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Section 4: Practice and services - understanding the issues and planning for the future
Matching the contribution of mental health nursing to service tiers, service development and community need
Mental health nurses practice within multi-disciplinary, multi-agency care environments in full engagement with the Joint Future agenda. 2 This is focused on promoting joint working primarily between health and local authorities to deliver better services to all people in the community.
Mental health nurses fulfil a range of core functions across a variety of service settings to meet the needs of people with different mental health needs (Box 5). They have a key contribution to make across all tiers of service provision, with the complexity of service users' needs determining the role focus at different tiers.
The review had to take account of workforce capacity issues and consider how best to match the role focus and skills of mental health nursing to community and population needs.
Work progressed during the review drew on existing capability frameworks (Sainsbury Centre for Mental Health, 2001; Brannigan, 2005) to map the role focus, capabilities and contribution of mental health nursing to service delivery in relation to service tiers and community and population needs. The outcomes of this work are presented in Appendix IV, which provides detail of the core general capabilities mental health nurses require to meet community needs and contribute to service delivery. This should usefully inform the design of pre-registration programmes and shape the focus of continuing professional development opportunities for mental health nurses.
Box 5. Core functions of mental health nurses. |
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- Providing care and interventions based on meeting people's physical, emotional, social, psychological and spiritual needs.
- Engaging people in care and treatment.
- Working with people to assess, plan, implement and evaluate programmes of care and support.
- Assessing risk and supporting the therapeutic management of risk.
- Creating and sustaining therapeutic environments in inpatient settings.
- Delivering psychosocial interventions and psychological therapies.
- Supporting people receiving pharmacological interventions, including medication management and prescribing.
- Providing case co-ordination and care management services, co-ordinating inputs from other professionals, services and agencies.
- Assisting people to connect with mainstream activities by working with a range of agencies outwith health and social care.
- Practising therapeutic management of a range of challenging situations, including aggression, violence and self harm.
- Adopting an illness-prevention, heath-promotion focused stance.
- Tackling health inequalities.
- Advocating for people, and supporting people's access to independent advocacy services.
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The pre-registration mental health nursing programme must recognise and value the variety of mental health nursing practice represented in Appendix IV, and post-registration development opportunities must support nurses to meet the needs of people in different service contexts.
Plans for workforce development have been progressed in children and young people's mental health and forensic mental health nursing, involving:
- induction to the area of practice
- progressive competency development frameworks
- opportunities for career pathways
- underpinning continuing professional development opportunities to enable skill and competency development and clinical career progression.
These kinds of opportunities must now be made available in all areas of mental health nursing practice.
Developing and enhancing the role and capability of mental health nursing in acute inpatient, crisis care and intensive home treatment services
Acute inpatient care
Acute inpatient care is an area of practice where the ability to deliver care and services based on the rights-based principles of the Act will be most tested and challenged. It is also the area in which mental health nurses sometimes feel most compromised in their ability to deliver rights, principles and recovery-focused care.
Lafferty and Davidson (2006) describe concerns (also expressed during the review process) that inpatient care is struggling against a culture of risk-averse, defensive practices. This serves to stifle some aspects of practice development and undermine efforts to meaningfully engage with service users and carers. There is a perceived risk that the prevention of untoward incidents and physical harm is becoming the sole focus of the nurse's role in inpatient care settings. While this is an important aspect of practice, nurses also have a critical part to play in supporting people to recover control of their lives.
External commentators of the review have suggested that 'what happens with acute inpatient care should be the barometer of evolution in mental health services in the future', and that reinvigorating the therapeutic role of nursing in acute inpatient care should be one of the outcomes on which the success of the review should be judged (Allan, 2005). Mental health nurses, service users, families and carers also gave a clear message to the review - there is a need to reshape/ remodel acute inpatient services to meet today's challenges.
