Where can mental health nurses make the most difference?

New skill sets are common but there remains fierce debate about what mental health nurses should do and how they need to be trained

In 2021, a historic milestone was reached by mental health nursing which passed by largely without note.

It was the moment when the number of mental health nurses working in community services in England’s NHS finally exceeded the numbers of those working in inpatient wards (NHS Digital 2022).

This was a long time coming.

Expansion of community services was often painfully slow

Mental health nursing was born in the Victorian asylum system that continued to grow until the 1950s. At that point, the view that total institutions were innately damaging to individuals and society and that alternatives could exist became widely recognised.

However, despite the first community psychiatric nursing roles being established in the 1950s (May and Moore 1963), expansion of community services was often painfully slow, mired by vacillating political commitment and, often, professional intransigence in the mental health workforce itself.

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Other important changes have taken place in mental health nursing in recent years, with an evolving philosophy demonstrated by the profession's increased use of service user derived language, for example ‘recovery’.

‘It is highly unlikely that there will ever be enough mental health nurses to meet the growing demands of a society that continually expands the range of issues seen as necessitating a psychiatric or ‘mental health’ input’

New skill sets are common, such as psychological treatments and non-medical prescribing. However, there remains fierce debate about what mental health nurses should and should not do and how should they be trained. A recent Mental Health Practice editorial argued that the competencies demanded in pre-registration courses minimise the mental health focus of training.

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Nursing practice affected by technology, such as online therapy

So, what will mental health nursing be in the future?

Technology will certainly become more important with electronic notes, cameras and online therapy already impacting, although such developments require solid research and engagement of service users to avoid the incidental damage that has been always associated with novel treatments in the psychiatric world.

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More generally, it is highly unlikely that there will ever be enough mental health nurses to meet the growing demands of a society that continually expands the range of issues seen as necessitating a psychiatric or ‘mental health’ input.

In such a scenario, perhaps the biggest question for mental health nursing is ‘Where can we make the most difference?’.

Find out more

• May AR, Moore S (1963) The mental nurse in the community. Lancet. 26, 213–214
• NHS Digital (2022) NHS Hospital & Community Health (HCHS) Monthly Workforce Statistics

Neil Brimblecombe is consultant editor of Mental Health Practice