When the last review of mental health nursing was carried out 10
years ago, nurses felt their contributions had been ignored.
Despite this, last week’s announcement by chief nursing officer
Chris Beasley of a review has been met with enthusiasm. And nurses
and service users have every reason to be confident that this one
will be more influential than its predecessor.
The Department of Health review is seen by many as long overdue
and recent and imminent legislation – not least the Children Act
2004, the draft Mental Health Bill and the public health white
paper – mean it is also imperative.
Rapid change in the way services are delivered in the past seven
years, including the creation of crisis resolution teams and
assertive outreach, set out in the national service framework, has
increased opportunities for mental health nurses.
Although these are viewed positively, the pace of change has had
several consequences. Among these are a confusion about the role of
the mental health nurse and an exodus of the most experienced
nurses from the acute sector. As a result, there appears to be an
identity crisis about what it means to be a mental health
“The context in which mental health nurses work has changed in
recent years as a result of government reforms, lessons from
serious incidents and new professional roles that have grown across
the health and social care system,” Beasley says.
The tight, nine-month timescale for completion of the review is
a clear indicator of the renewed push to define what mental health
nursing should cover.
Welcoming the review, professional officer at the Mental Health
Nurses Association Brian Rogers says: “We really need a steer about
the way mental health nursing is going. We really need to look at
what it is we should be doing and what we should not be doing.”
He adds that a clear statement and set of principles about what
the job involves is needed so that mental health nursing can remain
a distinct branch within the family of nursing.
The specific focus in the review on the contribution of mental
health nursing to child protection is one example of how new
pressures could shape the identity of the mental health nurse
Rogers says that the attention given to this issue has been
lacking in the past. “The significance of child protection has been
largely underestimated. Many people working in health – not just
nurses – have not really got a handle on the real impact of a
parent’s mental health problem on their child,” he says.
Over the years, child death inquiries have found shortcomings in
the way health professionals manage child protection
responsibilities. But there is little evidence that these findings
have translated into improvements in practice.
But the introduction of statutory duties on professionals to
safeguard children and promote their well-being set out in the
Children Act 2004 has increased the pressure to improve performance
in this area.
Greater clarity over the approved mental health practitioner
role, outlined in the draft Mental Health Bill as a replacement for
the approved social worker role, is also likely to be part of the
Rogers says opinion is divided in the nursing world as to
whether the new role is a desirable job. But it looks set to appear
in the final version of the bill despite any opposition. As the
newest addition to the roles mental health nurses can fill, it is
therefore essential that those in the field are clear about what it
involves. Ultimately, failure to do this will result in mental
health service users losing out, as well as the nurses.