NDIA Accountability Project

Submission 78 — MHNP Consulting — Inquiry into the Thriving Kids initiative

‹ PrevPage 1 of 7 · Source p. 1Next ›

Submission: Inquiry into the Thriving Kids initiative

Supporting Children with Psychosocial and Neurodevelopmental Conditions

Dear Committee Secretary,

Thank you for the opportunity to provide a submission to the inquiry into assessment and support services for children with psychosocial disability and neurodevelopmental conditions, including developmental delay, autism, ADHD, and related behavioural conditions.

This submission is provided on behalf of the National Nurse Practitioner - Mental Health Special Interest Group. Credentialed Mental Health Nurses (CMHNs), who deliver advanced expertise in child development, psychosocial disability, and mental health and many who are working towards their Nurse Practitioner AHPRA endorsement and those who are already endorsed and specialised in mental health (Nurse Practitioner - Mental Health (NP-MH)) are ideally placed to be included in the “Thriving Kids Initiative”.

NP-MHs are endorsed through the Nursing and Midwifery Board of Australia (NMBA), having completed master’s level training and extensive advanced practice experience. This is usually 12 or more years of study, training and supervision to successfully achieve AHPRA NP endorsement. Building on their foundation as Mental Health Nurses (MHNs) who have a minimum Post Graduate Diploma in MHN (6 years to complete a PGD in MHN), they provide extended scope of practice, including comprehensive biopsychosocial assessment, diagnostic authority, prescribing, clinical investigations, and child-focused therapeutic interventions. The ACMHN provide credentialing which defines their specialty area in mental health against other RNs, to allow them to provide specialised assessment, psychoeducation, psychotherapies, behavioural strategies, and systemic family therapy and interventions. Together, NP-MHs and CMHNs represent a workforce uniquely positioned to address the unmet needs of children with neurodevelopmental, psychosocial and behavioural mental health conditions.

Currently, families across Australia face significant challenges:

  • Long waiting times and limited availability of paediatricians and child psychiatrists, particularly in public health in regional and remote settings.
  • Insufficient recognition and utilisation of the mental health nursing workforce, despite their ability to provide timely, accessible, and evidence-based biopsychosocial care, advanced assessment and a range of psychotherapeutic interventions (play based assessment and therapy, specialised neurodevelopmental assessment including, child focused focus psychotherapy and family therapy).
  • The need for policy and funding alignment to enable NP-MHs and CMHNs to consistently deliver high-quality and integrated care.

The following submission addresses six key areas.

1. Evidence-based information and resources for parents

Parents need clear, trusted, and accessible resources to help identify developmental concerns early.

  • Resources should cover language, motor, cognitive, social, physical and emotional development, alongside guidance on when and how to seek professional support.
  • CMHNs provide advanced biopsychosocial assessments, parent coaching, family interventions, and a range of psychotherapies that help parents understand and support their child.
  • NP-MHs expand on this with comprehensive biopsychosocial assessments and authorised to undertake pathology and clinical investigations, diagnostic authority to confirm diagnosis, prescribing medications, and child-focused psychotherapies and strategies along with timely referrals to medical specialist where necessary.
  • Direct access advantage: NP-MHs can be accessed directly under Medicare without a GP referral. Families are eligible for rebates for unlimited number of consultations, in contrast to long waits and restrictive access to paediatricians and child psychiatrists.

However, access pathways are not consistent across the workforce. While NP-MHs are accessible directly, CMHNs face persistent barriers in private practice due to unclear referral mechanisms under Medicare. Despite being AHPRA-registered nurses with specialist training and the ability to provide high-quality, evidence-based therapeutic care, many GPs remain uncertain about how to refer to CMHNs. Currently, CMHNs are only eligible for GP chronic or complex care management plan referrals, which limits access to just five 20-minute sessions per year. This restricts continuity of care and contributes to delays in early intervention.

In child-focused, trauma-informed programs, specialists recognise that the duration of therapeutic support must be guided by each child’s own pace of processing. Arbitrary limits on access therefore undermine both effectiveness and equity.

Recommendation: Clear national guidance is needed for GPs and primary care providers including all general NPs regarding CMHN eligibility and referral processes under Medicare and the NDIS. Streamlining administrative pathways and formally recognising CMHNs as specialist mental health providers within Medicare would significantly enhance accessibility and reduce confusion. This would allow families to engage CMHNs without delay, ensuring timely, person-centred, and developmentally appropriate care.

