Editorial
Mental health nursing: getting the message across you are ill, you expect to be treated and cared for Iare fbydoing, skilled professional staff who know what they i.e. staff who have been trained for the job.
In the UK these fundamental principles are becoming increasingly more difficult to achieve. Nowhere is this more evident than in mental health nursing. The drastic decline in the number of people training to be mental health nurses over the past decade has worrying implications for the future mental healthcare of this country. In parallel with this alarming trend, the demand for services continues to increase. As the population ages, evidence suggests that the in cidence of chronic illness such as Alzheimer’s disease is rising. New problems are defined in psychiatric terms, e.g. post-traumatic stress disorder, and new clinical pri orities are being identified, such as HIV-related demen tia. These developments are taking place against a back cloth of inadequate strategic planning, where mental health services remain a low priority and society fails to understand and respond to the needs of mentally ill people. Identification of needs
The introduction of market forces into the health service is expected to greatly improve this situation by maximiz ing efficiency and effectiveness. Health needs are being identified and matched to the resources available, prior ities are being set and those in greatest need are being targeted. Obviously when demand always exceeds supply there has to be some form of rationing and diffi cult choices and decisions must be made. The major problem with competing pressures and rationing of services is determining where the available resources are best directed. People with severe mental illness are often considered to be the most deserving of scarce resources and those with less serious illnesses are considered ‘undeserving’. These are uncomfortable decisions to make since they involve value judgments and discrimination. Of course, the direct provision of treatment and care to the severely mentally ill must remain a central activity of mental health nurses since they have a distinctive con tribution to make. However, they could also use some of their time carrying out consultancy work with other district nurses, health visitors and different professional groups, delivering care to those with any form of mental distress. We know that more than 5 million people consult their GP each year because of mental ill health, and that it is the most common reason for consultation: it accounts for at least 15% of all consultations and is re sponsible for the loss of nearly 57 million working days (Jacobson ct al, 1991). British Journal ol Nursing, 1992, Vol 1, No 7
At long last this evidence has been heeded and policy makers have been persuaded that mental ill health needs to be pushed up the priority rating scale and seriously targeted. The Government’s White Paper (HMSO, 1992) specifies mental illness as one of the five priority areas to be targeted with the aim of improving the na tion’s mental health. Government review
In addition the Government’s review into mental health nursing could not be more timely. It provides an ideal opportunity to address these key issues, particularly re cruitment problems, the potential shortage of qualified mental health nurses and the identification of a future workforce. Cost-effectiveness is bound to be on the agenda and various options for improving management arrangements and diluting skill mix will be reviewed. Given that the demand for mental health services will increase, it is essential that these options are explored. This needs to be done in the knowledge that cutting back on qualified staff is not always equated with effi ciency, since the use of unqualified staff may result in reduction of quality. Qualified mental health nurses are necessary for the provision of quality patient care. In considering value for money it is important that the true value of mental health nurses is recognized and properly acknowledged. Our strength lies in our clinical expertise and skills; the potential shortfall in mental health nurses demands that these relatively expensive and scarce skills are properly used and that the dissemi nation of mental health nursing expertise to other pro fessions and agencies is increased. There has never been a better time to develop maxi mally efficient methods of delivering mental health nurs ing care, nor for innovative role developments, such as the clinical nurse specialist and the nurse consultant. It is important that the Government’s review panel recog nizes the value and potential of mental health nursing and we must sec that they are properly informed. Ben Thomas Chief Nurse Advisor/Director of Quality The Bethlcm Royal Hospital and the Maudsley Hospital Special Health Authority Honorary Lecturer Institute of Psychiatry London HMSO (1992) The Health of the Nation: A Strategy for Health in England. HMSO, London Jacobson, B, Smith A, Whitehead M, eds (1991) Preventing Mental III Health in the Nation’s Health: A Strategy f° r the 1990s. A Report from an Independent Multidisciplinary Committee, King Edward’s Hospital Fund for London, London
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Downloaded from magonlinelibrary.com by 154.059.124.102 on January 10, 2019.
