Mental health nursing: RCN lead Catherine Gamble on why she feels optimistic

Ms Gamble says there is so much potential in the profession that her optimism is well placed

Ms Gamble says there is so much potential in the profession that her optimism is well placed

Catherine Gamble says mental health nurses have an ‘image issue’. Picture: Barney Newman

Six months into her job as the RCN’s mental health professional lead, Catherine Gamble is optimistic. 

It is true that mental health nurses have been working under difficult conditions for years, with squeezes on budgets and workforce shortages that have taken their toll. But Ms Gamble says there is so much potential among the mental health nursing workforce that her optimism is well placed.

‘When I was interviewed for this job the first thing I said was that I want to raise the profile of mental health nursing.

‘We are at a point where we are very much the underdogs – unseen and unrecognised. No one buys flowers or chocolates for mental health nurses. We have an image issue. We have a lack of profile and we do need to consider what the next steps are.’

Hone and promote identity

She says the profession needs to hone and promote its identity and that the RCN has an important role to play to ensure that happens over the coming months and years. 

Ms Gamble works three days a week at the college and two days at South West London and St George’s Mental Health NHS Trust, where she is head of practice education and research. She has a long career in nurse education and as a nurse consultant and she says she appreciates the importance of networking and sharing best practice.

‘I’m mindful that there is so much to do that I won’t be able to do it alone’

A major concern she is keen to work on is parity between physical and mental healthcare, given the generally poor physical health of people with mental health problems.

‘The RCN is about to launch the parity of esteem programme because this inequality is all-prevailing. It’s everywhere, even to the extent that it is difficult to get decent healthcare in an acute hospital when you are seriously mentally ill,’ she says.

‘Mental health problems affect every part of a person’s experience: if you have a mental health problem you will be disadvantaged at every level, at every point, and patients die 15 to 20 years too young. 

‘We know people’s physical health problems are significantly altered and we know people die younger. Even if they manage to get a diagnosis of cancer, for example, people with mental health problems will die more rapidly than people who don’t have mental health problems and no one knows why.’

She hopes the RCN’s parity project will finally begin to make inroads into the inequalities that people with mental health problems face.

Thorn programme

Ms Gamble was involved at the RCN in running the pioneering Thorn programme in the 1990s. It was a scheme designed to create a group of specialised mental health nurses with the skills to be able to support people with schizophrenia, in that same way that Macmillan nurses support people with cancer.

‘It was great to ask people who I had nursed to help me run the curriculum’

It was an early example of having people with lived experience of mental health problems helping to run education courses.

Ms Gamble says: ‘Mental health was the first real area where we took this on.

‘Help from people from the Hearing Voices Network helped to change our perception of recovery in schizophrenia and that’s what that course did: it challenged nurses’ skills and competences into how to work with people who had previously been seen as people who we were not able to help.

‘It was great to ask people who I had nursed and gone through some extreme inpatient experiences to help me run the curriculum.

‘It felt empowering to be able to run that course at the RCN in that beautiful building. I think it helped to raise the perception of mental health nursing because we were there demonstrating some different styles of education and inclusion.’

RCN Congress in May

Ms Gamble is looking forward to the RCN congress in Belfast in May in her new role as a member of staff. In the past she has attended the annual event as a delegate and expects the experience to be different. But high on her agenda is meeting mental health nurses and hearing their stories.

‘I expect to find a great deal of energy – and a great deal of exhaustion. I’m hoping congress will discuss workforce again. 

‘We know that people do feel demoralised and – I can’t put it any other way – they feel unloved. 

'I am concerned that people hear the dark stories and nothing about some of the super work being done'

‘I’m also mindful that there is so much to do that I won’t be able to do it alone. I’m going to need people around me, so I’m delighted we have Ed Freshwater, chair of the RCN mental health forum. 

‘There are five vacancies coming up in the forum this year and I’m keen to get some diversity into the committee, to get that energy and some younger people.’ 

She has also set up an expert advisory group with nurses representing every element of mental health nursing from the four countries of the UK. She hopes it will become the place where people go whenever mental health nursing needs to be discussed. 

Changing role

Ms Gamble says the role of mental health nurses is changing and that there will be new opportunities, for example as a result of the review of the Mental Health Act (1983). 

‘Nurses have different conversations with patients than consultants do, and that’s exciting,’ she says.

‘There are new opportunities to do with places of safety and the way we are working with our acute colleagues: they are recognising the value of having experienced mental health nurses on site.

‘The five-year forward view provides fantastic opportunities to look at where mental health nurses could be most helpful. We know there’s been next to no change in the way that people from black, Asian and minority ethnic (BME) communities have experienced mental health services. There’s an opportunity for our BME communities to influence how we support people and understand their recovery systems in a better way.’

Positive stories

Ms Gamble says she is troubled about negative stories concerning mental healthcare. ‘I am concerned that people hear the dark stories and nothing about some of the super work being done by mental health nurses,’ she says.

‘If something terrible happens we hear about it every single day, but we don’t hear the success stories. People are doing a fantastic job 99.5% of the time.’

And she thinks mental health nurses contribute to patient care in a unique way. 

‘We are constantly curious and we know that curiosity is a fundamental element of what it is to be a good mental health nurse’

She says: ‘It is well known that nurses are easy to spot in multidisciplinary teams. It is an intangible thing, but there’s something about nurses: they get their hands dirty; they’ll do anything that’s necessary; they’ll step forward; they’ll step up. 

‘A good mental health nurse is a clear thinker’

‘Nursing is the pragmatic framework that we use. It is a bit of genius. There is something that stands out – a good mental health nurse is a clear thinker who is extremely good at juggling tasks, who can see the wood for the trees and is able to understand and use research to help.

‘They see the person in front of them as a piece of enquiry and use their knowledge in a therapeutic way. We are constantly curious and we know that curiosity is a fundamental element of what it is to be a good mental health nurse.’

‘When we set up the Thorn initiative we were accused of being elitist, but Dr Jim Birley, the psychiatrist who helped to set it up, said there was nothing wrong with being elite as long as you are still able to get your hands dirty. That’s the essence of good mental health nurses.’

She adds: ‘I am much more optimistic than I was a few years ago and much more positive than I have been.

‘I feel there are a lot more people wanting to do something about what’s happening for mental health nursing and mental health, and we have an opportunity to put together the little army of people we need to put things right.’ 

Read more

This article is for subscribers only