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  • 01 November 2018
  • 8 min read

Mental Health Nursing is the misunderstood nursing discipline

  • Abby Holland
    PICU Mental Health Nurse

Mental health nursing is not very well understood by those outside the profession. Helping to treat, care and support mental health illness requires skills and an approach unique to RMNs.

In a 2008 study that was conducted in the US regarding the view of nurses it was found that psychiatric nursing was the least popular choice of specialty.

What’s more, the perception of mental health nurses held it to be “unskilled, illogical, idle and disrespected”.

Sadly this attitude was echoed by Australian and UK nurses. McKeown (2008) states that it’s likely that mental health nursing is seen more negatively than general nursing, because of its association to psychiatry by the general public.

The media has often not helped the image of mental health nursing

RMNs have not had the best press

The belief seems to be that mental health nurses (RMNs) are cold, uncaring individuals. It’s arguable that this is partly due to the stereotypes constantly fed to the public via films and a media bent on peddling negative.

And then there’s the “lazy” label that RMNs are sometimes given. In the public’s mind a nurse ought to be physically busy, active and on their feet at all times.

Perhaps mental health nurses are perceived to be ‘escaping real work’ by having the time talk with their patients.

I believe we are still struggling with our identity and the perception of mental health nursing in comparison to other specialisms.

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The NHS struggles to fill mental health nurse vacancies. There are 1000s of unfilled nursing roles in wards across the UK, many of them in mental health nursing.

Is it possible the stigma of mental health is still present? Or is it that mental health nursing isn’t seen as “real nursing”?

Working as a RMN on an Intensive Care Unit (PICU) I am of course biased. Both general and mental health have their own very different difficulties. But I’ve come across attitudes and press stories that either exaggerate the negative or peddle false and notions of our work.

Mental illness is nothing like a broken leg

When a patient enters A&E with a heart attack, broken limb or respiratory failure, the symptoms are clear. Treatment is planned, given, and a home treatment plan formulated.

However when Jane Doe is brought in to a mental health unit, detained after reporting to hear voices, behaving bizarrely and erratically, unknown to services, I can’t just put a plaster on that. As Hannah Jane Parkinson noted earlier this year in an article in The Guardian, it’s nothing like a broken leg.

I have to spend hours calming her down, offering medication I know she will probably refuse and be called all sorts of vulgar names.

There’s no security or police when she goes to punch me, other than my team of healthcare professionals. I then have to assess if I can even have her on the ward safely, or do I need restrain her to enforce medication?

In the last few years I have lost count of the times mental illness has been compared to a broken leg. Mental illness is nothing like a broken leg.

Mental Health Nursing requires a unique skill set

Far from the common perception that mental health nursing is unskilled, I would argue it requires a very unique skill set.

What we do as RMNs can’t be learned from a book, or from a lecture.

Displaying and feeling true compassion in the face of adversity and challenging behaviours is fundamental.

I’m not saying that RGNs are uncompassionate. I’ve met many lovely, kind-hearted, generous RGNs.

It simply suggesting ours requires a very different skill: talking to someone who is presenting as manic, elated, delusional or grandiose, whilst remaining calm, showing empathy or trying to even follow the conversation.

RGNs need more psychiatry training; RMNs need more physical training

Having spoken to RGNs about the differences within the job, it is evident there is inadequate training for RGNs around psychiatry.

I have an RGN become frustrated by the manic man in bed 3, who’s been in A&E for 2 days, asking me when the bed will become available, even though they know there are no beds in the trust

Conversely, I believe RMNs need more training on treating and managing physical conditions. RMNs are taught the basics of performing physical observations, and Immediate Life Support, but is it enough?

Coping with stress?

Stress points for RMNs are different to those faced by RGNs

Mental health nursing presents us with different stressors and pressures compared to general nursing.

The challenge starts with the patient. Typically, with a physical injury the patient understands they need help and support. They can see and feel that their leg is broken. There’s willingness to have it fixed and a gratitude given to the fixer.

In psychiatry the individual often doesn’t accept or believe they are unwell; they can reject their medication and may not see a clear treatment pathway.

A RMN will need to navigate these tricky situations, while remaining calm, compassionate and sometimes assertive.

They are not only dealing with the patient’s needs, but attempting to find a way of managing the patient’s confusion about those needs.

Managing the bed crisis is a further stressor for RMNs.

You cannot magic a specialist bed for a patient, or create a bed that doesn’t exist.

Service users can end up in inappropriate beds for lengthy periods of time, with no care plan or way of managing their behaviour.

Sometimes they cannot be moved to other wards, whether that is because of historical concerns with other patients, or simply they are not well enough.

The rewards of working as a mental health nurse

“people don't realise I am more of a soldier than nurse" (Anon 2016)

Although the pressures are difficult to navigate, the job itself is incredibly rewarding.

I love being able to downgrade my patients to the acute ward, or send them off home. I brim with pride when that challenging patient starts to show insight and improves, and a different person begins to materialise. When that one difficult patient refuses medication for weeks, and they start to turn a corner, all that time you invested starts to pay off.

My proudest moment was when one of my male patients was on our ward for about 6 months.

We worked tirelessly changing his medication, being assaulted, threatened, numerous restraints, giving injectable medication.

Finally we got the right medication and a charming, thoughtful gentleman was suddenly stood in front of me.

On his last day on our ward, he and his family gave me a hug, and said they wouldn’t have their son back if it wasn’t for all our hard work.

There is nothing more rewarding than being involved in someone’s darkest moments, at their crisis point, and being one of the people to help pull them out of it.

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About the author

  • Abby Holland
    PICU Mental Health Nurse

I qualified in 2015 from Southampton University with a degree in Mental Health Nursing. I have worked in Psychiatric Intensive Care for the 3 years where I currently reside as a Charge Nurse. During these 3 years I also spent 3 - 4 months working on acute female ward. I am also a Makaton signer, and Learning Disabilities lead on my ward.

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  • Abby Holland
    PICU Mental Health Nurse

About the author

  • Abby Holland
    PICU Mental Health Nurse

I qualified in 2015 from Southampton University with a degree in Mental Health Nursing. I have worked in Psychiatric Intensive Care for the 3 years where I currently reside as a Charge Nurse. During these 3 years I also spent 3 - 4 months working on acute female ward. I am also a Makaton signer, and Learning Disabilities lead on my ward.