I never went in to mental health nursing as a career choice thinking it was going to be a bed of roses.
Sometimes when you are experiencing your own issues, the last thing you want to do is go to university to listen to lectures on depression, suicide and self-harm. I sometimes get caught up in my own world; I don’t always see the bigger picture of mental health nursing. One of our lecturers asked us what it is that mental health nurses do?
What is it then that separates us from other branches of nursing? What can other branches of nursing learn from us? It’s a challenge because what we do can be hard to define, but I will of course try.
There is a current focus on the importance of the therapeutic relationships and recovery; we help people to grow and develop; people can recover from severe mental illnesses like schizophrenia; and the model of treatment is shifting from a purely medical model to looking at psychological and social causes of mental illness.
I am part of a group of growing numbers of professionals interested in critical psychiatry. The argument is that we should be treating the person more holistically, seeking to understand the potential causes of symptoms that aren’t biological. There is no definitive evidence for what causes depression and schizophrenia, despite what pharmaceutical companies tell us. We should seek to spend time with people, get to know them, understand the cause of their symptoms of mental illness rather than throw medication and diagnostic labels at them. I am not totally anti-medication of course. However, I do think we over-medicate as has been reported on recently in the news with regards to primary care.
Three weeks ago, a former colleague of mine took her own life. To the outside world, she had battled with depression for a long time. From what could be seen on social media, there may have been clues. However, it was still a shock. This was a woman who had championed mental health awareness and challenged stigma whilst fighting her own battle. She sought to educate and empower others to get help. A couple of days later, in university, my group carried out a hanging scenario in class, to prepare us for these types of events in practice. I have learnt to compartmentalise my emotions.
Suicide can still happen regardless of suicide prevention strategies and when someone really wants to kill themselves, they will in all likelihood do it. We can’t always predict if and when someone will take their own life; we can however, look to potential clues and try to document and escalate risk where we can. Nonetheless, it scares me that a person at least perceived to be ‘okay’ can all of a sudden take their own life.
In other challenges, I have been ‘lucky’. I use inverted commas because I would like to see the potential worst of what I can, so I can be marginally prepared for it when I’m qualified. I have not seen anyone attempt suicide as yet; I have only seen superficial self-harm and only experienced mild physical and verbal aggression. The latter of course can be a side effect of mental illness, but we must seek to understand why someone is being aggressive. Is this person really being listened to? I have experienced more violence and aggression in schools in which I have been a supply teacher than I have seen on an acute inpatient ward.
So if there are so many challenges in nursing in mental health, where is the joy?
When you see someone recover over a period of time, you can have a small or large role in that recovery. Student nurses can see a snapshot of this when out on placement. For example, I recall a patient I helped nurse on an acute psychiatric ward who I then saw a few months later out in the community; he remembered my name and what I had done to support him. It’s the little things we do for people that count, such as cups of tea, listening and spending time with them, being curious and wanting to get to know a person. I love educating people about promoting good mental and physical health because they are so intertwined. It is such a fascinating and varied branch of nursing.
I think for my own good I need to not look too far ahead, not worry about what hasn’t happened yet and take each day as it comes. I do thrive on challenges and variety but I hope that I will have training and support to I will still need once I qualify. I do wonder what kind of mental health nurse I will be and whether I will have the emotional resilience to deal with the challenges that lay ahead.
Student nurses of all branches need to understand that you can’t prepare for every eventuality, but being self-aware and able to critically reflect is key to having the resilience needed for mental health nursing.
Becky Kidman is Student Nursing Times’ mental health branch editor