Mental health nurses locked out while Australia locks down

At the time of writing Australia is in lockdown, its state and national borders are closed, gatherings of more than two people in public are banned, and a raft of other unprecedented measures have been implemented in response to the COVID-19 pandemic. This comes on the back of apocalyptic fires, floods and cyclones. Those that have been involved in recovery efforts in any of these events will have been witness to the resilience of the Australian community. These adventitious crises tend to bring communities together. This pandemic poses quite a different existential, psychological and social threat to Australians. People are locked in and cannot avail themselves of their usual coping mechanisms which might include a workout at the gym, a beer at the pub, a swim at the beach or gathering at a place of worship. The community is (quite justifiably) in a heightened state of anxiety manifested in a myriad of ways such as panic buying and hoarding of toilet rolls. It is reasonable to expect that people's mental health will be impacted by grief and loss, enforced isolation, social disharmony, boredom and relentless stress. Meanwhile, people with mental health problems continue to need treatment. Australia has some of the highest rates of diagnosed mental illness, prescription of medication, coercive care and completed suicide. Social distancing laws mitigate against business as usual which in primary care settings has involved face-to-face communication with a health professional subsidized through the Medicare Benefits Schedule (MBS). Recently the Australian Government announced a massive investment in mental health in response to the pandemic. The largest share of mental health expenditure is committed to extending MBS rebates for the provision of psychological therapies via the phone or video conferencing (by psychologists, occupational therapists and general practitioners) and incentivising “bulk billing” (i.e. not part charging consumers for services). The patients of mental health nurses (MHNs) have been and continue to be excluded from accessing these rebates, effectively locking them out of providing services to some people most in need of their skilled support. Mental health nurses were not mentioned at all in the Government's response to COVID-19. This is despite recent research which found there are relatively large numbers of MHNs who are highly educated, skilled and experienced in the provision of psychotherapy in Australia, want to be able to practice their craft and could be mobilized quickly (Hurley, Lakeman, Cashin, & Ryan, 2020). A key problem in Australia is that any nurse (enrolled or registered) who works in mental health is considered a MHN. This has led to widely held perceptions that MHNs are poorly skilled, sees them excluded from decision-making, and has led to a gross underutilization of the skills and talents of those who are highly capable. The pandemic poses something of an existential crisis for MHNs in Australia. The opportunity is for MHNs to be recognized for their particular skills and to enable them the professional autonomy to practice within their scope of practice (a privilege afforded to other disciplines). A failure to realize this potential now will be a great loss to those who could benefit from their skilled assistance and may quash any hope that mental health nursing regains its specialty status. Health professionals are being urged to come out of retirement to address anticipated demand, and the regulatory bodies propose graduating psychology students early to address the mental health of the nation. Mental health nurses are urged by the Australian College of Mental Health Nurses to write letters to people of influence raising the issue of the under-recognition and underutilization of MHNs as a highly skilled workforce and specifically to address their inability to access the MBS.