Numerous reports (Sainsbury Centre for Mental Health, 1997, 2005 and 2006) produced over a number of years have highlighted areas for development in acute inpatient care, including the need for:
- improvements in environments in terms of size, mix of client groups, locality, provision of single-sex environments and enabling privacy
- structured activities and access to 'talking' therapies as alternatives or adjuncts to pharmacological therapies
- increased recreation and social activities
- service user involvement in their care and treatment being maximised
- actions to address staff morale and occupational stress to enhance the retention of skilled and experienced staff
- consistent and person-centred assessment and care planning systems
- good multi-disciplinary team working and inpatient and community team linking and working
- actions to address levels of aggression and violence, with a move from a custodial approach to observation towards an approach that maximises engagement and therapeutic contact time
- a shift in focus from managing organisational risk to the therapeutic management of individual risk
- robust structures for clinical leadership and increased access to education, training and career progression opportunities
- clear criteria and systems for admission and discharge to be developed.
A sub-group of the review specifically progressed work in relation to acute inpatient care, but issues they investigated are applicable across all inpatient mental health services, including children and young people's services, older people's services and continuing care and rehabilitation settings. Many of the issues they explored and their recommended actions reflect the pilot work taken forward by the Sainsbury Centre for Mental Health in the Searching for Acute Solutions projects (Sainsbury Centre for Mental Health, 2006).
There needs to be greater recognition of changes in the nature of acute inpatient care, which include increased levels of acuity of need and complex needs. For example, substance misuse is common among people with mental health problems and poses particular challenges in inpatient care.
There also needs to be greater valuing of and support for the highly skilled nature of working with people with acute mental health problems. Much education and training currently available in Scotland is not grounded in the work and challenges facing acute inpatient care. The Sainsbury Centre for Mental Health and NIMHE (Clarke, 2004) have produced guidelines on the education, training and continuing professional development needed for all members of the multi-disciplinary team working in acute inpatient care, including creative solutions to problems of releasing staff for training and maximising whole-team training opportunities. These should inform the creation of a national development programme for staff working in acute inpatient units in Scotland.
WE NEED TO:
- Create a national development programme for education, training and continuing professional development for acute inpatient care staff.
Working in partnership with multi-disciplinary, multi-agency team colleagues, charge nurses in acute inpatient care settings must be supported and enabled to have greater influence over activity in their wards, notably in relation to:
- decisions about admissions, discharges and transfers
- risk management activity
- the organisation of care to protect time for therapeutic contact.
Other disciplines have a responsibility to work with and support charge nurses to ensure that nursing resources are directed towards therapeutic contact time. Initiatives such as the Tidal Model (Barker, 2002) and 'refocusing' activities (Dodds and Bowles, 2001) outline approaches that help to direct nursing interventions in acute inpatient care in this way. Significant work has been undertaken in Newcastle, Birmingham and NHS Greater Glasgow on piloting the Tidal Model, with encouraging findings reported.
Benefits from these initiatives need to be more widely spread and adopted into practice. Good practice facilitators in mental health settings are well-placed to facilitate this through practice development initiatives aimed at implementing and sustaining change. A network for good practice facilitators would provide a suitable means of allowing exchange of information, evidence and opinion to develop this process even further.
WE NEED TO:
- Ensure all inpatient units develop models of care based on the principles of the Act and the recovery approach.
Developing the role of nursing in inpatient care necessarily depends on having adequate numbers of appropriately skilled staff to enable them to practice within the type of framework described above, maximising therapeutic contact time and initiating programmes of therapeutic group work. This is the kind of issue the National Workforce Planning Framework (Scottish Executive, 2005) was created to address (see Box 6).
Positive practice example
Person-centred care in practice - implementing the Tidal Model in inpatient care in NHS Greater Glasgow |
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The Tidal Model builds upon the nursing profession's core concepts of caring about people and is based on collaborative working that promotes people's strengths and attributes to bring about change in their own lives. The values of the model link well to the principles of the Mental Heath (Care and Treatment) (Scotland) Act 2003. Focused individual and group work promotes recovery-centred working. NHS Greater Glasgow has implemented the Tidal Model in several inpatient units across the city. Encouraging results have been found, including reductions in rates of physical and verbal aggression, self-harm, complaints and the use of restraint and observation. Additionally, nursing staff have consistently reported a greater sense of professional purpose and job satisfaction after the introduction of the model, and service users and carers are very positive about the recovery-focused approach and the opportunities the model provides for meaningful involvement in their care. For further information, contact Robert Davidson, Sector Nurse.
