Wednesday 2nd March 2011
The Lamp talks to members about the key issues and as well as the rewards of being a mental health nurse‘M y father was a psychiatric nurse and I learnt from him that mental illness is no less debilitating than sickness of the body, nor less worthy of our care and concern,’ said Prime minister Julia Gillard last September at an event held by suicide prevention service Lifeline.
As part of its package of health reforms announced last year, the Federal Government announced $277 million for mental health to boost frontline services, prevention and early intervention. The measures will include psychological counselling services for around 12,500 people each year who have attempted or are at risk of suicide and up to 20,000 psychiatry sessions. They also include a focus on men and children at risk of mental illness and access to online resources.
Yet the investment has been criticised by leading mental health advocates. Australian of the Year Professor Patrick mcGorry told Australian associated Press in July last year that it was ‘off scale and off focus’ and ‘failed to address the needs of more than 700,000 young people locked out of mental health services’.
The Mental Health Council of Australia and SANE Australia concurred, saying that the package fell short of the massive investment needed in the sector to address the major service gaps currently experienced by mental health consumers and carers.
NSWNA Assistant General Secretary Judith Kiejda said the investment was ‘a drop in the ocean’.
‘It’s very disappointing. If you compare the standard of cancer care in Australia to mental health, there’s a massive deficit in care for all segments of the mental health community.
We now have nurse-to-patient ratios for inpatient mental health embedded in the public health sector award. This will help address the major problem of staffing in this area, and we will be working to achieve mandated staffing in community mental health next time.
‘Mental health is an area where you need a high nurse-to-patient ratio. Nurses need to have the time to sit down and talk to patients to build rapport and find out what their issues are and how nurses can help them,’ said Judith.
‘One of the key issues for us is that while the average age of the average nurse is mid-40s, the average age of mental health nurses is late 50s. There is a real crisis in terms of recruitment and retention of nurses in the sector.’
But despite the challenges, mental health nurses love their work, finding it rewarding, varied and interesting. Three members at different stages of their careers offer an insight into the realities of mental health nursing.
In mental health nursing, teamwork is particularly important, yet staffing is a major problem, says Tristan chapman, a second-year RN working in the PECC unit at Nepean hospital in the Blue mountains.
‘We have major troubles staffing the unit at times. Keeping senior staff in mental nursing is a big one. Our main focus is keeping people out of hospital at all costs and to do that we need a strong community team. Unfortunately, we are most short of staff, especially senior staff.’
Tristan is studying for his master’s Degree in mental health. ‘My mum’s a mental health community nurse so she had an influence,’ he said. ‘also, I enjoy talking to people more than performing a lot of procedures and general nursing. You’re always meeting very different people from all sorts of backgrounds. Everyone’s story is different, which keeps the work very interesting.’
There’s no one ‘typical’ day in the PEcc unit. ‘We only have three staff, which is two RNs and an EN for a six-bedded unit. One of the RNs also does all the assessments and consultations to the Emergency Department,’ says Tristan. ‘So, depending on what shift you are on, you could be running the unit, dealing with families, dispensing medications, as well as liaising with other teams. If you’re on assessments you could be seeing anywhere up to five or six people in a shift. We see at least 300 presentations a month.’
Tristan has been at Nepean for the past 18 months while he completes his final four subjects of his MA. ‘I’m doing postgraduate studies because I’m interested in getting into a more educational role such as CNE. As CNE, I would be still working clinically on the unit but more with staff on providing better education and developing policies and procedures around the ward,’ he said.
The variety and the direct contribution mental health nurses make to helping people improve their lives are what drew Andrea Simpson to mental health nursing.
Andrea, CNC, has been part of the Camperdown Mental Health Team at RPA since 2007, and is currently working with the Early Intervention in Psychosis Service.
‘We do everything from counselling, care planning, helping with housing and accommodation needs, helping to navigate the Centrelink process with some young people, and collaborating with services such as juvenile justice and probation and parole. I work Monday to Friday in the community. Several days of the week we have case reviews and discuss treatment plans in a multidisciplinary team approach. We can do home visits or wherever clients are comfortable talking, such as school, a café, park or go to see someone who is in hospital. It’s very varied work,’ says Andrea.
‘Clients are all very different, so with any two people with similar symptoms, there could be multiple reasons why they have got to where they are. So you have to do detective work and work out what brought them to where they are to help them,’ she says.
Andrea began her career in mental health in the UK in 1996 when she qualified as a ‘Registered Mental Nurse’ – a title she finds amusing to this day. ‘Yes, I love being a “mental nurse”,’ she laughs.
Previously having worked in childcare, Andrea wanted something ‘more challenging’ where she could continue to put her skills to good use in helping young people.
‘Working with young people I see a very positive attitude with them in terms of their desire to get better. They want to work out what the problem is and get back to where they were before. You work with the young person to find out what their goals are and help them achieve these, rather than telling them what their goals should be. We take a recovery-focused attitude.’
Yet, despite the rewarding aspects of the job, there’s still a stigma surrounding mental health nursing, according to Andrea. Part of this is due to the perception that mental health nurses are constantly working with dangerous people and are at risk of being harmed. While this does occur on occasion, Andrea says the reality of mental health nursing is not as daunting as it is imagined.