2. Effectiveness of current and previous programs and initiatives

Current systems show strengths but are hampered by fragmentation and workforce shortages.

  • Maternal and child health services: Effective for universal screening, but often unable to provide sustained support for developmental needs nor undertake advance specialised assessment which CMHN & NP-MH are authorised to undertake.

  • Early childhood education and playgroups: Educators can identify concerns, but referral pathways are inconsistent or long waiting lists. Also, trauma informed approaches are not consistent across education systems.

  • Primary care and schools: The school mental health support is currently focused on addressing mild to moderate and emerging mental health concerns among students. While this is a positive step toward early intervention, several systemic gaps limit its effectiveness and sustainability:

    • Lack of Risk Frameworks for Escalating Needs Practitioners report an absence of robust risk assessment and management frameworks to support students whose mental health needs escalate beyond the mild-to-moderate range. This leaves a critical care gap for those who later present with more complex or high-risk concerns.

Insufficient Referral Pathways to Tertiary Services

There is a notable lack of clear, structured referral pathways bridging the gap between school-based support and tertiary mental health services. This disconnect delays access to appropriate care and places undue pressure on school-based practitioners.

Limited Capacity for In-School Therapeutic Intervention

Current practitioners often lack the mandate, resources, or frameworks to provide ongoing therapeutic support within schools. As a result, students are frequently referred externally, which can fragment care and reduce continuity.

GP-led referral creates bottlenecks, while school-based support varies significantly across jurisdictions. Credentialed Mental Health Nurses (CMHNs) and Nurse Practitioners – Mental Health (NP-MHs) could easily be integrated into the school system or accessed directly through the education system. Their advanced skills in assessment, psychotherapy, escalation management, and care coordination would strengthen risk frameworks, provide structured referral pathways, and enhance therapeutic capacity within the school environment.

  • Medical specialist shortages: Waiting times for paediatricians (workforce of 4000 but not all specialise in developmental and behavioural care) and child and adolescent psychiatrists (450 workforce across Australia - https://www.ranzcp.org/getmedia/5eb0fe45-5757-4c0f-aff4-83505591be23/fcap-workforce-infographic.pdf ) often exceed 12–18 months or more, with some regions unable to provide services at all. Private medical specialist services are often inaccessible and or prohibitive for many families. These prolonged wait times or barriers to access can lead to delayed diagnoses and treatment, often contributing to increased comorbid mental health diagnosis highlighting the urgent need for increased funding and recruitment of specialists in underserved areas.

  • NP-MHs and CMHNs as a Timely and Specialised Alternative NP-MHs can be accessed directly under Medicare without referral, providing timely access to assessment and treatment across a wide range of developmental and mental health needs, escalating only when specialist input is required. CMHNs offer sustained therapeutic engagement, supporting families to navigate community and mainstream services while delivering a range of psychotherapeutic interventions.

    In addition to direct care, NP-MHs and CMHNs are increasingly relied upon for their expertise in clinical supervision, consultation, and system navigation. Their advanced practice skills position them as key supports not only for families, but also for educators and other health professionals who require guidance in navigating complex and evolving funding structures, particularly within the NDIS and Medicare.

    Mental Health Nurse Incentive Program (MHNIP) The Mental Health Nurse Incentive Program (MHNIP) previously enabled Credentialed Mental Health Nurses (CMHNs) to deliver flexible, timely, and community-based complex mental health care to children and families under Medicare. MHNIP was widely regarded as one of the most effective primary mental health services in supporting early intervention and continuity of care reducing the economic impact on wider service systems. However, following its deregulation in 2016–2017, when funding was shifted out of Medicare, its impact has gone largely unreported. The loss of MHNIP reduced accessible primary mental health services, placing additional pressure on public systems and contributing to longer waiting times for specialist care.

This expanded role reflects the depth of trust placed in these clinicians and highlights their unique capacity to bridge service gaps, coordinate care, and advocate for trauma-informed, relational approaches across diverse settings.

