Introducing Mental Health Nursing

A service user-oriented approach

Cath Roper

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000257632
• Edition: 2
• Topic: Medicina
• Subtopic: Enfermería psiquiátrica y de salud mental

Introducing Mental Health Nursing offers a systematic overview of both the science and the art of caring for people experiencing mental health problems. It addresses the attitudes, knowledge and skills required to provide care for service users across all health-care settings, from specialist mental health services to general hospitals and community care.The authors place the service user at the centre of all aspects of mental health care and emphasise the importance of the therapeutic relationship as the cornerstone of good mental health nursing practice. Emphasis is placed on the role of the nurse as an intrinsic member of the mental health team, and nurses are encouraged to think critically about the perspectives that they bring to their practice.The second edition has been fully revised and updated, with increased focus on Indigenous social and emotional well-being, as well as two new chapters on Recovery and Cultural Safety. A must-have book for undergraduate nursing students, new graduates and professionals changing specialties or simply wishing to refresh their mental health nursing knowledge.'This is a brave and dignified text - beautifully written and conceived and given the current texts available - a must for any serious undergraduate nursing program in an Australian university.' - David Buchanan, De Montfort University, Leicester, United Kingdom 'I recommend this text to all students of nursing, whether you intend to pursue a career in this speciality or if you simply desire to provide the best care possible in any field of practice.' - Associate Professor Stephen Elsom RN PhD, Director, Centre for Psychiatric Nursing, The University of Melbourne

PART I
BACKGROUND AND CONTEXT TO MENTAL HEALTH NURSING

1
Introduction

Main points

• Mental health nursing is an important, exciting and rewarding nursing specialty.
• Mental illness is a common health problem; therefore, mental health nursing knowledge and skills are necessary for all areas of nursing practice.
• Language is important in shaping our attitudes to people experiencing a mental illness.
• Consumers of mental health services should be actively involved in all aspects of mental health service delivery.

Definitions

• Mental health nursing: A specialised field of nursing providing care and treatment specifically for people experiencing mental illness or significant mental health problems.
• Mental health service user: A person who uses, has used, or attempted to use mental health services.
• Mental health services: Specialist services designed to provide care and treatment for people with mental illness.

WHY STUDY MENTAL HEALTH NURSING?

The purpose of this book is to introduce you to the field of mental health nursing, and to the skills and knowledge you will require in providing care for people experiencing a mental health problem.

Many of you may be asking ‘Why do I have to study this subject?’ There is now a substantial body of literature indicating that most nursing students do not start their course with an interest in working in the mental health area (Happell & Cutcliffe 2011; Hoekstra, van Meijel & van der Hooft-Leemans 2010). The literature also tells us that one of the main reasons for this disinterest is a fear of people experiencing mental health problems. Commonly cited issues include fears that the nurse will become physically hurt by violent and aggressive acts, and fear of becoming emotionally damaged because of exposure to people’s pain and distress. If you currently share such feelings, it is important to know that you are not alone. It is also important to keep in mind that by the time you have completed the theoretical and clinical components of this subject, your fears about being with people experiencing mental health problems are likely to be significantly reduced or even to disappear altogether (Happell 2008).

Mental health nursing is a fantastic profession: it provides the opportunity to make a difference in the lives of people from diverse backgrounds, with differing needs and experiences. You have the opportunity to learn more about the interactions between people, their environment and their experiences, and through this you will learn a lot about your own thoughts, feelings and behaviours as well. As you will discover, mental health nursing offers many opportunities to practise in a variety of settings and to use a broad range of skills.

To answer the question ‘Why study mental health nursing?’—particularly for those who want to work in another field such as medical/surgical, paediatrics, midwifery, critical care or operating theatre—it is important to look at mental health nursing more broadly. There is no doubt that this field requires highly specialised skills and knowledge, but the principles of mental health nursing are not limited to mental health settings. In whatever areas of nursing you choose to practise during your career, as well as in your own life, you will encounter people experiencing mental illness or mental health problems, and it is crucial that you feel comfortable and confident with these issues. There are a number of factors involved in the delivery of mental health care in Australia, including changes to care settings, awareness of holistic health-care needs and provision of holistic nursing care. You will be introduced to these concepts in this chapter, and many will be dealt with in greater detail in other parts of this book.

MENTAL HEALTH-CARE SETTINGS

Changes in the delivery of public mental health services in Australia have occurred over the past 30–40 years (see Chapter 4). Most large psychiatric hospitals have now closed as the result of processes known as deinstitutionalisation and mainstreaming (Ash et al. 2012). People experiencing a mental health problem are now more likely to receive care and treatment from a community-based program or within in-patient units located in general hospitals. These changes to the model of mental health service delivery mean that more people experiencing mental health problems are accessing general hospital and community-based services.

