RCN mental health forum campaigns for adequate therapeutic time
The RCN's mental health forum, the college's largest, is intending to fight to get the profession the time it needs to provide therapeutic care
Mental health forum members got together at RCN Congress for a round table discussion about the state of mental health nursing
At RCN congress in Belfast in May members of the college’s mental health forum had an impromptu meeting to discuss the state of the profession.
They talked about how much they enjoyed their work, the challenges they face in a system that is creaking around the edges, and how the forum is working to improve the system for nurses and their clients.
Chair of the forum Ed Freshwater talked about mental health nursing and the power of listening
‘In my job I do talking therapies with mothers in the mother and baby unit, and the thing I love most and that inspires me every day is the effect that just listening to somebody describe their experience has on their mental health.
'The number one thing that I hear in my groups and one-to-one sessions is another mum saying: "thank god, I thought I was the only one". The power of that shared experience and knowing that they are heard and not judged is the most wonderful thing.'
Roisin McCartney, who is a memory service nurse, talked about the privilege of being a nurse in a community dementia service
‘I have the honour of looking after people at the end of their lives who have the challenging condition that dementia is.
'I work a lot with carers and offer them support, knowing that you are the only person that they can listen to. Dementia is a horrible illness and it’s very challenging, but very rewarding.’
Jeremy Davies, a forum member who is also an RCN steward, was blunt in his assessment of working on the front line
‘It is hell. I’m a staff nurse on an older person’s acute ward. We are in a situation where we never have enough beds. On an over-65s acute admission ward we have had people as young as 19.
'We deal with alcoholics, substances misusers and people with learning disabilities. We deal with the physically unwell who are waiting for mental health assessment, because they have presented with what are thought to be psychiatric symptoms, but which are actually masking a physical illness.’
Mr Davies said that the expected six-week admission and assessment turnover period has become meaningless because one patient has been on the ward for two years because a lack of alternative placements.
‘Delayed transfers are such a massive issue. When I used the term "hell" it was appropriate. We are working under incredible pressures trying to achieve basic healthcare and are hampered by trying to find out where these people are going to go and deal with the people who shouldn’t be there. Much as we love looking after them, there is nowhere else for them to go.’
Clair Carson, who is an associate director of operations, said being a nurse is important to her ability to do her job
'Although I now work at director level, and I don’t have a role delivering care, I do have a role to ensure we are delivering care in our services. I never forget what it’s like to be a nurse on the front line and always remember that if we need to implement a policy it will have an effect on patients.'
While all the forum members were keen to talk about the positives of their roles, it is obvious that the reality of front-line nursing weighs heavily on their minds. We know that mental health services are under great strain, with reduced numbers of registered nurses, pressure on beds and high levels of acuity among the patient group, especially those in hospital.
Laura Ecob, a clinical nurse specialist, said the impact of staffing cuts has been destructive
‘The cuts to the service have been absolutely astronomical and the impact it’s had on patient care is unbelievable, and we have another round of cuts to come. But it’s short sighted – our substance misuse patient group are quite chaotic with a multitude of physical and mental health problems alongside their substance misuse.
'They will be the patients who are rocking up in casualty, taking up beds, unable to move on, the patients with growing complexities that we struggle to look after with reduced resources.’
How does a 12,000 member forum influence the situation?
Talking to these nurses it is clear that they love the jobs they do and are passionate about doing them to the best of their ability. But most are finding themselves in a very difficult situation.
How does the forum, the RCN’s largest with nearly 12,000 members, influence the situation?
One step it has taken was to shape the RCN’s work over the next 12 months via its RCN Congress resolution on therapeutic staffing , making the point that ‘safe’ or ‘minimum’ staffing is not acceptable in mental healthcare settings.
Ed Freshwater said: ‘Mental health nursing is not about containment. Our skills give us the ability to treat people and not just moderate symptoms. So being able to do our job is what that resolution was about. But to get to that point we have consulted with our members.
'We got hundreds of responses and obtained a good idea of what issues were preventing them from doing their jobs.
'Staffing numbers was definitely the most pressing issue for our members, with people saying they did not have enough staff to actually do anything: they could dish out the meds, and they could cover breaks and get the paperwork done, and that was it.’
