Preparing Mental Health Nurses to Work in the Community

Article excerpt

Major changes have taken place in mental health training, with a need to teach nurses how to deal with specific illnesses and issues. Mark James, award leader of the mental health pathway on the BSc (Hons) Community Health Studies course at the University of Glamorgan, explains why such changes were necessary

SINCE the first post-registration education programme, preparing mental health nurses for practice in a community setting, appeared in 1970 at Chiswick Polytechnic, there have been significant changes in the nature of and academic level at which Community Mental Health Nurse (CMHN) courses have been offered.

In 1988, almost all educational centres offered courses at certificate level. However, by 1995, virtually all centres offered a relevant course at diploma level.

The introduction of Project 2000 in the late 1980s brought pre-registration nurse education to diploma level, and has encouraged post-basic education, like the CMHN course, to degree level, as enshrined in the United Kingdom Central Council for Nursing and Midwifery's PREP (Post-Registration Education and Practice) policy proposals of 1994.

At this time, the UKCC issued new standards for the post- registration preparation of community nurses.

Such standards allied the preparation of community nurses, CMHNs included, to specialist practitioner learning outcomes, and to academic achievement at degree level.

Courses were to maintain a 50:50 balance between theoretical and clinical practice based elements, and were to combine shared learning between the different branches of community nursing with branch-specific learning.

The past 10 years has seen the development of 'Thorn' nursing courses (sponsored by Thorn/EMI) that focus on the perceived knowledge and skills necessary to implement psychosocial interventions with the seriously mentally ill.

Interventions are aimed at families of such clients in order to reduce the rate of relapse.

National Health Service policies and priorities have continued to shape the role, expectations, and training needs of CMHNs.

Such initiatives include Working in Partnership: A Collaborative Approach to Care, the National Service Framework for Mental Health Services, the instigation of the Care Programme Approach in Wales, the Review of Health and Social Care in Wales, Designed for Life and the revised National Service Framework for Adult Mental Health Services.

Such initiatives encourage CMHNs to assess and meet the needs of people with serious mental health problems as a priority, provide a range of clinically effective, evidence-based interventions, provide care in a collaborative, user-focused manner, work effectively within a community mental health team, and practise effectively across discipline and agency boundaries, including working with primary care professionals, and potentially delivering mental health care to individuals in prison.

The drive towards evidence-based healthcare has been championed by the guidelines for practice issued by the National Institute of Health and Clinical Excellence (Nice).

With specific relevance to mental health, a number of guidelines have been recently published which include core interventions in the treatment and management of schizophrenia in primary and secondary care, core interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and related disorders, and cognitive behavioural therapy for anxiety and depression. …