However, systemic challenges remain:

  • Uncompensated Labour – Much of the consultative, supervisory, and system navigation work undertaken by NP-MHs and CMHNs is unfunded. In private practice, CMHNs are currently funded for only five visits at $61.80 under chronic disease management plans — a rate and structure that does not reflect the time required for evidence-based, trauma-informed care.
  • Role Confusion – Despite being expected to provide high-level consultation and support in complex care scenarios, CMHNs are not formally recognised within Medicare or NDIS frameworks, leading to ambiguity and underutilisation of their full scope of practice.
  • Policy Gaps – There is a lack of formal recognition and funding for the consultative and supervisory roles CMHNs and NP-MHs play, despite their critical contributions to workforce development, interprofessional collaboration, and family support.

3. Equity and intersectional issues

Children experiencing disadvantage face compounded barriers to accessing developmental and psychosocial support.

  • First Nations children: Face systemic inequities and geographic barriers. Embedding NP-MHs and CMHNs into community-controlled health organisations offers a promising pathway to culturally safer, earlier, and more accessible care. In the Northern Territory there are examples of ACCHOs, such as Anyinginyi Health Aboriginal Corporation, that include mental health services, and broader reforms under the NT Pathways to Community Control initiative aim to enhance service delivery in Aboriginal community-controlled settings. While full integration of NP-MH diagnostic and prescribing roles in ACCHOs may still be emerging, policy momentum suggests this is becoming increasingly feasible.
  • CALD families: Direct access to NP-MHs without referral reduces navigation complexity. CMHNs provide culturally responsive psychoeducation and family strategies.
  • Socioeconomic disadvantage: High private fees for paediatricians/child psychiatrists limit access. NP-MHs provide Medicare-rebated consultations with fewer out-of-pocket costs, and CMHNs deliver affordable, ongoing therapeutic care and would be more accessible given they had Medicare rebates equal to other clinical MH provides such as Clinical Psychologist.
  • Geographic inequity: The scarcity of medical specialists in rural/remote areas makes NP-MHs and CMHNs vital. Telehealth models further extend their reach.
  • Neurodiversity equity is a crucial topic that emphasizes the importance of recognizing and valuing the diverse ways in which people think, learn, and interact with the world. NP-MH and CMHN have the training and skills to recognise and provide support, assessment and resources to neurodiverse groups to ensure early intervention and access options are well considered across all sectors.

4. Workforce support and training gaps

The Thriving Kids agenda depends on maximising the full breadth of mental health nursing expertise and embedding it consistently across primary care, education, and community systems.

  • Core Workforce Australia has over 26,000 Mental Health Nurses (MHNs), with around 1,000 Credentialed Mental Health Nurses (CMHNs) (ACMHN data). CMHNs provide specialised psychosocial assessment, advanced therapies, family support, and psychoeducation, and are a critical but under-recognised workforce in developmental and psychosocial disability.
  • Expanded Prescribing Pathways In September 2025, AHPRA introduced a new prescribing endorsement for Registered Nurses (RNs). Importantly, CMHNs are included in this group of eligible RNs, creating a new tier of workforce capacity. Prescribing-endorsed RNs must practice under the supervision of a Nurse Practitioner (NP) or General Practitioner (GP). This pathway offers opportunities to expand access to timely interventions, particularly in primary care and schools, while ensuring that prescribing is embedded in safe, supervised models of care.
  • Advanced Practice Leadership Nurse Practitioners – Mental Health (NP-MHs) extend beyond the prescribing role with an expanded scope of practice to practice autonomously including diagnostic authority, prescribing, ordering pathology and imaging, psychotherapy, and behavioural strategies. For children with wide range of developmental needs, NP-MHs provide services comparable in scope to medical specialists and are ideally positioned to address current workforce shortages by escalating to paediatricians or child psychiatrists only when required.
  • Training and Systemic Leadership Allied health, GPs, and early childhood educators often report lacking confidence in recognising and responding to developmental and psychosocial needs. NP-MHs and CMHNs are ideally placed to provide workforce education, interprofessional training, and systemic leadership, including supervision of prescribing-endorsed RNs.
  • Unlocking Workforce Capacity Greater recognition of CMHNs and NP-MHs in Medicare, NDIS, and national guidelines would unlock existing workforce capacity, reduce bottlenecks caused by shortages of child psychiatrists and paediatricians, and ensure children and families receive timely, evidence-based, and trauma-informed care.

