health nurse salaries. The evaluation did not collect remuneration details or arrangements for individual MHNIP nurses, although salary figures have previously been collected by ACMHN. Financial models developed as part of a MHNIP feasibility study by General Practice Queensland also provide useful commentary on the financial arrangements on both employing and engaging mental health nurses on a full-time basis.
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Table 5.25: Impact of CPI indexing on sessional fee

YearCPIaResulting fee
2007-08
3.4
$240
2008-09
3.1
$248
2009-10
2.3
$256
2010-11
3.1
$262
2011-12
2.3
$270
2012-13
na
$276

a ABS, CPI weighted average for six state capitals

Employed mental health nurses

ACMHN report that the hourly rate earned by a mental health nurse is influenced by whether the nurse is employed or engaged under contract, and what conditions they have been able to negotiate with the eligible organisation.

ACMHN indicated that feedback received from nurses who are employed by eligible organisations receive on average $35 - $45 per hour. In some cases mental health nurses may only be paid for the time that forms part of sessions, which means that they are restricted to working a maximum of 35 hours per week. In this case, a mental health nurse who works full time (35 hours a week) and takes 4 weeks leave (ie annual, sick or education) in addition to two weeks of public holidays, will receive a gross annual salary between $56,350 and $72,450. This figure does not include a provision for professional development. Where the mental health nurse is paid a salary, with four weeks of leave included (ie annual, sick or education), an indicative yearly salary (37.5 hours per week) would increase to $68,250 - $87,750.

The estimated hourly rate of $35 - $45 is consistent with the financial models developed as part of the Mental Health Nurse Incentive Program Feasibility Study22 prepared by General Practice Queensland. The feasibility study presented three financial models that supported one full time mental health nurse, with two models focusing on the employment of a full-time mental health nurse. Salaries estimated in these financial models were estimated based on the 2009 Queensland Health N04 (Nurse Grade 7) pay scale and ranged from $35 - $40 per hour. The financial models demonstrated that a range of expenses that must be accounted for, other than the mental health nurses base salary. Additional expenses related to the employment of the mental health nurse included:
  • a provision for salary on-costs such as holiday loading and superannuation (range $7,155 - $9,750 per annum); and
  • a range of ancillary expenses (range $8,220 – $17,850 per annum) including:
    • clinical supervision;
    • professional development;
    • management and infrastructure expenses, including laptop, mobile, car allowance and internet connection; and
    • provision of group therapies (funding for preparation time).

Mental health nurses engaged under contract

The mental health nurse survey conducted as part of this evaluation revealed a number of nurses are engaged under contract by an eligible organisation (16.7%; n=48 respondents). While the evaluation did not seek to quantify the conditions of these arrangements, they are expected to vary substantially between organisations. Information collected by ACMHN suggests that some eligible organisations charge a fee per session. On top of this nurses are generally charged room hire for the use of their room and are responsible for their own superannuation and professional development. One mental health nurse reported that they are required to pay a fee of $30 per session to the eligible organisation, in addition to $50 per session for room hire (including phone, internet, stationary and office consumables). This leaves a total income of $160 per session, equating to $45.71 per hour. This hourly rate does not include a provision for leave (i.e. annual, sick or education), public holidays and salary on-costs such as superannuation and professional development. Feedback from case study sites who had engaged a mental health nurse indicated similar per session fees. Further information should be gathered from a larger sample size to validate this finding.
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Comparison with NSW public health system nurses' and midwives state award

A comparison has also been made with the NSW Public Health System Nurses' and Midwives (State) Award 2011. Advice was sought from the ACMHN on which categories would be suitable for comparison.

Table 5.26 presents the analysis of salaries under MHNIP and the NSW public health system nurses. There are notable differences between the working arrangements under MHNIP and the NSW public sector. For example, the NSW award remuneration is for 38 hours per week, whilst MHNIP payments recognise 35 hours per week. The analysis presents hourly rates to standardise this issue.

The analysis is conducted with the following assumptions: nurses work full-time, there are 10 public holidays during the year and no allowances have been applied to the public sector rate. A MHNIP mental health nurse salary has been derived assuming the nurse receives either the full sessional fee ($240), shown as 100%, or a proportion of the fee, calculated at 91.66 % ($220) and 66.6% ($160), based on the feasibility study and feedback from ACMHN. The NSW public health salaries and MHNIP salaries (employed) have had provision for 9% superannuation added. Two scenarios are presented:
  • under scenario A, a nurse works for the full year without taking any leave (i.e. annual, sick or education), resulting in being at work for 50 weeks (as there are 10 public holidays); and

  • under scenario B, a nurse takes four weeks leave, resulting in being at work for 46 weeks.
The result shows the MHNIP hourly rate to be slightly less than the NSW public sector for the selected nurse categories. It also demonstrates the impact of leave taken on the MHNIP mental health nurse remuneration. As noted above, these scenarios exclude all forms of allowances that exist under the NSW award. This analysis did not seek to quantify the additional costs borne by nurses engaged by eligible organisations in relation to salary on-costs, professional development and infrastructure/management. Further detailed analysis could be performed that would seek actual remuneration levels of MHNIP mental health nurses and consider the large range of allowances under the NSW public health system award.

An excerpt from of the NSW Public Health System Nurses' and Midwives (State) Award 2011 can be found in appendix D, which shows the definitions of the nurse categories used in the analysis.

Table 5.26: Comparison of indicative MHNIP mental health nurse salary with NSW public service

Table 5.26 is separated into 3 smaller tables in this HTML version for accessibility reasons. It is presented as one table in the PDF version.
MHNIP - mental health nurse engaged under contracta

Feature
Scenario A
Annual income
Scenario A
Hourly
Scenario B
Annual income
Scenario B
Hourly

Nurse receives 66.6% of sessional rate ($160) based on ACMHN feedback
$80,000

$45.71

$73,600

$45.71

Nurse receives 91.66% of sessional rate (based on GPQLD financial model)
$110,000

$62.86

$101,200

$62.86

Nurse receives 100% of sessional rate
$120,000

$68.60

$110,400

$68.57
MHNIP - mental health nurse, employed
FeatureScenario A
Annual income		Scenario A
Hourly		Scenario B
Annual income		Scenario B
Hourly
Hourly rate reported at $35 /hour
$66,763
$38.15
$66,763
$38.15
Hourly rate reported at $40 /hour
$76,300
$43.60
$76,300
$43.60
Hourly rate reported at $45 /hour
$85,838
$49.05
$85,838
$49.05
NSW public sector
FeatureScenario A
Annual income		Scenario A
Hourly		Scenario B
Annual income		Scenario B
Hourly
Clinical nurse specialist grade 2 year 2
$104,108
$54.80
$104,108
$54.80
Clinical nurse consultant grade 1 year 2
$115,105
$60.60
$115,105
$60.60
Table 5.26 footnotes

a this figure does not contain a provision for salary on-costs, infrastructure/management costs or professional development expenses.

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