health care

# I Interviewed Two Nurses About Nursing and Mental Health

by Beverly Blaine
May 12, 2017
Comments 6

What is the role of a nurse in your mental health care? I’ve never really considered this until today. When I think about it, nurses were key in improving my quality of life when I was an in-patient in a psychiatric ward. In another case, after I received surgery (appendicitis), I spent much more time with nurses than doctors. They really took care of my physical needs, which ensured my mental health wasn’t impacted.

Today is International Nurses Day, a day meant to honour and celebrate the contributions of nurses worldwide. To show my appreciation for nurses, I wanted to share stories and opinions directly from nurses themselves.

I interviewed Shanna, a psychiatric nurse from Montreal who has direct experience working with mental health patients. I also interviewed Jayne, who works in Toronto as a nurse in a cancer unit, with elderly patients who have their own unique mental health needs. These patients are suffering from a variety of cancers, such as breast, lung, prostate, colon, etc. They can range from quite healthy and receiving chemotherapy, to actively dying and breathing their last breaths.

I’ll get right into it with the questions and answers:

What is the role of a nurse in caring for a patient with mental health?

Shanna: It depends on what sector of mental health care the nurse works in. I work in in-patient care, which is when a patient is hospitalized as a result of their mental health issue. My role is to work with the health care team, which is made up of (but not limited to) psychiatrists, social workers, psychologists and occupational therapists. Together, we develop individualized treatment plans for each patient under my care. Throughout a patient’s treatment in-hospital, I will offer support, advice, communicate with families and advocate for those who are not in the condition to advocate for themselves. I also assess and monitor their medical issues.

Jayne: The role of nursing is very much the same across all specialties of healthcare. We are the front-line. We are the advocates for our patients. A nurse who actually works in mental health would have more training and experience in the unique needs of mental health patients. But that doesn’t mean nurses in other settings can’t provide quality care to these patients too. Personally, I think the most important role is patient advocacy. It is out of our scope to diagnose or prescribe treatments to these patients. However, it is well within our scope to recognize signs of depression, suicide ideation, obsessive behaviors etc. and bring it to the attention of the rest of the health care team. After that, we need to ensure that these issues are being treated just like we do with any physical symptoms or medical diagnoses. I believe that is the first step to helping patients get the best care for their mental health (especially when they’re not in a mental health setting).

What is the most rewarding part of your job?

Shanna: The most rewarding part of my job is seeing patients gain insight into their condition. Once that happens, they will most likely collaborate in their treatment, get well and be discharged from the hospital. I feel like a proud momma!

Do you have an idea on how mental healthcare could be improved?

Shanna: There are so many ways in which mental healthcare can be improved. We need more resources, in particular a bigger focus on prevention. We need more teaching and education around mental illness. There also needs to be a focus on hiring more nurses and funding more research. Finally, we need to work on debunking the taboo that surrounds mental illness.

Jayne: There needs to be more awareness of the importance of mental health in in-patient settings. Cancer has become like any other chronic illness, as survival rates are increasing. All these patients are living with an illness that needs consistent monitoring and treatment. How can we not think about their mental well-being? That is because our health care system is based on the biomedical model that solely focuses on physical well-being. I think one solution would be to re-focus our education system. Education for health care professionals need a bigger emphasis on mental health. And naturally, slowly, hospitals will evolve to be less biomedical, and more holistic. Hopefully we can get to a point where signs and symptoms of mental illness are assessed and screened in all health care settings just like how physical illnesses are now. I also think this helps answer your second question: if we, as health care professionals and the health care system as a whole, put more emphasis on mental health, then patients may be more inclined to advocate for their mental health instead of feeling embarrassed about their depression or that it’s not important to bring attention to.

Just to quickly summarize: I think our health care system is seriously lacking in education, and awareness of mental health. Although my answers are very specific to medical in-patient units, I think it strikes an alarming parallel to the real world where people in general are uninformed about mental health, and therefore ignorant to its importance and prevalence.

What did you learn about mental health in school versus on the job?

Jayne: Very little – in both those settings. There is a major gap in education on mental health, at least in my nursing program. We learned the basics of the major disorders such as depression, bipolar, schizophrenia, but it was such a small part of the curriculum that I hardly remember any of it. We had a larger focus on Alzheimer’s and dementia due to the demographics of our patients. But really we didn’t learn much at all about mental health.

At work, due to the setting, I have very little exposure to mental health patients. In fact, I admitted a patient that was labeled as “a psych patient”, meaning her major issues were not exactly “medical” and she was followed by psychiatry (also, an example of how mental health patients are quickly stereotyped even in a hospital setting). I remember having no idea how to care for this patient and feeling unprepared. So I just stuck with what I knew and cared for her as I would for any other patient. She was soon discharged with not many changes to her care plan. Although I understand psychiatry is not the expertise of our unit, I still felt I would have liked to be able to cater my care for her needs, instead of giving her a “one-size-fits-all” kind of care. So in a typical medical in-patient floor, there is very little education or training on mental health.