5. Domestic and international policy and best practice

  • International practice: Nurse practitioner-led developmental and ADHD clinics in the UK and USA manage the majority of cases directly, escalating to medical specialists only when strictly required.
  • Domestic practice: In Australia, CMHNs often train alongside child psychiatry registrars and deliver advanced therapeutic programs. NP-MHs extend this model, offering diagnosis and prescribing within Medicare-funded frameworks. NP-MH are currently prescribing stimulant medications for ADHD under permits under State authorities (inconsistent across Australia) and have the capacity beyond GP training to undertake advanced developmental and mental health assessment, confirm diagnosis and commence prescribing and other recommended treatment without requiring further training identifying them as a workforce underutilised and ready to provide services without further economic cost of training programs.
  • Best practice: Systemic family interventions, dyadic therapies, and child-focused psychotherapy are strongly evidence-based. CMHNs deliver these consistently, while NP-MHs build on these skills and integrate biological and medical dimensions to ensure holistic care.

6. Mechanisms for seamless transitions

Children and families need smooth transitions across health, education, and community systems.

  • Direct access pathways: Families can book NP-MHs directly under Medicare without GP referral. CMHNs provide ongoing therapeutic support, ensuring continuity across service transitions.
  • Continuity across the lifespan: NP-MHs provide care into adolescence and adulthood, bridging gaps when children age out of paediatric or child psychiatry services.
  • Funding and recognition: Explicit inclusion of CMHNs and NP-MHs in Medicare, PBS, NDIS frameworks and Thriving Kids Initiative would strengthen continuity and reduce fragmentation.
  • Family-centred care: Both CMHNs and NP-MHs embed psychoeducation, family therapy, and behavioural strategies to minimise disruption across transitions.

Closing Statement

Australia faces a critical gap in timely, accessible, and effective support for children with developmental, psychosocial, and neurodevelopmental conditions. The shortage of paediatricians and child psychiatrists in public health and prohibitive cost in private sectors is leaving families without care during crucial developmental windows.

Credentialed Mental Health Nurses (CMHNs) and Nurse Practitioners – Mental Health (NP-MHs) represent a highly skilled yet under-utilised workforce with the potential to significantly alleviate these pressures:

  • NP-MHs: Families can directly access NP-MHs under Medicare without referral. With authority to diagnose, prescribe, order investigations, and provide psychotherapy, NP-MHs deliver comprehensive, timely, and ongoing care. They escalate to medical specialists only when strictly necessary, relieving pressure on a system already stretched beyond capacity.
  • CMHNs: Despite rigorous credentialing and advanced skills in assessment, psychotherapy, psychoeducation, and systemic family support, CMHNs face barriers to access. Under Medicare, they can only receive referrals through GP chronic or complex care management plans, limited to five sessions. This restriction undermines their role, delays early intervention, and reduces therapeutic continuity for children who often need longer-term, trauma-informed support. In recognition of these limitations, there is anticipation of CMHNs being formally enabled to function under the Better Access program, which would provide families with improved, direct, and affordable access to their expertise.

To improve outcomes, national policy and funding frameworks must explicitly recognise both NP-MHs and CMHNs as core providers of developmental and mental health care.

Key priorities include:

  • Expanding direct Medicare access for CMHNs, with clear guidance for GPs and primary care providers.
  • Formally recognising CMHNs as specialist mental health providers under Medicare – Better Access, the NDIS, and Thriving kids initiative.
  • Promoting seamless integration of NP-MHs and CMHNs into mainstream child health, education, and community systems.

By addressing these barriers and maximising the reach of this workforce, Australia can provide families with the timely, evidence-based, and person-centred care children need during their most critical developmental years. This is both possible and necessary so all children can grow, develop, and thrive.

Sonia Miller BHSc-RN | PGDip MHN |MHSc MHN |FACMHN
Director — MHNP Consulting
Chair ACMHN NP-MH Special Interest Group
Nurse Practitioner - Psychiatry
Credentialed Mental Health Nurse - ACMHN
ACA Member - Level 4 Senior Clinical Psychotherapist
NDIS Registered Provider — Therapy and Behaviour Support
redacted

Meleeta Van Laarhoven BNurse | PGCert: CAFHN | PGDip MHN | PGCert PT | MMHN
Director — Evolve Well Health
Credentialed Mental Health Nurse - ACMHN
Provisional Nurse Practitioner — Mental Health
Registered Play Therapist - APTA-RPT — Child Psychotherapy
Registered Nurse — AHPRA Div1
ACMHN member: NP - MH Special Interest Group
redacted