Enterprise Bargaining - Mental Health Update
Psychiatric Nursing Agreement - Heads of Agreement 2004 - 2007

The Victorian Psychiatric Nursing Agreement - Heads of Agreement - 2004 is an Agreement between the Victorian Government, the Victorian Hospitals Industrial Association (VHIA), the Health and Community Services Union (HACSU) and the Australian Nursing Federation (ANF). The Agreement is effective from 1 April 2004 and expires on 30 September 2007

The Agreement allows for a wages outcome of three percent a year over three and a half years and contains a number of significant initiatives to enhance staff training and education and professional development and the staffing in acute inpatient units. It also commits to the development and implementation of a community caseload management model and additional occupational health and safety initiatives.

In negotiating the agreement, the parties and the Victorian Government have achieved a balanced resolution that forms the basis for fulfilling professions and careers and continuing quality clinical services to mental health clients.

The following material provides information regarding some Victorian Government achievements in the context of the Agreement. In addition the documents below provide more detail of the Governments current mental health plan.

Mental Health Services documents available

New Directions For Victoria's Mental Health Services. The Next Five Years - September 2002 (pdf, 268k)

New Directions For Victoria's Mental Health Services. The Next Five Years. The Plain English Version - September 2002 (pdf, 35k)

Victorian Psychiatric Services Certified Agreement 2004-2007 (link to WageNet website)

Psychiatric nurse practitioner

The Department of Human Services (DHS) has funded three mental health nurse practitioner projects that are coordinated by Nurse Policy Branch. For further information contact the Nurse Policy Unit at nursepolicy@dhs.vic.gov.au

Education and training group (ETAG)

ETAG was convened and met for the first time in March 2004 with an objective of developing and implementing training strategies to meet the ongoing professional development and training needs of the mental health workforce. Membership comprises parties to the Agreement and relevant stakeholders. ETAG generally meets on a quarterly basis. The major focus of meetings comprises the Mental Health Branch reporting and engaging in discussion on activity related to the training issues included in the Heads of Agreement.

Professional development package

Post-graduate scholarships

It was agreed DHS provide 440 scholarships over the life of the Agreement. Scholarships up to the value of $3,000 per scholarship year are made available to registered (division 1) nurses working in the public mental health sector. Scholarships are awarded to those nurses participating in a graduate program where credit points are awarded towards a post-graduate qualification; the remaining scholarships are awarded to division one nurses who do not hold undergraduate or postgraduate psychiatric nursing qualifications. Scholarships are available at the commencement of Semester 1 and 2.

Post-graduate scholarships distributed

A further 188 scholarships will be offered in the 2006/2007 financial year. Services will be advised when applications for the next round of scholarships are open.

The application process is managed through the DHS Nurse Policy Unit. For further information contact the Nurse Policy Unit at nursepolicy@dhs.vic.gov.au

Psychiatric State enrolled nurses (PSEN) Division 2

DHS funds 50 post basic mental health modules per year for PSEN's. In addition PSEN's undertaking a Bachelor of Nursing may be eligible for two week's leave to undertake clinical placement. Ten placements are funded per annum at $2,717 per placement. Funding is primarily directed to 'back-fill' those on clinical placement leave.

Services are invited on a twice yearly basis to nominate potential recipients.

Supervision

Supervision guidelines have been published on the Mental Health Branch website which you may access at www.health.vic.gov.au/mentalhealth and select Program Management Circulars.

Pre graduate positions

The Agreement provides for the introduction of Pre Graduate positions. The classification is to enable Bachelor of Nursing or Certificate IV nursing students to gain short term employment (such as in semester breaks) in order to gain exposure and to invoke interest in mental health as a career option. The positions must be supernumerary and supported by a preceptor with an agreed restricted scope of practice. It is at the discretion of each employer as to whether they participate in the program. However, where they do participate, an agreed induction and support program must be implemented. Prior to the introduction of these arrangements, an industrial instrument to cover these positions is to be negotiated between the parties.

Specialist mental health graduate programs

DHS has funded the following graduate placements over the life of the Agreement:

Graduate programs support the employment of newly registered nurses and recently qualified allied health staff in the mental health field. Employing services are provided with funding to employ new graduates and are required to provide structured training programs that are required to include the following:

• Appropriate induction and orientation
• Access to more experienced clinicians for supervision and instruction
• Peer support and mentoring as appropriate; and
• Introduction to specific clinical and workplace requirements. Includes both structured learning opportunities and support.

DHS invites services on an annual basis to nominate for a number of places.

Acute adult inpatient units

DHS funded services in 2004 to facilitate consistent staffing across seven days in adult acute inpatient units.

In the second half of 2006 it is anticipated that a survey of staffing profiles in bed based services will be conducted to obtain information about the model, level and numbers of staff in all clinical bed-based services including:

• Acute inpatient: adult; aged and CAMHS
• Community care units
• Specialist beds
• Secure extended care
• Aged care residential.

Caseload management systems

About caseload management systems

The Agreement includes a requirement that health service employers, including relevant clinicians and managers, develop and implement an agreed system of caseload management for community mental health teams and maintain it as the primary method of caseload allocation for case managers.