Mental health nursing: getting the message across you are ill, you expect to be treated and cared for Iare fbydoing, skilled professional staff who know what they i.e. staff who have been trained for the job.
In the UK these fundamental principles are becoming increasingly more difficult to achieve. Nowhere is this more evident than in mental health nursing. The drastic decline in the number of people training to be mental health nurses over the past decade has worrying implications for the future mental healthcare of this country. In parallel with this alarming trend, the demand for services continues to increase. As the population ages, evidence suggests that the in cidence of chronic illness such as Alzheimer’s disease is rising. New problems are defined in psychiatric terms, e.g. post-traumatic stress disorder, and new clinical pri orities are being identified, such as HIV-related demen tia. These developments are taking place against a back cloth of inadequate strategic planning, where mental health services remain a low priority and society fails to understand and respond to the needs of mentally ill people. Identification of needs
The introduction of market forces into the health service is expected to greatly improve this situation by maximiz ing efficiency and effectiveness. Health needs are being identified and matched to the resources available, prior ities are being set and those in greatest need are being targeted. Obviously when demand always exceeds supply there has to be some form of rationing and diffi cult choices and decisions must be made. The major problem with competing pressures and rationing of services is determining where the available resources are best directed. People with severe mental illness are often considered to be the most deserving of scarce resources and those with less serious illnesses are considered ‘undeserving’. These are uncomfortable decisions to make since they involve value judgments and discrimination. Of course, the direct provision of treatment and care to the severely mentally ill must remain a central activity of mental health nurses since they have a distinctive con tribution to make. However, they could also use some of their time carrying out consultancy work with other district nurses, health visitors and different professional groups, delivering care to those with any form of mental distress. We know that more than 5 million people consult their GP each year because of mental ill health, and that it is the most common reason for consultation: it accounts for at least 15% of all consultations and is re sponsible for the loss of nearly 57 million working days (Jacobson ct al, 1991). British Journal ol Nursing, 1992, Vol 1, No 7
At long last this evidence has been heeded and policy makers have been persuaded that mental ill health needs to be pushed up the priority rating scale and seriously targeted. The Government’s White Paper (HMSO, 1992) specifies mental illness as one of the five priority areas to be targeted with the aim of improving the na tion’s mental health. Government review
In addition the Government’s review into mental health nursing could not be more timely. It provides an ideal opportunity to address these key issues, particularly re cruitment problems, the potential shortage of qualified mental health nurses and the identification of a future workforce. Cost-effectiveness is bound to be on the agenda and various options for improving management arrangements and diluting skill mix will be reviewed. Given that the demand for mental health services will increase, it is essential that these options are explored. This needs to be done in the knowledge that cutting back on qualified staff is not always equated with effi ciency, since the use of unqualified staff may result in reduction of quality. Qualified mental health nurses are necessary for the provision of quality patient care. In considering value for money it is important that the true value of mental health nurses is recognized and properly acknowledged. Our strength lies in our clinical expertise and skills; the potential shortfall in mental health nurses demands that these relatively expensive and scarce skills are properly used and that the dissemi nation of mental health nursing expertise to other pro fessions and agencies is increased. There has never been a better time to develop maxi mally efficient methods of delivering mental health nurs ing care, nor for innovative role developments, such as the clinical nurse specialist and the nurse consultant. It is important that the Government’s review panel recog nizes the value and potential of mental health nursing and we must sec that they are properly informed. Ben Thomas Chief Nurse Advisor/Director of Quality The Bethlcm Royal Hospital and the Maudsley Hospital Special Health Authority Honorary Lecturer Institute of Psychiatry London HMSO (1992) The Health of the Nation: A Strategy for Health in England. HMSO, London Jacobson, B, Smith A, Whitehead M, eds (1991) Preventing Mental III Health in the Nation’s Health: A Strategy f° r the 1990s. A Report from an Independent Multidisciplinary Committee, King Edward’s Hospital Fund for London, London
323
Downloaded from magonlinelibrary.com by 154.059.124.102 on January 10, 2019.
