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A proactive approach to mental health care needs

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VOL: 102, ISSUE: 25, PAGE NO: 22

Working on the general wards of an acute trust has given one mental health specialist nurse the chance to address a vital care gap.

Working on the general wards of an acute trust has given one mental health specialist nurse the chance to address a vital care gap.

As an RGN, your training, knowledge and skills are geared towards caring for a patient's physical health needs. But physical and mental health are not exclusive of one another and knowing how best to care for a patient who also has mental health needs can be a daunting experience. That is why the work of Tiina Farrag, mental health nurse specialist at the Homerton University Hospital NHS Foundation Trust in London, is so important.

'When you can't see the problem it can be frightening,' says Tiina. 'My role helps to reduce the stigma attached to mental health problems by challenging patient and staff perception, and helping staff to share methods of good practice.'

Tiina previously worked in emergency psychiatric clinics and home treatment teams but it was while working as a psychiatric liaison nurse at The Maudsley Hospital in South London that she developed an interest in how mental health services are run.

'Psychiatric liaison is very much influenced by the medical model in that it is a very person-centred approach,' she explains. 'Prior to my role, the mental health service at Homerton was reactive rather than proactive. Staff could refer a patient for psychiatric assessment or access emergency services but there was no provision for ongoing support and advice.'

Tiina's role was developed to address this gap in care - it is the first of its kind to be funded solely by the trust. The local mental health trust still provides a 24-hour liaison service for A&E but it is Tiina's job to cover all the wards. 'My job has been made easier because the management recognised the need for the holistic care of mental health patients. I am a facilitator not an expert and I help balance the power between the professional and the patient.'

Raising the profile of patients with mental health needs is integral to the Department of Health's National Service Framework for Mental Health (1999), which set out standards to promote mental health and treat mental illness, including providing effective mental health services and improving access to these. From Values to Action: The Chief Nursing Officer's Review of Mental Health Nursing, published in April, also supports a holistic approach to mental health and stresses the importance of building and maintaining positive relationships with patients, their carers and families.

Tiina's role helps the trust meet the required standards by triaging ward referrals and undertaking mental state examinations, risk assessments and care planning to determine the most appropriate course of action.

Over a 12-month period, Tiina received more than 500 ward referrals. 'The bulk of these were self-harmers, people who have overdosed, for example. If someone has taken an overdose they may not be suffering from a severe mental illness but need immediate care and advice. An important part of my job is to pay attention to and really listen to what the patient has to say. I also explain all treatments and medications and answer any questions because when patients are well informed they are more likely to be compliant.'

Tiina follows up her patients throughout their hospital stay and then either handles their outpatient treatment herself or refers them back to their GP or community psychiatric team.

'I run weekly follow-up clinics, usually about six sessions, for patients who would find it hard to access their local mental health services, such as self-harmers or those going through a life crisis. There can be very long waiting lists for local psychiatric therapy but people still need rapid access to these services.'

In addition, the recent review of mental health nursing focuses on nurse practice education. Tiina helps educate and train general nurses in caring for mental health patients.

She runs weekly mental health reflection sessions for ward staff, teaches a preceptorship course for newly qualified nurses and is available for other teaching sessions. She is also in the process of developing mental health awareness sessions for administration and facilities staff.

'This is important because admin staff are sometimes the first people to have dealings with a patient and this can be anxiety-invoking for both parties,' she explains.

As well as Tiina, the trust now employs two substance abuse nurses and the feedback from ward staff on all these roles has been excellent.

'It's great to know I have really helped the staff but the best part is knowing how much I have helped the patients. When assessing a patient who has taken an overdose I am always surprised at how much they share with me.

'When someone has tried to take their life and during our chat a process takes place that changes their mind and they start to form a survival plan, it's amazing.'

How do I become a mental health nurse specialist in a general setting?

This could be for you if: you are interested in dealing with patients with a variety of mental health issues and are good at dealing with different staff groups.

You need to be good at: managing your own workload, motivating yourself and negotiation.

You need to have: a mental health qualification, five years post-registration experience in a variety of settings and basic counselling skills.

You don't need to have: specific qualifications, for example to have undertaken a substance misuse course, although it may be helpful.

Other similar jobs you could consider include: substance misuse nurse, nurse counsellor, mental health nurse specialist in sexual health, A&E mental health liaison nurse.

Where to find more about mental health nursing: you can visit the Mental Health Nurses Association website at Download a copy of From Values to Action from the DH website: and enter 'mental health review' in the search box.

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