Editorial
Mental health nursing: now you see it, now you don’t s we enter the closing decade of this century, mental health nursing has reached a crisis point and is on the road to invisibility. If the marginalization of mental health nursing continues it will reach the end of that road before the year 2000. The dominant ideology of physical hospital nursing is rampant among both senior nurse educators and those nurse leaders who decide the future direction of our profession. These people have little or no understanding of the culture or role of the mental health nurse and see the so-called general nurse as a Jack or Jill of all trades. They blithely decide the future of the profession without insight or appropriate consultation; for them the profession is physical hospital nursing. This is further reflected in the introduction of Project 2000 (U K C C, 1986), the EN B Framework and Higher Award (English National Board, 1990), and the develop ment of community healthcare nursing courses which will ensure that future registered mental nurse (RMN) training and post-basic education in mental health nurs ing become part of integrated and generic systems where high-profile, high-tech nursing is the hegemonic ruler. Student unrest in the minority branches of mental health and learning difficulties has been clearly identif ied. Allen (1992) describes the experiences of a student who suggested that Project 2000 students in these spe cialties feel they are denied their identity for much of the common foundation programme (CFP) and that
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*•••far from being what its name implies — a curricu lum that is common to and of recognizable relevance to all students equally — the generic spirit of the CFP has meant, in reality, conforming to the ideals, values and preoccupations of the dominant branch’. If such a concern is reflected across all Project 2000 courses then the prominence of physical hospital nursing will clearly cause some nursing students to perceive themselves as undervalued and marginalized as a result of having to conform to the dominant ideology. This marginalization has been added to by the advice that some teachers give their Project 2000 students, i.e. not to do mental health nursing because ‘it is not a rec ognized qualification in some European countries’ or there is ‘no future in mental health nursing’. It is there fore hardly surprising to hear the recent revelations by the EN B in which ‘shocked board members’ describe the ‘appalling drop’ in mental health nursing trainees from 3995 in 1981/1982 to 1869 in 1990/1991 (Nursing Times, 1992). Mental health services are being eroded as government policies close large traditional psychiatric hospitals but fail to provide adequate resources in the community. The future for the present-day RMN and those on
272
traditional and Project 2000 courses is uncertain and in secure. This erosion of mental health provision and the at tractive imagery perpetuated about high-tech, high-pro file nursing will obviously affect the choices made by students. Standards of care in mental health will decline if mental health nursing is passed by in the selection process of options by the more able students and care is delivered by inappropriate or untrained staff. Post-basic courses in mental health nursing specialties have existed for more than 20 years and their impact on mental health practice is well documented (Marks et al, 1977; Marks, 1985; Paykel and Griffith, 1983). However, the last 5 years have seen courses floundering and struggling to survive under the onslaught of the physical nurse ideology. This has resulted in the dis mantling of some, the closing down of others, and the lack of new course development. If mental health nursing is to survive, it must be por trayed in more positive terms. To do this we must ad dress the issue of the dominant ideology of physical hospital nursing and also ensure that appropriate oppor tunities exist in post-registration and higher education for mental health practitioners on a much wider scale than is presently available. It is hoped that the anomalies and marginalization that exist can be addressed before physical hospital nurs ing is the only branch of nursing left. This can only lead to poorer care for client groups who are already marginalized within society as a whole. It is ironic that Project 2000 fits neatly between two classics of the science fiction genre — Space 1999 and 2001 — A Space Odyssey. However, the solutions to the problems that exist for mental health nursing will have to be a lot more realistic than sci-fi if its continued existence is to be assured and our clients are to receive the quality of care they deserve. Andy Farrington Course Teacher an d Senior Behavioural Psychotherapist S heffield an d N orth Trent C ollege o f Nursing and M idwifery, Sheffield Allen C (1992) Foundation for success. Nurs Times 88 (2): 20 English National Hoard (1990) Fram ew ork f o r Continuing Education an d Training fo r Nurses, M idwives an d H ealth Visitors. Project Paper 3. EN B, London Marks IM, Hallam RS, Connolly J, Philpott R (1977) Nursing in Hehavioural Psychotherapy. RCN Research Series, Whitefriars, Press Ltd, London and Tonoridge Marks IM (1985) Psychiatric Nurse Therapists in Primary Care. RCN Research Series, Whitefriars, Press Ltd, London ana Tonbridge Nursing Times (1992) Appalling drop in M H trainees. (News item) N u n Times 88 (21): 6 Paykel ES, Griffith JH (1983) Com m unity Psychiatric Nursing fo r N eurotic Patients. RC N Research Series, whitefriars, Press Ltd, London and Tonbridge U K C C (1986) Project 2000: A N ew Preparation f o r Practice. U K C C , London Downloaded from magonlinelibrary.com 130.237.122.245 on1992, January BritishbyJournal of Nursing, Vol 19, l,N2019. o6
