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.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 35

The danger in the following media statement possibly best demonstrates the potential for nepotism in the fund-holding arrangements planned for the Medicare Locals to be rolled out by the Federal Government from July 1st 2011.

We already have a situation when the Southern Highlands Division of General Practice can determine who should (or should not) be recruited to provide mental health services to those patients with a diagnosed mental illness. This has already been demonstrated with the Better Outcomes for Mental Health initiative (BOMHi) and the Mental Health Nurse Incentive Program (MHNIP) which were both funded by Medicare Australia. The funds for the BOMHi program are held by the Division and are used to pay for patients of GPs to have sessions with private psychologists. Those psychologists selected for the program will tell you that invariably the money "ran out" before the end of the grant period.

In the case of the MHNIP, the Division endeavoured to divert patients from the GP practices to the RN they had recruited to run the program from their Division's rooms. Eventually, they had to cease that activity due to the fact that their RN did not gain the necessary accreditation to be able to carry out the functions required. From all reports, the Division then did nothing to support the implementation and extension of the program among their GP members and so, a useful and viable mental health service that could have been of benefit to many, has withered away.

Govt pledges $59m for mental health

15th April 2011

By: Australian Doctor

The new wave of Medicare Locals will be given $59 million to provide care packages to support people with severe mental illness.

The money will allow the new organisations being rolled out from July this year to buy bundles of services to support people in the community and keep them out of hospital.

Clinical services will include therapy from psychologists and social workers who, according to the Federal Government, will be "encouraged to link patients to other services in the community for people with severe illness".

The move follows national consultation on the funding plan.

The government claimed there was strong support from GPs, who will be central to "supporting and finding referral pathways" to other services.

The first 15 Medicare Locals will be eligible to access the funding.

AGPN CEO David Butt said the timing of the pledge was "a glimpse into the government’s vision" for primary mental health services.

"It’s encouraging to have these flexible care packages available to the first 15 Medicare Locals and indicative of a government that wants to see a fundamental change in the delivery of mental health services, in which there is a shift towards the primary healthcare sector rather than a reliance upon the acute sector.

"These packages will also enable interventions at different levels of intensity.

Depending on the patient’s needs, the care may need to step up’ to more intensive interventions, such as specialist care with a psychiatrist or psychologist, or the care may step down’ to services like community connectedness programs." Paul Smith

The Southern Highlands Division of General Practice and the disappearing Mental Health Nurse Incentive Program

Socrates has become aware of the fact that the Southern Highlands Division of General Practice appears to have changed is view on the value of the Mental Health Nurse Incentive Program (MHNIP) which is a Medicare Australia funded program designed to help persons with a severe mental illness receive the care coordination that would allow them to remain at home and out of hospital. It would seem to any reasonable person that this would be a useful initiative for the person with the mental illness, their carers or family members, and for the hospital services.

The MHNIP operates from general practitioners, general practices, private psychiatrists, Divisions of General Practice and from Aboriginal Medical Services who have registered with Medicare Australia as an "eligible organisation". The registration is simple enough and the Medicare Australia will even offer financial incentives to the "eligible organisations" to establish the MHNIP in the community.

Now, in Australia there are about 800 credentialed mental health nurses (CMHNs) able to to provide these services to patients through the "eligible organisations". Fortunately, as Socrates has discovered, there are 3 qualified CMHNs in the Southern Highlands, yet only one is being used by any of the eligible organisations here to provide any sort of service to patients of the practices in the Southern Highlands. Perhaps it's just a coincidence that the one CMHN being used was once an employee of the Southern Highlands Division of General Practice. Socrates, has recently discovered that patients who have been referred to that one CMHN have been told by them that they are unable to provide any additional people with the MHNIP services. Obviously (or hopefully), that information has been passed on to the Southern Highlands Division of General Practice so that they can pass that information on to their members.

