Monthly Archives: September 2009

A Mental Health Nurse?

Grand designs?

I thought it would be a good idea to identify the role of the mental health nurse.   Occasionally when people find out I’m a mental health nurse, they say, ‘mental health nurses – all they do is sit around talking all day.  This, and the general lack of knowledge about the role of the mental health nurse spurred me to start writing.  However, I’d dug myself a bigger hole than initially planned.  It was a bit like that programme ‘Grand Designs’, my expectation of the job was significantly underestimated and the overall time, cost and obstacles were greater than I’d initially considered.  Its complexity was also a reason for writing this piece.

Reading around

Reading around the subject and looking at roles identified by others I had difficulty distinguishing between role and skill.  I came to realise that both come hand in hand.  A nurse colleague said to me ‘anyone can fulfil a role but it is the quality of skill that determines the standard of the role delivered’.  I like this statement and hope to deliver a learning environment where students develop both.   I see ‘role’ as those laid out in a job description usually outlined from a top down approach.  In my view ‘skill’ defines the quality of the care and the interventions most appreciated by patients, carers, family and friends.  I want to be nursed by a person who cares enough to offer me a personal approach.

So, back to the point.  What is the role (and skill) of the mental health nurse?

Paperwork – lots of it!

Bureaucracy!  Never ending and it seems forever increasing, it is argued the amount of paperwork detracts from the time nurses have to actually deliver direct patient care but is now the norm.  Arguably, too much time is spent on filling in data when it is unclear that anyone really looks at the information (Gowodo and Nolan, 2008).  Nevertheless, if you’re a mental health nurse, paperwork is a daily expectation.  In conjunction with paperwork runs the Care Programme Approach (CPA) framework.  The CPA is HUGE! And does involve more paperwork. The CPA requires the skill to work with the service user, family and carers where appropriate, equally within a multidisciplinary team.   If used well, it can promote recovery and independence. Care plans, patient care reviews, involvement of carers and promotion of independence are all parts of the CPA.  We’re encouraged to write care plans with patients and carers.  Involving service users and carers in CPA is a skill that needs more attention by nurses as we are there to advocate and create an environment that allows for independent thinking and self development by the service user.  I feel healthcare workers as a whole are yet to fully embrace this concept as it involves positive risk taking and allowing the individual to have choices we don’t agree with. 

A power balance?

Shifting the power balance between service user and professional also has its own struggles, some patients appreciate formal health service offered and some professionals may struggle to give up some of their power.  I personally feel a positive mental health approach manages to strike a balance between all.  I often say a skill of a mental health nurse is knowing when not to take action or when not to take control in the right context.  All people should have the right to learn by making their own right and wrong choices.

Nurses have distinguished their unique contribution to individual care in terms of empathy, being non-judgemental, allowing time, providing support and promoting positive links with friends and family.  I see these as skills rather than roles, although I have seen ‘have a non-judgemental attitude’ in a job description.  The difficulties with these skills as pointed out by Gowodo and Nolan (2008) is that they are almost impossible to quantify, to evidence.  It is difficult to produce evidence that demonstrates the level of skill and care delivered by the nurse and also that this work is being done and continues to be an important aspect enhancing patient care and recovery.  Having said that, these skills are the pinnacle of good nursing practice and have a lasting impact in the memory of service users.


The role of the mental health nurse is ever increasing.  With the focus on specialised teams, mental health nurses have become specialised in their own right, adapting and developing skills specific to their area of practice.  For example, assertive outreach, home treatment, early intervention, primary care, eating disorders, mother and baby to name but a few of the specific areas a mental health nurse can work and will require an individual approach as a team and towards service users.  One benefit is that teams have immediate access to specialist skills, expertise and experience to provide a comprehensive and specialised package of care to that particular client group (Department of Health, 2009).  The downside of this perhaps is the employability of the mental health nurse as they become more skilled in say eating disorders with a significant loss of experience in other areas. 

OK  – it is nearly impossible to define!

It is almost impossible to define the role of the mental health nurse and I am becoming increasingly aware that many people have attempted this task dedicating much more time and thought than I have.  It’s actually much bigger than I ever anticipated and almost impossible to quantify.  I am aware there are many roles and skills that I have not identified within this blog, mostly because at this rate I would be writing a book not a blog.  If it has highlighted one thing it is that the skills of a mental health nurse should not be identified as a one shoe fits all approach. Although, having said that, the areas I have identified are relevant to all.  I’m confused!  If anyone can highlight any work specific to this I’d be interested to hear and appreciate any feedback.

(PS This is worth a look – Phil Barker talks about Mental Health Nursing  You will need Windows Media Player : Film is taken from this website  which is also well worth checking out)


Photos from Flickr creative commons.

