Mental Health Nurse Incentive Program: case studies project report
Executive summary
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The Mental Health Nurse Incentive Program (MHNIP) is part of the Australian Government‟s component of the National Action Plan on Mental Health 2006 – 2011. The MHNIP has been introduced as an alternative model of mental health care for those with serious mental illness, and significant impairment in their daily functioning. General practices, private psychiatrist services and other appropriate community providers (including general practice networks and private hospitals) can access sessional funding to employ mental health nurses to assist in the provision of coordinated clinical care for people, in the community, with severe mental health disorders.
Client outcomes expected from this collaborative approach to providing clinical support and services in the community are:
- to provide improved levels of care for people with severe mental health disorders
- reduce hospital admissions and readmissions for people with severe mental health disorders
- assist people with severe mental health disorders to stay well, and connect with their community.
The "Case Study of the Mental Health Nurse Incentive Program" project aimed to provide a case study report on a number of examples of the MHNIP across a range of settings. The case studies were intended to highlight the development, implementation and some early outcomes for the MHNIP.
This case study project investigated seven different sites where the MHNIP has been implemented, covering a variety of locations, service models and employment arrangements. Although no private hospitals or services from a remote location were included in the project, there was sufficient variation across the sites to explore different models, varying interpretations of the guidelines, a range of precipitating factors, and feedback from a range of sources about the impact the program is having.
As well as providing a detailed description of the implementation of the MHNIP at each location, this final report describes available information on clients. experience of care, their perception of the program more broadly, and some indication of mental health outcomes achieved. The report extends to a discussion of some of the themes that have emerged from within and across the seven localities. These in turn can inform the program evaluation planned by the Department of Health and Ageing.
Key questions that underpinned the case studies include:
- the perceived need that motivated the introduction of the MHNIP
- the way the role been interpreted and/or implemented in differing localities
- the service model used
- implementation challenges
- successes of the program
- any opportunities for enhancement.
- Ballarat and District Aboriginal Corporation
- Bathurst Mental Health Nurse
- Clare Medical Service
- General Practice Association of Geelong
- Ipswich West Moreton Division of General Practice
- Longford Medical Centre
- Mackay Division of General Practice.
There were four organisation types represented, along with examples of both direct and shared employment arrangements. Also included is an Aboriginal Cooperative that delivers primary health care services.
The methodology utilised up to four separate data collection processes including:
- an initial service survey
- stakeholder consultation at each site
- a client survey
- snapshot data collection.
Overall there was wide acceptance of the program and feedback from all stakeholders was extremely positive. General practitioners, psychiatrists, nurses, clients and non-government mental health service providers reported that the service is working well and is a welcome addition to the spectrum of mental health services available. In some cases, state mental health service managers were also included in the supporters of the program. Stakeholders reported that they thought that because of the MHNIP, many more people were receiving a mental health service in convenient and non-stigmatising settings.
The variety of service models seen, in the seven settings, shows that the MHNIP can be adapted to a range of situations and used to address different local scenarios.
There was considerable discussion about the current funding model and whether the sessional basis of the current model is the most suitable. In some cases, the auspice organisation had embraced the "incentive" concept of this program and could clearly recognise the benefits of the MHNIP over and above the financial commitment required of the organisation. State health services involved in delivering the MHNIP were making a significant financial contribution although concerns were expressed about their capacity to continue doing this over the long term, particularly if payments are not clearly indexed. It is interesting to note that none of the services included in this case study had chosen to introduce a co-payment.
At present, no limit has been set to the potential expansion of the program, although there has been limited uptake to date, in part it would seem due to the availability of credentialed nurses. This has resulted in an uneven distribution of the program, even within locations where the program operates.
The available evidence from all sources gathered in these case studies suggests that the program is currently reaching a much broader audience than that described in the program guidelines. Nevertheless, it is having a significant impact and is reaching many people in need of an ongoing mental health service.
Earlier intervention, shorter admissions and better follow-up in the community were also reported as outcomes for the program. GP knowledge about medications and medication reviews has improved, as has their confidence in working with people with mental health issues, and scarce psychiatry resources are better targeted.
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Results from the client survey indicate 80% of people who responded to the survey reported improvement in their mental health. Almost half of the sample reported improvements in their social relationships, while a third said that they now have more friends. Better physical health outcomes were also reported as a result of the nurse being able to focus on these in addition to, mental health issues.
These case studies show some clear examples of the benefits of the co-ordination role of the nurse, both within the implementation of the mental health treatment plan, and more broadly to link in to a range of other community supports. Examples were seen of service models where the mental health nurse is incorporated into an "in-house" interdisciplinary model, while in other places community service networking was used to provide the range of supports needed for clients.
Some locations however, reported a significant lack of resources in their community. It was not possible in this project to determine what impact the quantity of community resources available and the way that the nurse(s) is linked into these networks has on outcomes for clients. This may be a useful area for investigation during the evaluation.
Quality systems did not appear to be a major feature of most MHNIP services visited. Some had developed protocols and MOUs around how the service would roll out, particularly around lines of accountability, although local practice guidelines are not evident.
Data collection is an issue both observed and raised by stakeholders at all locations. Various difficulties in collecting and collating data were discussed. However, the most striking observation was the limited use of outcome data to measure treatment outcomes for individuals, and the lack of any analysis of this data to improve the program as a whole.