March 5, 2021, by School of Medicine
30 at 30: Mental Health Nursing: Past, present and future
The last thirty years has been an interesting time for mental health nursing. After decades of neglect, in the 1990s the UK Government recognised that the burden of disease and the disabling nature of mental distress were on a par with Coronary Heart Disease, cancer and stroke, the major cause of deaths at the time. Finally, providing safe, sound and supportive mental health services was a national health priority. Mental health nurses, the majority of mental health professionals in the UK, and elsewhere, were seen as central to the successful delivery of the national mental health strategy at the time. The increasing attention to mental health saw huge increases in the numbers of people seeking entry to the mental health field of practice, as this branch of nursing came to be called.
In 2003, an influential group of mental health nursing academics came together to form the national network Mental Health Nurse Academics UK (MHNAUK) to primarily ‘represent and promote mental health nursing policy, practice, education and research’. The move of colleges of nursing to the University sector in the late 1990s saw an increase in the number of mental health nursing academics and an increase in the number of Professors. The School of Health Sciences at the University of Nottingham appointed its first Professor of Mental Health Nursing in 2006, a joint post with Nottinghamshire Healthcare NHS Trust and a key position in the fledging Institute of Mental Health, itself a joint venture between the University and the Trust. Two of the six Deans of Health Sciences at Nottingham have been mental health nurses.
Despite the increase in the numbers of people entering the profession of mental health nursing, the numbers remain well below those studying Adult Nursing. Yet mental health nursing has been scrutinised like no other field of practice in the last 30 years. In that time there have been three national reviews of mental nursing; two conducted by the Department of Health in 1994 and 2004 and a 2017 review led by the Queens Nursing Institute.
The ‘Butterworth’ review of 1994 championed Psycho-Social Intervention roles for nurses and working in partnership with service users in the delivery of nursing practice and education. These issues are now part of mainstream mental health care. The 2005 review recommend a shift to ‘recovery-oriented care’ that is now widely embraced by many mental services. The 2017 review emphasised the importance of graduate mental health nurses using a co-production approach in working with service users in practice, research and education and, again, this now a central facet of practice in these areas.
The last thirty years has also seen mental health nurses researching issues of national and international significance funded by competitive grants. These transformed people’s recovery from incapacitating anxiety and depression, improved service users’ experiences of acute mental health care, enhanced the physical health needs of mental health service users, led national and international work on recovery-focussed practice, driving collaborative mental health nursing, and reducing restrictive practices when preventing and managing violence. Arguably, the most significant piece of mental health nursing research was the Safewards project, a multi-centre study of a new model of acute mental health care that significantly reduced conflict and containment practices better than usual care.
However, most of the published outputs based on the studies reported above have not been published in mental health nursing journals. Thus, mental health nursing academics seem as vulnerable to the pressure to pursue the higher-ranked academic journals in line with much of the higher education sector in the UK. As a result, the research reported in these papers is less likely to reach busy clinicians charged with implementing the findings or for whom the work may have most relevance.
In the last thirty years mental health nursing has thrived and today continues to do so. But, it remains a work in progress, rightly so. The routine practice of mental health nursing, especially on inpatient wards, often lacks a systematic approach making it less visible unless studied through research. Mental health nursing research is underfunded, partly because of a multi-disciplinary approach to research funding, at least in the UK. As a result, the evidence base of what we might call specific mental health nursing is lacking. The pressure for a generic approach in nursing education remains strong and there is a sense that what seems unique about mental health nursing may be getting lost as educational curricula become more generic. Undoubtedly, some mental health nurses have been successful in capturing significant amounts of competitive grant funding but most of this work is multi-disciplinary in nature. While this seems fitting in the complex landscape of mental health care where one simply cannot make advances without taking such an approach, what may be unique about mental health nursing remains hard to discern, at least empirically. The programme of work that ultimately led to the Safewards project is a notable exception. This was work led by a mental health nurse that focussed exclusively on mental health nursing practice, applied a high degree of scientific reasoning and methods, and produced discernible outcomes of huge relevance to key aspects of mental health nursing as practised on acute inpatient wards.
Next year sees the 40th Anniversary of my career practising the art, science and craft of mental health nursing. In that time, I have worked as a clinician, clinical academic, educator, researcher, manager and leader. I have practised mental health nursing in many parts of the world, widely published the results of my research, edited and wrote books, as well as professing on the state of mental health nursing. For eleven of those years I worked in the School of Health Sciences at the University of Nottingham, at Nottinghamshire Healthcare NHS Trust, as well as in the Institute of Mental Health, Nottingham.
Mental Health Nursing has a good history at Nottingham. During my time there I worked with a clever bunch of mental health nursing academics. We contributed to national and international debates, shaped mental health nursing practice, education, research and policy, locally, nationally and internationally. It was one of the most satisfying periods of my life as a mental health nurse.
I had the good fortune to be the Dean of Health Sciences at the University, a tenure that lasted four years. In this role I saw the prize-winning successes of colleagues and students from across the School. I was proud to lead the School during those years. I am delighted to contribute this blog as part of the School of Health Sciences 30th Anniversary of Nursing, Midwifery and Physiotherapy Education at the University of Nottingham. I send my very best wishes to my former colleagues for the continuing and future success of the School.
By Professor Patrick Callaghan