The recent dept of Health document “No health without mental health”emphasises the need to prioritise preventative and early intervention services when responding to the mental health needs of young people.
Yet, I believe that people are unaware of the numbers of young people suffering with serious mental health problems. Mental health promotion for young people is vital, in my opinion; failure to intervene early enough contributes to a life of distress, barriers, and problems for too many young people. I am aware of many children struggling with the challenges of education, learning and growing up whilst also experiencing low mood, depression, self harm and suicidal thoughts.
More young people are being referred to CAMHS services. It is worrying that at least 1 in 4 young people are likely to be referred to CAMHS during their childhood or adolescence. Within the West Midlands CAMHS community and in-patient services for young people have been developed in response to this growing need.
As a CAMHS nurse and a senior lecturer at BCU I believe passionately that the comprehensive health care needs of young people and their families must be integral to our courses. We must ensure all pre-registration student nurses have opportunities to consider child and adolescent development issues, the importance of attachments and supportive relationships, risk and resilience factors which impact on health, the incidence and nature of mental health and related challenges, the structure, and how to access CAMHS.
Child and adolescent mental health is “everybody’s business” whether we are engaged directly or indirectly with children and their families. We have a timely opportunity to integrate this perspective within our student population: tomorrow’s registered nurses.
I hope we do not miss this opportunity.
We also offer a Learning beyond Registration CAMHS pathway as part of our BSc(Hons) Mental Health Studies programme for registered nurses, allied professionals, and other people interested in the health and wellbeing of young people. Please contact me if you are interested in hearing more about our learning beyond registration BSC(Hons) CAMHS pathway. We are currently planning the two double modules which will be offered during the 2011/12 academic year which is scheduled to commence in October this year.
(Perhaps the last time our Mental Health Nursing graduates will wear a uniform?)
This post looks at some of the issues around the wearing of uniforms in mental health nursing, as usual we would welcome any comments that you may have.
Currently, although most mental health nurses do not have to wear uniforms this is under review at our local trust – (Birmingham and Solihull Mental Health NHS Foundation Trust ). According to Deputy Director of Nursing Martin Herriott, the Trust are looking at re-introducing uniforms in some areas such as acute in-patient and older peoples services.
Feedback from both service users and carers indicate that staff are often very hard to identify, uniforms might make this less of a problem as well as making staff appear more professional? Of course, there are ongoing concerns around infection control in areas where staff are likely to be exposed to bodily fluids of any sort.
In some areas it is likely that the Trust will avoid uniforms, such as for example long term residential areas where service users are likely to live for any length of time in home like environments. Also, staff going outside of care areas with clients (for instance escorting people to hospital appointments etc) will need to cover up uniforms.
Obviously, this is a potentially controversial idea – although some people are in favour of wearing uniforms, others are likely to be less keen. I found a recent survey amongst patients in a US mental health unit (Miller,T. Mann, N. Grim, R 2010). This study set out to examine patients attitudes about what nurses wore and whether their attire made nurses appear more approachable, competent and professional. Whilst most did have any particular preference what staff wore there was a lot of concern that nurses were difficult to identify. Interestingly, whilst over half of the respondents felt that attire made no difference to approachability, 29% felt that ordinary clothes made nurses seem less approachable!
Another, earlier study conducted in London (Tham, S & Ford, T 1995) concluded that it was other staff who had difficulty identifying nurses whilst 36% of patients felt that uniforms made staff less approachable. For some reason, patients in ‘old age wards’ were excluded from this study – (old age = ‘assume that everyone has dementia?) a shame as this is a client group most likey to encounter nurses wearing uniforms. This aside, it was generally agreed that identification of some sort was really important.
Across at Mental Nurse blog there was a discussion about uniform – most contributors were opposed although there was a contribution from a service user who flagged up the issue of nurses being identifiable (although in fairness, uniform/ identification might not have been at the top of my list of priorities to sort out in this example).
We did a quick (and totally unscientific survey) with a BCU student group and asked them what they thought about this issue.
