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Fundamental Aspects of Mental Health Nursing
Quay books, Dec 2007, Pages: 210
Mental health nurses care for people with mental health problems in the community or sometimes in a hospital setting. They help patients lead as ‘normal’ a life as possible, striving to enable the optimum potential of those they work with. The mindset of mental health nursing has shifted from that of a psychiatric nurse, whose primary function was to carry out ‘doctors orders’ and deliver the prescribed treatment to the patient, towards an evidence-based, health orientated leader of care, practicing in a diverse range of settings.
This book sets out to provide the reader with an insight into some of the fundamental elements of good quality mental health nursing in an accessible format. The themes will cover some of the physical, psychological, social and spiritual elements of quality mental health, and the part nurses play in their promotion.
Mental health nursing, sometimes referred to as psychiatric nursing, is a branch of the nursing profession that cares for people of all ages suffering from mental distress. Mental health nurses occupy the largest proportion of any other profession working in mental health services today (CNO, 2006), and utilize a wide range of skills, therapies and resources to help and support people in their daily lives. Assisting people resolve their own problems is a fundamental part of mental health nursing, and the types of problem people suffer from vary enormously. Mental health nurses make a vital contribution to providing care to service users of all age groups and in all settings.
The prevalence and frequency of mental health problems in the UK is statistically well documented, although as with all statistics they should be treated with caution. Depending on the research organisation, some figures suggest that it could be expected that 1 in 6 people will suffer some form of mental distress during their lifetime (Singleton et al, 2000). Traditionally, this distress may require the help of a professional if it becomes severe or threatens the safety of the person or other people, however, most mental health problems do not fall into this category.
Contemporary services aim to provide support that is easily accessible and meets the individual’s needs. This localised service revolves around the GP surgery in what is described as Primary Care, or where absolutely necessary within a hospital setting. The developments leading to this community focus for care were prompted by the closure of the institutions in the late 1980s. This saw in a new era for mental health nursing and a change of focus from providing continuing and long-term care in places removed from mainstream society, into more home based patient centred care.
The development of self-help, complementary medicine and computer-based therapy, has been reflected positively through the populations’ increased understanding and empowered status. The progress towards informed decisions, however, is hampered by the range and choice of service offered by private, public and voluntary sectors. Although the incidence of poor mental health cuts across social divides, it is particularly evident for those described as ‘socially excluded’. Their failure to engage voluntarily with the system does not suggest being overwhelmed by choice, rather it may reflect the difficultly they have in accessing services.
For some people the choice of receiving services is removed if they are detained under the Mental Health Act. About 1% of the population experience a disorder of perception (often referred to as schizophrenia at some point in their lives (Mental Health Foundation, 1999), and about 1% of the population experience manic depression at some point in their lives (Mental Health Foundation, 1999). Singleton et al (2000) suggested that 1 in 200 people have experienced a psychotic illness in the last year. For many people the experience of symptoms traditionally associated with mental illness will be a single event, and this does not necessarily indicate the need for a diagnosis. A first episode may well relate to a range of contributory external factors which if addressed will promote a complete and permanent recovery.
Recurrent symptoms may indicate the need for engagement with mental health services, and it is with this population that the majority of mental health nursing takes place.
In recent years mental health nursing has been shaped by a number of documents which feature in this book, but perhaps one of the most influential is the National Service Framework for Mental Health (DH, 1999a). It addresses the mental health needs of working age adults up to 65 and sets out national standards, national service models, local action, and national underpinning programmes for implementation. It is explicit that the majority of mental health problems are best dealt with in primary care, and presents Primary Care Trusts and primary care providers with some significant challenges:
- Providing primary care to the socially excluded, for example those with drug and mental health problems
- Development of professional skills and knowledge to deal effectively with mental health problems
- Providing information about available resources (social, welfare and voluntary resources)
- Addressing the physical healthcare needs of users
- Coordinating systems to enable communication between all stakeholders involved in the care of a user, leading to maximised outcomes for the individual with consistent advice
- Implementation of care pathways and protocols to enhance clinical outcomes
- Measurement of user experiences and performance against national target
- Meeting carers’ needs
- Suicide risk management
Mental health nurses need to be prepared to play their part in these successful outcomes, and it is through education, training and collaboration with other disciplines that will determine the success of these aspirations.
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