E-mail:Robert.Davidson@gartnavel.glacomen.scot.nhs.uk |
WE NEED TO:
- Ensure the workforce implications of models of care recommended in this report are accounted for in the production of workforce plans.
Box 6. National Workforce Planning Framework (Scottish Executive, 2005d). |
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The framework was published in August 2005 to allow NHS Boards and regions to plan workforce numbers for the future, aligned to service planning and financial planning arrangements. It introduced a planning cycle that will allow for a 'bottom up', evidence-based approach to future workforce planning and will help inform national decisions on future training numbers and supply. Workforce plans will help articulate the impact of a number of issues on future demand, including Delivering for Health and the Mental Health (Care and Treatment) (Scotland) Act 2003. |
Crisis care and intensive home treatment services
Acute inpatient care is part of a continuum of services aimed at supporting people during acute periods of distress. Significant progress is being made throughout Scotland in developing crisis and intensive home treatment services. They act as adjuncts or alternatives to inpatient care and nurses are playing a key role in their development and delivery. Evidence shows that such services can reduce the need for admissions and enable more people to remain in the community.
Delivering for Health has set a specific target to develop national standards for crisis services. These will provide a benchmark against which the development of flexible, responsive and appropriate services to meet the needs of individuals in crisis and their families can be measured. Crisis services fit with prevention, intervention and continuing care services.
We also need to ensure that the continuum of community and hospital-based services is 'joined up' in a way that supports people's transitions across different parts of services. New whole-systems approaches to working in mental health will enable this. Evolving models of 'in reach' and 'outreach' by community and inpatient staff to support people at transitional points of their journeys through services and provide continuity of care should be further developed and supported.
There should be planned rotation of staff across different service elements as the spectrum of services develops to increase integration and enhance staff development.
WE NEED TO:
- Support and develop whole-systems models that promote continuity of care across service boundaries for the service user, family and carers, with planned rotation of staff across different service elements.
Delivering for Health outlines nurses' potential to develop extended roles in unscheduled and acute care, including nurse-led admission clinics, nurse-led discharge and nurse-led services. New Ways of Working for Psychiatrists supports this change agenda in advocating development of nursing and other professional roles. Mental health nurses should be encouraged and supported to develop and extend their roles and contributions in this way.
To support this process, a managed knowledge and practice development network for mental health nursing that initially focuses on acute inpatient care before developing to embrace the spectrum of crisis care and intensive home treatment services should be developed. A progressive competency-based framework should also be established for work in this area, ranging from initial registration to consultant-level practice.
Strong professional leadership by practitioners working at advanced levels is needed to drive service and practice development in these directions, and nurse consultant posts should be developed to support this aim.
Positive practice example
Intensive home treatment and crisis intervention |
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An Intensive Home Treatment Team ( IHTT) has been established in NHS Forth Valley. Its aim, wherever appropriate, is to provide intensive care and treatment at home for people with acute mental health problems, rather than admitting people to hospital. The service, based on a multi-disciplinary, multi-agency model, operates extended hours over seven days. An evaluation of the IHTT conducted jointly with the Scottish Development Centre for Mental Health has shown that support from the team significantly reduces the likelihood of admission and enables earlier discharge from inpatient care. Occupancy of inpatient beds has reduced, and there is a high level of satisfaction about the service among service users and clinicians. The evaluation also shows that the IHTT is offering a recovery-focused alternative to hospital with high levels of user and carer involvement in decision making. For further information, contact Graham McLaren.
