Acute Mental Health Nursing: From Acute Concerns to the Capable Practitioner


Edited by: Marc Harrison, David Howard & Damian Mitchell

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    List of Contributors

    Ian Baguley qualified as a Mental Health Nurse in 1973 and worked in a range of NHS settings. He started work at University of Manchester 10 years ago and has been involved in developing skills based education courses in areas such as Psychosocial Interventions and Cognitive Behaviour Therapy. He is currently working as National Programme Manager for Mental Health Workforce Development.

    Joe Curran is a mental health nurse with experience in acute in-patient, forensic and community settings. He currently has a clinical caseload and is involved in education, training, and some research. His work interests include the application of CBT to in-patient environments, practice-based evidence, and behaviour analysis.

    Mike Doyle is a qualified RMN who has worked in mental health services for 18 years. He is currently undertaking Post-Doctoral Research at the University of Manchester and also has a Clinical Advisor role in the North West Adult Forensic Mental Health Service that includes work as a specialist therapist in Psychosocial Interventions.

    David Duffy is a Nurse Consultant specialising in suicide and self-harm, currently employed by Bolton, Salford and Trafford Mental Health NHS Trust. David has a Doctoral thesis on the subject of suicidality, and from 2001 was lead co-ordinator of the National Suicide Prevention Strategy for England. With Dr Tony Ryan, he is editor of New Approaches to Preventing Suicide: A Manual For Practitioners (Jessica Kingsley, forthcoming).

    Julie Dulson completed her nurse training in 1997, working in a range of inpatient settings mostly acute, but also rehabilitation and high dependency. She currently works for Mersey Care NHS trust as a practice development facilitator working within the acute inpatient wards. She has recently been seconded half time as practice development facilitator for the acute solutions project at Sainsbury's Centre for Mental Health, based within the acute wards in Mersey care NHS trust.

    Alison Faulkner is a mental health service user/survivor now working as an independent researcher, trainer and writer. She has over 16 years' experience in social research, including around 5 years specialising in qualitative methods, and is currently working on the evaluation of a crisis service in Leeds. She is owned by a small black and white cat.

    Kevin Gournay is a Chartered Psychologist and Registered Nurse. He has been involved in policy research and development in inpatient care for the last 10 years. He is an expert witness on inpatient suicide and has continued clinicial work throughout his career, latterly using CBT for psychosis as well pursuing his specialist interest in the treatment of severe anxiety disorders.

    Richard Gray is a Lecturer and MRC Fellow in Health Services Research at the Institute of Psychiatry, Kings College, London. He qualified as a mental health nurse in 1993 and in 2001 he was awarded his PhD from the Institute of Psychiatry. He has published over 60 papers and book chapters.

    Julie Hall has a background in mental health nursing who is currently employed as Care Pathway Manager and Audit Lead for Lincolnshire Partnership NHS Trust where she has led the successful implementation of integrated care pathways and variance reporting systems. Julie is currently supported by an Economic and Social Research Council research scholarship to evaluate the use of integrated care pathways in mental health services.

    Marc Harrison has a background in both community and acute mental health nursing. He is currently Head of Curriculum Development and Quality Assurance for HM Prison Service (England and Wales) and is also Honorary Research Fellow at the Institute of Psychiatry. Prior to this he was Senior Research Fellow at the University of Manchester and Senior Project Officer with the WHO ‘Nations for Mental Health Programme’.

    David Howard began his mental health career at the age of 17 as a nursing cadet and has worked extensively in areas of mental health practice, research and education. He is currently Director of the MSc in Organisational Leadership in Health and Social Care at the University of Nottingham, although he continues his interests in mental health by means of teaching and clinical work.

    Ann Jackson, RMN, BA (Hons.), MA, is Senior Practice Development Fellow with the RCN Institute Mental Health Programme. Ann's clinical background is in acute in-patient nursing. Her main research interests include: feminist and anti-oppressive research methodologies/practice and women's mental health.

    Mick James qualified as a mental health nurse in 1984 and has worked in a broad range of clinical settings. As a senior nurse, he had practical experience of implementing the use of HoNOS across a mental health service. Mick has been National HoNOS Advisor at the Royal College of Psychiatrists' Research Unit since 2000 and also continues to work as a senior manager in the NHS.

    Julia Jones, BA (Hons.), Ph.D, wrote this chapter whilst Research Fellow with the RCN Institute Mental Health Programme. She has conducted a number of research studies in acute in-patient settings. She is currently a Marie Curie fellow at the University of Verona, Italy.

    Damian Mitchell was appointed to the post of Head of Healthcare Training for the Prison Service (England and Wales) in July 2002, a post that moved across to NHSU in March 2004. Damian is also Subject Lead within the School of Interprofessional Health and Social Care, NHSU, for Mental Health, Criminal Justice and Offender Services.

    Rachel Perkins is a Consultant Clinical Psychologist and Clinical Director of Adult Mental Health Services at South West London and St. George's Mental Health NHS Trust. She is also a user of mental health services, vice-chair of the Manic Depression Fellowship, a Specialist Advisor at the Health and Social Care Advisory Service and a member of the Disability Rights Commission's Mental Health Action Group.