Mental health nursing: now you see it, now you don’t s we enter the closing decade of this century, mental health nursing has reached a crisis point and is on the road to invisibility. If the marginalization of mental health nursing continues it will reach the end of that road before the year 2000. The dominant ideology of physical hospital nursing is rampant among both senior nurse educators and those nurse leaders who decide the future direction of our profession. These people have little or no understanding of the culture or role of the mental health nurse and see the so-called general nurse as a Jack or Jill of all trades. They blithely decide the future of the profession without insight or appropriate consultation; for them the profession is physical hospital nursing. This is further reflected in the introduction of Project 2000 (U K C C, 1986), the EN B Framework and Higher Award (English National Board, 1990), and the develop ment of community healthcare nursing courses which will ensure that future registered mental nurse (RMN) training and post-basic education in mental health nurs ing become part of integrated and generic systems where high-profile, high-tech nursing is the hegemonic ruler. Student unrest in the minority branches of mental health and learning difficulties has been clearly identif ied. Allen (1992) describes the experiences of a student who suggested that Project 2000 students in these spe cialties feel they are denied their identity for much of the common foundation programme (CFP) and that
A
*•••far from being what its name implies — a curricu lum that is common to and of recognizable relevance to all students equally — the generic spirit of the CFP has meant, in reality, conforming to the ideals, values and preoccupations of the dominant branch’. If such a concern is reflected across all Project 2000 courses then the prominence of physical hospital nursing will clearly cause some nursing students to perceive themselves as undervalued and marginalized as a result of having to conform to the dominant ideology. This marginalization has been added to by the advice that some teachers give their Project 2000 students, i.e. not to do mental health nursing because ‘it is not a rec ognized qualification in some European countries’ or there is ‘no future in mental health nursing’. It is there fore hardly surprising to hear the recent revelations by the EN B in which ‘shocked board members’ describe the ‘appalling drop’ in mental health nursing trainees from 3995 in 1981/1982 to 1869 in 1990/1991 (Nursing Times, 1992). Mental health services are being eroded as government policies close large traditional psychiatric hospitals but fail to provide adequate resources in the community. The future for the present-day RMN and those on
272
traditional and Project 2000 courses is uncertain and in secure. This erosion of mental health provision and the at tractive imagery perpetuated about high-tech, high-pro file nursing will obviously affect the choices made by students. Standards of care in mental health will decline if mental health nursing is passed by in the selection process of options by the more able students and care is delivered by inappropriate or untrained staff. Post-basic courses in mental health nursing specialties have existed for more than 20 years and their impact on mental health practice is well documented (Marks et al, 1977; Marks, 1985; Paykel and Griffith, 1983). However, the last 5 years have seen courses floundering and struggling to survive under the onslaught of the physical nurse ideology. This has resulted in the dis mantling of some, the closing down of others, and the lack of new course development. If mental health nursing is to survive, it must be por trayed in more positive terms. To do this we must ad dress the issue of the dominant ideology of physical hospital nursing and also ensure that appropriate oppor tunities exist in post-registration and higher education for mental health practitioners on a much wider scale than is presently available. It is hoped that the anomalies and marginalization that exist can be addressed before physical hospital nurs ing is the only branch of nursing left. This can only lead to poorer care for client groups who are already marginalized within society as a whole. It is ironic that Project 2000 fits neatly between two classics of the science fiction genre — Space 1999 and 2001 — A Space Odyssey. However, the solutions to the problems that exist for mental health nursing will have to be a lot more realistic than sci-fi if its continued existence is to be assured and our clients are to receive the quality of care they deserve. Andy Farrington Course Teacher an d Senior Behavioural Psychotherapist S heffield an d N orth Trent C ollege o f Nursing and M idwifery, Sheffield Allen C (1992) Foundation for success. Nurs Times 88 (2): 20 English National Hoard (1990) Fram ew ork f o r Continuing Education an d Training fo r Nurses, M idwives an d H ealth Visitors. Project Paper 3. EN B, London Marks IM, Hallam RS, Connolly J, Philpott R (1977) Nursing in Hehavioural Psychotherapy. RCN Research Series, Whitefriars, Press Ltd, London and Tonoridge Marks IM (1985) Psychiatric Nurse Therapists in Primary Care. RCN Research Series, Whitefriars, Press Ltd, London ana Tonbridge Nursing Times (1992) Appalling drop in M H trainees. (News item) N u n Times 88 (21): 6 Paykel ES, Griffith JH (1983) Com m unity Psychiatric Nursing fo r N eurotic Patients. RC N Research Series, whitefriars, Press Ltd, London and Tonbridge U K C C (1986) Project 2000: A N ew Preparation f o r Practice. U K C C , London Downloaded from magonlinelibrary.com 130.237.122.245 on1992, January BritishbyJournal of Nursing, Vol 19, l,N2019. o6