E-mail:graham.mclaren@fvpc.scot.nhs.uk |
The crisis intervention team in NHS Grampian is a nurse-led, out-of-hours service covering seven nights a week and weekends. The service aims to prevent hospital admission by providing a rapid response to a person experiencing a mental health crisis, enabling the person to remain within his or her own environment whenever possible. Service users have access to the crisis service via a direct-line number, which enables them to feel there is someone at the end of a phone who will respond quickly, and support is also provided for families and carers. The team accepts referrals from GPs, the police, social workers, NHS24 and others for people experiencing a crisis who are not currently service users. The team works alongside out-of-hours emergency doctors and liaises closely with acute hospital at night and daytime services to ensure a seamless service and that appropriate follow up is provided during the working day. For further information, contact Paula Hall.
E-mail:paula.hall@pcrc.grampian.scot.nhs.uk |
Positive practice example
Whole-systems ways of working |
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The perinatal mental health service in NHS Greater Glasgow provides a comprehensive service for women and their infants and families. Staff nurses are rostered to work each week across the spectrum of services in the inpatient unit and community. This means the service and key worker follow and support women across their entire care episode, enabling continuity of care and support. For further information, contact Clare Donnelly, Clinical Nurse Manager.
E-mail:Clare.Donnelly@glacomen.scot.nhs.uk |
In NHS Highland, a transitional discharge pilot has been completed in collaboration with Stirling University, with encouraging results. The transitional discharge model is well established in some parts of Canada and involves the nurse who cares for an individual during an inpatient stay maintaining involvement during the transitional period after discharge while the person establishes a relationship with community staff. The Highland pilot also included volunteer peer support for people post discharge. The outcome of the pilot produced evidence that transitional care was effective in reducing readmission rates. For further information, contact Tom Allan.
E-mail:Tom.Allan@hpct.scot.nhs.uk |
WE NEED TO:
- Develop a managed knowledge and practice development network for mental health nursing, initially focusing on acute inpatient care.
- Develop a progressive competency-based framework for mental health nurses working across the spectrum of acute inpatient, crisis care and intensive home treatment services, ranging from initial registration to consultant-level practice.
- Create nurse consultant posts to lead the development of mental health nursing's contribution across the spectrum of acute inpatient, crisis care and intensive home treatment services.
Enhancing capability in services for people with complex long-term health problems and older people
Complex long-term health problems
Delivering for Health emphasises the need for multi-disciplinary, multi-agency services for people with long-term health problems. It also promotes measures to improve people's self-management capacity and enable service users and their families and carers to take greater control over their own care. These priorities are already the foundations for much mental health nursing practice in community settings.
The 'strengths' model of case management has been used by assertive outreach teams in the UK and has been widely applied in New Zealand as the preferred approach to case management in supporting people with long-standing mental health problems. The model is evidence based and has been subject to several studies that have produced consistently positive results in comparison with other models of case management. Benefits include reduced hospitalisation, increased quality of life and social functioning and increased access to social supports (Marty et al, 2004; Rapp and Goscha, 2006).
The key principles and functions of the strengths model of case management provide a framework that should inform the roles of mental health nurses (and the focus of whole teams) in supporting people with long-term health problems in the community (Box 7).
Box 7. The 'strengths' model of case management. |
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- Focus on strengths rather than deficits.
- The community is viewed as an 'oasis' of resources - the emphasis is on engaging people in existing community services rather than 'disability' services.
- Interventions are based on the principles of client self determination.
- The case manager/client relationship is primary and essential.
- Staff should outreach to see people in their own and preferred environments.
- People have the ability to continue to grow, learn and change.
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There is an important link between social justice, social capital and mental health. Mental health nurses, particularly those working in the community, are well placed to identify and respond to social needs. This part of their role is likely to become even more important in the context of emerging care and case management roles mental health nurses will fulfil in integrated health and social care teams. The strengths model of case management provides a useful framework to enhance this.
Developments in the support of people with long-term health problems are contingent on new ways of working across multi-disciplinary teams. The New Ways of Working for Psychiatrists framework signposts the need for service redesign to move towards more person-centred care models and the use of tools such as the 'capable teams toolkit' to enable teams to reflect on their key functions and make best use of the expertise of all concerned.
Older people
Delivering for Health sets out the health challenges Scotland's ageing population will pose over coming years. Mental health services and mental health nursing must make the support of older people with mental health problems a priority, backed by appropriate competency development, education and training activity and leadership through the creation of nurse consultant roles.
