Rights, Relationships and Recovery: The Report of the National Review of Mental Health Nursing in Scotland

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Appendix IV: Role focus, capabilities and contribution of mental health nursing to service delivery in relation to service tier and community and population needs

Service Tier/Community and Population Need

Role Focus of Mental Health Nursing

Mental Health Nursing Practice Capabilities
(adapted from The Capable Practitioner Framework. ( SCMH, 2001) Capabilities are applicable through each service tier levels 1-4

Tier 1
Community Health and Well Being in the Neighbourhood and Local Community

Prevention of mental health problems in high-risk groups.

Community awareness of psychosocial aspects of mental health impacting families and individuals.

Information on maintaining mental well being.

Anti-stigma and discrimination awareness and education and information about self help and other support services.

Public health and mental health promotion at various population levels including communities, schools, non-mental health workers, voluntary organisations and families and carers.

Anticipatory care with 'at-risk' groups.

  • Capable of understanding and applying the principles and practice of mental health promotion, including: the continuum of mental health promotion and prevention; the interplay between mental health and physical health.
  • Capable of increasing others' understanding of the wider implications of mental health promotion practice.
  • Capable of educating the public, communities, other disciplines and organisations, service users and carers about mental health and the role function and limitations of mental health services.

Mental Health Nursing contribution to service delivery (adapted from The Capable Practitioner Framework. ( SCMH 2001); and Promoting Psychosocial Interventions - a Strategy for Nursing (Brannigan, 2005)

  • Work with others to assess the prevalence and nature of mental health needs among local populations.
  • Advise, consult, educate, supervise and support non-mental health professionals, including education and social care workers.
  • Work with others to contribute to national public mental health initiatives (progressed via the National Programme for Mental Health and Well Being), including mental health awareness raising and stigma reduction, 'mental health first aid', 'choose life' and other prevention initiatives.
  • Develop and contribute to regional and local mental health improvement and prevention initiatives.
  • Contribute to the empowerment of individuals through information sharing and resource utilisation in a range of community settings, including schools and further and higher education institutions.
  • Engagement, information sharing and partnership working with self-help, user and family/carer forums.
  • Engagement, information sharing and partnership working with patient councils and other advisory and monitoring groups.

Service Tier/Community and Population Need

Role Focus of Mental Health Nursing

Mental Health Nursing Practice Capabilities
(adapted from The Capable Practitioner Framework. ( SCMH, 2001) Capabilities are applicable through each service tier levels 1-4

Tier 2
Primary, Health Care, Primary Care Mental Health Teams, Liaison Services, Out-of-Hours Primary Care Services

Mental distress and health problems caused by distressing life transitions and events, traumas and physical health problems.

Large proportion of the population presenting with problems associated with depression and anxiety in primary care.

Screening and recognition of people with more complex mental health needs who require support from secondary care services, and facilitating referral, access and links with services if required.

Consultation, education, support and advice to other health workers including primary care, A&E staff and acute general hospital workers.

Anticipatory care, prevention and early interventions with 'at-risk' groups.

The early detection of mental health problems such as postnatal mental health problems, eating disorders and dementia.

Preventive interventions to avoid unnecessary referral to secondary mental health care systems.

Delivering time-limited psychosocial interventions and psychological therapies in primary care and liaison services.

Supervising and supporting other workers in delivering interventions.

  • Capable of recognising and understanding various mental health problems from biological, psychological, social and spiritual perspectives.
  • Undertaking or participating in comprehensive, collaborative, holistic needs and strengths- based assessment.
  • Capable of identifying and collaborating with the range of local community, voluntary and health and social care resources available to service users and carers to assist them to attain or maintain quality of life.
  • Capable of participating in the provision of a range of evidence-based psychological therapies including systematic assessment of needs, negotiation of goals and targets and the evaluation of outcomes.
  • Capable of self-reflection, development and maintenance of skills and knowledge through continuing professional development activities.
  • Capable of communicating effectively with service users, carers and families and other members of the therapeutic team.
  • Capable of listening to service users and maximising opportunities for users, carers and families to be heard.

Mental Health Nursing contribution to service delivery (adapted from The Capable Practitioner Framework. ( SCMH 2001); and Promoting Psychosocial Interventions - a Strategy for Nursing (Brannigan, 2005)

  • Screening, assessment and diagnosis of people with, or at risk of developing, mental health problems.
  • Ensuring communication needs of service users and carers are met through utilisation of sensory aids, translators, interpreters, sign language, Braille, and advocacy.
  • Assessment of individual history: strengths, individual goals and resources; mental state, signs and symptoms; health and social care needs, including factors relating to impact of ethnicity, gender, social class and lifestyle; risk - self harm, neglect, harm to others or suicidality; functional needs; family needs - carers and dependants; complex social and co-morbidity needs; need for compulsory measures.
  • Facilitating the participation of users, carers and families in the development, delivery and evaluation of individual care plans.
  • Delivery of a range of short-term interventions and assisted self-help interventions at specialist and practitioner levels for service users with transient needs or moderate mental health problems.
  • Advice and consultation to non-mental health professionals.
  • Supervision and support of other disciplines in the delivery of assisted self-help interventions and modified psychosocial interventions and psychological therapies.
  • Early intervention and prevention strategies and interventions.
  • Mental and physical health promotion, including facilitation of physical health screening.
  • Referral to, and collaboration with, secondary care and specialist mental health services to meet the needs of service users with enduring and complex problems.
  • Partnership working with other agencies.
  • Training and education of others.
  • Collaboration with, and critical understanding of, the team, clinical work delivered by the team, services provided and outcomes to be achieved for service users, families and carers, skills in multi-disciplinary, multi-agency team working, professional boundaries and the willingness to flexibly negotiate these to provide individualised care.
  • Understanding of the roles, tasks, systems, structures and processes essential for multi-disciplinary, multi-agency team working.