1. Construction of our house – Framing : by Lee Coursey

2. Juggling bean bags : madaboutasia

A Critical Observation of Critical Insurance

Like many people, I have a mortgage and with it, the necessary life insurance. With mine, I took out the ‘critical cover’ – what this means is that if I die, the mortgage is paid off and if I become ill and cannot work, then the mortgage is paid off. But stop…if I become ill? No, if I become physically ill. Mental illness doesn’t come into it. It’s not covered in any shape or form. Not even a whisper. Basically then, you are not allowed to have a mortgage AND a mental illness. Don’t even think about it. You are being greedy having both things.

I have thought a lot about this. I understand the need to cater for someone who loses limbs and so cannot work or someone who develops a terminal illness and so obviously has other priorities than working. I understand that many conditions can stop a person from having a sufficient income that allows them to pay a mortgage. 

I also understand that insurance companies would probably be inundated with claims if mental illness was included – I am certain that many dishonest people would try to make a claim by claiming a mental illness. But hang on a minute, we have psychiatrists don’t we? And aren’t insurance companies renowned for putting in clauses? Why can’t there be a clause that states a mental illness ‘that has lasted at least 6 months and prevents the claimant from working and is under the care of an appropriate medical consultant and is receiving appropriate treatment’? Hopefully the false claims would be weeded out – please note that the sentence above is from my insurance documents but is applied to physical conditions.

The insurance company is willing to weed out false claims for physical conditions but will not even entertain the idea of even considering a genuine claim for mental illness. Why not mental illness?  We know that with many illnesses people are simply unable to work but here they do not have the benefit of insurance that others may have.

But I begin from a false ideal, that life is fair.


Pictures from Flickr commons

1. Shark House by Mattyboyjim

2 Wet roofs by diavolo_felice

3. Houses of England by Gúnna

Schizophrenic man terrifies kids at party

This is a guest post from the people responsible for promoting an anti mental health discrimination campaign called ‘Time to change’.

We don’t normally do adverts but I thought that this would be ok – it would be very interesting to hear if you have any comments or observations?

 Time to Change is run by leading mental health charities Mind and Rethink, and backed by £16 million from the Big Lottery Fund and £2 million from Comic Relief. 

The Time to Change charity was successfully launched in Jan this year with an advertising campaign created by MCBD, with media planning by Naked and media buying by the7Stars.  The campaign featured a TV ad: “The Bridge”, celebrity and real people testimonial posters and press ads (featuring Ruby Wax, Stephen Fry and others) and a Mental Illness Myth/Fact press and online campaign.


The latest phase of the campaign includes a more provocative piece which tackles the stigma surrounding mental illness head on.  It was decided to launch these films online for a number of reasons, firstly because most mainstream movies are launched through rich media online and we wanted to ape this type of media placement.  Secondly a vital part of this campaign is to encourage people to pass on these films to friends so online is the perfect environment to facilitate the viral spread of the campaign.


Two films break online on 10th August, both of which play on the negative stereotypes that people hold about people with schizophrenia. The first film “Schizo movie” fools the viewer into believing that it’s a promo for a thriller. It purposefully takes its cues from horror movie trailers, using lots of dark imagery.  However once the film starts to play we meet Stuart who is a regular guy, just like you or I, but who also happens to have schizophrenia.  This approach allows TTC to challenge the perceptions people have about people with mental health problems without finger-pointing.


The second film “Kid’s Party” will be seeded into video sites with the title “schizophrenic man terrifies kids at party” with a still of a typical kid’s party next to it.  Instead of seeing youngsters being frightened by a person with schizophrenia, viewers see a normal children’s party with the person “scaring” the children with a giant spider made out of balloons.  As this footage is revealed the person voices over the film and explains how thanks to support from his friends he’s able to live a full life despite having schizophrenia.


1 in 4 of us will have a mental health problem at some stage in life, yet research shows that attitudes to mental illness are just getting worse. And for many the stigma is harder to deal with than the illness itself.  Time to Change aims to improve public attitudes and get mental health problems out into the open.


Sue Baker, Director of Time to Change, said: “Both films have been designed to attract members of the public who don’t realize they are causing stigma and discrimination.  Evidence shows that provocative films make a big difference to attitudes and both films will go a long way to reducing the stigma associated with mental health problems.”


She continued: “One in four of us will have a mental health problem at some stage of our lives. It can happen to anyone. Stigma and discrimination wrecks lives. Yet everyone can make a change in their attitudes now – you don’t need to be an expert to make a difference to friend, family member or colleague who needs your support.”


Michael Pring, managing director, MCBD said: “This is a very brave campaign for the mental health world to run with but we’re confident that getting people to nod along with prejudice and then confronting them with the reality will prove an effective approach”.