A rift among the mental health nursing community has emerged over education reforms which could see a move towards more generic nursing degrees, an investigation by Nursing Times can reveal.
Last year a major review of nurse education recommended a new model that would see students spending more time on general training – including both mental and physical health – before specialising in their final year in either adult, children’s, learning disability, mental health nursing or other new branches such as community nursing.
But mental health nursing experts have warned the proposals could lead to a dilution of mental health as a specialty, despite agreeing that the lack of dual skills in both mental and physical health care among nurses needed to be addressed.
Meanwhile, nursing directors have said a more integrated approach to pre-registration training would ensure nurses are equipped for future models of care.
“The number of mental health academics is much smaller…so we’re going to end up with adult lecturers giving the lion’s share of education”
Professor Joy Duxbury, chair of Mental Health Nurse Academics UK, said the group had concerns about the proposals from the Shape of Caring review and warned dilution of the mental health specialty could have a “devastating” impact.
Moves towards more generic training risked the mental health element sidelined due to lack of resources, she said.
“The number of mental health academics is much smaller than in the adult field so we’re going to end up with a situation where we have a lot more adult lecturers giving the lion’s share of the education in universities,” she added. “So the skillset is going to be significantly skewed.”
The proposed new model also includes a year-long preceptorship with an employer in a student’s chosen field.
“Preceptorship is a good idea but what concerns us is that many services – particularly mental health services – are so overstretched and under-resourced at the moment,” said Professor Duxbury.
“[The proposed move to more generic training] is a broad brush approach that turns off mental health nursing students and is the worst of both worlds”
She urged policy-makers to look at the evidence from other Western countries where the introduction of more generic nursing qualifications had failed to equip nurses with the competencies to work in mental health.
Chris Hart, consultant nurse in forensic and intensive care nursing at South West London and St George’s Mental Health Trust and principal lecturer at Kingston and St George’s University of London, warned some mental health courses had already been altered to include more generic content, leaving students with the “the worst of both worlds”.
He said adult nursing students did need more mental health skills but that a move to increased generic training in reality meant a “bias” towards adult nursing.
“Mental health students are spending so much time not looking at mental health - but are looking at issues geared towards adult nurses,” he said.
“They need to understand issues to do with physical health tailored to the needs of people with mental health, but this is a broad brush approach that turns off mental health nursing students and is the worst of both worlds.”
“Unless we start developing people with those broader, generic skills we won’t achieve that vision [for integrated physical, mental and social care]”
The Royal College of Nursing’s professional lead for mental health Ian Hulatt said there was growing recognition physical and mental health were “artificially divided” but agreed it still made sense to retain separate specialties.
“There is a lot of talk about the need for a flexible and responsive workforce, which is coded language for someone who can work pretty much work anywhere,” he said.
“But I wouldn’t want a plumber doing the electrics in my house. You need specialised skills for specialised needs.”
However, directors of nursing have called for more generic training to ensure nurses can provide holistic care in integrated settings.
Claire Johnston, director of nursing at Camden and Islington Foundation Trust, told a recent Nursing Times event the current system for training nurses was “built for asylums” and stood in the way of ensuring mental health was placed on the same footing as physical health.
Meanwhile Stephanie Dawe, chief nurse at North East London Foundation Trust, said she wanted all her nurses to be “dual-competent” in mental and physical health.
While the trust had launched rotational posts to ensure newly-qualified nurses experienced providing both types of care, she said a change in pre-registration training was also required.
“When you look at the Five Year Forward View, it’s all about integrated physical, mental and social care and unless we start developing people with those broader, generic skills then we won’t achieve that vision,” she said.
Professor Tony Butterworth, chair of the Foundation of Nursing Studies, which is currently examining the current and future role of mental health nurses, agreed courses would have to change.
”General nursing and mental health nursing draw in rather different sorts of people and that is one of the problems with having a single portal”
However, he said NHS organisations also had a role to play: “What employers want are instant puddings but as employers they have the responsibility to get people working in the ways they want them to work,” he said.
Ian Norman, professor of mental health at King’s College London, said there were both benefits and drawbacks to combining adult and mental health training more closely.
“I can understand the attraction for employers. In theory it could lead to a practitioner who has both mental health and adult nursing skills,” he said.
But he said this approach risked diluting the mental health course content and could also be off-putting to those who want specialty training.
“Mental health is a key part of the Five Year Forward View and HEE is working closely with providers and stakeholders to ensure the workforce is equipped”
“In many ways general nursing and mental health nursing draw in rather different sorts of people and that is one of the problems with having a single portal,” he said.
Mental health nursing students tend to be older with more work and life experience, and significant proportion of those applying to do mental health nursing at King’s are graduates with a psychology degree, said Professor Norman.
National workforce planning body Health Education England, which commissioned the Shape of Caring review, is currently looking into the recommended changes to pre-registration training.
It said it was “only right” that mental health had the same importance placed on it as physical health and that this was “a hugely powerful impetus for improvement”.
“Mental health is a key part of the Five Year Forward View and HEE is working closely with providers and key stakeholders to ensure the workforce is equipped to respond, available in the right numbers and has the right skill mix,” said Lisa Bayliss-Pratt, director of nursing and deputy director of education and quality at HEE.