What will the future hold for mental health nursing?


What will the future hold for mental health nursing?

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It is ten years since the last government review of mental health nursing. Much has changed in the past decade in terms of health policy in the devolved countries and, in the age of austerity, the increased demand on the NHS.

Tony Butterworth, Royal College of Nursing (RCN) fellow, is undertaking a ‘reflective consultation process’, looking at the future of the graduate mental health nursing profession for the Foundation of Nursing Studies (FoNS). The intention is to reveal the current contribution of nurse graduates, and what it should be in the future.

So far he has held six Twitter chats with the expertise of FoNS and @WeMHNurses, and seven ‘round table’ focus group events to delve into the heart of the profession to discover how nurses can contribute to seamless professional care across all services.

‘Nurses’ behalf’

In early 2017 the FoNS will publish a consultation report that Professor Butterworth wants nurses and other healthcare professionals to scrutinise and critique before a final report is published, hopefully before the end of January.

The expectation is that it will include a handful of recommendations for the profession to take forward.

‘I was asked by several people in very senior positions how we might raise the profile of graduate mental health nurses.

‘Given that so many things are happening in mental health, with at least seven policies bearing down on the profession, who is going to say something on nurses’ behalf?’, asks Professor Butterworth. 

‘They asked me because I am now outside of the system, and as chair of FoNS, I can speak without fear or favour.’

Not universally welcomed

Despite his illustrious career and the enormous contribution he has made to the profession, Professor Butterworth’s involvement in this review was not universally welcomed.

‘At the beginning I had one or two phone calls from senior people who were saying: “Who do you think you are?” I said we know exactly who we are.

‘It is important that we articulate who graduate mental health nurses are ~ an expensive workforce educated in universities ~ and what is it they are doing that will be different from other parts of the workforce.’

Professor Butterworth used a report based on his Twitter chats to inform the round table events. He asked nurses to present their views on the main themes, what they think they should be doing differently, and whether there are new things that mental health nurses should focus on in the future.

‘On the front foot’

He is adamant that the report will not have dozens of recommendations. Instead it will put forward several things to put mental health nursing ‘on the front foot’. Unsurprisingly, given the government’s assumed intent to push forward with a more generic pre-registration curriculum for all nurses, one of the focuses will be on education.

‘How do you turn someone into a mental health nurse? The universities that provide undergraduate mental health nursing programmes are all different, and so are the courses. They all have to meet certain Nursing and Midwifery Council requirements, but outside of that, there is no commonality.

‘We have to think about how we can develop an evidence-based curriculum. Our view is there should be a standing conference of mental health nurse educators to provide an expert view of what the curriculum should be.

‘We want all the students to come out of their courses with a common understanding of the role.’

Another question that kept coming up in the Twitter chats and focus groups was the matter of who loves mental health nurses.

Caring for the professionals

Emerging themes from Twitter chats
  • Education and training
  • Employment, staffing and capacity to improve
  • Therapeutic environments and care systems
  • Care systems and the contribution of mental health nursing
  • Mental health nursing identity
  • The role of mental health nurses
  • Motivations for change
  • Person-centred mental health nursing

‘The sense is that no one does, really,’says Professor Butterworth.

‘I have spoken to Janet Davies at the RCN and asked: “You have 35,000 mental health nurses ~ how are you going to look after them more?” And to her great credit, I am going to be meeting with her and her colleagues to discuss that. That to me that is very encouraging.

‘Some people said we should develop our own college, but it makes much more sense to get our own royal college to show it loves us more.

‘I went to a meeting of nurse directors and it’s a powerful forum – these are very senior people, but who knows they exist and what influence do they bring to bear? They’ve got to do something, as do mental health academics. They meet regularly but do they speak to the average mental health nurse? I’m not sure they do. That’s worrying.’

The Nursing and Midwifery Council is going to be changing its competences and Professor Butterworth is keen to impress on the working group in charge of the process that mental health nurses are different.

Mental health first aid

‘My view, having spoken to so many nurses, is that every single type of nurse graduate should be able to do mental health First Aid. But equally, every nurse should be able to do physically assessments. That’s all we need to do. We don’t need to go down a generic path just to satisfy this strange pressure. In Australia and New Zealand, they regret getting rid of mental health nurses and they come over here looking to steal our workforce.’

Professor Butterworth says the report will help mental health nursing get to ‘a better place’, with a clearer understanding of what it is that can be conveyed to those who hold the purse strings and make decisions about the future of the NHS.

He sees one possible future would be for the profession to to be employed increasingly in primary care, because that is where many people with the most serious mental health problems are now located. They need the expertise of graduate mental health nurses on their doorsteps.

Professor Butterworth hopes the powers that be will respond positively to the final report in the new year. ‘We will be able to say to the chief nursing officers, this is what the graduate mental health nurses look like - now take advantage of this highly-qualified workforce.’

Who is Tony Butterworth?

Professor Butterworth qualified as a mental health nurse in 1965 and became a national figure in the 1980s because of his groundbreaking work on clinical supervision in nursing and his highly influential contribution to psychosocial education for people with schizophrenia.

Tony Butterworth
Tony Butterworth. Picture: David Gee

He led a government review of mental health nursing in 1994 and was involved in the last review in 2006.

He has held many senior roles in education and in the NHS, including pro-vice chancellor of the University of Manchester, chair of the Council of Deans of Health, chief executive of the Trent Workforce Federation and director of a research centre at the University of Lincoln.

He is a fellow of the RCN, an emeritus professor at the University of Lincoln and chair of trustees at the FoNS. 

Further information

Tony Butterworth’s mental health nurses blog mhnurses.wordpress.com