Analysis

Nurses and service users voice their concerns over mental health services

Mental health nurses are concerned about decreasing opportunities for long-term supportive relationships with patients, a major workforce review has found.

Mental health nurses are concerned about decreasing opportunities for long-term supportive relationships with patients, a major workforce review has found.

Access to continuing professional development and clinical supervision are also insufficient, according to the Foundation of Nursing Studies (FoNS) review of mental health nursing in the UK.

Concerns of care

The study, which used social media, round table events and conferences to gather the views of approximately 600 nurses and service users, found concerns about the care nurses were able to provide.

Our work has confirmed that people who use mental healthcare services greatly value the sustained contact nurses offer, the report, Playing our Part, says.

However, the rush to provide session-based psychological intervention services has placed this subtle but valued relationship

...

Mental health nurses are concerned about decreasing opportunities for long-term supportive relationships with patients, a major workforce review has found.


Concerns have been raised over the care that nurses are able to provide in mental healthcare
Picture: John Houlihan

Access to continuing professional development and clinical supervision are also insufficient, according to the Foundation of Nursing Studies (FoNS) review of mental health nursing in the UK.

Concerns of care

The study, which used social media, round table events and conferences to gather the views of approximately 600 nurses and service users, found concerns about the care nurses were able to provide.

‘Our work has confirmed that people who use mental healthcare services greatly value the sustained contact nurses offer,’ the report, Playing our Part, says.

‘However, the rush to provide session-based psychological intervention services has placed this subtle but valued relationship under threat.’

38,000 

registered mental health nurses in the UK

Unreported

Work by nurses in medicine management and case management often goes unreported or underappreciated, the report says.

But support from service users in the work carried out by mental health nurses remains high, according to FoNS chair, Tony Butterworth and FoNS chief executive, Theresa Shaw.

Fears about frontline services were raised repeatedly, despite not being the focus of the study. ‘Debate and arguments on funding and poor service provision featured constantly during the course of the work’ the report says.

There were no doubts from those who were consulted in the preparation of the report that mental health nursing should retain its own pre-registration course and separate professional identity.

The Nursing and Midwifery Council is consulting on nursing competencies and standards and there are concerns this could lead to a single generic nurse registration, meaning mental health nurses could lose their specialist identity.

'Not on the cards'

However, commenting on the report, RCN chief executive Janet Davies dismissed concerns that mental health nursing could be absorbed into a generic nursing degree, saying: ‘I don’t think that is going to happen. I don’t think it is on the cards.’

She welcomed the report’s recommendation for a countrywide core curriculum for mental health nursing degrees and said the RCN was looking at how this should be shaped.

She added that the role of a mental health nurse was complex and that there was a need to examine ‘how we enable adult care nurses to have some mental health skills to work better with adults who have multiple needs’. ‘People often don’t just have either physical or mental health issues,’ she added.

10%

decline in mental health nurses over the past five years

The FoNS report calls for all nurses, regardless of specialty, to be able to carry out physical and mental health assessments to provide good care.

Professor Butterworth says that a number of non-mental health nurses are doing mental health first aid courses, to help give them basic assessment skills. ‘They give basic confidence to be familiar with a mental health assessment, which is commendable,’ he says.

Refresher

While the review found no support for a move to generic nursing registration, it did find that the curriculum of mental health courses should be refreshed to be made more evidence-based. Too many courses are currently based on the preference of the teaching staff.

600

The number of healthcare professionals and service users involved in the review

‘Conversations with students and educators suggest experiences vary widely between universities,’ the report states. ‘This cannot be right and we would urge the creation of a standing conference of mental health nurse educators, so an agreed curriculum spine can be established.’

Nurses involved with the review said they would like to be better equipped with skills to work with children and young people and with carrying out routine assessments of sexual violence and abuse.

Providing rotational contracts to newly graduated nurses to help them gain experience in different areas; more education on children and young people on university courses; and offering nursing staff the chance to work briefly in other areas to gain expertise, could all help in this area.

Key messages
  • There is strong support for the work of mental health nurses from service users.
  • Nurses are concerned about diminishing opportunities to sustain long-term supportive relationships with vulnerable people.
  • The mental health pre-registration programme should not be ended.
  • All nurses need physical and mental health assessment skills.
  • Improved clinical supervision is needed to support staff well-being, the safety of people who use services and professional development.
  • Establish a UK college or alliance of mental health nurses.

 

Monitoring attendance

The report says applications to mental health nursing courses should be carefully monitored to check if numbers are declining. There is a shortage of mental health nurses and figures from the NHS’s Health and Social Care Information Centre in January, suggested that the numbers working in the specialty has fallen by more than 10% over the past five years. The impact of the removal of the student bursary on numbers entering the workforce also needs to be carefully monitored.

People who use mental health services greatly value the sustained contact nurses offer

Playing our Part report

Improved clinical supervision is needed to support staff well-being and professional development, as well as the safety of people who use services, Professor Butterworth and Dr Shaw say.

Step guidlines

The report sets out six steps to support the mental health nursing workforce, including starting a college or alliance focused on mental health nursing, and developing clinical academic careers.

Professor Butterworth urged nurses to speak up for their specialty.

‘The report gives some next steps to take and there are good, clever people in mental health. As a largely graduate profession mental health nurses have responsibilities – play your part more actively or else others will play it for you.’

Read the report here

Future shape of the workforce

Too few nurses are working in primary care despite the long-standing focus on prevention and early intervention in mental health policy, the review found.

Currently the majority of the workforce is based in secondary care, followed by tertiary care.

Putting more mental health expertise in primary care, the community and schools could help prevent and reduce problems, such as the increasing risk of suicide and self-harm among children.

In January, prime minister Theresa May announced a renewed focus on mental health, particularly on preventive services in the community. She pledged better access between teachers and NHS specialist staff, but critics said more funding was needed to support such a change.

The Playing our Part report says moving more staff to primary care will be difficult.

‘This will prove challenging; workforce shortages are already critical across the UK as employers struggle to appoint experienced nurses,’ the report says. ‘We are uncertain on how this shift might be achieved, but its importance is clear enough.’

A strategic examination of the employment of mental health nurses in primary care, secondary care and tertiary care is needed, according to the report.

The success of dementia specialist Admiral Nurses at working across sector boundaries is highlighted. Admiral Nurses, who can be mental health nurses, generally work for the NHS in communities, helping people with dementia to stay at home for longer.

 


Erin Dean is a freelance health writer

Additional reporting by Matthew McKew

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