SWSLHD and Bowral's Health - 41

Mental health nurses improve access

• By Gemma Collins on  24 October 2011 - 6Minutes

Incorporating mental health nurses into general practice can lead to better outcomes for patients and GPs, but a shortage of these specialist nurses could make it difficult to expand the program, a pilot scheme has found.

A four-year program, which involved mental health nurses working with GPs and private psychiatrists in five states, was found to have “significantly improved” access to appropriate mental health services, a report has revealed (link).

More than 40,500 people received a service through the $191.6m Mental Health Nurse Incentive Program (MHNIP) from 2007-2011, in a range of areas which ranged from one nurse supporting one practice to seven nurses supporting 29 practices, according to the recently released report.

The authors say the program led to earlier intervention, shorter admissions and better follow-up with patients receiving mental health services in “convenient and non-stigmatising settings”.

GPs said they felt better supported in their work with mentally ill patients and said their knowledge and confidence had improved. 

Out of the 57 patients who were surveyed, 80% reported improvements in their mental health and almost half reported improvements in their social relationships. 

The government has since announced it will allocate a further $13m over two years to employ an additional 136 mental health nurses.     

But the limited availability of ‘credentialed’ nurses, particularly in rural areas, could make it difficult for the program to expand, the authors say.  

The funding which was based around a fixed payment per half day session was also found to be a deterrent, as it did not allow for any additional costs including computers or professional development and for the extra time needed to get around rural areas.

Now here is an interesting tale! I'm told that the Southern Highlands still has only one Credentialed Mental Health Nurse who provides this service. Other's have tried to enter the SH area to also provide the service but have not been supported by .... you guessed it !... the CEO of the Southern Highlands Division of General Practice..... who suggests it may be due instead to the others not being able to market themselves to the GPs. I guess it does not help if the CEO informs the GPs who are interested that they would be more open to being audited and other bits of misinformation guaranteed to turn off even the most ardent advocate for the program. The fact remains that since the failure of their own staff member in achieving credentialed mental health nurse status, the Southern Highlands Division of General Practice has taken their bat and ball and left the MHNIP field of play.

SWSLHD and Bowral's Health - 40

GPs to prepare for mental health cuts

• By Gemma Collins on  21 October 2011 - 6Minutes

Many bulk-billing GP practices will have to start charging patients for Better Access services, the RACGP says.

With the final report into the Senate inquiry on mental health cuts being delayed, the College has said that the changes to the Better Access general practice mental health item numbers announced in the May budget, are likely to come into effect from November 1. 

Ina  series of likely scenarios (link) the College says it will continue to lobby the government but “practices may require revised practice systems and billings in order to continue delivering high quality patient care”.

College members have come up with a list of different practice scenarios to provide GPs with alternatives models of care for mental health services.

It has given the scenarios of a large practice in the northern suburbs of Melbourne and a small busy private practice in the western suburbs of Sydney that will both no longer be able to afford to continue bulk-billing mental health services through the Better Access program.

They will instead charge a patient co-payment for all the mental health services or refer their patient to public state-based services.

Meanwhile a medium sized private rural general practice in Queensland that employs a practice nurse with mental health skills is planning to use General Practice Management Plans (GPMP) and Team Care Arrangements (TCAs) which will involve the GP and the practice nurse who will coordinate mental health screening and assessment. 

Meanwhile a fourth scenario for a bulk-billing practice that is unable to charge a patient co-payment due to its service charter, is to use the new MBS item 2715 in combination with other appropriate MBS items.

GPs are being told to contact the RACGP Policy & Practice Support Unit for advice (advocacy@racgp.org.au)

Comments

We drew up our new fees at the beginning of October and published them at the practice for patient’s information. Mostly our Gap is $30, but the gap for <40minutes plan is higher. I only realised this week when I received a mailing from Psychologist Association the if a patient has already used 10 sessions this year, they are ineligible for any more session after November 1st.

Milton Doctor | 22 October 2011 at 20:56

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 45

Analysing the 2011 mental health Budget

23rd May 2011

Sebastian Rosenberg   all articles by this author

THE most interesting element of the Budget was not the quantum promised to mental health: $2.2 billion is a reasonable outcome, but only $1.5 billion of this is new money.
Over five years, and as the centrepiece health investment in a tight Budget, there is reason to be appreciative without being overwhelmed.

Fact is, the health Budget grows by around $9 billion each year. At this rate of investment, mental health’s share of the overall health Budget is diminishing.