(thanks to Kate Hopley, Oliver O’Connell & Kimberley Zilke for filming and BCU pre reg MH group Dip HE 0409 for appearing in the film)
Miller, T. Mann, N. Grim, D (2010) Clothes Encounter: Patient Perception of Nursing Attire in a Behavioral Health Unit. Journal of the American Psychiatric Nurses Association. 16(3):178-183, May/June 2010
Tham, S & Ford, TJ (1995) Staff dress on acute psychiatric wards Journal of Mental Health 4, 297-299
Simpler days – a fresh faced Staff nurse sets out to change the world (back row 2nd from Left)
In my life, 1979 saw two important events, firstly it was the year in which I started my nurse training at Hollymoor Hospital in Northfield, Birmingham and secondly, Maggie Thatcher became Prime Minister.
In so many ways, life seemed simpler back then – for example, you knew where you stood with politics and politicians.
My early political understandings were informed by Clash lyrics, the NME and the Anti-Nazi League. Down the road from me, Red Robbo was stirring up the Car workers at Longbridge & UB40 were composing their first album ‘Signing off’. I remember a feeling of pride about working for the NHS.
In the opposing corner was.. Maggie
At least with Maggie you knew where you stood. The Tories were the party of privatisation, anti-Union and we all knew that given the chance they would have liked to run down the NHS. Of course, even Maggie didn’t manage to do away with the NHS, despite attempts to boost the influence of private medicine etc.
Nowadays of course, things are not nearly as clear.
David Cameron has previously stated that the Tories were wrong to weaken the NHS and has been keen to distance his party from it’s percieved anti NHS bias. If you really want more reassurance see Hector from Abingdon who had never voted for the Conservatives before but was doing so now to protect the NHS.
In common with everyone involved in the NHS we have been talking about the implications of the proposed NHS reforms. Amongst the proposals are plans to hand control of NHS budgets to GP consortia to spend on behalf of patients whilst cutting Primary Care Trusts and strategic health authorities. According to the DOH, the reforms will ‘Liberate’ the NHS leaving it ‘streamlined with fewer layers of bureacracy’.
Why am I so worried?
This is what I think is really going to happen:
Look out for an increase in Private involvement in the NHS (see Tag cloud reference to ‘consortia’ & ‘choice’)
Private companies have to prioritise the interests of their share holders therefore..
Foundation Trusts opting out of the NHS, local pay & conditions, reduced entitlement to leave, reduced redundancy payments, pensions etc
An increase in (profitable) patients recieving private medical care
A decrease in care for less profitable patients, i.e. long term conditions, people with mental health problems etc (see White paper “begin to introduce choice of treatment and provider in some mental health services from April 2011, and extend this wherever practicable”)
I could go on but like to keep posts short – feel free to add your own to the list though.
The RCN campaign ‘Frontline first’ is an attempt to defend patient care – one of the speakers in the launch says that ‘when nurses speak, people listen’
Despite a clear history of mental health problems in the period leading up to his arrrest and conviction for drug smuggling, British citizen Akmal Shaikh was executed in China this morning.
Anyone with any experience of working with people who have mental health problems will easily identify elements of mental illness in descriptions of Mr Shaikhs behaviour. It seems clear to me that there is a very obvious history of mental health problems and it is puzzling that the Chinese Government is still insisting that there is no such history.
People with problems such as those experienced by Mr Shaikh often do not have a firm grasp of reality and would be very vulnerable to manipulation by unscrupulous individuals. The likely influence of such factors appears to have been completely ignored by the authorities in China.
I hope that mental health nurses worldwide will join me in condemnation of this dreadful action – please take a moment to click on the links below.
This is the second guest post from Kate Hopley (first post here) who recently commenced a course here at BCU. Kate has also started a BCU mental health nurse student area on Facebook
I am now more than half way through my first placement, and I have had many new experiences since writing my last entry. I have been involved in all of the day to day nursing duties: meds round; ward round; helping residents to wash and dress; assisting residents with eating meals; completing all the relevant paperwork and, most enjoyably, getting to know each of the residents by spending time with them.
