"Playing our part - the work of mental health nurses" is the title of some work being undertaken by the Foundation of Nursing Studies (www.fons.org) on the present and future work of mental health nurses. Emeritus Professor Tony Butterworth CBE, Chairman of the Foundation of Nursing Studies, explains in his blog "Mental health nurses– working with purpose in primary care?" 

Mental health nurses– working with purpose in primary care?

What are we trying to do?
Outputs from this blog will contribute to a report to be produced by the Foundation of Nursing Studies (www.fons.org) at the end of 2016 on the present and future work of mental health nurses. As a graduate profession, mental health nurses must now be confident enough to offer a constructive debate about their work rather than playing a limited part in policy development and service re-design. We hope the approach used in Playing our part will allow us to think differently by asking purposeful questions and sometimes we will allow ourselves to think disruptively! We want to put mental health nurses in a place where they can proactively contribute to service delivery.
This first blog is to stimulate early discussion towards developing a contemporary view of the work of mental health nurses and their potential for working in primary care. Secondary and tertiary care will be considered in later blogs and all outputs will be used to inform round table conferences from July onwards.

What’s our approach?
Working within a public health and preventive model of psychiatry allows us to test the actual and potential work of mental health nurses. Traditionally they are thought of as working in in-patient settings, early intervention services and recovery, it could be argued that this focus is limited. There should be a shift of view in which mental health nurses become more purposefully involved in primary prevention (stopping it happening) and secondary prevention (catching it early) rather than just tertiary prevention (intervention, treatment and recovery). If this is the case, are education providers and commissioners willing to re-examine their curriculum? Who might employ them and what will their career pathway look like? Will the Nursing and Midwifery Council have a view on this?

Question 1. Is this a valid and useful way of thinkingabout the work of mental health nurses?

Question 2. How can we improve career pathwaysfor mental health nurses working in primary care?

The demand for mental health nurses working in primary careand primary prevention.
There are growing pressures to think purposefully about mental health and primary prevention. Discussions generated through Playing our part should help us determine the place of mental health nurses in such work. It is certainly at the top of policy makers and service designer agendas. Both left and right of the political spectrum have offered recent views on the importance of primary care. The Reform think tank has suggested that General Practice is overwhelmed with people who might well be better managed by ‘non-doctor clinicians’. The Government has promised to put additional investment into General Practice in England and part of this investment is likely to be put towards the better management of primary prevention and mental health. Interestingly there is talk of employing more mental health ‘therapists’ in primary care, yet previous attempts to use graduate mental health workers had only limited success and there are very few now in practice. Equally, initiatives using IAPT and Psychological well-being practitioners have been uneven with mental health nurses now picking up some of that work. Surely, this is where mental health nurses can play an important and increasing role? Although not asked for by name, mental health nurses might well offer an answer to pressures in primary care others have yet to consider. 

What do they already do and what more might they do?
It might be useful to relieve work pressures on General Practitioners and primary care services but it is also important to purposefully engage mental health nurses in integrated health prevention through early detection of potential self-harm, peri-natal care, alcohol misuse as well as diet and exercise. Active community engagement in developing recovery assets offers a fascinating opportunity for co-production and mental health nurses might lead on this. There are examples of them already working in primary care as liaison nurses, undertaking street triage, working with emergency services and the police as well as running community -based medication clinics. This is good work that can be further extended.
Large numbers of people attending general practices have psychological as well as physical illness. Anxiety, depression and more general somatic disorders can be expertly managed by mental health nurses and locating them in community and primary care settings allows early intervention with these difficult disorders.Research would suggest that working with individuals showing early signs of dementia is much more productive than waiting for increased problems of daily living and behaviour. Many people who have had previous episodes of mental ill-health attend general practice. Primary care and thus primary prevention is a proper place for on-going support from mental health nurses for those with continuing mental ill-health and chronic conditions.

Question 3. Is this an accurate and complete description of the present work of mental health nurses in primary care?

Question 4. Are we missing something here – what else do you know and can share?

Who will employ them?
This is difficult and will depend in which country mental health nurses work. Given that general practice is largely a small business enterprise then would they want to employ mental health nurses? If, as in England there are commissioners then what help can they bring and what persuasions can they bring to bear? It might not be helpful for them to hold contracts with mental health trusts but if not them, then who? General practice nurses, health visitors and community nurses are good practice partners for mental health nurses but their own employment arrangements do not always offer useful examples. New arrangements may be needed.

What models of practice supervisionmight be needed?
Clinical supervision is critically important for mental health nurses working in primary care and primary prevention. A recent editorial in the JAN laments the poor implementation and spread of clinical supervision by nurses and renewed efforts to use it are necessary for those undertaking new ways of working. Their more independent practice requires closer scrutiny and support.We would hope that Playing our part will help to re-stimulate the wider use of clinical supervision.

Question 5. What are the likely issues of employment and do good existing and alternative examples exist?
Question 6. How can clinical supervision for mental health nurses be more purposefully and constructively used?
Question 7. What if any continuing professional development might be needed to begin to place mental health nurses in primary care and prevention now?

And finally -

Question 8. For mental health nurses to properly play their part in co-designing policy and service development do they need a dedicated College of Mental Health Nursing to support them?  

Please join @FONSCharity @WeMHnurses and @WeNurses on May 9th at 8pm to discuss the blog post above and explore some of the questions posed