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Section 1: Forewords and Key Messages
Forewords
by the Deputy Minister for Health and Community Care
Mental Health is a major priority for NHS Scotland. We want to improve the quality of life and increase opportunities for social inclusion for people experiencing mental health problems and their families and carers.
We can take pride in our distinctive and rights-based mental health legislation in Scotland. The Mental Health (Care and Treatment) (Scotland) Act 2003 is rightly recognised as groundbreaking, rights-based legislation, and is admired throughout the world.
We can also take pride in our transformational policy for the NHS. Delivering for Health sets out a radical and progressive new vision for NHS Scotland and partner agencies and signals a new direction for services. It reaffirms our vision of better prevention, better health promotion and better services to meet the mental health and physical needs of people within their communities.
We now have all the ingredients for a new environment for mental health care in Scotland. An environment in which people with mental health problems are valued as full members of their communities, in which their rights are respected, and in which they and their families are supported by experienced mental health practitioners in all aspects of prevention, care and recovery. And an environment in which the support and contributions made by families and carers are truly valued.
Mental health nurses are the largest professional group in NHS Scotland mental health services. They have an enormously important role in shaping, changing and developing the culture of services. Service users highly value nurses' contribution, as do I.
We need to keep focused on the potential the Act sets before us and make sure the contribution nurses make is enhanced and developed as we move forward with mental health services in Scotland.
We want to ensure we can support and empower nurses to enable continual improvements in the experiences and outcomes of care by doing more of what is most helpful for service users and their families and carers. This will enable us not only to deliver more effective care and treatment, but also to increase the professional satisfaction of mental health nurses. That is what has driven this important review.
The review process has actively reached out to and engaged with people who often have limited opportunity to drive policy development. I welcome that involvement and participation, and I also welcome the positive direction set out in this report.
The accompanying action plan sets in train the momentum we need to develop our mental health nursing workforce. Properly delivered and maintained, it will make a significant contribution to shaping the services and processes we all want to see delivered for people with mental health problems, their families and carers.
Lewis Macdonald, MSP
Deputy Minister for Health and Community Care
by the Chief Nursing Officer
This is the first Chief Nursing Officer's review of mental health nursing in Scotland and is set in the context of innovative and progressive policy and service agendas.
This is an exciting time for mental health nursing in Scotland. We now have the ingredients and opportunities to enable us to progress a new era of mental health care and services, and mental health nurses will be central in enabling this to happen. This is therefore an appropriate time to review the contribution mental health nurses make and set out an action plan for developing the profession to take its place in the mental health services of the future.
The review and its report and action plan should be seen as part of a suite of initiatives designed to inform service development and new ways of working. Progress on delivery will only be made through the adoption of a service development, organisational and multi-disciplinary, multi-agency ethos.
The methodology used in the review maximised involvement and ownership of a range of stakeholders. The process successfully enabled joint and productive working among service users and carers, individuals holding senior organisational posts in the mental health field in Scotland and 'champion' practitioners, all of whom devoted considerable time and energy to shape the outcomes. We learned that regardless of the stakeholder group people might belong to, we share a common vision and want the same things for the future.
I had the privilege of chairing the review's Steering Group, so could see at first hand the enormous shared commitment and desire to improve services for people with mental health problems and their families and carers. The group's drive, energy and imagination have shaped this report and action plan - this is most definitely a piece of work that has service users, families and carers and mental health nurses at the centre and which has heard their voices loud and clear.
The review has enabled existing strengths and innovations in mental health nursing practice in Scotland - and there are many - to be explored and celebrated. It has also highlighted the challenges that lie ahead. Most importantly, it has identified the way forward to help us meet these challenges and grasp them as opportunities.
The action plan that accompanies this report now calls on everyone involved in mental health services to play their part. It is a wide and challenging agenda, but one that is achievable, and which must be achieved.
My challenge to mental health nurses is to own this report and drive implementation of the action plan. To do this, you need to positively exercise your accountability, voice, influence and leadership to bring about the changes you want for yourself and others, harnessing and strengthening alliances to make a difference. Be brave, challenging and productive in promoting service users' rights and recovery.