Shanna: In school, (CEGEP Registered Nurse program) mental health took up half of a semester. I learned about the main illnesses and disorders in a lot of detail, as well as the main medications. I completed a few weeks of clinical hours on a psychiatric unit, which did help prepare me to work in psychiatry. However, working full- time on a psychiatric unit, or any hospital unit in our public health care system, is eye-opening to the resources we lack.

How can patients advocate for themselves in their own mental health care?

Shanna: By understanding their illness/disorder, their triggers and seeking help when their condition changes. Additionally, they can better advocate for themselves by understanding the medications they’re prescribed, how they work for them and why they need them. If they have concerns, they should also address them with their psychiatrist. They could also better advocate for themselves by knowing what resources are available to them and making use of them. Finally, they can help themselves by creating a support system, whether it be friends, family, or resources (crisis centres, group homes, community health centres, etc).

Jayne: This is a difficult question to answer because the first thing that comes into my head is the concept of health literacy. Health literacy is basically a person’s ability to understand their health and illness to an extent that allows them to make informed decisions. (Many things like level of education, socio-economic status, literacy and more, all affect health literacy.) All of our patients on my floor are diagnosed with at least one type of cancer, and because they are in the hospital, it means they’re not doing so well. You can imagine that every single patient probably has some kind of mental health need. The issue here is that they may not realize it – they do not have the health literacy to realize they have mental health needs. And without that basic knowledge or understanding of their own needs, how can they advocate for themselves? Building on top of that, even the patients who are already diagnosed with mental illnesses hardly get much support on that aspect of their health, as most of the focus is on oncology and medical treatments.

So that’s it for my interviews with Jayne and Shanna! Do you have a good experience with a nurse that you want to share in honour of International Nurses Day? Comment below!

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## 6 comments on “I Interviewed Two Nurses About Nursing and Mental Health”

1. Jodi
   May 12, 2017

   During my inpatient stay and ER visits the nurses were amazing. I can’t say enough about how much they helped me during a very dark time. They all deserve a huge thanks!!!

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2. rainicorn
   May 13, 2017

   Nurses have helped me during critical times, in the ER and in inpatient mental health setting. Their kindness, experience and perceptivity has made my life better. Nurses rock.

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3. 2angelsandablackdog
   May 13, 2017

   Nurses certainly have a great impact.

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4. tonyroberts
   May 13, 2017

   Great interview on a vital subject. Nice work.

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5. andthentherewashope
   July 1, 2017

   It’s interesting being a mental health nurse with bipolar (type 1 to be old fashioned) and ADHD…. working on inpatient acute when you’ve been an inpatient yourself and having family members with other serious mental health illness, sometimes without ‘insight’ 🤔 you see things from all sorts of weird angles.
   It’s really quite mixed up 😂

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6. andthentherewashope
   July 8, 2017

   I’ve been giving this much more thought from the perspective of being a carer, person with bipolar and mental health nurse.

   As a nurse:

   In the UK, there are various teams that mental health nurses work in so whilst we share the fundamentals of caring, day to day activities/differing structures can vastly differ. Some diagnose and/or prescribe, some don’t. It depends on what level of experience you have and whether you have chosen to go down that route. For instance in some areas of the uk the first port of call for GP’s is to refer to ‘primary care liaison’ in the community. Nurses there gatekeep referrals to crisis teams and longer term community mental health teams through an assessment (often SBAR - assessing ‘situation, background, mental state assessment and recommendations’). This is where some nurses may diagnose and prescribe but not hold on to patients and refer back if low risk/can then be managed by GP so it’s all very much one off, maybe two or three contacts. If you’re an intensive team nurse, you’ll be visiting patients who are on the verge of hospitalisation - monitoring daily or twice daily mental state and supervising medication and arranging hospital admission if needed - the team gatekeep hospital beds. It’s intended to be short term and alternative to admission.

   If hospital is needed then obviously your role is somewhat different depending on what hospital service is needed - it may be a specialist eating disorder unit which requires an extremely structured approach to a general acute ward. Or mother and baby. Mostly working age adults have ‘functional’ diagnosis so go to general acute wards which is where very unwell patients go who have the most usual difficulties - psychosis, depression, personality disorder etc but are medium to high risk of harm to self or others. If unmanageable there then we have PICU (Psychiatric Intensive Care Units) for very high risk… if it’s an ‘organic’ mental illness as in the illnesses that come under the umbrella term of dementia then there are special wards for that, which obviously require a lot more physical care.

   As the 2 nurses interviewed have said it’s all about individual care planning based on what should be a thorough assessment of needs, formulation, risk assessment, physical assessment/welfare, medication management, and if inpatient or manager then leadership of your team. On inpatient you’re constantly reviewing and monitoring patients and staffing levels on a shift to shift basis and feeding back to/working with the multidisciplinary team - Consultant Psychiatrists, Ward Doctors and the wider team (psychology/court hearings/pharmacy/occupational therapy/CMHT and outside agencies such as housing/substance misuse providers/social care etc). Also advocating, writing reports (e.g.tribunal reports/attending hearings) and sometimes having to temporarily place patients on a section.

