It should be an easy question to answer but I really had to sit down and think about it.
First, consider our patients. This can be anyone. The statistic banded around is that 1 in 4 people will have a mental health problem in a year. 1 in 6 report having to deal with common mental health problems within a week. Even higher is that around 20% of people experienced suicidal thoughts over their lifetime (Mind, 2017)
Now the really hard question: what is it we do? I’ve heard stigmatised views that we’re not real nurses and all we do is “sit around drinking coffee and talking”. I mean, hot drinks are the staple of any nurse! I’ll cop to talking too. To use a simplified analogy of our adult nursing colleagues: someone presents as ill to you. Generally, there’s a test you can run. A diagnostic tool. There’s generally a treatment to that and a recovery time (this is VERY simplified…don’t shout at me adult nurses) and continuous management.
It’s not quite the same in mental health. Mental Health nursing is extremely complicated. There’s no test we can run to see whether someone is having psychosis or suicidal thoughts with real intent to carry out a plan. There are questionnaires and tools we use to assess someone, but this depends on talking to someone. We need to build strong therapeutic alliances. Pick up the subtle cues they give off when talking to them. It’s understanding whether they are a risk to themselves or to others. Or perhaps a risk of neglect or vulnerable to exploitation. There’s collaboratively building a working care plan for a person with mental health issues. Assessing, planning. Implementing and evaluating. Like any nursing process.
I ask questions of my practice all the time. What actions do you need to take for this? Does the person have the capacity to make an informed choice? Can they agree to an admission onto an inpatient ward? Are they in immediate danger? Do you need to consider detaining a person under the Mental Health Act? Mental Health nurses have the legal power to detain someone on a ward for up to 6 hours. Can you justify this legal detainment? If someone is hurting themselves or becoming aggressive towards others on a mental health unit, you need to intervene. This can sometimes mean de-escalation through talking to someone or it could mean having to put “hands on”. Restraint is, or should be, an absolute last resort to abide by the least restrictive practice or promoting other methods of changing the culture of the ward to stop things from getting to the stage of an altercation (a whole other blog). Again; can you justify putting hands on someone as a nurse? Have you contravened their Human Rights? You need to consider this before taking any action. Sometimes in split second decisions. These are only a small portion of the decisions that need to be made by mental health nurses every day. You need to be top of your game. People’s lives are on the line. People’s rights need to be protected.
A good knowledge of physical health is required too. We need to be able to assess when someone’s physical health is deteriorating and in need of further treatment. People with serious mental illnesses are more likely to develop serious physical illnesses such as diabetes, cardiovascular disease, respiratory problems and are, according to the Department of Health, likely to die 16 to 25 years earlier than someone without.
Then the treatment of mental health issues is a long process. Depending on the diagnosis different medication can be prescribed. NICE guidance states depression and anxiety is best treated using a combination of drug therapy and talking therapy, but waiting lists are long so it takes time. There’s also the shaming and stigma that comes with the use of mental health drugs. There’s the added issue that some mental health conditions cannot be treated with medication alone such as Personality Disorders (That’s another blog…hey I’ve got a few topics going now!) It’s a constant struggle with mental health difficulties. Peaks and troughs in wellness. The fight to get help from stretched services. Mental health nurses are there to support as best we can. It’s fantastic to see someone improving from when they enter the ward or engage with services. It can be heart-breaking when someone relapses after a period of wellness. Even more heart wrenching when someone you’ve nursed has taken their life.
Maybe the most difficult thing to give our patients is hope. In their mind they’re hopeless, full of self loathing and unable to see a way out. We need to validate them, support them and somehow instil hope in them that there is another way.
Mental health nursing is a privilege. Nursing generally is, but mental health nurses are a special breed of privileged people. People trust us enough to tell their story, knowing we will listen. Some people’s stories have such trauma in them which led them to their difficulties. People trust us to care for them when they’re at their most vulnerable. We need to live up to this trust.
(Luke Woodhouse – student nurse)