Mental health plans a mixed bag

We must maintain nurse managers in mental health services

While the fight continues with the North Sydney Central Coast AHS and other AHSs to maintain the role of nurses in hospital management, the NSWNA now turns its focus to the make up of the proposed structures for mental health services.

The NSW Government’s Mental Health Plan for NSW called for a separate structure for mental health services from mainstream health services to ensure they receive the appropriate focus and are not sidelined by other health service needs. The result is a separate clinical structure for mental health services within each newly formed AHS.

The proposed structures for mental health services have been released by the new AHSs. Like the mainstream health ser-vices, the make up of the proposed structures for mental health services varies across the AHSs.

NSWNA Assistant General Secretary Judith Kiejda said some AHSs have tabled sound proposals for mental health services with a strong role for nurses at a management level.

‘For example, the Sydney South West AHS has proposed a well-considered structure – the result of consultation with the NSWNA and nurses on the needs of mental health services.

‘Unfortunately, other AHSs have deleted mental health nurse manager positions or reduced their operational roles. They have failed to engage in consultation with nurses involved in the delivery of mental health services – or they have ignored feedback – leading to proposals that reek of inconsistency and demonstrate poor understanding of the needs of mental health services.

‘Take the case of the North Coast AHS. The NCAHS has downgraded the Mental Health Nurse Manager from level 7 to level 5, and deleted operational responsibility from the role. This is totally unacceptable given there are 100 mental health beds on the North Coast with nurses working at 11 health centres in the Area.

‘Deleting mental health nurse manager positions and replacing them with generic managers who are not nurses will have negative implications for mental health services and the nursing workforce,’ said Judith.

‘There is substantial evidence that services benefit and quality of care is enhanced when nurses at the bedside have strong leadership and management from senior nurses.

‘If nurses down the line are reporting to a generic manager who is not a nurse they will not receive the clinical support they require. Despite their lack of nursing qualifications, the generic manager will be making crucial operational decisions in matters such as staffing and resources,’ said Judith.

‘There are also long-term implications for the nursing workforce. We already have a severe shortage of mental heath nurses – particularly in rural and remote areas. Deleting nurse manager positions in mental health services or reducing their role sends a negative message down the line that nurses are not valued in the structure. It also cuts dead a career in mental health nursing,’ said Judith.

Greater Southern plans one big bungle

The Greater Southern (GS) AHS has put forward a backward-looking proposal with no nursing presence at the executive level.

The GSAHS plan regrades three mental health nurse manager positions, leaving only one senior mental health nurse manager in its mental health structure.

Yet there are to be 17 cluster managers for the GSAHS, more than twice that of any other AHS.

The GSAHS proposal also includes plans to convert CNC positions to senior clinicians in any discipline.

Keith McCulloch’s position as Mental Health Nurse Manager at Kenmore Hospital has been deleted in the restructure proposal – to be replaced by a cluster manager.

Keith is concerned the move to delete nurse manager positions will weaken already struggling mental health services in the GSAHS.

‘We need nurses represented at an executive level in the GSAHS structure. Mental health nurses are desperately needed in regional areas. But we need sound leadership and resources to attract nurses to this speciality area.

‘Recruitment and retention of mental health nurses is already difficult. Deleting positions for senior nurses will exacerbate the problem.

‘Instead, the GSAHS is pouring resources into funding non operational manager positions. A non operational manager is paid around $100K. Nurses want these resources paid to nurse practitioners and consultants,’ said Keith.

The NSWNA is holding meetings with the GSAHS over coming months to discuss the deep concerns of nurses and the Association with this proposal. ‘We will be asking the AHS to review the positions and roles of senior mental health nurses in its plan,’ said Judith.

Robust plan for Sydney South West

In contrast to the slapdash plan proposed by the GSAHS, the Sydney South West (SSW) AHS has tabled a robust plan for mental health services.

According to Charles Linsell, Mental Health Nurse Manager (Education) at Rozelle Hospital, members are satisfied the SSWAHS has consulted appropriately with nurses and the NSWNA and come up with a plan that maintains a strong nursing role.

The proposed structure in the SSWAHS includes an Area Director of Nursing (Mental Health) and a Senior Nurse Manager (level 7), who has operational responsibility.

‘With this structure, nurses are reporting to a senior nurse manager, who has an understanding of their issues and needs, rather than a non-nursing manager, said Charles.

There are also five nurse managers (level 5) and after-hours nurse managers (level 3) to enhance the after-hours management of mental health services.