Paul Martin, RN, RHV, DMS, MBA
Chief Nursing Officer
by the Service User and Carer Reference Group and the Practitioner Reference Group
The policy context for mental health services in Scotland is admired all over the world. We now need to see cultural change to deliver our enlightened policy agenda for the benefit of service users, families and carers.
For too long, mental health nurses have known what they would like to do to improve service users' lives, but have sometimes felt constrained. The review of mental health nursing in Scotland now gives us the instrument to support, develop and liberate mental health nurses' undoubted skills and talents.
We have heard service users, carers and nurses throughout the review process tell us what they value most in a nurse, and the same messages come through time and time again.
People want nurses who care about them, who listen and engage with people, who spend time with them, who can develop relationships that inspire hope, and who can equip people with the skills and techniques they need to work towards recovery. The action plan developed from the review sets in place the strategic, managerial, education and practice infrastructure we need to ensure those kinds of nurses become the norm in mental health services.
One of the key ingredients in making the action plan happen in practice is leadership. We need nursing leaders at every level of the profession, not just the top echelons. We need leaders who show through example every day in their practice that they are committed to the agenda set out in the review and action plan and are prepared to challenge any obstacle to achieving their goals for service users and their families and carers.
'Hope' is an important word for us all. It encapsulates the aspiration of a better future, building on the strengths and aspirations of people using mental health services and enabling positive engagement with life. The review of mental health nursing gives us hope - hope of nurses doing more of the things that help people, hope of nurses adopting models of care that have been proven to be effective and reflect what service users and their families and carers know helps them most, and hope of nurses reaching new heights of professional satisfaction as they work together with service users, families and carers to create better lives for all.
Shaun McNeil
On behalf of the Service User and Carer Reference Group
Karen Robertson
On behalf of the Practitioner Reference Group
Our Key Messages
Culture and values - strengthening the climate for care
- Mental health nursing is focused on caring about people, about spending time with people, and on developing and maintaining helpful relationships with service users and their families and carers.
- We need to continue to develop rights-based and person-focused mental health care by promoting values and principles-based practice in mental health nursing.
- The recovery approach should be adopted as the model for mental health nursing care and intervention, particularly in supporting people with long-standing mental health problems.
- We need models of practice that are centred on relationships between mental health nurses and people, maximise nurses' contact time with service users, families and carers, and promote rights and recovery-based working.
Practice and services
- We need to support the development of mental health nurses' roles in priority areas of acute inpatient, crisis care and intensive home treatment services.
- In particular, we need to support and develop the role of mental health nursing in acute inpatient care.
- Mental health nurses will continue to have a key role in contributing to supporting people with long-term and complex mental health problems and need to adopt strengths-based approaches to working with people towards recovery.
- Mental health services and mental health nursing must make the support of older people with mental health problems a priority. We need to make sure mental health nurses are prepared and developed to deliver this.
- The role of mental health nursing in providing early intervention to people at risk of developing mental health problems needs to be developed and enhanced.
- Mental health nurses must continue to develop their roles in health improvement, health promotion and tackling inequalities.
- People who use mental health services want more access to 'talking therapies' such as psychosocial interventions and psychological therapies, but demand outweighs supply. We need to increase opportunities for mental health nurses to be developed to deliver these therapies.
Education and development
- We need to attract the right people into mental health nursing and make sure they are prepared in the right way. A national framework that will ensure consistency of content and standards throughout Scotland is necessary to achieve this.
- All mental health nurses, whatever their area of work, need opportunities to continue to learn and develop.
- We need to actively involve service users, families, carers and practitioners in the design and delivery of education programmes for mental health nurses.
- We need to develop the role of health care support workers in mental health, matching the roles and skills of heath and care workers to people's needs.
- Leadership is the key ingredient to realising the potential of mental health nursing in Scotland. We need nursing leaders at every level of the profession, not just the top echelons - people who lead through example in their practice and are prepared to challenge obstacles to achieving their goals for service users and their families and carers.
- We need to continue to strengthen capability for research and evaluation in mental health nursing.
- The mental health nursing community in Scotland is relatively small. It should be able to, and must, share and build on existing innovation on a national basis to inform developments. We need to develop a much more robust learning climate across the mental health nursing community, enabling innovations to be shared and a common approach to finding solutions to challenges to develop.
To make this happen
- Everyone involved in mental health services needs to play their part and work together to form strong alliances to bring about change.
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