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Mental health nurse education model is 'built for asylums', claims nursing director

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The lack of a single registration for nurses trained in both physical and mental health is a workforce education model “built for asylums”, a chief nurse at a London mental health provider has said.

Claire Johnston, director of nursing and people at Camden and Islington NHS Foundation trust, warned the current system for training nurses – which forces them to specialise in a certain discipline – was a barrier to ensuring mental health was placed on the same footing as physical health.

“It is positively 19th century that we are still working in a model built for asylums”

Claire Johnston

Ms Johnston pointed to the lower life expectancy of patients with mental health problems, but noted it was their physical conditions – such as chronic obstructive pulmonary disease or type 2 diabetes – that would cause their death.

She described it as “so disheartening” to see nurses ill equipped to manage patients that have both mental and physical health problems.

Speaking at Nursing Times’ Deputies’ Congress event earlier this week, Ms Johnston told the audience of deputy directors of nursing that “your generation can sort that”.

“It is positively 19th century that we are still working in a model that is presumably built for the asylums which we no longer have, whereby we have registered general nurses and registered mental health nurses,” said Ms Johnston at the event in London.

“Your generation can sort that,” she said. “And I think within five years, hopefully, we will have that single registration.

“Otherwise, all of the plans, all of the aspirations and dreams that we have to reduce that parity of esteem gap with patients with mental health problems dying up to 20 years earlier are going to be wasted,” she warned.

“[Without] single registration… all of the plans we have to reduce that parity of esteem gap are going to be wasted”

Claire Johnston

Last year, a major review of nurse education recommended a new model that would see students spending more time on general training – including both physical and mental health – before specialising in adult, children’s, mental health, learning disability nursing or other new fields.

The Shape of Caring review’s recommendations are currently being considered by the Nursing and Midwifery Council and workforce planning body Health Education England.

The NMC also agreed last month that it would begin revising its pre-registration education standards for nurses, with students starting on the new courses from 2019, after it found they were not fit for the future.

  • 18 Comments

Readers' comments (18)

  • Most RGN 's / Adult branch nurses I have worked with appear to have no knowledge of Mental Health patients and how to support them and show little desire to work with them. Completing a couple of modules in university seems an inadequate solution. Just having general trained nurses in reality does not meet the needs of patients with Learning Disabilities, Mental Health or for those individuals who are dual diagnosed. When we look at the prison service the NHS Teams
    employ all branches of nurses to meet the overall needs of the offenders why should it be different out side of forensics who for those in need trying to live in the community ?

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  • Same goes for learning disability nursing.

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  • I quite agree with one point, that rmn's need more physical health training, however, likewise rgn's need more mental health training. RMN's are not trained to an asylum system, quite the opposite, its very much frowned upon, but the system is outdated, for all nurses, not just RMN's. In fact if our RMN is outdated, to asylum times when mental health nursing was recognised, when is general nursing outdated to? It is very unfair to criticise one type of nursing, when it is proven the both mental and physical health affect the other, its not just a one way thing, the consequences can be just as damaging if not recognised or treated properly. The gap is not due to mental health training, it is due to underfunding and resourcing mental health, and a lack of awareness, understanding and skill in both mental and physical health, by everyone. Surely singling out one type of nursing only serves to widen the gap, not unite everyone. And the same goes for every type of nursing, every type of health and social care professional (or not) and every member of society. Lets not single out mental health, that is the outdated view here.

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  • Claire Johnston what you have said is incredibly disturbing and so ill put it is disgusting. Mental health should be credible unto itself inclusive of the right credible physical input, not put specifically on a par to a footing of physical care in order to be seen as credible. Well Claire it sounds like you want 'mental health' nurses to be all thing to all people including dare I say 'blame' for a lack of input and resources from elsewhere. Nice one Claire you just managed to alienate a whole profession. I'm so fed up of MH nurses taking the blame for every other healthcare professional and management trying to hide blame from themselves. Sometimes it feels like candour of duty is nought but a way of excusing organisational liability. Nobody denies the importance of physical care but putting it all on a mental health nurse is so ill informed its sickeningly wrong. And make sure there are plenty of staff to complete all physical care necessary. Since the Tories every poorly skilled senior management has come out of the woodwork. And what is shocking is there are so many.

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  • Also i fail to see how training rmn's physical health will solve the reason why people with m/h die younger - medication, social isolation, deprivation and poverty, stigma and discrimination. It will give a more holistic approach in one place, but it wont promote good physical health, encourage people to access healthcare (in the same way anyone else would) or enhance knowledge or skills surrounding m/h medication (in particular prescribing and monitoring antipsychotics). The demographic of people with m/h contributes to premature mortality far more than the care they receive from m/h nurses. And with increased cuts to health and social care, benefits, housing etc, the gap will only widen.

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  • Am i right in thinking that non-General Nurses cannot work in some other countries due to their training not being recognised?
    its reminscent of the 1960s when many immigrant people(who were invited and then welcomed to train in the assylums as they could not fill vacancies),were trained as Enrolled Mental Nurses -roles not recognised in some of their countries)

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  • Look at in-patient statistics- people with mental health issues are on every ward and community e.g that fracture in AE -result of Alcohol Misuse, that obese person - Depressed, that overdose- result of domestic abuse and anxiety, that ex-soldier with Asthma_ living rough and survivor of PTS....
    I know a auxilary in a cottage hospital who claims never to have cared for Substance Misue or Dementia untill past two years. Why not have a more holistic approach to training if the Common Foundation approach was critiqued?

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  • Yerr and NHS senior management stuck in the Victorian age - Claire don't give it if you can't take it.

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  • Is this article meant to take the heat of blaming epidemic bad management in NHS mental health services?

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  • Very provocative board behind her, says it all really they don't want RMNs - that's okay . Maybe it's time RMNs reclassified themselves in order to have better professional freedom away from nursing.

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