    Julie Repper is Senior Research Fellow at Sheffield University and Lead Research Nurse for Sheffield Care Trust. Her research interests include social inclusion, recovery and user and carer involvement. She is currently exploring best practice in the assessment of carers' needs and has recently published, with Dr Rachel Perkins, a book entitled Social Inclusion and Recovery: A Model for Mental Health Practice.

    Paul Rogers worked as a clinician in secure services for 14 years prior to commencing his research career. His current research includes suicidal thinking and mental disorders in prisoners, and the examination of predictive tools for criminal reconviction. Paul has published over 50 peer reviewed and professional papers and was the recipient of the Professor Annie Altchul Publication Prize in Mental Health in 2001.

    Tony Ryan has worked as Service Development Manager and Senior Research Fellow since 2000, initially at the North West Mental Health Development Centre and now for the Health and Social Care Advisory Service (HASCAS), as well as working at the University of Manchester. Tony has also spent 10 years working in the NHS as a mental health nurse in a variety of roles.

    Gail W. Stuart is Dean and a tenured Professor in the College of Nursing, and a Professor in the College of Medicine at the Medical University of South Carolina. She is currently President of the American College of Mental Health Administration and a fellow in the American Academy of Nursing. She is a prolific writer possibly best known in nursing for her textbook: Principles and Practice of Psychiatric Nursing, now in its 7th edition.

    Martin Ward is an independent mental health nursing consultant and director of MW Professional Development Limited. He has 35 years' experience in mental health care, as a nurse, teacher, researcher, politician and writer. He was formerly Director of Mental Health for the Royal College of Nursing, and has a large portfolio of publications and a history of international teaching and supervision.


    When I first started my career in nursing during the 1960s, there were something over 130,000 in-patient places for people with mental health problems, largely sited in the large Victorian asylums. We now know that literally tens of thousands of patients spent their lives incarcerated, when there was probably no reason why they should not have lived reasonably productive lives in the community. Visionaries such as Jim Birley, George Brown, John Wing, Julian Leff and others, were the driving forces behind deinstitutionalisation in the UK, a process that has now been paralleled worldwide. Without any doubt, deinstitutionalisation has brought major benefits, and the lives of countless people have been improved because they are now able to receive treatment in their own homes and communities, rather than being banished to a distant ‘bin’. However, we also have to admit that deinstitutionalisation and the setting up of community mental health teams have been far from free of problems. It needs to be said that the expectations of community care have not been realised and I believe (and I know this is an unpopular view with many of my colleagues), that when Frank Dobson said in 1997, community care has failed, he was substantially correct. I had the great pleasure of providing Frank Dobson with advice at this time, and I know that he recognised that community care had failed, not because of the shortcomings of the dedicated people who are the doctors, nurses, psychologists, social workers and others working in our mental health services, but because of starvation of necessary funding, which had been a problem for more than 20 years. With a few exceptions across the world (Australia being a notable example), there had been no bridging funding made available to start up community mental health teams and no real investment in training the necessary numbers of mental health staff for this work and providing them with the means to deliver psychosocial interventions and other evidence-based treatments. Another set of reasons for the relative failure of community care is connected with a range of complex issues concerning public acceptance of the mentally ill. As a consequence of society's views of mental illness and of under-resourcing we now have the spectre of what Len Stein (the architect, with his collaborator Marianne Test, of assertive community treatment) called transinstitutionalisation; i.e., housing mentally ill people in prisons rather than in humane residential care settings.

    It is within this wider context that this book is being published. Its publication is extremely timely given that we have at last realised that the emphasis on community approaches has led to the neglect of the acute care area. This book is a valuable addition to the growing literature on acute care and should provide great encouragement to the frontline staff in this area. More positively, we are beginning to see some real new financial investment in mental health services and while some say this is too little too late, I am optimistic that this new money will make a real difference. One other development which should lead to improvement is the setting up of the National Institute for Mental Health which has an emphasis on improving standards in a uniform and systematic fashion. Thus, new textbooks, such as this, will provide the means of disseminating up-to-date knowledge to services across the country.

    The chapters in this book should provide the reader, who may be an undergraduate or an experienced mental health worker, with current perspectives on a range of important topics. I was particularly pleased to accept the offer of contributing a chapter, as when I saw the chapter outline, what struck me was the emphasis on providing humane mental health care, within the context of a sound evidence base. Now that I have been able to read the whole text, I am even more pleased to see that the chapter focus is on topics that will make a real difference to people's lives. These important issues are: psychosocial interventions, medication management, risk assessment and management, and the use of various assessment methods. While the issues of what constitutes evidence, and how that evidence is obtained, preoccupies many academics, these chapters go to the heart of what is important to patient care, and the reader will obtain an overarching, and practical-based, view of each area. In addition, the chapters on integrated care pathways, the analysis of the UK and US systems, and two excellent chapters which focus on social inclusion and patient perspectives will provide much food for thought.

    Finally, I was delighted to see a chapter on observation, which sets forth the view that the observation of the most ill patients in our residential settings should be provided within the context of a therapeutic relationship. By bringing together this range of excellent material the editors have also been able to produce a book which addresses the most thorny problems which face most frontline staff for much of their working day. Most importantly, the reader of this book will be availed of a wide range of information which, if put into practice, will improve the quality of services that we provide to one of the most needy groups in our society.

    KevinGournay CBE Institute of Psychiatry, King's College London March 2003

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