Mental health nursing in decline

In a 2019 submission to the Productivity Commission, the NSWNMA said public mental health services in NSW had received inadequate funding since “deinstitutionalisation” became policy in the 1980s.

The union also warned that “leakage” of mental health funding to other areas of health had created systemic issues in the state’s mental health services.

The submission said LHDs had failed to acknowledge the competency, education and experience of specialist mental health nurses, leading many to move to other areas of health or leave the profession altogether.

The current workloads and the added strain of the COVID pandemic have exacerbated the situation with many services bringing in staff with no mental health training and little experience.

Richard Noort is a 40-year veteran of mental health nursing and a member of the NSWNMA’s Council. He trained as a mental health nurse at the former Rozelle psychiatric hospital in Sydney and has worked in the Illawarra region for most of his career, which spans in-patient and community services, acute assessment teams and court liaison. He says mental health has been downgraded as a specialised stream of nursing in university training.

Lack Of Clinical Placements

“Some universities don’t even have a mental health component in their clinical placements – they only provide lectures about very basic stuff,” he says.

“There are a couple of unis that offer a diploma or masters in mental health but they don’t have significant clinical placements related to that degree.”

He says nursing students at Wollongong University, for example, can no longer do a post-graduate term in mental health.

“The nurses do their post-grad year through the hospital system and then apply for a transfer to a mental health unit if they are interested.”

Richard says young nurses who enter mental health units are apparently expected to learn by example.

“However, their potential mentors

– the experienced mental health nurses – are retiring or leaving due to excessive and unsafe workloads. Some mental health units only recently employed a CNE in their ward, and they often get taken out of their roles to fill clinical vacancies.

“As a result, we are losing the beginning practitioners really quickly because they are thrown in the deep end without adequate support.

“If we’re going to maintain our mental health workforce, we’ve got to look at a better way of providing support and education to the people who are choosing to come into the profession.”

Community Care Needs Funding

In the 1980s, under the policy of “de-institutionalising care”, NSW reduced its in-patient mental health bed base and transferred patients to community care.

However, successive governments at the state and federal level have failed to provide the money, services or staff needed for community services to meet the demand.

Richard calls the policy “a complete and utter failure”.

This is one of the reasons the NSWNMA is calling for minimum safe staffing levels in acute and community mental health, says Assistant General Secretary Michael Whaites.

“Members everywhere are saying that inadequate services and poor staffing levels across the system have led to an endless cycle that causes on-going harm,” he says.

“When an individual needs a psychiatric intensive care unit bed, someone else is transferred to an acute ward before they’re ready. This leads to someone else being transferred to sub-acute, and then someone being discharged into the community early who then may not be able to access the care they need in a timely manner. They then need admission to an acute bed, and so it goes on.

“Our members are reporting an increase in workplace injuries due to understaffing and inappropriate patient placement. This leads to units being short staffed which leads to more injuries”.

Mental Health Units Overwhelmed

Richard says methamphetamines have raised the levels of agitation and psychosis, which are best managed by nurses with acute care experience.

Mental health units are “overwhelmed with presentations from people with short-term acute psychiatric needs and there’s just not enough beds available for them.”

He says people with chronic mental illnesses who are not adequately supported can “become disenfranchised and socially disadvantaged very quickly.”

“This can lead to homelessness,” he says.

Richard says it is estimated that up to 60 per cent of people serving a sentence or remanded in custody have some form of mental illness

“Justice Health have mental health staff including nurses in every jail. They do a good job of providing mental health assistance to people in custody provided they have adequate staffing.

“However, many wouldn’t be in prison in the first place if they had access to decent mental health services.”

Michael Whaites says we need more beds and community mental health services and argues that increasing the services should be complemented by increasing our capacity for nurses to complete formal mental health training.

The key to rebuilding the mental health workforce will be the introduction of nurse to patient ratios and maximum face to face hours in community mental health, he says.

“Unless there is a circuit breaker which leads to safer workloads for mental health nurses we’re not going to have the workforce to meet the needs of our communities, and we’re seeing demand grow, not reduce. It’s time the government agreed to our claim.” n

Get involved

Are you interested in developing, or helping others develop, mental health nursing? Check out the Bob Fenwick Mentoring Programme on page 34.