Jeremy Davies said the situation in Wales ought to be better than elsewhere in the UK because Wales has a safe staffing levels bill
‘Mental health is one of the next areas they are going to be looking at. The people working at the Welsh Assembly are having an ongoing battle now because they are looking to establish a safe staffing level for a mental health ward: but as Ed Freshwater said, there’s a difference between what’s safe to keep a ward running – to hit the targets, to tick the boxes, to do the paperwork – and providing therapeutic care.’
Forum member Angela Howarth
‘Without the therapeutic time that you need to support people through their journey through our services, we are lost, we’re not even off the starting blocks.’
Forum member Ellie Gordon works at Health Education England. She said being in the forum enables her to keep in touch with what’s going on in practice
‘I could get stuck in this ivory tower of “we’ve got the Five Year Forward View, and all this money and isn’t it fantastic? And we train all these lovely people”. But it’s great to hear from my colleagues that in the “real world” this is what you are looking at, and this is reality.
‘And it’s helpful for me to be able to take that back to Health Education England and say we are doing great stuff, but we have to remember what we are actually doing is trying to build up a workforce that has been decimated over the years and not been well supported and not been well skilled, and we are starting from a low level.’
Mr Davies highlighted the comparison between nursing now and when he trained in the 1980s
‘We’ve had steps forward in the care that we are supposed to give. But actually, back in the 1980s, that’s when we had the time. We’ve got all these amazing interventions, but no time and no staff to provide them.’
Forum member Becky Hoskins works on Mental Health Act compliance at an acute trust
‘A lot of my role is about compliance with the Act and educating general health staff about mental health awareness. Part of that and my work on the forum is to break down the stigma that mental health faces, to challenge it. The work of the forum is important to that and how we are using social media platforms to widen the debate and get the message out to people who specifically don’t work with people with mental health problems.’
Forum member Deanne Turner said the main issues for her are not just safe staffng levels, but skill mix
‘We are supposed to have six members of staff on a shift. We rarely have six, usually five, sometimes four. I know of at least one shift where the only permanent staff member was a nursing assistant – all the rest were all bank staff. This causes problems from just not knowing the patients, to staff going into their rooms when the patients hate it, and it causes an incident – it’s dangerous for staff and patients.’
RCN mental health lead Catherine Gamble is proud of the work the forum is doing, especially on parity of esteem, therapeutic staffing levels and suicide and she is keen to get more nurses involved
‘I want to increase the diversity of who is represented in the forum. We are fortunate in that everybody on the committee is passionate about mental health nursing. But I am aware that we don’t have diversity on the forum and committee. We are actively going out to members – there are too many issues with black and minority ethnic communities that are not getting discussed, and I want to change that.’
Forum member Tim Coupland is a consultant working across a number of trusts. He said equality is the central issue for forum members
‘All of the things we have spoken about today represent inequality: inequality of staffing, inequality in the resources necessary to drive safe and therapeutic responses to people in mental health distress, inequality in black and Asian minority ethnic communities around how they are treated and responded to.
'Staff on the ground will tell you that they do not have the resources they need to do the job that they trained for. What they end up doing is containing and holding and managing resources.
'I don’t care what anybody says, the resources which we are told are coming from the top, from commissioners to the shop floor, are not getting to where they are needed – it is not the same as the resources that are going to acute care and other fields. That’s what we are standing up for now, and that’s what we are passionate about.’
Prison nurse Gillian Burgoyne said much of what goes on in prisons mirrors what happened under the old asylum system of the past century
‘I work in a male prison and I’ve been nursing a long time. Often there are parallels in prison with the old asylum approach. The men I work with don’t feel valued, they don’t know kindness. The most important thing I do on a daily basis is to open the filing cabinet that has a secret store of KitKats. That develops a relationship and dialogue with people, and it’s important because of the draconian system the inmates are in.’
Catherine Gamble said the forum helps to point out the uniqueness of mental health nursing and ensures that its voice is heard. But she said it is also important to admit that nursing takes its toll
‘Nursing is dangerous and that’s a really powerful message: I don’t want to put mental health nurses off, but to acknowledge the fact that our levels of resilience are only achieved if we work together, as we have done in the forum and here at congress.’