A difficult time
I had a difficult couple of days a week or so ago, in the midst of several deaths. Over the week following the deaths I noticed how stories of those who had died were told over and over again in the staff room, alongside stories of other deaths which had been experienced. I reflected that the communal processing of grief was important for nurses, because fitting our experiences together and telling and re-telling them led to an acceptance of death and to moving on. We knew that we had done our very best to care for our patients during their stay at the unit, and in the end I felt honoured to have cared for them at the end of their lives, and no longer sad.
Another subject which struck me forcefully over the past weeks is the need for nurses to act as advocates for people suffering with dementia, and especially for those who are in the stages of the disease where they may have lost the ability to communicate verbally. Most of the residents at my placement are not able to choose from a menu prepared to their liking – they rely upon the nursing staff to make informed choices on their behalf to ensure that they eat a varied and balanced diet. Many of the residents cannot walk about unaided, and so cannot choose whether to sit in a sunny window or right next to the television or who to sit by. Nursing staff must consider what they know of the person’s history alongside non-verbal clues as to what mood or preferences are being expressed on that day, and then make an informed choice.
A good environment?
I have also spent some time reflecting on the physical and sensory state of the healthcare environment for those who are inpatients with dementia. If the rooms are moved around every day this may be confusing for the person with dementia; if different and unfamiliar staff help residents to wash each morning this may be confusing and frightening; if someone starts to offer food on a spoon without first explaining what they are going to do this could be frightening. If music is played or interesting sensory objects are available and nursing staff spend time talking to or sitting with the residents, then this creates a space for the residents to engage with the world around them and to express themselves. I have spent a lot of time getting to know the residents better, and over time I have learned to understand what they are saying to me better, and finding that it is indeed possible to have a conversation, one side of which consists solely of an array of meaningful facial expressions and gestures.
I am absolutely loving my placement and I will be really sad to leave. Every day something happens that puts smile on my face, and every interactive response from a resident, be it a belly laugh or simply the raising of an eyebrow, makes placement feel nothing like a job at all, and everything like a satisfying vocation.
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 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.
This blog has taken a bit of a break over the last few weeks & I am pleased to say that we are back in business & looking forward to continuing where we left off.
I am delighted to start us off with a guest post from Kate Hopley who has recently begun her mental nurse training at BCU. Kate has also started a Facebook group for BCU students & wanted to let you know about this as well.
Don’t forget – we are always very keen to publish contributions from anyone who has something to say about mental health – from any perspective, see the ‘about us’ page.
I started this course in April to learn about and get involved in mental health, to pursue my own interest, and to get job satisfaction by doing something useful in society. These sound like laudable aims I am sure, but I honestly had absolutely no idea what to expect from going back into education approaching 30. I was not entirely confident that walking away from a secure (paper-pushing) career path after 8 years was the ‘sensible’ thing to do, although it certainly felt right…
So I am now almost 4 months into the course and about to start my first placement. I have enjoyed my first few months of university, especially the biology lectures since I used to like that subject at school, although I have found it strange to get back into the whole routine of study after such a gap. I have rediscovered the joy of reading text books and doing homework in bed, but I have also felt a strange unease about not being at work since that is what I am used to doing… I have a lot less cash than I had before, so we’ve adjusted the weekly shop and are eating like students and drinking endless cups of tea instead of wine. Which is good for the liver, I suppose.
I am excited about starting placement as it will be satisfying to get into a hands-on work-based routine again. I went with a fellow student to visit our placement earlier this week and we were both really enthused and impressed by the progressive approaches we were introduced to, and the whole ethos of person-centred older adult care.
Last time I worked in a nursing home (12 years ago) I can remember heated debates at handover between the night shift and the day shift about how many residents had been got up for breakfast. The idea had been to ensure that the routine of getting up, washed, having breakfast, lunch, afternoon tea, dinner and going to bed ran to the schedule which was most convenient for the nursing staff. My visit to placement showed me just how much things have changed.
Nowadays the emphasis is on the needs of the individual resident: if Doris doesn’t normally get up until 11, and prefers a shower rather than a bath, then she should be supported to continue her personal daily routine. For a patient with dementia or Alzheimer’s, any sort of change of routine or environment can be unsettling and can cause confusion, so person-centred care is important for rehabilitation.