   Then there is involving carers which means aiming to build relationships, including anyone close to that person given consent, which can really get overlooked. Plus not only are you advocating for your patient, ensuring they are aware of their rights and making sure they have independent advocates and legal representation if they want/is warranted.

   Reflecting on your practice is crucial everyday.

   But…. throughout all of this, whatever area/speciality you’re in is the basics. Nursing is not just the above mechanical stuff. It is an art. We need to embrace the ‘6 C’s’ - Compassion, competence, care, courage, commitment and communication. Connect with our patients whatever their background, building a therapeutic relationship, with a non-judgemental approach (unconditional positive regard) demonstrating the basics of kindness, sensitivity, empathy and congruence (carl rogers core conditions for person centred care is what is taught mainly now as personal characteristics in a nurse - though when selected for nurse training they look for that anyway so shouldn’t need to be taught that!)

   For a long time there has been a focus on shifting from the medical model of care to the ‘recovery’ model. Many professionals are still confused about what the recovery model means and how that fits with the medical model. I’m being a bit political here but it’s actually very relevant to our role and is particularly a challenge in inpatient settings. On one hand we are playing the ‘psychiatric nurse’ role (paternalistic, illness focussed and frequently coercive) and the other a ‘mental health nurse’ (positive, health focussed and collaborative)… for example, trying to build a recovery focused therapeutic relationship with a patient you’ve just had to place under a nursing section is really rather tricky as one example of many. Not all patients lack insight so that’s easier in one way as it’s easier to work together. We sometimes find though that patients who want to be in hospital are better out of it and the ones that don’t want to be there are the ones that really need to be.

   So all in all, nursing requires good communication and assessment skills, be reflective and committed to learning all the time and be able to navigate all the stuff above!

   Anyway, I digress…. haha..

   The most rewarding part? Numerous. From simply making a connection, collaborating together to move forwards, seeing treatment work, drawing on therapies we’ve learnt from our training - CBT, DBT, Solution focussed brief therapy, motivational interviewing that is helpful in the here and now and skills for the future. Identifying relapse, crisis and contingency plans. All educational stuff to not only help now but hopefully in their future. Working on that stuff and seeing it in action is brilliant.

   The simple smiles, thank yous and occasional hugs during a 1-1 or anytime! That means so much. And of course, seeing people get better.

   How mental healthcare can be improved?

   Massively. More staff to spend time building relationships, more intense work and for safety. I actually disagree with the closure of so many inpatient beds. The fact is, as I see it (and personally experienced and witnessed) is patients having to travel hours away for a bed. Often these beds are in the private sector.

   As Shanna said, prevention needs a much bigger focus. We need the resources to, for example, go into schools and provide psych education. Even when a person does have a first episode of psychosis, if they receive early intervention it can reduce relapses by up to 50%. Yet funding is cut. Thresholds for services are high so people become more unwell…. so lowering those would be extremely helpful in my opinion.

   Therapy waiting lists are too long.

   Community mental health nurses have too many people on their caseloads.

   All mental health nurses should receive specialist training with personality disorders and many need to stop stigmatising them.

   We also need a bigger focus (and training) on physical health as does general nurses on mental Heath.

   What did you learn about mental health in school versus on the job?

   I felt I learnt a lot from my degree except I would’ve liked more focus on physical care - maybe a placement in a general hospital setting would’ve been helpful.

   I noticed a massive practice gap as in we were taught best practice and research skills to evaluate practice but out in practice it’s really not like that. All the official policies, nice guidelines, reports, research out there seem to say the same things for years yet little actually changes.

   How can patients advocate for themselves in their own mental health care?

   This is a tricky one… it really depends on their strength and knowledge at the time. It’s very hard navigating a system you’re not familiar with if you’re unwell so that’s when you need others. Once well in an ideal world, you’ll know when you need help before things get to crisis. Advance statements are good. Learning about your illness (or however you view your experience), triggers, treatment available, effectiveness of past treatments and your rights is invaluable. Sometimes you just need to have in place someone trusted to fight for you as services can be hard to access.

   Linking in with external support system is great and remembering that PALS can help you too.

   From my own experiences on the receiving end of mental health care:

   I’ve had mixed experiences being a service user and carer. A lot of it has been written about on my blog. The best nurses I’ve had are the ones that really listen, validate my viewpoints and address my needs, support my goals, forward plan, attentive, give the added extra of therapies they’ve learnt and are consistent! Although I was one of those patients sent hours away for inpatient treatment, it was really excellent care but it was private (funded by NHS due to lack of beds!). Lots of staff, therapy, daily activities etc.

   Trying to access care or have continuity have been major issues though and inadequate medication management/advocacy. It’s hard when you’re in crisis to get the help you need quickly - navigating the system can be hard but nurses could improve that. As a carer I’ve found that hard regarding adequate communication and high thresholds.

   Sorry for long post 😂

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