A Place of Mental Health Nurse Practitioner in Health Care Systems - Literature review Example

Mental Health Nurse Practitioner Introduction Following the enactment of the Nurse Practitioners Act in 1998, New South Wales became the first state in Australia to legally recognise the position of Nurse Practitioners (NPs) in health care systems. Later on, other states begun to enact legislations that recognise the position of NPs. In the United States, NPs have been practicing since the 1960’s and following a series of research studies, it was established that NPs significantly helped to improve quality of care and cost-effectiveness in health care settings. Similarly in NSW, a number of studies were carried out to evaluate and determine the viability of the NP position. A majority of these studies found that NPs were efficient and feasible in their roles and helped to enhance the quality of health care in different settings. Later on, it was established that mental health is a critical area of practice for NPs, this in turn led to the creation of the Mental Health Nurse Practitioner (MHNP) position (Fisher, 2005). Currently, most MHNP roles are based within public mental health services whereas some are based within the private sector (Cashin, 2006). Similar to other NPs, MHNPs have Master’s Degree level of education and are trained to provide advanced level of clinical leadership across the health system. Generally, the role of MHNP is an advanced clinical role that is evidence based and grounded on theoretical models relating to mental health nursing practice. Due to their advanced knowledge and skills, MNHPs have an extended scope of practice than enables them to act autonomously and work collaboratively in a variety multiservice and multidisciplinary environment (ANMC, 2006). This paper seeks to examine whether there is a place for Mental Health Nurse Practitioners (MNHPs) within the community mental health sector. Foremost, it will explore the existing needs and issues within the community mental health sector. Secondly, it will examine the roles played MNHPs and how they can address the needs and issues within the community mental health sector. Subsequently, this paper will provide justifications why there is indeed a need and place for MNHPs within the community mental health sector. Issues in the Community Mental Health Sector In Australia, mental health is part of the primary healthcare system. Actual treatment of mental disorders is provided at the primary level. There are also community care facilities which provide mental health services to specific individuals or families within the community setting. (WHO, 2005). Although the Australian government has over the years instituted major reforms in a bid to improve the mental health outcomes of the Australian population, the community mental health sector is still grappling with many challenges. According to Elder, Evans & Nizette (2012), mental health consumers within the community represent a population who are regularly underserved in primary healthcare systems and whose health problems have been underdetected and undertreated. Many mental health consumers within the communities especially in the rural areas do not have ready access to quality health services due to barriers such as accessibility and the lack of adequate specialized mental health practitioners. A study carried out by the National Rural Health Alliance (NRHA) also found that people in remote and rural areas tend to have lower levels of access to specialised mental health services since most advanced mental health practitioners are based within metropolitan areas. Consequently, the mental health conditions of people in remote and rural remain underdetected and undertreated (NRHA, 2009). Hunter (2007) notes that, the services provided in mental health facilities within the community health sector do not effectively address the needs of mental health consumers. Many community mental health facilities do not employ a holistic approach when it comes to dealing with mental health issues. These facilities lack the capacity to effectively detect mental health issues, provide early intervention and continuously address emerging mental health issues (Elder et al., 2012; Hunter 2007). A study carried out by the Commonwealth Department of Education, Science and Training suggests that mental health nursing in most community mental health facilities mainly emphasise on acute care for mentally ill patients by relying on biomedical treatments rather than psychosocial care (Commonwealth Department of Education, Science and Training 2002). Consequently, this implies that interventions provided are hospital-based rather than psychosocial or custodial care (Fisher 2005). Furthermore, other important roles of mental health nursing such as; illness prevention, health promotion, rehabilitation, wellness counseling and patient education have been sidelined. There is also lack of adequate and effective rehabilitation programmes, early intervention programmes, suicide prevention strategies, carer support strategies (Clinton & Hazelton, 2000; Select Committee on Mental Health, 2002). Moreover Fisher (2005) observes that, the community mental health sector is faced with major challenges revolving around the mental health nursing profession. Firstly, almost half of the workforce working in the community mental health sector lacks specialist mental health nursing skills. This in turn raises the concerns regarding the capacity of community mental health facilities when it comes to delivering quality care and maintain high standards of practice. Secondly, recruiting and retaining specialist mental health nursing practitioners in the community mental health sector is also a major challenge. As a result, there is a significant shortage of specialist practitioners who can effectively facilitate various mental health intervention programmes or work with patients with serious mental health conditions (Fisher 2005). Due to the shortage of specialist services, General Practitioners (GPs) succumb to workload pressures from patients with mental health issues. For patients with co-occurring mental health issues, GPs find it difficult to follow-up or coordinate care with other services. Furthermore due to understaffing and lack of adequate specialist practitioners within the community mental health sector, numerous incidences and cases of inappropriate patient assessment and treatment have been reported. Some patients have reported that complicated cases of mental health were not effectively addressed