Nurse Practitioners integral to mental health outcomes

Nurse Practitioners integral to mental health outcomes.

Mental illness is common, with one in five Australians experiencing a mental illness in any given year and almost half (45 per cent) affected in their lifetime. Sadly, 54 per cent of people with a mental illness do not access treatment.

Mental Health Nurse Practitioners can help to improve accessibility and affordability of quality mental health care, which can be challenging and confusing for those affected.

Sian Pritchard, a Mental Health Nurse Practitioner and Director of Pritchard Health, is a specialist in psychiatry and substance abuse, providing mental health support through a nurse-led model at her primary care clinic in Geelong.

The nurse-led, mental health care clinic uses a biopsychosocial assessment, which incorporates the biological, psychological and social domains of health to provide treatment and care in substance abuse and mental illness.

“We offer a range of short-term psychological interventions through to longer-term complex care coordination.

“This may include anxiety, depression, bipolar disorder, personality disorders, schizophrenia, substance abuse – including smoking cessation plans – and eating disorders.

“We also offer unplanned pregnancy counselling,” said Ms Pritchard.

Ms Pritchard believes an evidence-based, holistic approach to mental health care is what sets Nurse Practitioners apart. 

“When we work with people, we consider their mental, physical, spiritual, emotional, social and cultural needs.

“As nurses, we practice on an evidence-based background, and as credentialed mental health nurses, we hold additional qualifications in mental health nursing-specific study.

“In my opinion, and the evidence does demonstrate, the therapeutic alliance is fundamentally what is going to support someone in their recovery.”

There are many therapies and counselling techniques that Nurse Practitioners can employ to treat mental illness, such as cognitive behaviour therapy and motivational interviewing.

“Motivational interviewing can assist people in reflecting on current use and supporting them moving towards wanting to make changes to their use for improved health outcomes.

“These therapies can be utilised across many spheres, not just when working in the area of anxiety or addiction.

“Whatever therapeutic technique I choose, it needs to be tailored to the individual, their situation, and consider how their disease or illness is affecting their ability to lead a fulfilling life,” said Ms Pritchard.

Nurse Practitioners undertake master’s level qualifications and have extensions on their scope of practice traditionally reserved for those practising medicine.

“I have a mix of counselling and psychotherapy skills complemented by the ability to prescribe, or deprescribe as is often the case, order and interpret investigations, diagnose illness and disease and refer to specialists when required.

“I can conduct a diagnostic assessment, plan care and treatment which often includes a referral to work with a credentialed mental health nurse, discuss medication management with GPs or psychiatrists and undertake the responsibility for prescribing medications.

“I am also able to refer people to see a specialist for clarity of diagnosis and or medication in complex cases.”

Nurse Practitioners can minimise unnecessary appointments, disruption to care and the cost for repeat services.

“I can afford people more time than GPs generally can.

“This is never more important than when working with people with mental illness or addiction.

“Evidence shows us that even when linked to GPs, people with mental illness have poorer health outcomes than those who do not have a mental illness.

“This is often because of the need to have longer appointment times and specific questioning around health issues that are best provided by a specialist mental health nurse.”

Patients don’t need a referral to see a Nurse Practitioner and can access Medicare rebates.

“People can book an appointment to see me without a referral from their GP.

“I can conduct an initial assessment, and then support them to be linked with the most suitable service.

“This may be to provide them with a letter to take to their GP to organise a Mental Health Care Plan to see a mental health clinician for up to 10 sessions per year.” 

The cost of mental health treatment is a barrier for many people, and GPs may not be aware of the options available.

“GPs are often confused by the mental health services available and may be unaware of associated costs.

“Costs can be a barrier for people accessing psychological care, and I can assist them in finding services they can afford.

“Some GPs have expertise in mental health and addiction. I would argue that many do not.

“GPs are also time-poor for many reasons, leaving people to try and tell their story in five to 10-minute consultations.

“Doctors and nurses work exceptionally well with each other and complement each other’s skillsets.

“The GPs I have worked with are supportive of the skill set of credentialed mental health nurses and Nurse Practitioners.”