‘Mental health nursing is a speciality you can elect on completing general nursing training rather than a specific career in its own right. It’s only when students complete a placement with mental health during their training and see that mental health nursing isn’t this scary, strange thing they think it is that they choose to work in this field,’ says Andrea.
It’s because of this stigma that recruitment to mental health nursing is a challenge. Additional administration work compounds the problems of staff shortages, particularly in the community teams.
‘Hospitals need to employ staff to do the admin work as this would improve our lives immensely,’ says Andrea.
Andrea would also like to see more opportunities for access to transition training in mental health for new graduates.
She says mental health nursing is ‘no walk in the park’, and particular qualities are required to do the job successfully. ‘You have to have a lot of resilience, be very self-aware and non-judgemental,’ says Andrea.
‘So you need to leave your baggage behind and be aware that what is going on with that person is not directed at you, so they’re not calling you that name because you are a horrible person it’s because of what’s going on in their life. You have to be aware of your own values and attitudes and leave them at home.’
as manager of in-patient services at Greater Southern area health Service, Julie mooney, RN, faces challenges unique to mental health nurses working in rural or remote areas – particularly those working in areas beleaguered with problems of drought and/or flooding.
Julie’s community has seen a higher number of mental health presentations as well as suicides recently due to farmers’ livelihoods being decimated by the weather as well as government restrictions on water.
‘It has an accumulated effect on farmers – the effect of years and years of everything going wrong and having no control over it,’ says Julie, who has worked in mental health nursing for 30 years. ‘The farmers can’t control the weather so you can do everything right and then it doesn’t rain for six months or it rains 10 inches in an hour. Rural people have usually inherited the farm so they are the generation who are failing.’
Many female mental health nurses in rural areas are also farmers’ wives, like Julie. ‘This means you are feeling the angst yourself as a person who is part of the community, and then you have to go and work and experience the anguish of other people. It hits very deeply because you really understand what is going on. Often in mental health you deal with difficult situations but it doesn’t hit home because it’s not your issue – but this hits very close to home,’ says Julie.
Another issue is one of confidentiality in a small community. ‘In small communities, everyone knows everyone else so you are often dealing with your friends and acquaintances and it can be difficult because of confidentiality issues,’ says Julie. ‘If you are the mental health nurse people may feel uncomfortable coming to you because they know you personally.’
Staff shortages in rural areas are particularly chronic. ‘We can’t even fill the shifts we have got. We are struggling on a day-to-day basis,’ says Julie. ‘Nurses aren’t coming into mental health and certainly not in rural areas. I hear students saying they are not encouraged to go into mental health. They are getting the idea at university that mental health nursing is not good, with a stigma of thinking it’s aggressive or dangerous and you’ll get hurt. You get difficult people but that’s what we are trained to do – to manage difficult people.
‘We need to support new grads and increase staffing levels so we can fill our positions as they arrive. If you have understaffed teams everyone gets stressed and leaves, which makes it worse,’ says Julie.
Despite the challenges, Julie loves her work. ‘It’s incredibly rewarding,’ she says.
‘The nurse in a mental health setting does a lot more than a nurse in the general setting because you do all the care for the patient. A psychiatrist might prescribe medication but all the work done to get the patient well is done by the nurse. You sit with them, talk and spend lot of time with the patients, so it’s very satisfying because you know your work has a profound impact on patients.’
In November 2010 NSW Health hosted the Sixth National Seclusion and Restraint Reduction Forum attended by Mental Health nurses and other mental health professionals and stakeholders from across Australia. Approximately 190 participants attended the venue each day and over 120 others tuned in to the live video and audio webcast of the event.
The forum highlighted efforts from mental health nurses, consumers, allied health and medical staff to reduce the use of seclusion and restraint in mental health and emergency services across Australia and New Zealand.
Many services across Australia continue to access these presentations for staff training through the webcast of the forum at http://vioca.st/NationalSeclusionRestraintForum. The webcast is available for open public viewing until November 2011.
The Mental Health Professional Online Development Program (MHPOD)
The Mental Health Professional Online Development Program (MHPOD) is a new evidence-based online learning resource being developed for people working in mental health. Based on the National Practice Standards forthe Mental Health Workforce (2002), it draws on the evidence base for mental health care and contemporary practice wisdom.
The program aims to support the mental health workforce, and is primarily designed for staff in their first two years of mental health
practice working in nursing, social work, occupational therapy, psychiatry and psychology in Australia. Although the training is targeted at the novice workforce, it is expected the wider mental health workforce will also find it useful.
MHPOD has been funded by all states and territories, and the Commonwealth Government. The content has been written by the Psychosocial
Research Centre at the University of Melbourne. The program provides about 70 hoursof material on 45 topics, including recovery, legislation and complex presentations. Each topic includes an overview, knowledge check, an activity, an in-practice section and a list of resources.
The MHPOD training will be available from the first quarter of 2011. Currently, mental health educators and facilitators are being identified
in each mental health service to support the implementation and staff can access the training through their local co-ordinator. The online learning platform will be introduced to support and expand existing training and staff development processes.
NSW Health has also funded a Project Officer (for 18 months) to support the implementation of the program. A small number of topics are currently available to trial on the MHPOD website: www.mhpod.gov.au