What will nursing be like in ten years time? That’s the focus of International Nurses’ Day, being marked on Wednesday 12 May, with the theme ‘a voice to lead – a vision for future healthcare’.
To mark this annual event we are exploring the important role of mental health nurses, hearing from those who know best – our staff. We’re also taking a look back at the history of mental health nursing – what’s changed and what it means today.
The History of Mental Health Nursing
Today, mental health nurses have an established and well-respected place within the nursing profession. They fulfil an important role working within a wide range of mental health care pathways. Until formal training was introduced in the 1900s, nurses based their care mostly on patient behaviour and their own individual ideas of why their charges spoke and acted as they did.
In the very early years, most mental health nurses were men, because patients were often restrained as part of their treatment. They were referred to as “keepers” or “attendants”, very different to the status of today’s fully trained mental health professionals.
It was only in the early twentieth century that the term ‘mental nurse’ begin to emerge and was accepted as the official title for the role, when the General Nursing Council (GNC) formed in 1919. In 1923, when the GNC published its first Register of Nurses, it included just 639 mental nurses, out of a total of 12,097 general nurses.
In the 1940s the term “Psychiatric Nurse” emerged and that became widely used by the 1960s.
The introduction of specialist training
Training was the first step towards registration of nurses and this was proposed towards the end of the nineteenth century. In those initial discussions, it was made clear that “male, mental nurses” should not be included and that registration should be reserved for “female general trained nurses” only. This decision sparked years of controversy. The inability to reach an agreement between the GNC and the Royal Medico-Psychological Association (RMPA) led to 25 years of two ‘rival’ sets of training, examinations and registration.
One scheme was organised by the GNC, and particularly appealed to ‘mental nurses’ who wanted to go on to general nurse training (the majority of whom were female); the other was an almost identical scheme run by the RMPA, which was attractive to those who wanted to make their career in what were known as mental hospitals.
The education of attendants and nurses was undeveloped during the I850s, and psychiatric tuition for asylum doctors was not much better. William Battie, a pioneer in the care of mental patients, helped ensure mental health care became a respectable medical speciality. He was also the first public figure to recognise that mental nurses needed to be specially selected and carefully trained.
In 1906, the proposal by the Educational Committee of the RMPA that the nursing examinations be divided into two parts, was agreed at the annual meeting. The new curriculum, which came into force that year, extended the training to three years with a first examination to be held after one year. This was to deal entirely with anatomy, physiology and first aid, leaving mental illness and care of the insane to the third year.
The 1972 Briggs report on the role of nurses and midwives in hospitals suggested nursing was not the right place for work with the “mentally handicapped” and that a new professional group was needed. It was only in the mid-1970s that community “mental handicap nurses” start to be introduced in some areas – eventually spreading to most parts of the country.
In 1983, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting set up a new professional register with four disciplines: Mental Health, Children, Learning Disability and Adult.
Project 2000, introduced in 1990, allowed student nurses to study for three years, splitting the time between class-based learning, and practical placements. The first 18 months of the course provided basic grounding in the four nursing disciplines, including mental health. This was then followed by another 18 months dedicated to the nursing discipline of choice.
Between 2016 and 2019, the Royal College of Nursing‘s Mental Health Forum ran a campaign called "Parity of Esteem" aimed at raising awareness of the role that nursing staff have in improving health outcomes for people with complex mental health needs.
Mental health nursing today and in the future
The treatment of people with mental health conditions today is very far removed from the early years of nursing practice in a mental health setting; fortunately a major transformation has taken place over the years.
However, mental health care is not always the first choice for most nursing graduates and there is an argument that more needs to be done to ensure that nurses are supported and encouraged to take up this specialism, confident they will have a rewarding and fulfilling career ahead of them
Looking to the future, the NHS Long Term Plan prioritises good mental health care; and the pandemic has also emphasised how important it is.
Significant national funding has been ring-fenced by NHS England for mental health to provide and sustain services.
Over the last five years, and particularly during the COVID pandemic, much work has gone into seeing how new technology can be successfully applied to mental health nursing practice.
As the ambitious NHS Long Term Plan is rolled out, with greater innovation and better funding, there are exciting developments ahead for everyone working in mental healthcare.
C&I has moved the service we normally offer in emergency departments to our 24-hour Mental Health Crisis Assessment Service, at St Pancras Hospital. The service will see people in need of urgent care so that they do not have to go to a hospital emergency department unless they have an urgent medical need. Emergency departments are under unprecedented pressure due to COVID-19 – the illness caused by coronavirus. We are urging people in mental health crisis to telephone our 24/7 crisis line on 0800 917 3333 or contact their usual community mental health team. If service users attend the 24-hour Mental Health Crisis Assessment Service in person we will see you but we urge you to contact the crisis line in advance for advice to ensure you are only leaving home when absolutely necessary.