rather they were inappropriately referred to non-government mental health services. For instance, there have been incidences in mental health facilities where patients with suicidal tendencies were referred to other services without receiving any explanation or assistance (Bambling et al., 2007). Additionally, Bambling et al (2007) argue that another major challenge in many community mental health facilities is that they tend to emphasis on crisis management instead of continuum mental health care. This in turn makes it difficult for these facilities to effectively address mental health issues such as alcoholism and drug abuse, suicide tendencies and depression since these types of conditions require holistic and patient centered interventions. Implementing effective mental health care will require cultural change in the community mental health sector. Focus should be directed towards early intervention and the provision of patient centered mental health interventions (Bambling et al., 2007). Role of Mental Health Nurse Practitioners (MHNPs) Over the years, the role of NPs has gained considerable momentum in Australia. Their areas of practice has expanded to include; prescribing drugs, ordering investigative assessment procedures, referring patients to other specialists or facilities and admitting and discharging patients. Generally, NPs are trained to work autonomously and undertake extended authoritative nursing roles. They are also expected to take up leadership roles and provide guidance to nurses and staff working under them (Elsom, Happell & Manias, 2005; Fisher, 2005). The notion of extended nursing practice amongst NPs goes hand in hand with the possession of advanced skills, knowledge and experience (Elsom et al., 2005). Hicks and Hennessy (1999) argue that as compared to other nurses within the primary care setting, NPs posses highly autonomous and evolved clinical nursing skills and research competence. Furthermore, NPs play more advanced roles revolving around business and management tasks, preventative medicine, strategic communication and innovation. They also work towards providing patients with holistic care (Gilfedder,Barron & Docherty, 2010; Hicks & Hennessy 1999). The recognition of mental health as an important a priority area of practice for NPs further led to the expansion and specialisation of NPs roles and the creation of the Mental Health Nurse Practitioner (MHNP) position (Fisher, 2005). Unlike NPs, MHNPs specifically focus their practice on mental health issues. Basically, the role of MHNPs is an advanced clinical role that enables them to act autonomously and work collaboratively in a variety multiservice and multidisciplinary environment (ANMC, 2006). Wand and Fisher (2006) argue that MHNP is a clinically based role that is grounded on mental health nursing theory. The role of MHNPs can be distinguished from other expert nursing roles based on their expanded clinical role and clinical autonomy. Generally, MNHP’s role revolves around the provision of expert and patient-centered mental healthcare and intervention. Their role further extends to their involvement with other health professional, carers and patients’ family or community (Wand & Fisher 2006). The professional practices of MHNPs are governed by regulations and standards of practice that enforce the appropriate and safe care of patients. In their roles and capacities in different mental healthcare setting, MHNPs address unmet patient needs and service gaps by working collaboratively with a multidisciplinary team within the mental health sector. Secondly, MHNPs demonstrate clinical leadership by providing guidance and working efficiently and collaboratively with peers, colleagues and other health professionals within the healthcare system. Their possession of advanced skills, knowledge and experience gives them leverage to exercise effective leadership that contribute to better mental health outcomes amongst patients(Elsom et al., 2005). Thirdly, MHNPs act as educators and consultants. They educate mental health professionals and other staff on suitable practices, interventions and behaviour that promote better mental health outcomes amongst patients. They also facilitate organisational learning by organising training programs, workshops, networking programs and providing relevant reading materials. Furthermore, MHNPs act as researchers, policy developers and advocates. Besides their day to day clinical practices, MHNPs also undertake research on complex clinical issues and thereafter come up with recommendations that help to inform policy. Additionally, MNHPs carryout clinical supervision in order to enhance the quality of care provided in mental healthcare facilities. In their role as clinical supervisors, MNHPs provide professional support to mental health staff and ensure quality improvement, accountability and responsibility amongst mental health professionals (CPN 2010). A study carried out by McCann & Baker (2002) suggests that the role of MHNPs is not only confined within mental healthcare facilities. It was established in this study that MHNP’s role extends beyond the boundaries of normal mental health settings. McCann & Baker (2002) found that some MHNPs employ array of quasi legal measures while working in rural and remote settings that have no access to regular doctors. Some cases MHNPs would diagnose, provide counseling services and prescribe medication in patients’ homes. A study carried out by Fisher (2011) also found that MHNPs also carryout therapeutic roles. The findings of this study showed that MHNPs empowered patients, carried out wellness planning and used therapeutic strategies such as recovery focused approach to nursing and cognitive behavioural therapy (CBT) to enhance and maintain the wellbeing of patients with mental health conditions (Fisher, 2011). Need for MHNPs in the Community Health sector In reference earlier discussions in this paper regarding the issues and challenges facing the community mental health sector and the role played by MHNPs, it is plausible to suggest that there is indeed a place for MHNPs within the community mental health sector. MHNPs can play a significant role in addressing the unmet patient needs and service gaps evident within the community mental health sector. The placement of MHNPs within community mental health facilities could help to address the continuing concerns regarding the shortage of specialists, accessibility of quality healthcare and the use of appropriate mental health interventions (Fisher, 2005). Since MHNPs posses advanced