We were introduced to the local policies of the placement, and how they are founded in research. We were given an idea of how the placement planned to develop further, and were talked through examples of the change process in action. This helped me to see links to our university Personal and Professional Development module and to our placement documents – linking practice to evidence.
I am sure I will learn a lot on placement – I only hope I can remember what we did at university by the time we come back in October!
This is another guest post from Julie Cresswell, one of our ex BCU mental health nursing students who is now a qualified staff nurse. (This is Julie’s second guest post – see her earlier post here)
Following a comment from a member of staff regarding the lack of reading material on our acute ward, I decided to raise funds by running the Birmingham half marathon in 2008. We raised around £200 in sponsorship and also held a ‘Reading for Recovery’ party where friends were asked to ‘bring a book’ to donate to the ward. 100 books of all genres from classic novels to biographies were donated. I also approached celebrities who have some connection to mental health awareness and received around a dozen donations.
A local blind gentleman who heard about the initiative donated a large amount of talking books for client’s who had difficulties reading or concentrating on the written word. We were also able to purchase books to be used with clients to encourage them to share their experience of mental illness and material to further staff’s personal development and broaden their knowledge of areas such as substance abuse, managing diabetes and cognitive behavioural therapy.
We now have an in-patient Reading Group. The aim of this group is to hold regular sessions where the written word (sometimes short stories, sometimes poetry) provides service users with the opportunity to read aloud, listen to others, interpret themes and more often than not, participate in lively debate! I have found that the groups can be cathartic for some clients, tears are not uncommon and can reignite an interest in reading or the discovery of their own talents in story-telling or creative writing.
Clients often make special requests for further sessions to explore a particular poet/poem or writer. I have also learnt so much in researching such information and the lively debate that it often invokes..…one that comes to mind is the theory that Shakespeare’s sonnets were focussed around a man, rather than a woman. This session raised issues of sexuality, religion and how words can be interpreted at one point in history and reinterpreted in today’s world. A contemporary story by Michael Faber about a ‘safe haven’ where the people that stayed there had their life histories printed on their shirts, prompted a lively debate about stereotyping. The most popular books that client’s read away from the group are autobiographies and special interest books such as militaria or sport.
Research tells us that service users are not satisfied with the level of interaction with staff on acute wards. In addition, boredom is often cited as a primary concern. Our Reading group tackles both issues. The Group has read texts as diverse as Chekov, Rudyard Kipling, Wordsworth to Benjamin Zephaniah. My hope is that the service users who enjoy the group benefit in some way, whether they are empowered by the words they read, distracted for a short time from their difficulties, comforted or indeed grow in their confidence when mixing with others.
The Mental Health Foundation has this month published the results of a survey which suggests the ban on smoking in inpatient units has been highly problematic, and has lead to ‘secret smoking’.You can read the full report here on the Mental Health Foundation website.
I began working as a CPN when the ban was introduced – and, certainly initially, I felt very sorry for the colleagues I had left on the PICU of a Regional Secure unit who had to tell patients with very limited access to outside that they were forbidden to smoke.I am not a smoker, however I can imagine that if I smoked and found myself in very distressing circumstances, and in an unfamiliar environment, I would find smoking a source of comfort and reassurance.
The Mental Health Foundation report suggests that attempts to ban smoking are simply driving the habit underground.They found that only a minority of wards in England have introduced the ban successfully. 85% of 109 respondents to the survey said the ban, which came into effect in July 2008, had not been implemented effectively.The rise of “secret smoking” has lead to safety concerns:the risk of fire, and also the risk that patients who are very unwell may become aggressive to staff when told they may not smoke.
Members of staff are reportedly unhappy to take on an additional policing role, when they are already faced with the problems of holding people against their will and persuading them to take medication.Some staff members said they felt they had no choice but to break the law and ‘turn a blind eye’ to smoking, especially when patients were acutely unwell, and in units which lack an appropriate outdoor space to allow people to smoke.The ban was also felt to be a drain on resources as staff members were needed to escort patients off the unit to smoke.