A substantial amount of mental health work in Scotland currently involves supporting people with dementia and their families and carers, and a dramatic increase in the number of people affected by dementia is expected. There needs to be greater consistency in the quality of care available in dementia services across Scotland, and nurses could do much to reduce current divergence.
Much of the care offered to people with dementia in care home settings is provided by care assistants or general nurses. There are opportunities to continue to support and enhance this important area of care through enabling staff in this sector to access mental health nurses' knowledge, skills and experience for clinical advice, education and support.
Many examples of positive and innovative practice submitted during the course of the review illustrate mental health nurses' key role in providing support and education to other workers. Mental heath nurses also provide education and counselling support to families and carers, particularly in the early stages of dementia. Such practice should be disseminated and built upon nationally.
The Scottish Executive funds the Dementia Services Development Centre at the University of Stirling to support and provide multi-disciplinary, multi-agency education initiatives, and these should continue to be promoted.
WE NEED TO:
- Develop a progressive competency-based framework to support skills escalation for mental health nurses working in older peoples' mental health services, from initial registration to nurse consultant- level practice.
- Create nurse consultant posts to lead the development of mental health nursing's contribution to older people's mental health services.
Developing capability in anticipatory care, prevention and early intervention
Delivering for Health stresses the need to promote anticipatory care focused on providing early intervention to at-risk groups. Early intervention approaches are applicable in supporting people with a range of mental health problems. They emphasise mental health workers' contribution to mental health promotion, supporting people during their first experience of problems and first contact with services, and supporting families and carers.
Mental health nurses also play a key role in early intervention to both prevent admission to hospital and prevent referral into the secondary care system. Early intervention is embedded in recovery-based and strengths-focused approaches. It emphasises preventing and minimising crisis and relapse and enhancing people's resilience and self-help strategies. The principles of early intervention should be embedded in the practice of all mental health nurses, regardless of the service context within which they operate.
The role mental health nurses play, and should continue to play, in liaison services are also key - for example, in liaison roles in primary care, general hospitals, accident and emergency services with people who self harm and in the early detection of dementia in older people. Mental health nurses can make very positive contributions to the care of people with physical health problems accessing these services, and their contribution and capability within a broad spectrum of liaison services should continue to be developed and enhanced.
Positive practice example
Anticipatory care and early intervention |
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Anticipatory care with people experiencing homelessness People who experience homelessness also experience inequalities in relation to their physical and mental health. Moving into Health is a joint initiative involving West Lothian Council and NHS Lothian (West Lothian Division) in which a team of community mental health nurses, using the principles of assertive outreach, provide open access to health assessments for people who are, or are at risk of becoming, homeless. The service includes a comprehensive programme of health assessment and promotion, support plans for homeless people and education of other workers supporting homeless people. For further information, contact Gillian Wilson.
E-mail:Gillian.Wilson@westlothian.gov.uk |
Early intervention in accident and emergency liaison A significant number of people present at accident and emergency (A&E) departments following deliberate acts of self harm, but many leave without a comprehensive psychosocial assessment. Improved services for people who self harm lead to better detection and support for people at risk of suicide. A nurse-led initiative in NHS Forth Valley has been developed to offer assertive follow up to all people leaving A&E following acts of self harm, including a comprehensive assessment and access where appropriate to solution-focused therapy. For further information, contact Susan McConachie.
E-mail:susan.mcconachie2@fvpc.scot.nhs.uk |
Enhancing capability in health improvement, health promotion and tackling inequalities
People with long-term mental health problems have higher rates of physical ill-health and a lower life expectancy than the general population. Historically, people with mental health problems have been disadvantaged in accessing health promotion advice and health screening in relation to physical health (Scottish Executive, 2005e).
Improving the physical health status of people with mental health problems is one of the actions outlined in the mental health delivery plan in Delivering for Health. The health improvement agenda is also at the heart of community health partnership developments and is an area where mental health nurses should play a considerable role.
