As a mental health nurse on an acute adult assessment unit, thinking fast under pressure is an important part of Ben Rajaratnam's daily work. 'When a patient is referred to us, usually from A&E, we have to make a rapid assessment to decide whether it is best to treat them in the community or on a ward,' he says.
With a maximum length of stay of 15 hours, patients have to be managed in a very short space of time. The unit has nine beds, with a further four that can be opened if necessary. 'It has a homely and non-regimented feel to it. There is lots of space so the patients don't feel that they are crammed in like battery hens,' says Mr Rajaratnam, a G-grade RMN who has been at the new unit at BasildonHospital, South Essex Partnership NHS Trust since it opened in March 2005.
The government has made radical changes in its approach to mental health over the past five years. In the 1999 white paper Modernising Mental Health Services they pledged to deliver a modern and dependable service, investing £700m to improve mental health care. The National Service Framework on Mental Health was also developed to provide national, evidence-based standards of care, empower and support staff, and involve patients and relatives in the planning and delivery of treatment.
The new draft Mental Health Bill also aims to make the law on mental illness reflect modern treatments and care. Although concerns have been raised about the effect the proposed changes will have on compulsory treatment, one of the welcome aims of the bill is improving client-centred care. 'We have to focus on the client's needs. Although some patients want to be treated in hospital, the majority would rather be at home,' emphasises Mr Rajaratnam. Nurse-led home treatment and crisis management teams operate in conjunction with the new unit: the crisis team take on an admission and, if appropriate, the home treatment team offers community support.
The home treatment team also offers support and education to patients and their relatives. 'Education has been poor in the past,' says Mr Rajaratnam. 'People often want to sweep mental health problems under the carpet and hope they'll go away. The home treatment team can provide family therapy and psychological counselling.'
As part of The NHS Plan, the government pledged 335 mental health teams to provide an immediate response to the crisis. This has opened up many career opportunities. As well as the crisis and community teams, the unit also has an early intervention team that provides early diagnosis and treatment before an illness becomes too severe. 'Young people with schizophrenia are frightened by the voices in their heads,' says Mr Rajaratnam. 'So the quicker treatment can be started, the better.' A nurse-led recovery unit is also due to open and will operate like a day care centre by providing intensive therapy and intervention.
The new services have boosted recruitment at the trust. 'A lot of interest has been expressed in the new recovery unit, particularly from E and F grades, which is great because it is experienced mental health nurses that we need.' The unit has also motivated Mr Rajaratnam to continue working as an acute adult RMN. 'The approach means that patients really feel that something is happening. And the new working ethos means that the nurses really do have valuable input.'
The government has pledged more training for all those involved in caring for patients with mental illness. Nurses can apply for postregistration courses ranging from assessment in the treatment of addictions to models of intervention in forensic health care. Training is also given on the job: 'You don't need prior experience of acute assessment to work in this field. You just need a willingness and a desire to work with people of all ages with a variety of conditions.'
Mr Rajaratnam has worked in acute adult services since qualifying as an RMN in 1993. He now cares for adults with a wide range of mental health problems, from drug dependency to severe psychotic episodes. His role is not only about caring for the patients, but also teaching them. 'Imparting knowledge to a patient helps them to rationalise their illness,' he says. 'And knowing that what I've done and said has really helped them gives me a great sense of achievement.'
Nurses like Mr Rajaratnam have welcomed the increased funding and new policies. 'Modernisation is working,' he says. 'Our chief executive is very supportive of new initiatives and input from the staff, meaning that the nurses really feel motivated. It is very fulfilling to see a start and an endpoint during an admission, from when a patient comes to us to when they are referred back to the community or to a ward. It is a pleasure to help them.'
How to become... a mental health nurse in acute adult assessment?
THIS COULD BE FOR YOU IF: you are interested in working in a fast paced and challenging environment with adults of all ages with a variety of mental health problems, including learning disabilities
YOU NEED TO BE GOOD AT: making quick decisions and thinking fast under pressure, teaching as well as caring for patients, liaising with a multidisciplinary team
YOU NEED TO HAVE: an RMN qualification with a background in adult mental health nursing and a willingness to change your working environment
YOU DON'T NEED TO HAVE: prior experience of acute adult assessment as training will be given
OTHER SIMILAR JOBS TO CONSIDER: other acute inpatient services, such as working with adolescents or the elderly, crisis team or early intervention team
WHERE TO FIND MORE INFORMATION: South Essex Partnership NHS Trust (www.southessex-trust.nhs.uk/adults)
Mental Health Nurses Association - the professional association and trade union for mental health nurses (www.amicus-mhna.org)
The Sainsbury Centre for Mental Health - a mental health charity that carries out research, development and training to influence policy and practice in health and social care (www.scmh.org.uk).