There are questions that need to be asked about the effect the ban has had on the wellbeing of patients.Whilst it may be the case that a smoke-free environment is a healthier one in terms of the physical effects of smoke, Vicki Nash, of the mental health charity Mind, said: “Forcing people to stop smoking abruptly on admission to hospital when they are already likely to be distressed is inappropriate and could heighten anxiety”.According to Mind, people with mental health problems are twice as likely to smoke as the general population – which means that this ban is very difficult for a high proportion of patients.
Despite all of this the government’s mental health tsar said he had visited many trusts where a ban had been smoothly implemented.Louis Appleby, the National Director for Mental Health, said other research had shown that although implementing the smoking ban had posed challenges, most trusts believed it had been done successfully. Professor Appleby said: “I have visited many trusts who have implemented the ban with little or no difficulty. Mental health wards are being transformed for the better and going smoke-free is part of this. We believe that mental health staff and patients deserve the same healthier, smoke free environment as the rest of the NHS and there are no plans to change the policy.”
Hospital or Prison?
Prison inmates are allowed to smoke in their cells, as prison is classed as a ‘home’.Does it seems odd that there is greater freedom in prison that in a mental health setting?May be not!Prison inmates also have the right to refuse medication.
On July 28th 2008 there was a nine hour rooftop protest at Ashworth Hospital in response to the smoking ban.The Liverpool Echo reported that an Ashworth source said: “It just went cold turkey on July 1. After that it was no smoking for anyone anywhere on the premises.We’ve got lags coming in who are used to prison life and have that prison mentality, and now they have lighters and cigarettes confiscated when they come through these doors. They don’t like it and you could see trouble had been brewing because they didn’t take kindly to it. We’ve been waiting for something like this to happen.”
I’m not sure I would take kindly to the smoking ban either if I had been admitted to hospital from my own home.Even if I wanted to give up smoking I am not sure that the day of my admission to a psychiatric hospital would be the best time!
What do you think?
Pictures from Flickr (click images to see more from these photographers)
This post is from Samantha Chapman, who has just started work as a Mental Health Nurse Lecturer at BCU. We are delighted to welcome her to BCU & hope that you will give her a warm welcome too!
Having spent the last 6 years working with people who experience severe and enduring mental health needs I am now into my third week as a mental health nurse lecturer at Birmingham City University.Frequently having to pull myself down from cloud nine, I shake my own shoulders and remind myself ‘this is the honeymoon period’.Soon I will be committed to my own workload and responsibilities.The transition from nursing in an Assertive Outreach Team to nurse lecturer so far has been very different but enjoyable.I loved nursing; in fact it’s the longest I have ever stayed in the same job.I loved the variety, the experience, the presentation of symptoms, patient’s strengths and advocating, caring and the ongoing learning process as I became more experienced.People I worked with predicted the world of lecturing for me before I chose the path myself.In response I would tell them I’m not ready to leave clinical practice, equally I loved presenting and sharing information to teams, staff, patients and students within my nurse role.
Now I have entered a world where the language and terms used are strange and new.Three weeks into the job I have met withMoodle, Eyelit, Talislist and Uceel, tools I am to become familiar with as they become part of my daily teaching.There is plenty to keep any lecturer busy, with moderation, invigilation, interviews, marking, quality meetings, boards of study and Rolex.There are students to visit on placement, tutorial meetings and personal students to support.There are pathways to co-ordinate, modules to run and classes to teach.In addition, lecturers will want to commit some of their time and interests in research, publication of work, design and creation of new teaching systems.For me, effective time and diary management is essential if I want to contribute fully to my role.
Considering the amount of work expected of the lecturer is it also important to allow time for ongoing involvement in clinical practice.How much time can I realistically commit?Is clinical practice the only way to stay fresh and ahead with clinical issues and skills?Is it essential and do students notice a difference to the quality of their learning experience? Having recently come from clinical practice, I am more concerned with the long term effects if clinical experience is not maintained.Is there cause for concern?
With all that I have highlighted, the University is a buzzing place to work, this week there were delicious homemade cakes, strawberries and cream and fruit punch to tempt us all and raise money for charity, the lemon slice with homemade lemon curd was particularly tasty! When the sun is shining the grounds are perfect for a sunny lunch break.