The links between positive mental health and positive physical health are well recognised, and mental health nurses are suitably placed to promote and enhance the physical health and well being of people with mental health problems. This should be a prominent feature of the role of all mental health nurses, regardless of service context within which they practice.
Similarly, efforts should be made to ensure that nurses in other branches of the profession (adult, learning disability and children's) and midwives are aware of mental health issues for people accessing their services. This should be considered by the reviews of nursing and midwifery's contribution in relation to Delivering for Health and nursing in the community being taken forward by the Scottish Executive.
Several positive and innovative practice examples submitted to the review show mental health nurses effectively promoting physical health and tackling health inequalities faced by people with mental health problems. They include:
- supporting people to access primary care services for health screening and health advice
- using exercise, health promotion work and meaningful occupation activities in inpatient and forensic mental health services as a means to improve mental and physical health, self-confidence and self-esteem
- implementing smoking cessation support
- engaging in 'community referral', or 'social prescribing'.
Positive practice example
Health improvement, health promotion and tackling health inequalities |
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The East Ayrshire Well Person Service in NHS Ayrshire and Arran and the Health and Well Being Clinic at the Riverside Resource Centre in NHS Greater Glasgow are nurse-led initiatives aimed at tackling physical health inequalities experienced by people with long-standing mental health problems. Both services provide a systematic, holistic and comprehensive approach to improving the physical and mental health of people, incorporating a range of interventions including health screening, health promotion and the management and treatment of physical health problems. The initiatives emphasise a socially inclusive and collaborative approach which involves a number of agencies including primary care, organisations offering smoking cessation support, drug and alcohol services and specialist practitioners in the management of particular physical health problems. Emphasis is also placed on detecting physical health problems associated with medication, such as identifying unwanted effects and supporting people to manage their medication. Both services have led to the detection and treatment of previously unidentified physical health problems experienced by people with long-standing mental health problems, and have created an enhanced health improvement role for practitioners. For further information, contact Samantha McEwan or David Law.
E-mails:
Samantha.mcewan@aapct.scot.nhs.uk
David.Law@glacomen.scot.nhs.uk |
Community mental health nurses, in particular, are well placed to develop roles in community referral (see Box 8), maximising service users' access to recovery by promoting support within their local communities. Recent work progressed on behalf of the National Programme for Improving Mental Health and Well Being makes several recommendations to fully integrate community referral as a patient pathway for primary care practices in Scotland. Potential exists for similar initiatives in secondary care mental health services (Scottish Development Centre for Mental Health, 2005).
Box 8. Community referral. |
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Community referral (also known as social prescribing) aims to promote social inclusion by strengthening the provision of and access to socio-economic solutions to mental health problems by linking people with sources of support in the community which might lead to opportunities to engage in: - creative arts
- physical activity
- learning and volunteering
- mutual aid
- befriending
- self help.
It also offers support on a range of issues including legal advice, benefits advice, and support with parenting issues. |
WE NEED TO:
- Develop mental health nursing's contribution to community referral.
Mental health nursing's role in health improvement, health promotion and tackling inequalities should be further developed, with existing good practice evaluated and disseminated to inform learning and practice nationally.
Mental health nurses should also be encouraged to recognise and deal with symptoms of physical and psychological ill health among carers. Programmes of carer education and support should be provided to alleviate symptoms, backed by an adequate allocation of resources to support the nurse-carer alliance.
Enhancing capability in increasing access to psychosocial interventions and psychological therapies
Scottish mental health legislation makes it clear that all service users have the right to expect and be able to access a range of interventions and support to aid their long-term recovery.
Service users and professionals view 'talking therapies' as a key part of delivering recovery-centred services and treatment, and the literature review commissioned by the CNOs in England and Scotland to accompany the review have established the efficacy of a number of psychosocial interventions and psychological therapies (see Appendix III for a summary).
Despite national initiatives aimed at increasing capacity to deliver such services, demand across all care groups far outweighs supply. The National Mental Health Services Assessment (Grant, 2004) noted positive moves to train a range of clinical staff in psychosocial interventions and psychological therapies in many NHS Board areas, but this was not found to be happening systematically across the country.
