What are we trying to do?
Outputs from this third blog will contribute to a report to be produced by the Foundation of Nursing Studies (www.fons.org) at the end of 2016 on the present and future work of mental health nurses. As a graduate profession, mental health nurses must now be confident enough to offer a constructive debate about their work rather than playing a limited part in policy development and service re-design. We hope the approach used in Playing our part will allow us to think differently by asking purposeful questions and sometimes we will allow ourselves to think disruptively! We want to put mental health nurses in a place where they can proactively contribute to service delivery. This third blog is to stimulate early discussion towards developing a contemporary view of the work of mental health nurses in tertiary care. We wish to explore existing and further potential for mental health nurses working in tertiary care and ask some questions about their present engagement and future work. The paper and your responses will help to stimulate a twitter conversation on Monday 11th July at 8pm. Please join us at #WeMHnurses.
A Definition for TERTIARY care and prevention
Working within a public health and preventive model of psychiatry (Caplan 1964) allows us to test the actual and potential work of mental health nurses. Having considered primary and secondary prevention in earlier Twitter debates we now finally turn our attention to tertiary prevention and must not only consider where mental health nurses are already working to good effect, but how they can work differently and better. For the purposes of this blog, tertiary care is defined as –‘mitigating the residual effects of mental disorder and the effects it may leave on individuals and families’.
Where does Tertiary care take place?
Health care professionals, social care agencies and the charity and voluntary sector can and should play an equal part in supporting and working with people and families who live with the residual effects of mental ill health. In previous times, tertiary care was in large part where many mental health nurses learned to work and offer support and help but the settings for tertiary care have now changed significantly. The closure of large institutions has meant that those in recovery or in need of long term support now go to very different destinations. Many have returned to live in their communities, some have gone to safe sheltered care, others re-emerge in the prison system and some are lost altogether and appear in the statistics of the homeless and rootless populations that can be found in most UK cities. Persistent system reorganisations created by services looking to work more efficiently have meant that vulnerable people in greatest need of long term care have likely suffered the most and the notion of ‘asylum’ in its best sense as a place of retreat and security has somehow become out of date as services implement models of ‘recovery’ which claim to be more active and purposeful. Several services have now established centres or ‘recovery houses’ in which both the realising of a persons’ full potential as well as the offer of asylum hold equal weight.
Question one – are mental health nurses still offering skills more appropriate to institutional care?
What is happening in tertiary care?
If, as we discussed in our blog on secondary care acute in-patient settings are highly charged environments for those in acute distress, than it must follow they are unsuitable for respite and sheltered recovery. In the search for alternatives such as the training available through ‘recovery based training’ programmes, day care and residential settings being created in ‘recovery houses’ and patient empowerment through ‘victim to victor’ approaches exciting new possibilities are emerging. If mental health nurses are to engage with the tertiary care revolution, then some questions are necessary. The first is a difficult one – is this mental health nurses work? The second is equally difficult – are tomorrows graduates being properly prepared for the new work landscape and is the University teaching faculty up to the job? The third question asks us to bite a very hard bullet – should mental health nurses ‘move aside’ and leave tertiary care to more expert non-statutory agencies? In doing this they can concentrate on using their skills in secondary acute care settings? The role of community psychiatric nurses (CPN’s) has continued to evolve and still provides essential support for those who have returned to their communities to live. Continuity of care for those requiring sustained contact is vital. Much of the work undertaken by CPNs has been drawn into active recovery and outreach programmes and is often measured in ‘sessions’ and defined programmes of intervention. Has this subverted the important work of sustained contact with people who need minimal but skilled support?
Question two – Is the work of community psychiatric nurses becoming differently focussed towards active intervention? Is this at the cost of ‘other work’?
Question three – Is tertiary care a place where mental health nurses belong?
Question four – are mental health nursing skills necessary in locations where recovery and retreat are on offer?
Do models of care developed in dementia service provide some answers?
Those individuals and families living with a diagnosis of dementia require particular support and service responses. There is ample evidence that mental health nurses can play a vital role. Models such as those on offer from Admiral nurses and their co-production systems offer a different way of working with families. The powerful lobbies created by partners and families of people with dementia offer good examples for professionals and families working together and the demand for skilled mental health nursing support is loud and clear as they move across the boundaries of primary, secondary and tertiary care.
Question five – What more general lessons can be learned by all mental health nurses from the creative co-production models being established in dementia care?
Two final big Questions
This is the last of our three blogs. We will now take the outputs from these blog papers and the twitter events that have followed and develop a paper and a series of questions for some ‘roundtable conferences’ in which we will further develop out thinking
Question six – Is our analysis of the work of mental health nurses through primary, secondary and tertiary prevention tenable, or should models which embrace continuity of care be used instead?
Question seven – If not what alternative platforms might we use and can you describe them ?
We will be holding a twitter chat on Monday 11th July at 8pm on mental health nurses working in tertiary care. To join in please use and add #WeMHnurses to your Twitter favourites!
We have a large amount of rich and informative data from our twitter events.
During September and October we will be holding a series of roundtable conferences with participants from the professions, people who use services and other invited guests. Outputs from theses will again contribute to our final paper to be completed by the end of 2016.
Tony Butterworth July 2016