Mental health’s ‘looming loss’

A GENERAL practice division serving Victorian communities ravaged by the 2009 ‘Black Saturday’ bushfires is on the brink of sacking 20 mental health nurses – the biggest mental health nurse workforce in Australia – because Medicare payments have failed to keep up with inflation, they argue.

Eastern Ranges General Practice Association (ERGPA), which covers some of the worst hit parts of the Yarra Valley, said the move would leave more than 600 patients without urgent mental health care in Marysville, Kinglake and Healesville.

ERGPA CEO Kristin Michaels told MO she was forced to contemplate the move after budget projections found keeping the nurses, who work closely with GPs in the region, would lose $70,000 this financial year.

The division is reimbursed for the nurses under the Mental Health Nurse Incentive Program (MHNIP), under which Medicare provides a $240 incentive payment for each 3.5-hour session in which the nurse visits two patients. 

Ms Michaels said the payment had not changed since its introduction in 2007, but inflation and the significant travel requirements required by ERGPA nurses to see patients has brought the cost to $320 per session. That is despite many of the nurses paying their own expenses such as car, telephone and internet. 

“My board [is] asking me as CEO to justify keeping this program, and all I can say is ‘because it does such a great job for patients and for the GPs who use it’, but I can’t give a financial argument because I don’t have one,” Ms Michaels said.

“There’s been no way for me to even break even on this program because of the capped arrangements and the fact we haven’t had a rebate increase.

“If we can’t maintain that because of the rebate... we’re going to have 20 people without work and potentially 600 clients without a place to get service.”

Marysville GP Dr Lachlan Fraser, who helped rebuild his community in the aftermath of the February 2009 fires after losing both his home and practice, said the looming loss of mental health staff could not come at a worse time with many victims only now feeling the impact.

“In the bushfire regions some of the mental health problems take a year or two to present themselves and for people to go and seek help,” he said.

“For some people, they’ve been struggling along and just dealing with the emergency initially, and then the necessities of life and home and recouping documents and possessions and accessing grants, and the depression and anxiety come afterwards.”

A health department spokesperson said there would be an “evaluation” of MHNIP this year which would “inform any future decisions” by government. 

The spokesperson said the payments attracted a 25% rural loading in some regions, however Ms Michaels said ERGPA did not qualify.