Imagine if you had the care of someone with a severe diagnosed mental illness to fit in with a busy day's schedule of work, study or simply self care. Wouldn't you feel somewhat relieved if there was someone who could supply a care coordination role to the person with the mental illness. Would that take some of the load off you? Things like medication compliance, re-socialising within the local community, arranging connections with non-government and government services and general practitioners that could usually be out of your reach. Well the answer is to use the Medicare Australia funded initiative: The Mental Health Nurse Incentive Program (MHNIP).
The entry point for this program is through any general practitioner or any general practice who elects to become an "eligible organisation" registered with Medicare Australia. What does it take to become and eligible organisation? Two pages of basic details about the practitioner or their general practice. What do they get in return? If they refer patients for between one to four sessions each week for care coordination the GP or their practice will receive a grant of $5,000. If they refer their patients to five to ten sessions in a week they receive a one off grant of $10,000. The only requirement for the doctor or the practice is that they have to either recruit or engage (contract) a Credentialed Mental Health Nurse to provide the care coordination. There are less than 800 such Credentialed Mental Health Nurses in Australia so when the Southern Highlands have 3 such Credentialed Nurses we could say we are somewhat blessed. However, the Southern Highlands Division of General Practice does not appear to have effectively promoted this MHNIP to its GPs or Practices. Socrates is aware that every other Division of General Practice has wholeheartedly adopted the MHNIP concept except (apparently) for the Southern Highlands Division.
This is what the Royal Australian College of General Practice had to say about the MHNIP:
Fact sheet for general practices
Summary
• General practices can now engage or retain a mental health nurse to assist in managing community based patients with a severe mental disorder.
• The minimum case load for the mental health nurse is at least two individual patients with a severe mental disorder and being treated in the community per 3.5 hr session (minimum 1 session per week).
• A payment of $240 (GST inclusive) per session is available in urban areas, and $300 (GST inclusive) in very remote, remote, and outer regional areas (defined by the Australian Standard Geographic Classification scheme).
• From 31 December 2009, eligible mental health nurses need to be credentialed by the Australian College of Mental Health Nurses. Until this time, interim arrangements will apply to enable mental health nurses that are not yet credentialed to be engaged.
• Practices choosing not to engage or retain a nurse may still have access to services through nurses employed by a division or other eligible organisation.
• Definitions of eligible practices, and patients with ‘severe mental disorder’ are included within program guidelines available from www.medicareaustralia.gov.au or at www.health.gov.au/coagmentalhealth
• Advice on recruiting mental health nurses can be obtained from the Australian College of Mental Health Nurses at www.acmhn.org.
Background
The Mental Health Nurse Incentive Program provides a non-MBS incentive payment to community based general practices, private psychiatrist services and other appropriate organisations (such as divisions of general practice) that engage or retain mental health nurses to assist in the provision of coordinated clinical care for people with severe mental disorders in the community.
What services are provided?
Mental health nurses engaged under this initiative will support general practitioners (GPs) in managing patients with severe mental disorders in the community and provide a package of services that are tailored to the person’s needs, which could include:
• periodic review of the patient’s mental state
• medication monitoring and management
• providing information on physical healthcare to patients
• integrating services from GPs, psychiatrists and allied health workers (such as psychologists) including arranging access to interventions from other health professionals when these are required
• undertaking home visits (including family interventions if needed).
What are the benefits for general practices/practitioners?
General practices that engage or retain a mental heath nurse under this initiative will have increased capacity to directly provide and coordinate services for people with severe disorders in the community. Services provided by the mental health nurse may also reduce workloads for GPs and other practice staff.
General practices choosing not to participate directly may still be able to access mental health nurse services for their eligible patients through other organisations, such as divisions of general practice, who have engaged a mental health nurse under the initiative.
The RACGP strongly recommends that general practices considering involvement carefully review the guidelines for this initiative in light of their local patient, practice and mental health services profile. Practices are also advised to review the obligations incurred through different models of participation in this initiative. For example, insurance obligations on practices may vary depending on whether mental health nurses are employees or independent contactors.
What are the benefits for patients?
• Access to clinical care by a mental health nurse in the community.
• Continuity of care.
• Provision of multidisciplinary, community based care through one practice.
• Additional assistance with medication.
• A single person coordinating both clinical care and co-ordination with other agencies and
service providers.
How are these services funded?
The Australian Government has provided funding of $191.6 million over 5 years from July 2007 through the Mental Health Nurse Incentive Program. Payments to eligible organisations will be administered by Medicare Australia.
Socrates does have to consider that there is something amiss in the Southern Highlands where this MHNIP initiative does not seem to be taken seriously by the Southern Highlands Division of General Practice or its general practitioner members. In the meantime mentally ill patients and their carers and family members are being denied access to the full extent of the Medicare- provided care coordination services available to them.
As this is a democracy, and everyone has the right to expect access to a complete mental health service available to it, Socrates urges the reader of this tablet to be the activist, advocate and agitator and ask their general practitioner for access to this valuable service. If they can't provide a reason why they don't have the MHNIP service for their mentally ill patients, suggest that you will have to move to a practice which does provide such a service.