knowledge, skills and experiences there are several ways in which their placement in community mental health facilities can help to improve the quality of care provided, enhance accountability and responsibility among mental health care professional, address the unmet patient needs and bridge the existing service gaps within the community mental health sector (Elsom et al., 2005; Fisher, 2005). Foremost, the role played by MHNPs is relevant within the community mental health sector. The current state of the community mental health sector lacks holistic, patient-centered and evidence based interventions that can improve the health outcomes mental health patients. As Bambling et al (2007) observes, many community mental health facilities tend to emphasise on crisis management rather than continuum mental health care. This in turn makes it difficult for these facilities to effectively address mental health conditions. The advance nursing practice roles that MHNPs take up are relevant across various clinical settings since they are health-focused, holistic and patient centered in nature (Bryant-Lukosius et al. 2004; Fulbrook 2004). Therefore, their placement within the community mental health sector can help to promote the use of approaches and interventions that are more holistic, patient-centered and evidence based. This may in turn address the unmet needs of patients and improve their mental health outcomes. Secondly, in order to address issues pertaining to the shortage of specialists and accessibility of specialists services in the community mental health sector, there is need for MHNPs to be placed in community mental health facilities (Fisher, 2005). MHNPs possess specialised clinical knowledge and skills grounded on theoretical models relating to mental health nursing practice (ANMC, 2006). Due to their advanced knowledge and skills, they have an extended scope of practice than enables them to act autonomously and work collaboratively in providing specialised care and services that can help to address a wide range of mental health issues. Thus, the placement of MHNPs may help to minimise the shortage of specialist services in the community mental health sector. Thirdly, the placement of MHNPs in community mental health facilities may help to solve issues pertaining to service gaps. According to Hunter (2007) many community mental health facilities lack the capacity to effectively detect mental health issues, provide early intervention and continuously address emerging mental health issues. Hunter (2007) further notes that, many mental health facilities tend to emphasise on biomedical treatment while sidelining important services such as early intervention, carer support strategies, health promotion, rehabilitation, wellness counseling and patient education. The presence of MHNPs in community mental health facilities could help bridge the existing service gaps (Clinton & Hazelton, 2000; Select Committee on Mental Health, 2002). Since MHNPs posses advanced knowledge, skills and experiences, they can play a significant role in facilitating patient education, rehabilitation and health promotion. A study carried out Fisher (2011) suggests that MHNPs can play a significant role in facilitating holistic therapeutic programmes for patients with mental health issues. For instance, they can carry out assessments and diagnose issues faced by patients and then come up with early interventions that prevent patients’ condition from deteriorating. Moreover Fisher (2011) found that MHNPs use therapeutic strategies such as recovery focused approach to nursing and cognitive behavioural therapy (CBT) to enhance and maintain the wellbeing of patients with mental health conditions (Fisher, 2011). The current challenges facing the community mental health sector can be addressed through effective leadership. There is deep need for effective leaders within mental health facilities to provide mental health professionals and staff appropriate guidance and support that will enable them to improve their practice and implement mental health interventions that will improve the outcomes of patients. MHNPs can provide an advanced level of clinical leadership across the community mental health sector. The fact that MHNPs posses advanced skills, knowledge and experience gives them leverage to exercise effective leadership that contribute to better mental health outcomes amongst patients(Elsom et al., 2005). In addition to this, MHNPs can act as clinical supervisors within the community mental health sector by providing professional support to mental health staff and ensuring quality improvement, accountability and responsibility amongst mental health professionals (CPN 2010). Conclusion Generally, this paper has examined whether there is a place for a mental health nurse practitioner within the community mental health sector. In order to establish this, foremost this paper has looked at the current state of the community mental health sector by exploring some of the challenges and issues facing this sector. Secondly, it has examined the role played by MHNPs. Subsequently, based on the issues identified within the community mental health sector and the roles played by MHNPs, it is established, there is indeed a need and place for MNHPs within the community mental health sector. It is illustrated in this paper that since MHNPs posses advanced knowledge, skills and experiences, they can play a significant role in addressing the unmet patient needs and service gaps evident within the community mental health sector. The placement of MHNPs within community mental health facilities could help to address the continuing concerns regarding the shortage of specialists, accessibility of quality healthcare and the use of appropriate mental health interventions (Fisher, 2005). Moreover, they can help to improve the quality of care provided and enhance accountability and responsibility through clinical leadership and supervision. Reference Australian Nursing and Midwifery Council (ANMC) (2006). National Competency Standards for the Nurse Practitioner. Retrieved March 7 2014 Bambling, M., Kavanagh, D., Lewis, G., King, R., King, D., Sturk, H., Turpin, M., Gallois, C. & Bartlett, H.(2007). “Challenges faced by general practitioners and allied mental health services in providing mental health services in rural Queensland”. Australian Journal of Rural Health vol 15, 126-130. Cashin, A. (2006). “The first private practice as a registration authority authorized nurse practitioner in Australia”. 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