Working as a mental health Nurse Practitioner is rewarding because there is the ability to make important decisions toward patient treatment, explained Ms Pritchard. 

“Every day, I enable people to find the right resources to support their recovery is a great day.

“Reducing people’s medication and supporting them to manage their illness in other forms is always pleasing.

“People with psychotic illnesses generally have shortened life expectancy — anything from 15 to 30 years less than those who live without psychotic illnesses.

“Medication is often a contributing factor, as is lifestyle such as smoking, lack of exercise, sunlight, connectedness to the community.”

The capability to prescribe and alter medication is an important factor in treating patients as a Nurse Practitioner.

“GPs are often not confident to change psychiatric medication, unless they know someone is being supported by a mental health specialist, due to the risk of relapse.

“I can order investigations to assess metabolic health. We know this isn’t done well generally in public mental health services, and it is a vital part of peoples care and treatment if someone is prescribed psychotropic medication.”

Nurses are trusted health professionals who are experts at coordination of care, but also treat the physical and mental of their patients.

“Nurses are fundamentally better prepared than other mental health professionals to provide physical and mental health care combined due to our undergraduate training.

“Credentialed mental health nurses and mental health Nurse Practitioners are vital in Primary Health Care, working collaboratively with GPs and practice nurses and alongside other service providers.

“Nurses are excellent at coordinating care, and they know the system well, are the most trusted and highly regarded health professionals while also being able to provide psychotherapy. That should speak volumes.”

Unfortunately, mental health nurses and Nurse Practitioners are not adequately supported in Australia, according to Ms Pritchard.

“There are many barriers for nurses working in primary care and private practice, not just those practising in the area of mental health.

“The Australian health care system is discriminatory against people being able to choose to see nurses as part of their care team in primary health care.

“Credentialed mental health nurses and mental health Nurse Practitioners are not able to see people under mental health care plans funded through Medicare.

“This disadvantages the community from being able to access mental health nurses.

“It also makes it difficult for GPs and psychiatrists who may believe a credentialed mental health nurse or Nurse Practitioner is the best clinician for their patient.

“You are also not able to see us using private health funds which is extraordinary considering our practice is evidence-based.

“These barriers make it difficult for the community to choose to see nurses as part of their care team.”

ACMHN Board Director Tom Ryan agrees: “There’s a widespread and tragically incorrect belief that psychotherapy is the sole province of psychologists.

“Unfortunately, that influences organisations such as PHNs and many other providers, to the detriment of the consumer.

“Mental health nurses often bring a more eclectic blend of psychotherapy and counselling skills to the workforce than other disciplines.

“Nurses have a more holistic approach and an ability to look at physical as well as psychological aspects of a patient’s presentation. 

“We are generally also familiar with and skilled in managing the more severe and complex presentations.  This has actually been quite well recognised but is inadequately supported,” said Mr Ryan.

“The Year of the Nurse is 2020. Let’s hope we see some dynamic and major changes to enable nurses to work to their full scope of practice while also enabling the community to access our expertise in Primary Health Care,” said Ms Pritchard.

What is a Mental Health Nurse Practitioner?

A Mental Health Nurse Practitioner is educated and endorsed to work autonomously and collaborative in an advanced clinic role in a mental health care setting. They are equipped with the education and expertise to refer, diagnose and treat people with a range of mental health conditions.

Where do Mental Health Nurse Practitioners work?

Mental Health Nurse Practitioners provide high-quality patient-centred care in a range of settings, such as community centres, aged care homes, hospitals, GP’s practices, pharmacies or in private practice.

Training to be a Mental Health Nurse Practitioner

Mental Health Nurse Practitioners are educated at the master’s degree level and have extensive clinical training. Nurse Practitioner is a protected title in legislation and is endorsed and regulated by the Nursing and Midwifery Board of Australia.

For more information on training requirements, contact:

• The Australian College of Mental Health Nurses
• Australian College of Nurse Practitioners
• Australian Health Practitioners Regulation Agency

This article was originally published on Health Times at https://healthtimes.com.au on 16/9/19 by Haley Williams.