Mental health system under strain and facing a nurse shortage

The mental health system is failing to provide treatment to the people who most need it.

That was the opinion of last year's report on mental health by the productivity commission which found that, among other things, mental health is costing the Australian economy $220 billion each year.

"Australia's current mental health system is not comprehensive and fails to provide the treatment and support that people who need it legitimately expect," the report said.

The report found that almost one in five Australians has experienced mental illness in a given year, and many do not receive the treatment and support they need.

Since the report came out in November last year the world has been gripped by a pandemic which so far seems to have had an enormous effect on the mental health of the population.

Since March last year there have been noticeable rises in people trying to access mental health services.

Calls to Lifeline in the four weeks from 10 August to 6 September last year were up 15.3 per cent compared with 2019. Contacts to Beyond Blue (total of call, web chat and email) were up 38.6 per cent over the same period while contacts to the Kids Helpline were up 24.5 per cent.

An ANU poll based on just over 3,000 respondents suggests that the proportion of the population experiencing severe psychological distress as measured by the Kessler 6 Scale rose from 8.4 per cent in February 2017 to 10.6 per cent in April 2020.

Hospital admission also shows an increase in mental health needs over the last decade leading up to the pandemic.

In 2018–19, there were 18,836 same day public admitted mental health-related separations with specialised psychiatric care. This increased from 16,258 in 2008–09 representing an average annual increase of 1.5 per cent over this period.

Similarly, the number of overall same day public mental health-related separations without specialised psychiatric care increased from 28,339 in 2008–09 to 41,052 in 2018–19, representing an average annual change of 3.8 per cent over this period.

One recommendation from the report stated that we need to invest in the mental health workforce and that the Australian Government should develop a new curriculum standard for a three-year direct-entry undergraduate degree in mental health nursing. In addition, all nurse training courses should include a mental health unit.

In spite of these findings, mental health nursing is listed in the top three nursing disciplines that are likely to see a significant shortage in practitioners in 2021 and Dr Mike Hazelton, President of The Australian College of Mental Health Nurses, believes this shortage will be a huge obstacle to righting the mental health system.

"On one hand the projections from organisations like Health Workforce Australia is that we may not have a shortage of mental health nurses right now if what you're doing is counting the people who work in mental health services. But we have a problem with the skill and capability of a lot of those people. That's one issue," said Hazleton.

"The other issue is that if you look at some of the findings that have been put forward over the last decade by organisations such as Health Workforce Australia, they predicted from about 2012 onwards there would be an increase in shortfall of psychiatric nursing, or mental health nursing positions, so that by about 2030 we would be somewhere between about 12 and 24,000 positions down within the sector. And that's not taking into account COVID, for instance.

"This was all predicted well before COVID came along. So, on some readings we have been moving into a workforce shortage anyway. It's been compounded by COVID."

Hazelton argues that there is a drastic need for nurses to be specifically trained in mental health practices and that filling the workforce shortage with untrained nurses would be problematic.

"There is an absolute need for some sort of formal endorsement for someone to be a mental health nurse, so you can at least identify the difference between someone who has formal mental health nursing qualifications and skills, and someone who's just working in the area, who may not even be a registered nurse. You have a lot of enrolled nurses working in mental health services these days. They've got virtually no mental health input in their place based course education," he says.

The decision to abolish the need for separate psychiatric nurse registration in the 90s is an issue according to Hazleton, and re-introducing such a register would make sure the mental health workforce is up to the task of dealing with a larger population of Australians with mental health needs.

Hazelton believes there needs to be a concerted effort by the health department to plan for nurse shortages and a greater understanding of the skills a trained mental health nurse has.

"The starting point needs to be that we can actually identify who a mental health nurse is, in terms of their knowledge, skills and capability. It should be people who have formal qualifications in the area, through whatever means they can legitimately obtain those qualifications," he says.

"The second point would be that we need to be planning for the predictions in terms of workforce shortage. We don't see much evidence of that, and we haven't for a long time," he says.

"The third area would be that very good expert mental health nurses have quite a high skill and capability level, much of which is basically not being utilised because of the narrowness of the expectations that governments and health departments seem to have, surrounding what it is that mental health nurses can actually do.

"You talk to politicians and bureaucrats, they seem to have no awareness of what it is that people can do. Here we are talking about the medium and longer term consequences of COVID and the need to significantly expand the mental health workforce, and mental health nursing doesn't seem to be part of the equation. We don't have access to Medicare-funded programs, and we can't get them to even come to the party and start to have a serious discussion about what it is that we could do to expand our practise and start actually filling in some of the gaps that everyone's identified in the mental health service area."

And with all this in mind, Hazelton urges nurses to consider a career in the mental health space.

“Mental health nursing would suit someone who really wants to make a difference and work with some of the most vulnerable members of our society. Mental health nursing can be very rewarding and embodies the concept of caring by supporting clients who are unable to maintain mental, social or physical health functions for themselves. We work on the basis of empowering our clients to take an active role in self-advocacy and self-care,” Hazelton says.

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