Perhaps it is also a coincidence only, that the Southern Highlands Division of General Practice in 2008-09 employed a mental health nurse/psychologist to provide the MHNIP services to their member general practitioners. The aspiring nurse, who was seeking credentialing, was unable to obtain this requisite by the January 2010 deadline so the Southern Highlands Division of General Practice was unable to continue the MHNIP program. However, it would seem that they did continue to employ the nurse because they were also a psychologist and now they offer a "Better Access" counselling service in competition to those psychologists and social workers in private practice.

Now, as far as Socrates is aware, the Southern Highlands Division of General Practice is still an "eligible organisation" or could easily become one again. However, the Division has made no attempt to engage or contract the other CMHNs in the Southern Highlands nor does it appear to have been advocating to their general practice members that they take up this initiative for the benefit of their patients. One could easily draw a conclusion that the Southern Highlands Division of General Practice is taking the view that if they can't retain or employ a CMHN of their choice, then no-one else should be able.

Strangely, any recent information about the MHNIP which was originally publicly provided by the Southern Highlands Division of General Practice to all, through their "Highlands Doctor" newsletter on their website, was suddenly transferred to the login section of their website for member GPs only. One can only deduce what the general practitioners are being told by the Division's Executive Officer.

Socrates has been told of one patient who is seeking access to the MHNIP because they have a number of severe mental health conditions that they have been unable to get any sense out of the Southern Highlands Division of General Practice. It is most likely that there are many such people who have been struggling with a severe mental illness but are now being denied a potentially excellent service. Socrates has noted that the Network which advocates for Divisions of General Practice is very supportive of the MHNIP initiative and there is ample proof that it is a win-win situation for all.

So the question needs to be asked: Why does the Southern Highlands Division of General Practice not advocate with its members to implement this Medicare funded initiative for patients with severe mental illnesses? Surely, the Southern Highlands has it's share of people afflicted with such mental illnesses? Why does the Southern Highlands Division of General Practice not use its "eligible organisation" status to employ, contract or retain our other CMHNs? And what was so secret about the Division's advice to its general practice members that they felt the need to place that information in the login section of their website. If it is simply the same information that they have freely published in their past issues of the "Highlands Doctor" newsletter why was there a need to place the information in their website which is not accessible to members of the public.

Socrates has previously commented on the MHNIP as an ideal initiative for persons with mental illness and for their carers. Perhaps it is now time for those members of the public to challenge the secretive behaviour of the Southern Highlands Division of General Practice and its Executive.

About the Southern Highlands Division of General Practice and the Mental Health Nurse Incentive Program.

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.

Southern Highlands Division of General Practice - working collaboratively or competitively?

Socrates has said this before, that there is a whiff of smoke coming from the offices of the local Division of General Practice (or is it the smell of bull dung?)

From the Athenian network have come some recent gems of the non-wisdom of the Division's illustrious leader! Take this one, for example, where a local private allied health professional suggested greater collaboration between the private practitioners and the public health system and the local Division in order to improve the health outcomes of their patients, and increase their access to allied health services. The letter was written on 15th February 2010 just after a meeting, sponsored by the Southern Highlands Division of General Practice, with some public health service nursing staff and allied health professionals and perhaps 2-3 general practitioners and their practice nurses. Not many when you consider that there are 18 practices with some 72 general practitioners in the Southern Highlands.

"Dear Dr Ruscoe,

RE: Live Life Well presentation

Thank you for the opportunity to attend the presentation by LD last Thursday. I found it informative, and a useful forum to make contact with other health service providers, many of whom I knew from my previous work within the area health service.

What was perhaps very disappointing was that, with the topic being the connection between chronic medical conditions and mental illness, there was little representation from general practitioners and none at all from the SSWAHS mental health services.

When one speaks of communication between the various health service providers one does usually mean between all health service providers, those in the private and the public health sectors.

It puzzles me that the general practitioners and the local mental health services are now not as responsive to these gatherings and presentations to enable improved utilisation of the health service initiatives available to their patients.

I would be interested to know how an improvement in the liaison and collaboration between all health service providers could be achieved in the future. Perhaps you and the Division have some ideas how this could be achieved.

