19th April, 2022

An open letter to the Australian Federal Government, all political parties, and Primary Health Care Networks of Australia.

Regarding: The failure to mobilise mental health nurses to best assist in improving the mental health of Australians and responding to pandemics and disasters.

Mental health nurses are the oldest regulated mental health profession in Australia next to medicine. Credentialed mental health nurses (of which there are less than 2000 in Australia) must complete a minimum of 1200 hours of post graduate education (a graduate diploma) on top their undergraduate nursing preparation, and work for at least two years in supervised practice. Most have decades of experience and many also have the highest level of education possible in psychotherapy.

Mental Health Nurses have repeated requested eligibility to provide services under the Medicare Benefit Schedule (MBS) programme “Better Access” to offer subsidised therapy to people affected by fires, floods, the pandemic and other disasters. This is the lowest tier of services in the stepped care model. MHNs have been informed for several years that ‘Better Access’ is under review by a committee and have been refused access while a $2 million ‘comprehensive evaluation of the programme is undertaken’. Yet extending ‘Better Access’ (the number of sessions or the mode of delivery) has been the Federal Governments primary ‘mental health’ response to fire, pandemic, and floods. ‘Better Access’ is unaffordable to those most in need due to some professionals who charge unaffordable ‘gap-fees’. Mental Health Nurses have no history of such avarice. MHNs are ready, able, and often living in the communities most in need of their specialised expertise. We call for credentialed mental health nurses to have immediate eligibility to ‘Better Access’ and associated MBS item numbers, so they can serve their communities now. Not when the committee reports back long after the incumbent Health Minister retires.

Reforms to improve access to the right dose or the right therapy by the most qualified person can occur immediately without further expenditure on a lengthy review. We call for an immediate revision of the tiered subsidy for the provision of the same services by different professionals and an immediate mandate to ‘bulk-bill’ all mental health services under ‘Better Access’. This would not preclude people from making private arrangements if they can afford to (and as they need to with MHNs or to receive psychotherapy in primary care currently).

We further call for a review of the conduct of Primary Health Care Networks (PHNs) in the commissioning of what was formerly called ATAPs. This programme persisted to enable access to brief psychotherapy for people unable to access ‘Better Access’ or had a higher level of acuity. In the past MHNs provided a higher tier psychotherapy under this programme. However, it is now monopolised in many regions by professionals who refuse to ‘bulk-bill’ under “Better Access”. This is wrong and eligible providers who refuse to ‘bulk-bill’ under ‘Better Access’ should not be providing ATAPs. There are numerous under-employed and highly skilled psychotherapist including MHNs who can and ought to be providing ATAPs services. Some PHNs have also taken the lead from the Federal Government and pay different rates for different professionals providing the same service under ATAPs. This is morally wrong, against the principle of equal pay for equal work and is money poorly spent with no demonstrable better outcomes for anyone other than the enrichment of some health professionals.

MHNs quite reasonably want to be treated equitably with other health professionals and empowered to provide skilled assistance to their communities. Access to the MBS by MHNs is needed immediately.

5770 supporters agree and have signed a change.org petition requesting that Credentialed Mental Health Nurses are recognised as eligible to provide subsidised services under the MBS and other funding streams in primary care to play their role in improving the mental health and wellbeing of Australians.

Yours Sincerely,

Associate Professor Dr Richard Lakeman, DipCompNsg, BN, BA Hons (First Class), MMH (Psychotherapy), DocNSci, Credentialed MHN and Fellow of the ACMHN