Nursing studies

What it takes to be a mental health nurse

A complex mix of skills is needed to put people in control of their situation

A complex mix of skills is needed to put people in control of their situation

Image: iStock


Being a mental health nurse was never my plan. I  had run my own business, managed a chain of shops – I knew nothing about mental health. But during a stint of unemployment I volunteered with a charity that helped people with mental illness through the medium of bike repair.

I found I could quickly establish a rapport with people; when I asked them how they were, they actually told me. I began working as a healthcare assistant in forensic community rehabilitation, then a child and adolescent service before starting my nursing degree. Now I run group therapies for pregnant and postnatal women who experience mental illness.

Harsh truth of nursing today

There’s a lot going on in mental healthcare in general, and nursing in particular. In the past eight years, we’ve seen more than 5,000 nurses leave the profession, and cuts to inpatient services that mean there are more than 10,000 fewer beds on wards.

The harsh truth of our situation is that mental health nurses are burdened with bigger-than-ever caseloads, tight deadlines, more paperwork and high levels of accountability with little autonomy.

Meanwhile they are left to navigate tortuous, everchanging referral and treatment pathways between services that don’t share information.

Intellect and empathy

It’s common to associate words such as ‘dedicated’, ‘compassionate’ and ‘empathy’ with mental health staff. These are things we incorporate into our practice, but they don’t encapsulate our role.

For instance, I will receive a referral from a GP and use my judgement to determine if the person meets the criteria for our service. I will conduct an assessment, asking about social, financial, physical and emotional concerns, observing body language and tone.

I also need to understand their cultural background and beliefs, and I have to do all this in an hour. You have to think fast and build trust quickly without making it an interrogation. I can hear someone’s experience and, using my training, my knowledge of the person and the context in which they live, help them find hope and meaning.

Mental health nursing is not like other fields of nursing. You don’t get to run conclusive diagnostic tests; your most essential skills are your intellect and your empathy. You will be surprised with tough questions and brutally honest answers; you might pick up the phone and have someone in extreme distress tell you they want to die, and the only tool at your disposal is your voice.

You will see people at their very worst and sometimes be the only person who believes in the best for them. You might have to battle against indifference and hostility, hopelessness and despair, and you’ll need confidence in your clinical skills and the assertiveness to advocate for a total stranger.

Find the meaning behind the words

Above all this, you’ll need the ability to listen in a therapeutic way. It means being present with someone and hearing not just the words, but the meaning behind them. It means learning about the person and where they are, where they want to be and how they want to get there.

We aim to provide care that puts people in control of their situation. Although I didn’t plan to be a mental health nurse, there has been no greater privilege in my career than to advocate for people at their lowest point and to help them reach new understandings and strengths they didn’t know they had.

Mental health nursing is a hard job to define in a few words; I hope this has given you some idea of the potential you have to make a change for the better.

Ed Freshwater is chair of the RCN mental health forum

Click here to find out more about mental health nursing and the RCN mental health forum

The first ever Mental Health Nurses’ Day takes place on 21 February 2019. Click here to find out more or follow us on Twitter at @MHnursesday

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