Another interesting aspect of the Budget was the choices the Government made that reflect willingness to support innovation. There are overdue investments in the Early Psychosis Prevention and Intervention Centre (EPPIC) and also funding for headspace, new services for new clients.
But whether enough funding has been provided to enable their national deployment with integrity of their model of care is less clear.

There is new investment in flexible care packages – $343.8 million – but this funding is supposed to assist 24,000 Australians with severe, persistent mental illness over five years, equating to only $2865 per person per year.

Access to this funding is up for tender, between NGOs and the new Medicare Locals. For the Government, this is a neat way of bringing the nascent Medicare Local enterprises into the community mental health service realm. The risk here is for a continuation of a biomedical approach to these packages of care at the expense of more psycho-social approaches.

The establishment of a pool of incentive funds for states and territories to engage particularly in the development of supported accommodation is most welcome, as is new investment in e-mental health.
There is mounting evidence that for some treatments, e-mental health care is at least as effective as face-to-face services and this is critical if we are to address the needs of remote and regional Australia.

Around a quarter of the whole mental health package is funded by minor administrative changes to the Better Access program, with reductions to the Medicare rebate to GPs and a reduction in the number of subsidised sessions of psychological therapy from 12 to 10 each year.

The Better Access program now costs $10 million per week – the Department of Finance could not ignore it. The fee for service payment model militates against collaborative care.

This is why the Government reassigned funds to the Access to Allied Psychological Services program.

The establishment of a new National Mental Health Commission is exciting, offering a new level of federal scrutiny and accountability over a system characterised by an inability to demonstrate the impact it makes on people’s lives.

Again, however, the Budget papers indicate expenditure of only $12 million over five years, limiting the initial capacity of the commission to really drive new accountability.

The Federal Government has given no indication of its intention to seek state and territory support for a COAG National Action Plan on Mental Health Mk II. As it stands, the Government is bringing around $200 million to COAG, seeking co-investments from the states. By contrast, the 2006 COAG plan delivered $5.5 billion.

This Budget sets out many challenges for the sector but perhaps the most significant challenge is for the political gods to resist the urge to simply now cross mental health off their ‘to do’ list. Now is the time for advocates for mental health reform to be pointing out how much there is still to do.

People with mental illness and their families are used to waiting, often with sad, sometimes tragic consequences. This Budget does not mean that wait is over.

Sebastian Rosenberg
Senior Lecturer, Brain and Mind Research Unit, University of Sydney

SWSLHN and Bowral's Health - 9

Budget expected to benefit mental health programs

5th May 2011 - Medical Observer

Shannon McKenzie and AAP   all articles by this author

MENTAL health has been tipped as a major winner in next week’s Budget, with fresh predictions that the Gillard Government will tip around $2 billion into that area.

Part of the mental health plan would involve establishing a $50 million Mental Health Commission, charged with ensuring people’s minds are treated with as much care as their bodies.

The prediction from media source AAP and mental health experts comes as Health Minister Nicola Roxon this week admitted mental health had "for many decades really fallen between all the gaps".

Professor Ian Hickie, executive director of the Brain and Mind Research Institute, is confident the Government will deliver on its promise to make mental health a priority.

However, the rest of the health portfolio is unlikely to see a vast increase in new funding, with the Gillard Government still finalising its $16 billion hospital reform deal struck with states and territories.

Labor promised to consider investment in dental care as part of the deal that saw the Australian Greens help deliver Julia Gillard a minority government.

But due to the summer's natural disasters, and the continued promises to return the Budget to surplus, a universal Denticare scheme looks unlikely.

Greens spokesperson Senator Rachel Siewert admitted as much.

"We're hoping we're going to see the start of the Government's commitment to dental reform and to progress towards a Denticare system," Ms Siewert told AAP this week.

"But we're realistic and we don't expect to see it all at once."

Reported cuts to medical research totalling $400 million are unlikely to be in the budget following a backlash from scientists.

Tags: mental health programs, Federal budget, Mental Health Commission

raven
5th May 2011
5:21pm

WA MP Martin Whitely has published a blog raising significant questions about EPPIC and Headspace and about undeclared conflicts of interest among the authors of the recent mental health reform blueprint. Professor Patrick McGorry has responded. Both are available at: http://speedupsitstill.com/patrick-mcgorryE8099s-independent-mental-health-reform-groupE8099s-3-5b-blueprint-australian-mental-health-forward-prescription-E28098psychiatric-disordersE28099-E28098off-label#more-1530

SSWAHS and its view of how the "Code of Conduct" should be interpreted

Let's take another look at how the SSWAHS executive interprets its "Code of Conduct" when it comes to complaints about its staff.