Service Tier/Community and Population Need

Role Focus of Mental Health Nursing

Mental Health Nursing Practice Capabilities

(adapted from The Capable Practitioner Framework. ( SCMH, 2001) Capabilities are applicable through each service tier levels 1-4

Tier 3a
Secondary Mental Health Services including: Community Mental Health Teams and other community based services; Early Intervention Services; Crisis Care, Intensive Home and Inpatient care; Secondary Care Crisis Resolution Services

People experiencing acute episodes of mental health problems or who are at risk of relapse.

People with long-standing and/or complex mental health problems requiring ongoing support and treatment within secondary care mental health services.

Key roles as direct providers of care and interventions in a range of community and hospital-based settings.

Supporting people during acute periods of mental health problems in inpatient and intensive home treatment settings.

Care and case management role with people with long-standing and complex mental health problems.

Delivery of psychosocial interventions and psychological therapies using a stepped approach provided in various care settings.

  • Capable of participating effectively in multi-disciplinary, multi-agency team working across the statutory, independent and voluntary sectors.
  • Capable of participating in the development and documentation of written care plans either as the main case manager and co-ordinator or as a member of the therapeutic team.
  • Capable of participating in the provision of a range of evidence- based psychological therapies, including systematic assessment of needs, negotiation of goals and targets and the evaluation of outcomes.
  • Capable of implementing strategies to safely and effectively manage anger, violence and aggression, including de-escalation and conflict avoidance, negotiation and crisis resolution, breakaway techniques, physical control and restraint.
  • Capable of participating in and facilitating arrangements to address the physical health needs of service users by joint working with primary care.
  • Capable of facilitating choice about and concordance with effective treatments.

Mental Health Nursing contribution to service delivery (adapted from The Capable Practitioner Framework. ( SCMH 2001); and Promoting Psychosocial Interventions - a Strategy for Nursing (Brannigan, 2005)

  • Facilitation of engagement and therapeutic co-operation through the use of flexible and responsive engagement strategies for people with complex needs.
  • Where health needs of the service user are the predominant need, ensure seamless delivery of care by co-ordinating care and acting as the point of contact for the service user and carer, making use of other agencies, professionals and specialist services (such as crisis intervention, out-of-hours and social care services) as need demands.
  • Recognition of the health and social factors that precipitate acute relapse and crises, and the recognition and monitoring of early warning signs, working collaboratively with the service user and carers to identify individual relapse signatures.
  • Support and intervention for crisis resolution in the least restrictive setting consistent with effective treatment and safety, involving social and family networks of support and initiating strategies for recovery.
  • Identification of risk categories and specific risk factors while recognising and acknowledging individual strengths and opportunities for positive risk taking.
  • Participate in the complex care planning process surrounding care plans for hospital admission and discharge/transfer.
  • Establishment of safe and consistent mechanisms for continuing communication with service users when they disengage from services.
  • Implementation of a range of risk management strategies, including interventions to reduce the risk of suicide and self harm.
  • Supporting people managing medication and make informed choices about medication. Assessing the effectiveness of medication and intervene to manage unwanted effects.
  • Supplementary prescribing of medication within a psychosocial medication management framework.
  • Commitment in providing interventions which emphasise strengths, promote independence and enhance the autonomy of service users.
  • Arrange or provide a range of therapeutic, social, occupational and leisure activities, including group therapies based on individual preference and need.
  • Work with others to support and facilitate service users' opportunities to obtain meaningful and independent work where they can develop skills, receive an income and contribute to the community.
  • Contribute to community referral, or social prescribing.
  • Delivery of a range of interventions using a stepped approach such as relapse prevention, CBT, DBT, family interventions, problem solving.

Service Tier/Community and Population Need

Role Focus of Mental Health Nursing

Mental Health Nursing Practice Capabilities
(adapted from The Capable Practitioner Framework. ( SCMH, 2001) Capabilities are applicable through each service tier levels 1-4

Tier 3b
Specialist services (community or inpatient):

  • Children and Young People's Services
  • Addictions Teams
  • Eating Disorder Services
  • Forensic Services
  • Perinatal Mental Health

Tier 4
Highly specialised service for rare or particularly complex conditions provided on a regional basis:

  • Children and Young people's Services
  • Eating Disorder Services
  • Forensic Services
  • Perinatal Mental Health.

Role focus as for Tier 3a, with application to the needs of particular client groups or specialist service settings.

  • Capable of developing effective working relationships with service users, families and carers, including people who have disengaged from services.
  • Capable of diagnosis, treatment or care of service users, including the comprehensive assessment of mental and physical health needs initiating appropriate action and interventions to meet identified needs, prescribing and administering medications and other treatments, and monitoring and managing any adverse effects.
  • Capable of supporting people during transitions from secure to less secure environments.