UNIQUENESS OF NURSING - MENTAL HEALTH BRANCH
From the 16th Century mental health patients were contained in asylums until mental health hospitals were introduced during the 1950's. Sometimes people who were a disruptive or were only reacting in a normal way to difficulties in their lives were 'put away'. Often patients were excessively medicated and subject to treatment which would be totally unacceptable today such as 'muffling' or being put in a 'swing chair'. In the 1960's being inadequate and too costly resulted in mental health hospitals closing and care being moved to general hospitals. Patients who were allowed home at the weekends recovered more quickly and therefore care increasingly moved to the community (Hannigan and Coffey 2003). Today most people with mental health problems are cared for in the community (NHS 2010).
The 1959 and subsequent 1983 Mental Health Act, together with the updated Care Community Act (1990) form the basis of modern community mental health nursing. In 1999 the Government declared mental health as being one of its top three priorities in the Health Service (Jackson & Hill 2006). Since then numerous guidelines such as the Department of Health guidance (2003), the National Service Framework for Mental Health (1997) and the NHS Plan (2000) (cited in Jackson & Hill 2006) have been introduced to reform and improve services focusing on mental health promotion, primary care, access to effective services for patients, services for people with severe mental health problems, support for carers and action to reduce suicide. The Department of Health has also invested significantly in inpatient mental health settings as issues such as a reduction in the number of beds available, lack of privacy and dignity of patients and wards that did not support provision of self care have ultimately led to problems with staffing levels and morale (DOH 2009). As a result many new opportunities have been created for mental health nurses over the last few years, for example the modern matron and nurse consultant, and new skills have been developed, such as nurse prescribing and psychosocial interventions (Brimblecombe 2009).
Mental health nurses will with work with children and adults who suffer with various mental health problems. The primary role being to form therapeutic relationships with patients (sometimes called clients) and their families to help them recover from their illness and promote independent living (NHS 2010). Mental health nursing is varied and complex, for example treatment may include conventional nursing interventions such as administering drugs and injections or it may be to encourage patients to take part in art, drama or occupational therapy. In order to assess, plan, implement and care for people mental health nurses need to have good knowledge of the theories of mental health and illness, psychological and biophysical sciences and theories of personality and human behavior which will enable them to take a holistic and psychosocial approach with patients (Hannigan and Coffey 2003).
One in four people will suffer with a mental health illness at some point during their life and one in twelve will require medical intervention. Women are 1.5 times more likely to suffer with anxiety and depression whilst men are more likely to suffer from substance abuse and anti social personality disorders. For some patients a mental illness is triggered by a crisis in their life, which they can't cope with, such as depression following the death of a partner (NHS 2010).
Some of the more familiar mental health illnesses are anxiety, depression, schizophrenia, eating disorders, drug and alcohol addition, personality disorders and impulse control such as gambling. Some of these illnesses will require treatment in hospital but many will be treated in primary care settings, such as outpatient clinics, schools, community mental health centres, residential facilities, prisons and day treatment centres (Hannigan and Coffey 2003). Care is person-centered and is delivered by a multi-disciplinary team which will include mental health nurses, GP's, psychiatrists and social workers and other health care professionals.
A mental health nurse will require good interpersonal and communication skills. They will need to emphathise and care about people. There is still some stigma attached to people with mental health problems and it is important for a nurse to help the individual and their families deal with this (NHS 2010).
Dealing with the human mind and behavior is not an exact science and sometimes people with mental health problems can be violent, one skill that will be a nurse will be required to have is to recognise building tension and diffuse it when necessary (NHS 2010).
Sometimes nurses may find themselves faced with awkward situations, such as controversial issues which cannot be disclosed and where confidentiality needs to be maintained. On the other hand if someone is at risk of serious harm, have an infectious disease or criminal activity is involved they may have to inform the appropriate bodies (Hannigan and Coffey 2003).
Nurses may find themselves giving care or treatment which is against their beliefs, for example someone addicted to drugs may request a supply even though medically it is not in their best interest or an anorexic patient might protest when food when the nurse tries to care for them.
In practice, mental health nurses will come across difficult situations were an assessment of the capacity and ability of a person to consent will be required. People with mental health disorders have the same rights to consent or refuse treatment as those with physical illnesses unless some mental health issue means they are unable to make a decision and nurses need to support them to take responsibility for their own well-being and provide information that is accessible and understandable. This may mean working with the clients, advocates and carers to ensure it happens. Although giving certain treatments might be in the client's best interest it not enough to impose treatment without consent. In some circumstances a small number of people with mental health problems will be detained under the Mental Health Act (1983). (Hinchcliff, Norman & Schober 2003).
To conclude mental health care has developed considerably over the last few years. Mental health nursing is not an exact science but is varied and complex and is about building therapeutic relationships with people and understanding and reacting appropriately to individual circumstances and needs to promote recovery and maximise life potential.