Existing caseload management systems that contain the specified requirements may continue. Caseload management systems that do not adhere to the requirements must be amended to incorporate them.

It is expected that that the introduction of caseload management systems will enhance operation of continuing care case management and increase equity and fairness in the distribution of workload. Caseload management has has been identified in the literature as an important component of service operation, with implications for the kinds of services that case managers provide to their clients and therefore potentially client outcomes. Better caseload management might therefore be expected to impact favourably on workplace stress.

Criteria

All agreed caseload management systems will:
Be based on the principle that a clinician's caseload capacity (including secondary caseload capacity) and case management is determined by a range of factors, including:

• The clinician's ordinary rostered hours;
• Client complexity and needs (which includes travelling time and documentation);
• Their clinical commitments to clients as well as team/service;
• Their organisational commitments;
• Their professional development and clinical supervision commitments;
• The skill, competency and/or experience of the clinician.
• Be based on the principle that all tasks assigned to the employee, including caseload allocation and fixed and variable clinical and organisational commitments, are expected to be able to be completed within the employee's normal hours of duty.
• Be a system that provides for systematic triage, allocation, monitoring, discharge and review of client cases.

• Contain a case weighting system that reflects the acuity and complexity of cases allocated to each employee.
• Incorporate a regular method of clinical workload assessment and a system for caseload review between the clinician, team and/or manager on a weekly basis or as otherwise determined at the service.
• Not be dependant upon overtime and/or time in lieu as a means to augment the existing workforce or case load requirements.
• Include consultation at the team level as to how to best manage the caseload of a clinician during their planned and unplanned absences.
• Provide for backfill if the secondary caseload is unable to be managed despite active prioritisation of caseload.

Key points

• Each Area Mental Health Service must develop and implement a locally agreed case management system.
• The process of development and implementation must engage, at a local level, the industrial bodies (HACSUA and ANF).
• Must as a minimum meet the criteria specified in the EBA.
• Must be signed off by management and the industrial bodies.
• Must be formally written up as a service policy that is available to all relevant staff.

Frequently asked questions

Q. Are all programs required to have a case management system?

A. Yes the requirement is that locally agreed case management systems be developed and implemented for community teams.

Q. Does the case management system have to be the same across Adult, Aged and CAMHS?

A. No. While a uniform system may be adopted across a service this is not required. The essential requirement is that the CSM operating in any area meet the requirements set out in the EBA.

Q. Do we still need to do this as we do not have any workload or industrial problems?

A. Yes. The EBA is a legally binding document between the parties and is capable of being legally enforced. Parties to the agreement are employers, HACSUA and the ANF. The responsibility rests with each employer to ensure they are in compliance with the terms of the agreement.

Q. Is a case management system only required for nursing staff in our service?

A. No. The agreement covers all clinical staff, including allied health, employed in a community team as case managers/case coordinators.

Q. Is there a model for case management that has been developed or approved by the Department of Human Services (DHS) Mental Health Branch (MHB)?

A. No. The essential requirement is that the principles set out the EBA are meet. DHS is not a party to the agreement nor does DHS have a preferred model. The role of DHS as a service funder is to monitor any impact on service delivery and to support services as required or requested.

Q. Are we required to adopt the SWIM program?

A. No. During negotiations the industrial bodies used SWIM as mode. Each service is required to develop and implement a model or models that are locally agreed, meet service needs, and comply with the requirements set out in the agreement.

Q. What are other services doing?

A. Services are at varying stages and a number of models are being developed. Several have modified the Meldrum Yellowless model to meet local needs while others have or are in the process of developing new models.

Most services are very willing to share their ideas, experience and learning. However, the Agreement requires services at a local level to develop and implement an agreed model of caseload management.

Resources and contacts

• DHS is providing discharge Data (throughput data) to the parties on a quarterly basis.
• DHS has contracted the University of Queensland to conduct an evaluation of implementation that commenced on 15 March 2006. Dr Robert King is conducting the evaluation and all case managers and team leaders have been invited to and are encouraged to participate. The survey may be accessed at www.uq.edu.au/som-caseload . When logging on for the first time use the generic:
  User name: register
  Password: loadcase
• Periodic bulletins will be produced throughout the evaluation. If you require further information about the survey contact may be made with the University of Queensland at robertk@psychiatry.uq.edu.au .

Occupational health & safety

DHS has published and circulated the "Industry occupational health and safety interim standards for preventing and managing occupational violence and aggression in Victoria's mental health services 2003" - September 2004 (pdf, 301k). And as contained in the Agreement has provided $320,000 to services to support aggression management training targeting inpatient nursing staff. The Interim Standards may be ordered in hard copy version at "Ordering Publications (Mental Health Branch Publications and Brochures)".

Contact us

If you would like further information regarding DHS initiatives or wish to make suggestions or comment on workforce matters you may contact us by email: mentalhealthworkforce@dhs.vic.gov.au.au

or if you have questions of an industrial nature see: Victorian Hospitals' Industrial Association (VHIA) at www.vhia.com.au