My Journey to Become a Mental Health Nurse Practitioner
By Sonia Miller
Sonia Miller's journey to becoming a Mental Health Nurse Practitioner (MHNP) is a story of resilience and dedication. Growing up on a dairy farm in rural Victoria, she faced isolation and family trauma. After leaving home at 16 and working various jobs, she returned to education at 23 and discovered a passion for psychiatry. Sonia's determination led her to advanced roles in mental health, advocating for NP legislation and expanding her practice to include neurodevelopmental assessments and therapy dog interventions. Her story highlights the importance of perseverance and continuous learning in improving mental health services.
Becoming a Mental Health Nurse Practitioner (MHNP) has been a non-linear journey for me, shaped by a combination of personal challenges and professional achievements. Growing up on a dairy farm in rural Victoria, I faced isolation and family trauma that impacted my education. After leaving school and home at 16, I worked various jobs in Melbourne before deciding to return to education at 23, when I discovered free bachelor’s programmes in nursing.
Balancing 38 hours of study with up to 40 hours of casual work was tough, but I supported myself through university. Despite my aversion to bodily fluids, I was determined to pursue nursing. I found a natural talent for science and developed a passion for psychiatry, inspired by motivating lecturers. As one of the first graduates of the Bachelor of Health Science Nursing programme in Victoria, I completed a general graduate programme and worked in various wards, eventually focusing on Paediatrics and Neurosciences. Concurrently, I pursued a master’s degree with a mental health specialisation.
Midway through my Master’s, I earned a Graduate Diploma in Health Science Nursing with a focus on Mental Health, which led to my endorsement as a Psychiatric Nurse by the Victorian Nurse and Midwife Registration Board in 1995. This endorsement allowed me to transition into psychiatry, starting with child and adolescent mental health acute services. I later moved to the Intensive Mobile Youth Outreach Service (IMYOS), deepening my understanding of complex mental health conditions, and expanding my practice through a developmental psychiatry course.
I resumed my master’s studies in 1998, focusing my thesis on MHNP roles. My research, titled “Independent Nurse Practitioner Roles in Mental Health,” explored post-structural discourse on how advanced practice MHNs view their roles, with discourse focused on dependent rather than independent practitioners. Despite advancements in nursing education, the practice often lagged, with my research finding NP roles in the USA and UK showcasing more autonomy for over 40 years beyond Australia.
In the IMYOS role, I frequently operated independently, managing complex cases which led to advocating for NP legislation. The NP legislation was established in 2000, but the endorsement process remained complex and varied across states and organisations, making it difficult to navigate. Balancing my master’s studies with starting a family, I worked on quality management projects, improving health services and transitioning into an education role for over six years. I provided training, supervision, and developed competency assessment tools, supporting graduate nurses and advancing MHN qualifications.
In 2009, I led a state-funded NP project, reigniting my interest in NP endorsement. Witnessing advancements in NP legislation and the introduction of Medicare items and PBS in 2010, I pursued additional studies and achieved NP endorsement in September 2012. My subsequent roles included managing intake for child and adolescent mental health and working with Primary Health Networks (PHN) to develop various mental health programmes, including suicide prevention, PTSD, child mental health, perinatal mental health, and services for Aboriginal and Torres Strait Islander communities. I also served as a clinical lead in setting up the headspace service.
Since gaining my NP endorsement, I have expanded my scope to include neurodevelopmental advanced assessment, diagnosis and treatments, a range of prescribing psychotropic medications for complex mental illness, medicated assisted opiate replacement prescribing, medicinal cannabis prescribing, and safely managing deprescribing.
I believe MHNPs represent the pinnacle of mental health clinical nursing where access to non-management and non-academic career pathways has been limited compared to other health professions. This ongoing journey requires unity among colleagues to support each other and advocate for appropriate funding and recognition for the clinical advancement of MHN to work towards NP endorsement. I advocate for MHNPs, supervising colleagues and founding the MHNP Special Interest Group in 2014 to support those pursuing and maintaining NP endorsement. As the chair, I have developed many submissions for guidelines of diagnostic groups or funding proposals. I am proud of my leadership in the ADHD Senate Inquiry in 2023, collaborating with the ACMHN and colleagues to elevate our voices in Parliament, highlighting the essential role of MHN & MHNPs in delivering specialised mental health services. I have managed to navigate my way through most funding resources and overcome barriers to MHN having access to opportunities in the workforce.
Currently, I am a board member for the Mental Health Professionals Network and the Nursing and Midwifery Health Program Victoria. These roles connect my background in education, mentoring, and supervision to continue supporting the mental health workforce and reducing burnout and turnover. For over 14 years, I have enjoyed the freedom and flexibility of private practice. I work very hard and take many wonderful holidays while balancing clinical work with supervision, training, and corporate roles. I never stop learning and try to take on something new each year, giving me a long list of psychotherapy certifications and qualifications.
Over the last few years, I have completed ADOS2 training and added this to my practice with neurodevelopmental assessments for children and adults. Over the past two years, I have been undertaking Animal Assist Therapy training and education. I added a therapy dog named Bobbi to my practice, which has been an amazing journey of experiencing some very meaningful moments for me personally and for my clients. Despite the challenges of MHN work, the reward comes from seeing clients and colleagues achieve their best. The gratitude expressed by those I help keeps me motivated and passionate about my work.
TAGS Australian College of Mental Health Nurses membership, mental health career change, mental health nursing career, mental health policy Australia