Editorial
Mental health nurses needed in acute general settings I
t does not take a team of academic referees, just a bit of common sense, to realize that many people who attend acute general hospitals because of physical ill health also require mental health support. Mental health problems often occur at times of major life events. How many of these are played out within the confines of a medical ward, outpatient or accident and emergency department? Relatives, nurses and patients are each susceptible to the effects of grief, trauma, disability and fear, but despite the obvious im portance of psychological support, there are other provi sions that take priority; not surprisingly, and rightfully in most cases, physical care comes highest on the agenda. What about the notion of making mental healthcare more accessible? Educationalists offer a glimmer of hope when they say that Project 2000 and its common foun dation programme ensures that all nurses are given fun damental counselling skills. If not, they say, the post graduate courses that are springing up everywhere should enhance the psychological care on offer. I don’t think that this is the case. Despite shared train ing, further reflection and reading around psychological care, one can only get more and more frustrated as ‘real’ priorities get in the way. This was made only too evident recently when I was working with a group of nursing diploma students, most of whom were working in a general setting. We were talking about notions of health, reductionism and holism, and after much debate, acknowledged that al though aspiring to holism most nurses were reductionist in practice. More importantly, we agreed that health in the mental, spiritual and emotional domains were of greater importance than health in the physical domain. More frustration ensued as the realization dawned that because of nurses’ actual work priorities, many patients and relatives who require a depth of emotional and psy chological support are neglected. What is the answer? Well, an RMN on every ward
would be helpful; not just somebody doubly qualified working as an RGN, but a person whose priority would be to work around the mental, as opposed to physical, health needs of clients. Failing this optimal (perhaps Utopian) aspiration, certainly an accessible and skilled counselling service should be made available, staffed by mental health nurses who understand patients’ needs and also the system. Before people start talking about the erosion of roles, and saying that if you need an RMN you also need an RSCN and an RMHN, read on. What we are talking about is people getting access to good mental healthcare. Who could disagree with that? At a time when the role of mental health nursing is being explored and re-examined, we should not be sit ting in our ivory towers (or ivory cars in the case of CPNs), we should be identifying our core skills and finding out where they are best utilized. The acute gen eral setting is just one arena. In 1993, the RCN congress will be in Harrogate. The last time it was there a resolution was made supporting the notion of an RMN in casualty. The resolution failed, primarily because of fear, ignorance and traditionalism. I shall be urging for such resolutions to be once again high on the agenda for the RCN’s consideration. I hope that others will do the same. However, as more and more units gain Trust status, the chances of my aspir ations coming to fruition will decrease. When you have been contracted to give physical healthcare, that is what you do. Let us push for some precedents, for some examples of fine practice with regard to mental healthcare in acute general settings, before it is too late. Antony Sheehan Consultant Nurse in Addictive Behaviour St George’s Hospital Stafford
BJN CLASSIFIED SECTION Just the job for BJN readers! Are you looking for a job? Or are you interested in going on a course? Turn to our classified section starting on page 741
696
BritishJournalofNursing, l,N16, o 14 Downloaded from magonlinelibrary.com by 130.237.122.2451992,Vol on January 2019.
Mental health nurses needed in acute general settings I
t does not take a team of academic referees, just a bit of common sense, to realize that many people who attend acute general hospitals because of physical ill health also require mental health support. Mental health problems often occur at times of major life events. How many of these are played out within the confines of a medical ward, outpatient or accident and emergency department? Relatives, nurses and patients are each susceptible to the effects of grief, trauma, disability and fear, but despite the obvious im portance of psychological support, there are other provi sions that take priority; not surprisingly, and rightfully in most cases, physical care comes highest on the agenda. What about the notion of making mental healthcare more accessible? Educationalists offer a glimmer of hope when they say that Project 2000 and its common foun dation programme ensures that all nurses are given fun damental counselling skills. If not, they say, the post graduate courses that are springing up everywhere should enhance the psychological care on offer. I don’t think that this is the case. Despite shared train ing, further reflection and reading around psychological care, one can only get more and more frustrated as ‘real’ priorities get in the way. This was made only too evident recently when I was working with a group of nursing diploma students, most of whom were working in a general setting. We were talking about notions of health, reductionism and holism, and after much debate, acknowledged that al though aspiring to holism most nurses were reductionist in practice. More importantly, we agreed that health in the mental, spiritual and emotional domains were of greater importance than health in the physical domain. More frustration ensued as the realization dawned that because of nurses’ actual work priorities, many patients and relatives who require a depth of emotional and psy chological support are neglected. What is the answer? Well, an RMN on every ward
would be helpful; not just somebody doubly qualified working as an RGN, but a person whose priority would be to work around the mental, as opposed to physical, health needs of clients. Failing this optimal (perhaps Utopian) aspiration, certainly an accessible and skilled counselling service should be made available, staffed by mental health nurses who understand patients’ needs and also the system. Before people start talking about the erosion of roles, and saying that if you need an RMN you also need an RSCN and an RMHN, read on. What we are talking about is people getting access to good mental healthcare. Who could disagree with that? At a time when the role of mental health nursing is being explored and re-examined, we should not be sit ting in our ivory towers (or ivory cars in the case of CPNs), we should be identifying our core skills and finding out where they are best utilized. The acute gen eral setting is just one arena. In 1993, the RCN congress will be in Harrogate. The last time it was there a resolution was made supporting the notion of an RMN in casualty. The resolution failed, primarily because of fear, ignorance and traditionalism. I shall be urging for such resolutions to be once again high on the agenda for the RCN’s consideration. I hope that others will do the same. However, as more and more units gain Trust status, the chances of my aspir ations coming to fruition will decrease. When you have been contracted to give physical healthcare, that is what you do. Let us push for some precedents, for some examples of fine practice with regard to mental healthcare in acute general settings, before it is too late. Antony Sheehan Consultant Nurse in Addictive Behaviour St George’s Hospital Stafford
BJN CLASSIFIED SECTION Just the job for BJN readers! Are you looking for a job? Or are you interested in going on a course? Turn to our classified section starting on page 741
696
BritishJournalofNursing, l,N16, o 14 Downloaded from magonlinelibrary.com by 130.237.122.2451992,Vol on January 2019.
