Newly-qualified mental health nurses are not being adequately trained for the role, while mentoring and supervision of students and staff are being undervalued and given too little funding, a new workforce report has found.
Key competencies and skills needed to deal with the “shrinking workforce, growing expectations and exhausting demands” on the profession were being missed during training, according to the report by the Centre for Mental Health.
“Mentors don’t have time to breathe, reflect, evaluate or even think about their own work”
Centre for Mental Health report on workforce
More practical skills needed to be taught – as well as clinical – such as knowing how to assess and manage risk in a situation, the charity was told by mental health staff as part of its research for the report.
In addition, it was unclear how far new roles such as nursing associates would alleviate workforce shortages, there were concerns the removal of bursaries may increase competition with other degree subjects for students, and not enough was being done to promote careers to school pupils, the charity heard.
It was commissioned by the body NHS Employers to look at mental health workforce issues in secondary care across the country, because these problems were seen as “important and not always well understood”.
The charity spoke with more than 100 people at consultation events after reviewing other recent national mental health workforce reports.
The resulting document -– titled Future of the Mental Health Workforce (see PDF attached) – highlighted the 10% decline in mental health nurses working in the NHS – down from 40,862 in October 2009 to 35,943 in October 2016.
“We need to attract young people to mental health work from school age and create lively, varied and challenging careers”
It noted this was occurring mostly in inpatients services, which it said was likely because of bed closures.
When the charity spoke to staff at NHS trusts, it uncovered a series of problems with attracting people into mental health nursing, high rates of staff turnover and a lack of time and money being invested in mentoring and supervision.
Placements for students were often limited to where nurses who had trained as mentors were based, while trainees reported that mentors struggled to juggle the role with daily demands of their nursing job.
“I’ve had to cut students in the team because of the number of mentors,” said one nurse. “Mentors don’t have time to breathe, reflect, evaluate or even think about their own work.”
Meanwhile, supervision was seen as critical in the retention of staff, who “often hear of and see quite harrowing things…”, and are susceptible to burnout.
While new nursing apprenticeship training routers and nursing associate roles may offer “potential opportunities”, staff reported concerns that their introduction were not part of a coherent and co-ordinated plan.
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“At one event it was reported that the introduction of the nursing associate role had ‘scuppered’ local planning and thinking about more general mental health associate roles,” said the report.
New mental health nurses ‘not adequately trained or mentored’
The charity noted that the system regulator NHS Improvement had earlier this year launched a programme to help NHS trusts, in particular those running mental health services, to hold onto staff.
It also flagged that NHS England’s Five Year Forward View, launched in 2016, had set out plans to increase the size of the mental health workforce.
But it said “major, and in some cases, fundamental” changes were required beyond the next five years to improve how all parts of the mental health workforce were trained, employed and supported.
The charity made 22 recommendations including calling for employers to target school leavers for recruiting into the workforce, the creation of a specific career pathway for inpatient care, additional training for existing staff, and recognition that mentoring was a “core” aspect of work for staff.
“The future mental health workforce will need to be skilled in coproducing services with those who use them; in educating and supporting GPs, teachers and hospital staff; and in engaging with communities,” said the Centre for Mental Health’s chief executive Sarah Hughes.
“We need to attract young people to mental health work from school age and create lively, varied and challenging careers that change as people get older. And we must create compassionate organisations that support the wellbeing of those who work in them,” she added.
Danny Mortimer, chief executive of NHS Employers, said he hoped the report’s recommendations were acted on across healthcare services more widely.
“We particularly welcome the recommendation to highlight the rewards of working with service users and their families and the focus on the development of the existing workforce,” he said.
Professor Lisa Bayliss-Pratt, director of nursing at Health Education England, which supported the research, said: “HEE very much welcomes this report and is looking forward to working with partners across the system on both recommendations from this insightful report, as well as our own mental health workforce plan Stepping Forward to 2020-21 to ensure we provide the very best care.”