Mental health nurses in Scotland have made significant progress in developing and extending their skills in psychosocial interventions and psychological therapies, but more needs to be done. Access to training should be increased and progressed in the context of service development alongside robust infrastructures that support dissemination of skills into practice and ensure the necessary governance arrangements for quality assurance and clinical supervision are in place.
It is important that psychosocial intervention and psychological therapy skills are developed within all areas of mental health nursing, and not only within specialist services and roles. For that reason, a stepped approach should be adopted in which all nurses have opportunities to develop their skills, with some progressing to advanced levels.
There is also a need for nurses with expert skills in psychosocial interventions and psychological therapies. Where nurses with these levels of skills practice in Scotland, they have been key in developing the capability of the wider nursing workforce and ensuring that the training, support and supervision infrastructure is in place to ensure skills are developed and disseminated into practice.
Positive practice example
Increasing access to psychosocial interventions and psychological therapies |
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A nurse-led strategic approach has been taken to increasing access to psychosocial interventions for people experiencing psychosis and their families and carers in NHS Ayrshire and Arran. Using a stepped approach to training, psychosocial interventions have now been embedded into the everyday practice of mental health nurses working in community mental health teams in East Ayrshire. A model of clinical supervision and professional development has been created to ensure skills are disseminated into practice. For further information, contact Maria Gilfedder.
E-mail:Maria.Gilfedder@aapct.scot.nhs.uk |
There is a pressing need to improve access to psychological therapies for people during their stay in acute inpatient units. A nurse-led initiative in NHS Argyll and Clyde enables people to access psychological assessment and therapies during their admission, helping them to increase their understanding of their problems and explore psychological treatment options that will support their ongoing coping and recovery. Nurse therapists also provide training, supervision and support to the wider nursing team to promote psychological thinking and embed psychological therapies into practice. For further information, contact Kate Sloan or Theresa Kelly.
E-mails:
Kate.Sloan@renver-pct.scot.nhs.uk
Theresa.Kelly@renver-pct.scot.nhs.uk |
WE NEED TO:
- Support mental health nurses' contribution to psychosocial interventions and psychological therapies services using a stepped approach to competency development.
- Create nurse consultant posts to lead the development of mental health nursing's contribution to psychosocial interventions and psychological therapies services.
Some NHS Board areas have developed strategies to mainstream mental health nurses' capability in delivering psychosocial interventions and psychological therapies. The strategy developed by Brannigan (2005) for NHS Greater Glasgow outlines a tiered approach that could usefully inform the effort to enhance capacity and capability in this area on a national basis.
Enhancing capability in nurse prescribing
Enhancing the capability of nurses in supplementary and independent prescribing is a strategic objective of the Scottish Executive and is currently being supported via education initiatives. As yet, developing mental health nurses' roles in nurse prescribing is in its infancy in Scotland.
Any future development of mental health nurses' prescribing roles must be grounded in the context of a broader medication management approach that focuses on making sure people have the information and education they need to understand their medication and make informed choices about their treatment, and supports people to manage unwanted-effects of medication.
Research evaluating the outcome of nurse prescribing in mental health is extremely limited. Evidence that exists and consultations carried out for the review suggest positive and negative implications.
On the positive side, nurse prescribing may increase service users' access and choice in medications and improve detection and management of unwanted effects. It may be cost-effective and seems to sit well with service redesign and professional role change initiatives.
On the negative, there is a perception that current nurse prescribing courses in Scotland are not designed to meet mental health nurses' needs. Service users have expressed some concerns about mental health nurses' skills and knowledge base to support prescribing, which may be lacking in subjects such as psychopharmacology and polypharmacy. The costs of mental health nurse prescribing are unknown.
The Mental Health Nursing Forum, which acted as the Expert Reference Group for the review, has undertaken exploratory work on enhancing the role of nurse prescribing in mental health. In addition, the Scottish Executive is developing a national framework for nurse prescribing.
WE NEED TO:
- Develop mental health nursing's contribution to nurse prescribing.
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