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Mental health crisis: focus on nurse-led and recovery programs

Mental health crisis: focus on nurse-led and recovery programs

Increased funding for mental health services, a more coherent and better integrated suite of patient support services, and immediate investment in acute inpatient beds are just some of the ANMF (Vic Branch)’s key recommendations to the Royal Commission into Victoria’s Mental Health System.

The ANMF believes chronic underfunding of the mental health sector has stretched the existing system to the limit, resulting in acute patients being ‘churned’ from hospital beds despite needing longer, continuing care.

As well, the relationships between various existing mental health services are often broken or unclear, even for professionals operating inside the system, making it doubly confusing for patients trying to navigate a path to suitable care.

In its 157-page submission, the ANMF has underscored some of the recommendations and observations made in earlier reports, notably the Victorian Auditor-General’s March 2019 Access to Mental Health Services, which found the existing system was ‘overwhelmed’ by demand and the priorities of a decade ago no longer matching the current challenges.

The Auditor-General reported that, despite numerous external reviews, the Victorian Department of Health and Human Services had failed to demonstrate how it would cater for the forecast strong increase in demand for mental health services in this state.

And it highlighted how insufficient funding over the past decade had forced mental health services ‘to focus on acute and crisis treatment at the expense of earlier intervention services in the community’.

The Auditor-General’s report called for increased funding, a focus on increasing the strength and skills of the mental health workforce across the state, and sustained capital investment in new and expanded facilities.

In its submission, the ANMF says it shares the Auditor-General’s concerns about ‘profound repercussions’ caused by the lack of proper planning, investment and monitoring. It describes a ‘taut and fraught system’ in which clinical services, including the effective and much-valued Mental Health Nurse Incentive Program (MHNIP), have been cut back or eliminated entirely.

‘These changes have contributed to the situation we now have, where people who are acutely unwell must reach crisis point before they can access either a bed within a mental health ward (for a very short stay) or emergency community care from clinical mental health services,’ the ANMF (Vic Branch) submits.

The ANMF wants specific measures to build and develop the mental health workforce in all areas of public health services, community and private practice, and it wants programs and processes that focus more closely on the experience and needs of patients. These needs include consideration of physical health given the strong correlation between poor physical outcomes in the mentally unwell population and in many cases, a disproportionately shorter life span.

Among the ANMF’s 70 recommendations to the Royal Commission into Victoria’s Mental Health Services is a call for ‘clear, seamless, readily accessible pathways to tailored, holistic care’ for the increasing number of people seeking mental health treatment, recovery programs and support.

‘Nurses are at the front-line of managing this heightened demand,’ the ANMF says. ‘They deal with people when they walk in the door, as they wait for assessment and admission, and through their admission, assessment, treatment, discharge and follow-up care.’

The ANMF believes that because nurses and midwives play vital roles at every stage in medical services, they are also well-placed to assist with early-intervention strategies.

‘As our submission details, nurse-led interventions deliver best practice, person-centered, recovery-focused care and are integral to a quality mental health system.’ The ANMF believes investing in nurse-led programs and models of care that focus on the patient and long-term recovery will have strong impact, be cost-effective and efficient.

At the same time, the ANMF has stressed the need for additional scholarships to meet the growing number of registered nurses and midwives wanting to undertake postgraduate education in mental health and enrolled nurses wanting to undertake graduate certificates and graduate diplomas in AOD education.

It has called for nurse practitioner positions to be added into perinatal mental health services, emergency department hubs, aged persons’ mental health services, child and youth mental health services, alcohol and other drugs health services.

Preventative measures could include using programs led by nurses and midwives to provide universal early screening of mental health risks or illnesses, plus health promotion strategies and therapeutic solutions.

The ANMF has recommended introducing nurse navigators, nurses who know the health system and can guide people through what can be a challenging referral process. Nurse navigators help people obtain the mental health care they need, with the appropriate practitioner, whenever they need it.

Other ANMF proposals include reinstating dedicated Crisis Assessment and Treatment Teams (CATTs), as opposed to having them integrated into area mental health services. CATTs can provide intensive support to patients after discharge, including daily, at-home visits and early intervention.

The union also recommends investment in, and prioritisation of, community-based responses for mental health, including funding Prevention and Recovery Care (PARC) services to ensure they can provide specialist mental health nurses 24 hours a day, every day of the week.

Among the 19 case studies is one from a nurse formerly involved in the Mental Health Nurse Incentive Program and letters from several of her clients who have been deeply concerned about the impact the termination of the program has had on their lives.

The ANMF has also suggested easing the burden on the general health care system by investing in dedicated mental health facilities for forensic acute patients. This would entail three facilities across the state, comprising 20 beds each, to cater for medium-security forensic inpatients.

The Auditor-General’s report noted almost half of all Victorians will suffer from a form of mental illness at some stage in their life. The number of suicides in Victoria is more than double the number of fatalities caused by road accidents, and it is rising. The Coroners Prevention Unit has revealed that more than 50 per cent of Victorians who took their own lives in the six years to 2015 had some form of contact with the health system in the preceding six weeks.

More than $500 million is paid each year in workers compensation claims relating to mental health issues, and health and welfare support workers are among the top three categories of occupations considered most at risk. In response, the Andrews Government has introduced a pilot program that provides public sector nurses and midwives, who make a mental health-related WorkCover claim, access to provisional payments immediately for mental health treatment. This program radically reverses the need for workers to prove from the outset that their mental health concerns arise from conditions in the workplace.