HOLISM

It is likely that during your nursing course you have already been introduced to the concept of holistic nursing care. The underlying principle of holism is that the nurse provides care for the person as a total person, encompassing all aspects of physical, social and psychological well-being (Cowling 2011; Povlsen & Borup 2011). What this means for you as a nurse is that, although you may specialise in a particular area of practice (for example, midwifery), you must constantly remember that the needs of the people for whom you care very rarely fit into neat categories. For example, a pregnant woman requires the expertise and knowledge of a qualified and experienced midwife during the antenatal, labour and post-natal periods of childbirth. Parenthood is not always a planned event, and even when it is, the expectations of childbirth and parenthood often involve anxieties about the future—questions such as ‘Will my child be healthy?’ or ‘Will I be a good mother?’ Attending to these needs is just as important as meeting the physical needs of the pregnant mother. The expectant mother may also experience a mental health problem prior to, during or related to pregnancy or childbirth, such as post-natal depression. The midwife must be able to assess the woman for signs and symptoms of mental health challenges, and provide appropriate care to ensure optimal physical and emotional health for the woman and her family at all stages of contact.

Approximately one in five Australians will experience a mental health challenge at some stage in their lives (Wynaden 2010). The percentage has been found to be higher in people accessing the health-care system. Mental health problems within the general health-care system are covered in detail in Chapter 16. As you progress through the theory and practice of mental health nursing, remember that what you learn during this time will be invaluable to your further career as a nurse, irrespective of where you choose to work in the future. For some of you, the experience of mental health nursing will be considerably more positive than you expected. Despite the reservations you may have at present, some of you will choose this as the area in which you wish to work in the future. Whatever the outcome, keep your mind open, view this as a useful learning experience and, above all, enjoy the challenges you will encounter as you study mental health nursing.

As well as preparing you to better meet the mental health needs of the people for whom you care across a broad range of health-care settings, the study and practice of mental health nursing is likely to bring personal rewards. You will learn more about yourself as a person, and how you relate to the people with whom you live, work and socialise. A student nurse made the following statement after completing a mental health/psychiatric nursing subject: ‘I thoroughly enjoyed the semester of psych nursing. I felt it was not only beneficial for nursing, but for life.’

LANGUAGE IN MENTAL HEALTH CARE

The language used in Australia to refer to people experiencing a mental health problem varies between different mental health settings and service providers, and across policy documents. There is no single term that has currency over any other; however, many Australian health policy documents continue to use the term ‘consumer’ to refer to people who use health services, and this is also true of mental health.

What is a consumer?

‘Consumerism’ is the health and human services language of the day, and it is reflected in current health policies and guidelines. The terminology comes from a business model, and the focus is not on the ‘condition’ of the customer, but on the quality of the transaction between the consumer and service.

A business framework is useful when it comes to describing the sorts of things all customers or consumers should reasonably expect in any business transaction, including the right to complain if a service is less than satisfactory, and the right to choose within a competitive market. The term ‘consumer’ is now used widely by people who have become more knowledgeable about health rights and activism, and who see themselves as citizens with a right to expect a partnership from health-care professionals—including being properly informed throughout all contact with health services. The relatively recent shift from provider as ‘expert’ to provider as ‘partner’ in a person’s health concerns means that people expect to be fully informed and empowered to make decisions and choices. Knowing how to communicate respectfully, negotiate and impart knowledge in ways that people can grasp are now key skills for all health providers.

One limitation of the business model when it is applied to mental health service use is that it cannot adequately describe circumstances surrounding an involuntary admission to hospital or treatment patterns that do not involve free choice, as occurs when a person is governed by mental health legislation—that is, when they are hospitalised on an involuntary basis.

Self-identification

While ‘consumer’ is currently used in mental health policy, the merits or otherwise of this term continue to be hotly debated. Another way to think about language use is the way people choose to individually identify themselves. Paralleling black pride/gay pride movements is ‘mad pride’ where people adopt terms that were historically experienced as discriminatory or oppressive, in new empowering ways. Reclamation of language in this sense includes such self chosen terms as ‘batty’, ‘nutter’ or ‘mad’. In mental health, the term ‘survivor’ is self-chosen, meaning someone who is a survivor of the mental health system—rather than someone surviving or recovering from a mental health problem. People who identify themselves as survivors have usually experienced mental health services involuntarily. While some people do not like the term ‘patient’ because of the connotations of passivity, and medical ‘paternalism’, others prefer this term as it is the terminology most often used in general health. Some prefer the term ‘client’ because it seems to accurately describe a professional relationship with a practitioner, while others do not have a strong opinion about it either way. More recently, the term ‘lived experience’ has been used to describe first-hand experience of using mental health services and/or experiencing mental health problems.

In this book, we primarily adopt the term ‘service user’, defined as a person who uses, has used or has attempted to use mental health services. This term is commonly used internationally, and we adopt it here in preference to the term ‘consumer’ because it maintains the focus on service provision while also allowing reference to involuntary service...