I intend to discuss with other psychologists the concerns that I have expressed above, that there is a need to find an improved way of developing the communication between all service providers. This may involve better use of telephony (phone, email or fax), or discussion with the Division’s general practitioners as to the way in which they would prefer contact by other allied health workers.

Additionally, I suggest that communication is a two-way process otherwise it is just information. If the Division and the general practitioners have any thoughts about how we allied health professions can improve our process of communication I would be pleased to hear from you or any of the general practitioners.

I might add that I have attempted recently to improve the communication between allied health professionals and the local community mental health service. Unfortunately, the health service appears to be taking the view that they will not proactively encourage their patients to seek appropriate and available help with their long-term health and support needs in the community and private sector. They cite, instead, the NSW Health Code of Conduct which, suggests that they provide a list of local health service providers to a patient who requests it. It is disappointing to discover that the Bowral service do not actively seek to inform their patients of the availability of Medicare funded private mental health services through the Better Access and the MHNIP programs.

I would be pleased to have the opportunity to be able to discuss with the Division and the general practitioners how the private allied health professionals could improve the mental health services they are able to provide to the patients attending their practices. I would be open to any suggestions you might be able make about how this could be achieved.

Yours sincerely,

Kevin O’Neill

Psychologist and Credentialed Mental Health Nurse"

Sadly, the author of this letter sent in February is still awaiting a response to this suggestion that better communication be sought between the private health sector, the public health sector, and the Division of General Practice.

Not to be seen as a unassertive person Mr O'Neill has also provided old Socrates with some additional tablets of writing which may shine a (bright) light upon the workings of the Southern Highlands Division of General Practice and their idea of collaboration.

"Dear Dr Ruscoe,

RE: MHNIP referrals to the Division

I note that in meeting with TK at the MHPN meeting last week that she is no longer pursuing her application to become a Credentialed Mental Health Nurse for the purpose of the Care Coordination role of suitable patients of the general practitioner members of the Division.

Given this current situation I am wondering if the Division would consider informing the general practitioners and the various practices of this change. I believe that this would enable some practitioners, and their practice groups, not already linked with AT to have the additional choice of retaining the two remaining Credentialed Mental Health Nurses in the Southern Highlands.

I would be most happy to discuss how this might be achieved, with individual general practitioners or their practice managers, at their convenience.

In any anticipated discussion the mutual benefit of the practices gaining a financial outcome from Medicare Australia and the added advantage of appropriate care coordination for their referred patients will be an issue to be discussed.

I note that there is possibly due to be an issue of the Highlands Doctor going out to the practices soon. Might I ask that this information be included in the pending Highlands Doctor issue, or by some other means to your Division’s members.

I look forward to your response.

Yours sincerely,

Kevin O’Neill

Psychologist and Credentialed Mental Health Nurse"

Now for the response on July 14th - if it can be called that!

"Dear Kevin,

Thank you for your letter of June 29 in regard to services under the Mental Health Nurse Incentive Program.

Please be assured that we have thoroughly researched the procedures with the Department of Health for the implementation of this program in our practices and that the appropriate advice has been provided to practices.

Yours faithfully,

Warwick Ruscoe"

Well, of course that led to some headscratching on the part of the recipient but, not to be overwhelmed by the vagueness of it all, he did persist. Following his own questions to the Australian College of Mental Health Nurses, who credential the nurses working in the Mental Health Nurse Incentive Program, and who, one would expect, would know all there is to know about how general practitioners can use the Credentialed Mental Health Nurse, it would appear that there had not been any change in the contracting or employment of the qualified nurse by general practitioners. So off went a follow-up letter to the local Division of General Practice.

"Dr Warwick Ruscoe

Southern Highlands Division of General Practice

PO Box 724Bowral NSW 2576

11 August 2010

Dear Dr Ruscoe,

Thanks for your response of 14 July in which you responded to my earlier letter in which I asked about whether General Practitioners would be advised of the availability of the MHNIP services in light of your employed staff member not attaining her credentialing from the Australian College of Mental Health Nurses (ACMHN).

I did ask whether the general practitioners would be advised through the Division’s “Highlands Doctor” that there were other options available should they wished to refer their patient to another credentialed mental health nurse.

