Introduction by the Chief Nursing Officer
Rights, Relationships and Recovery ( RRR) is as relevant to mental health services in Scotland now as it was when it was first published in April 2006 and will remain so as we move forward into the future.
The reason for this is clear. In promoting a values-based, rights-based, recovery focus for mental health nurses, RRR anticipated the patient-centred, safe and effective underpinning that is now the aspiration for all in health and social services. The ethos, actions and approaches it advocates mirror and complement those of the Healthcare Quality Strategy for NHSScotland, which is the central driver for improving service users' experiences and outcomes in the NHS.
This is about providing care that is responsive to individual personal preferences, needs and values and assuring that patient values guide all clinical decisions. It is about developing mutually beneficial partnerships between service users, carers and those delivering services that demonstrate compassion, continuity, clear communication and shared decision-making.
When I read these words taken from the quality strategy, I could easily be reading RRR. If anyone doubts that, just take a look at Box 4 on page 21 of the RRR report (reproduced opposite), which sets out the underpinning elements of models to guide mental health nursing practice. The read-across is unmistakeable, reassuring and inspiring.
Models of mental health nursing practice - from Rights, Relationships and Recovery: the report of the national review of mental health nursing in Scotland
Models of mental health nursing practice need to:
- acknowledge and promote people's central role in assessment of their own care needs and in planning and evaluating care, decreasing their need to rely on formal services and support
- respect people, value their contributions and views and preserve their dignity
- focus on people and maximise individual choice
- enable people to take greater control of their lives and instil hope and belief that recovery is possible
- encourage people to retain or regain social networks, work, education and community connections as early as possible
- build on people's strengths and aspirations, emphasising strengths rather than deficits or dysfunction
- foster partnerships between people who need support and people who support them
- acknowledge the key role played by families and carers in the person's recovery
- shift the emphasis of mental health nursing interventions and services from managing organisational risk towards therapeutic management of individual risk.
This RRR report, Keeping Going!, sets out how significant a part RRR is playing, and must continue to play, in supporting services to put the quality strategy into action. It shows how mental health nurses across the country are adopting the ethos and approaches advocated by RRR and the quality strategy, and how they are responding flexibly to service user and carer need to develop partnerships and improve experiences and outcomes. This is being driven from a strong education base, with a new framework for pre-registration education and training packages on the Ten Essential Shared Capabilities (10 ESCs) and recovery approaches being accessed by students and staff throughout Scotland.
But adopting a values-based, rights-based approach isn't necessary only for frontline practitioners. It must permeate through entire organisations, reaching and influencing every level. That's why, along with colleagues from the Chief Nursing Officer Directorate of the Scottish Government, I undertook training that has been developed through RRR on the 10 ESCs and values-based practice. This training has helped us to think about our own values within the Directorate and to reflect on how we can help to develop person-centred approaches in policy and practice. My grateful thanks go to Steve Wright and Lynn Murray from NHS Ayrshire & Arran, who delivered the training, and to my colleague Hugh Masters, who organised the session.
Mental health nursing needs to be at the heart of approaches to improving service users' and carers' experiences and safety. The wider service can learn much from mental health nursing in terms of adopting partnership approaches with service users and carers, about placing them at the centre of care and about responding positively to the things that they, and not the professionals, identify as being important.
RRR recognises that nothing stands still in health care and that it is important for mental health nurses to keep themselves up to speed with best practice developments. RRR consequently set up PIRAMHIDS, "Positive and Innovative Resources: a Mental Health Interactive Database (Scotland)", which we are continuing to support and maintain. This online resource offers a portal through which practitioners and others can share their good practice and help to build a solid and broad evidence base for mental health nursing. PIRAMHIDS stands as a strong example of how the original call in RRR for a more robust climate for learning and development, evaluation and research is coming to fruition in Scotland.
RRR also supports the drive to promote new ways of working in health and social care in Scotland. The refreshed action plan for RRR, published in 2010, called explicitly for new whole-systems ways of working to be developed and implemented to enable continuity of nursing care across service boundaries and elements. This reflects RRR's strong focus on helping people to work across traditional boundaries, concentrating their efforts on supporting service users and carers in all the multiple facets of their lives.
We have seen real changes in the way mental health services have been configured over the last five years, particularly in acute care settings, with the advent of intensive home treatment teams and other nurse-led initiatives. These services are not only reducing hospital admissions in line with HEAT targets, but are more importantly providing people with mental health problems and their carers with new and accessible supports.
Clinical supervision remains central to supporting modernised mental health nursing practice and is key to nurturing and sustaining person-centred, values-based and rights-based approaches. We will be doing all we can to ensure that RRR's aspiration of access to regular clinical supervision for all mental health nurses is achieved and maintained.
RRR is an initiative that encapsulates many of the aspirations we now have for NHSScotland. It is also a challenging initiative, calling as it does for changes not only in what mental health nurses do, but also in how they think and feel. It is to the enormous credit of the mental health nursing community in Scotland, in practice, management, education and research, that they have taken on the challenges posed by RRR and seized the opportunity to develop themselves, their service and, ultimately, the quality of care offered to service users and carers.
While the refreshed RRR action plan officially closes at the end of 2011, I implore all mental nurses in Scotland to stay in it for the long run and ensure that the excellence RRR is creating becomes the norm for the future.
Ros Moore Chief Nursing Officer for Scotland