International Nurse's Day: a mental health perspective

Could you talk us through your journey to becoming a Mental Health nurse? 

To begin with, I wasn’t sure what I wanted to do after leaving school and was working in elderly care homes. I knew from then that I would move into the health and care sector with the mysterious world of mental health seeming more alluring than general nursing (not just because I didn’t fancy the uniform!), and was unperturbed by the opinions of some which felt negative - e.g. ‘not real nursing!’. I was interested in understanding more about mental health and having applied, was offered a place to do my RMN (Registered Mental Health Nurse) training at Friern Hospital - a psychiatric hospital located in a large gothic building (famed for having the longest corridor) in north London, which has since closed.

I worked with patients with severe mental health needs, many of whom had been living in hospital for years from a young age. One of my warmest memories is of working on a rehabilitation ward with a particular client group. The ward was their home and staff like family – regular outings, trips to the pub and holidays – one nurse even returned from a trip to Morcombe to discover one of the patients wearing his shoes! 

How has the provision of mental health services changed over the years?

Having worked across a spectrum of services since the late 1980’s, starting in a ward-based environment and then moving on to community rehab services, outreach and finally Primary Care Liaison, I have witnessed many changes and developments in how mental health care and treatments are implemented. The 1990's brought the Care in the Community Act and the closure of the older psychiatric hospitals, and a move to independence away from institutionalised care. I worked in Friern Hospital until its final day - supporting clients in their move from the hospital - a huge event for many for whom the hospital had been their home for years. The hospital wasn’t perfect and clearly an unhappy place for many, but for many it was a haven. Moving to a leafy street in Hampstead sounds idyllic but many of the patients struggled with failed placements, becoming unwell and being readmitted – a prime example of the revolving door syndrome.

Another area of change has been the move from prescribing strong medications such as chlorpromazine (bright orange and poured from the heaviest of bottles!). These medications provided relief of symptoms but unsurprisingly caused major side effects. When the newer antipsychotic medications were introduced, I watched as one of the most unwell and disturbed patients stabilised, without being over-sedated, and revealed her true personality – funny and very cheeky! These medications have enabled many people to leave hospital and lead much more independent lives.

There have also been massive advances in technology in the past decade or so. Options for more varied interventions such as phone and online, especially since the Covid-19 pandemic, have really helped with the uptake of services particularly for anxious or housebound clients. The introduction of wellbeing services have brought other benefits, such as Navigators and Employment teams – a fabulous and hard-working crew of people who frankly made my life easier and reduced the number of hours I have had to spend on the phone to the benefit office!

Do you think public attitudes to mental health have changed since you entered the profession?

Looking back, I recall the attitudes and fears of the public towards patient integration back into the community. There were sadly several high-profile cases involving seriously mentally ill people, concerns around failings in community care and the general media demonisation of the mentally ill as dangerous. 

Over the last ten years, societal attitudes to mental health have changed significantly - from limited understanding, fear and mistrust about mental health, to being able to talk openly at work and with friends about mental wellbeing or seeking direct help with mental health. There’s also been an increase in community and ‘self help’ resources that people can access themselves online, such as the NHS Good Thinking website, helping to establish strategies to manage difficult symptoms such as anxiety and panic. These resources can help people to build resilience and reduce the reliance and pressure on hospital interventions. However, more active interventions to support those with severe mental illness are still needed. The continued development of Complex Emotional Needs services and a move towards Trauma Informed Care has been helpful both for the clients, as well as improving understanding for mental health professionals.

If you were to choose a defining moment in your career, what would it be?

A highlight of my career was helping to set up an outreach team in a rehabilitation unit-based in Hampstead supporting clients through the process of their discharge. The service was extremely effective and successful, a lovely team and a stepping stone to my work with Assertive Outreach services (AOTS).

Also, around 15 years ago I made a pretty radical change of role, joining a team responsible for setting up a new Primary Care Service attached to GP’s and the first to be incorporated as part of a wider primary care psychological health service (IAPT). I worked with clients with common mental illness and stable Serious Mental Illness (SMI),enabling me to experience a wider range of mental health disorders and interventions – with clients coming to see me in more of a community setting rather than the other way round.

What are your hopes for the future of mental health care in London?

My hopes for the future would be to ensure adequate funding, research and innovation across all areas of mental health, particularly areas of higher demand, such as child and young adult mental health services, many of whom really struggle with adjusting to adulthood. Support for those continuing to struggle with more severe and enduring mental health needs and a focus on supporting staff working there is crucial, ensuring their involvement in future service planning, alongside service users.