Unfortunately, your response of 14 July does not inform me of what your research and discussions with the Department of Health referred to, in respect of the implementation of the MHNIP in the Division's practices, nor was there any indication what the advice might have been that was provided to practices.

Today I received a response from the CEO of the ACMHN who has advised me that there has been no change to the MHNIP by Medicare Australia and that eligible organisations may continue to employ, or engage a Credentialed Mental Health Nurse to carry out the roles described in the program documentation. This means that GPs or Practices which are, or may wish to become, eligible organisations (EO) may employ them or engage them, by way of an agreement between the CMHN and the EO, to provide the service. The engaged or contracted CMHN is required to have adequate PII and registration to assure the EO that they can provide the service adequately to the doctor’s referred patients. The engaged CMHNs are not required to work on-site at the EO but can work from a private practice or even from home.

I would appreciate having access to the information about MHNIP provided by the Division recently to its practices.

Yours sincerely,

Kevin O’Neill

Psychologist andCredentialed Mental Health Nurse"

And here, of course, is the local Division's final word!

"August 18, 2010

Dear Kevin,

Thank you for your latest letter of August 11 in regard to the services under the Mental Health Nurse Incentive Program.

As previously stated, we have informed member practices of the Health Department's guidelines and rules for the engagement by practices of credentialed mental health nurses, either as contractors or employees. Should you wish to offer services in this regard, that is a matter between the practices and yourself.

It is not our policy however to inform outside parties of our communications to our members. The above information is available through the Department of Health's website.

Lastly, I commend to you that, unless there is a change to the rules to this program, this concludes our correspondence on the matter.

Yours faithfully,

Warwick Ruscoe."

Well, that certainly shows that the exchange of wax tablets has certainly dried up! Very pesky of the psychologist to ask such pointed questions. Anyway, it's Doctor's Secret Business anyway! Or is it really? You see, until the most recent "Highlands Doctor" issue the Mental Health Nurse Incentive Program (MHNIP) was commented upon in every issue of the "Highlands Doctor" from late 2007, and the local doctors were exhorted to use the Division's own Credentialed Mental Health Nurse while she was attempting to get her credentials through the Australian College of Mental Health Nurses. After this did not happen and the Division was no longer able to use her, the MHNIP became "secret" business. Now, following the exchange of the wax tablets, Socrates has noted that the public information on this program (which could help many local people with severe mental illnesses) has suddenly been moved to the member's only Login page of the Highland's Doctor. I guess one can only speculate why a once public piece of information has now gone to "It is not our policy to inform outside parties of our communications to our members." Well, in Socrates's reading of the older editions of the "Highland's Doctor" on the Division's website he finds each edition full of the Division's "communications to our members." Especially, the current one, which publicly urges all their member general practitioners to refer their patients to the Division's employee for counselling under the Medicare "Better Access" initiative.

Hmmm! I guess the Southern Highlands Division of General Practice has to go where the money is! I wonder, what happens to the notion of the patient's of the general practitioners having a choice in who they want to see. The Division's position and involvement with the local medical practices does seem to suggest that it has a conflict of interest and, monopoly and, the Gods forbid, might be seen as part of a cartel arrangement. I wonder if the Oracles in the Department of Fair Trading, Small Business, or Medicare Australia would (or should) be concerned about this?

Does the Southern Highlands Division of General Practice deliver the "optimal service" to the people of the Southern Highlands?

Does the Southern Highlands Division of General Practice deliver the "optimal service" to the people of the Southern Highlands as it states on its website? Or is it merely a subservient tool for the Imperial SSWAHS? The local Division seems to be more intent on acquisitions rather than delivering a service to their GPs.

For example, the SH Division employs staff to provide services that are already delivered by private allied health service providers in the community. Yet, because of its influence over the general practitioners it is meant to support, it exercises a monopoly. That is, it recommends GPs to preferentially refer their patients to the member of staff employed by the Division rather than to the private practitioners in the community. Where is the right to choose their practitioner for the patient?