Here's another gem from the Bowral community members. A complaint is made to the manager of one of the local services about comments they have made to their staff about a community member are inappropriate and contrary to the Fair Trade Act (among others) and could be seen as defamatory. This time the complaint, made on 16 October 2009, is forwarded to SSWAHS Area executive. Socrates has been given a copy of the response to the complainant from someone who goes by the name H.E on behalf of the Director of Corporate Services.

"Dear Mr ........

Subject: Allegations in relation to Mr ..... .......

I refer to your correspondence dated 16 October 2009 in which you allege that you have received reports from unnamed sources to the effect that Mr .... .... (... ....) has expressed opinions in relation to referral processes between the Mental Health Service and yourself in the capacity as a private clinician. The matters raised in your correspondence have been investigated by Area Mental Health Services and I have been informed as follows.

Mr ..... denies having made any statements to staff and/or others in relation to the (sic) whether the Mental Health Services should refer clients to you. I am advised that in accordance with NSW Health Policy, the Mental Health Service has had a long-standing practice of providing clients who require private sector services with the names of a range of clinicians who practise in a geographical area. This information is provided without commentary or opinion being passed by Health Service staff in relation to the skills of any of the clinicians listed. I am also advised that the expectation that this practice continues to be followed was reconfirmed by a senior manager within the Mental Health Service at a recent meeting of the Bowral Mental Health Team.

I would be grateful if you could direct any further concerns that you might have in relation to service interaction between yourself and Bowral Mental Health, and/or the actions of any Health Service staff member, to Mr William Midson (Service Manager, Community Mental Health Wingecarribee/Bowral). Mr Midson can be contacted by email william.midson@sswahs.nsw.gov.au or telephone 4629 5414.

If you have any further questions in relation to this matter please do not hesitate to contact me.

Yours sincerely,

H.E.
pp Jan Whalan
Director of Corporate Services
Date: 23 December 2009

Again, we seem to have the SSWAHS policy of simply asking the person against whom the complaint is made to decide the outcome. Hardly consistent with the Code of Conduct 1.5 Fairness in Decision Making: ..."I will deal with issues, cases of complaints consistently, promptly, openly and fairly".

What a pity that the investigator of the " investigation by Area Mental Health Services" didn't bother to ask any of the staff present at that Tuesday morning staff meeting at which the statement was made by Mr .... , what they were told by him in no uncertain terms. Instead SSWAHS simply relied on Mr ....'s word that "No, I didn't say that." Ah well! At least there was an opportunity to respond according to the H.E. letter: "If you have any further questions ...... please do not hesitate to contact me."

Well, I'm informed that the complainant took up the offer and on 31 December penned another letter to Ms Jan Whalan, Director of Corporate Services. In summary, the letter suggests that the SSWAHS investigator revisit the complaint and speak with other staff (even a consultant psychiatrist) who were present during the meeting at which the statement was made by Mr ..... . It was also suggested that clients of the mental Health Service were not advised that they could be given a list of private practitioners in the area to who they could be referred. It was also noted that a SSWAHS employed psychiatrist in Bowral was making direct referrals of his public patients to a private practitioner in the Bowral area in apparent contravention to the "long-standing practice of providing clients ... with the names of a range of clinicians who practise in a geographical area without commentary or opinion being passed....". This was in contrast to other consultant psychiatrists employed by SSWAHS had been advised that they were not to do so.

I suppose the "If you have any further questions in relation to this matter please do not hesitate to contact me" really didn't say "However, if you do - don't expect a reply". You guessed it - the complainant is still waiting for the response from that second letter.

As a side note to the response from SSWAHS, when the Manager of the Wingecarribee/Bowral Mental Health service was asked for the list of local clinicians which was made available to clients of the Bowral mental health service, the response was that very few clients asked for any list and any that did would simply be told to look up the local Yellow Pages.

I guess this is the classic case of the right hand (SSWAHS) not knowing what the left hand (Bowral MHT) was doing. Perhaps this is a timely lesson for Highlanders using any of the local SSWAHS health services to ask for a list of local clinicians in private practice that they might ask for any continuing service. Just don't depend only on the local Yellow Pages for the answer.