Socrates is aware from personal experience that the general practitioners he has had to see over his long years (treatment for hemlock poisoning, etc), that the majority of GPs do have a mind to treat their patients with respect and provide them with options. This dialogue of mine today is not about the GPs in the Southern Highlands but about their Division and its Chief Executive. Their Chief Executive has openly stated that he will fight to market the Divisional staff to the area's GPs simply to be able to continue to employ them. Who has employed them - well the Chief Executive. But what processes does he follow in employing the staff, and what qualities and skills do they bring to ensure the provision of "optimal care" is delivered by them?

And can the staff employed by the Chief Executive deliver all the programs that he says (in the website) the Division can deliver to the people of the Southern Highlands. There is no doubt that the Aged Care and the Diabetes Coordinators are well experienced in their clinical fields and the services they deliver are well used. But what about the other services that the Division touts on the website? Mental health services delivered to the aged care facilities in the Highlands, the non-directive pregnancy support counselling, the better outcomes in mental health program, the better access mental health program, the mental health nurse incentive program - who delivers these?

These programs are all funded by the federal government through Department of Health and Aging or Medicare Australia. The qualifications of the practitioners used for these programs are dictated by the Medicare Australia and/or the relevant professional college or association. The Division, however uses its own set of hoops to select who it should anoint to do the work. I wonder what Medicare Australia or the Department of Health and Aging would think about the Southern Highlands Division of General Practice? In particular its Chief Executive and its Board.

Socrates is already aware from his reading of the scroll called "The Highlands Doctor" that, for example, GPs are being encouraged to refer their patients to a person for the "Better Access" program when they could be doing some of the "Better Outcomes" program which is funded by the federal government and the Division is the fundholder. Why use a Medicare funded program to keep their staff member employed? Perhaps it has something to do with running out of the funds for "Better Outcomes" because the funds were used for something better - like employing staff rather than providing a service to the patients referred to it.

The other program that seems to have disappeared off the scroll appears to be the Mental Health Nurse Incentive program - another of the Medicare funded programs. From the more ancient scrolls on the Division's website it would appear that the Chief Executive was employing someone who was hoping to be a Credentialed Mental Health Nurse, the only people (besides GPs and psychiatrists) who Medicare allows to participate in the program's delivery. It appears to be a good program (perhaps even a great one) which allows vulnerable people with a severe mental illness to have care coordination by a credentialed mental health nurse so that they might remain out of hospital and be cared for in their own community.

It would seem that the person employed by the Division was not successful in obtaining the credentialed mental health nurse qualification so the Division could no longer use them. From the official website of the Australian College of Mental Health Nurses the list of Credentialed Mental Health Nurses shows that there are three qualified and approved CMHNs in the Southern Highlands, which is not bad considering there are only about 800 nation-wide. However, the Division, for reasons unknown, is not supportive of the existing CMHNs and appears to have gone secretive as to their reasons why. The information about the MHNIP is no longer public on the website having been placed in the log-in "doctor's secret business" section on their website.

In the meantime, patients who could or should be referred to this program are not able to be referred because the only two CMHN in the Highland currently being used by GPs are unable to take on any more patients, and the other although credentialed since August 2009 has never received any referrals at all possibly due to misinformation provided by the Division to the local general practitioners.

Hmmm! Socrates has to then wonder at the Division's claim:

"Southern Highlands Division of General Practice (SHDGP) is a federally funded not for profit organisation which assists general practitioners and the Health Service to deliver health services to people in the Southern Highlands.

The Division acknowledges the support of the Commonwealth Department of Health and Ageing in respect of funding the Division's activities."

And:

"The mission of the Southern Highlands Division of General Practice is to assist local general practitioners in providing optimum care to health consumers in the Southern Highlands area."

Does it really, Chief Executive, or is the Division just as money grabbing as the so-called "for profit" organisations? Perhaps it is now time for the merger with the Macarthur Division of General Practice where they don't seem to run out of funds for their funded programs, and they employ people but they still seem to manage to work collaboratively with their general practitioners and with the private sector, especially the allied health and mental health nurses, without having to prostitute themselves to the empire of SSWAHS.