ISSUES IN MENTAL HEALTH NURSING

Issues in Mental Health Nursing

Issues in Mental Health Nursing

Part A:

Introduction

Mental health problems are the most common cause of disability and premature death, accounting for 23% of the burden of disease experienced by high-income countries (WHO, 1999). In response, The World Health Organisation Mental Health Unit of the Regional Office for Europe has prioritised action to reduce stigma, counteract depression and audit the quality and efficacy of mental health services. As part of this international agenda, the UK National Service Framework (NSF) for Mental Health (DH, 1999) states that UK mental health service providers need to ensure adequate service user and carer involvement, indicating that the experience of users and carers, including those from black and minority ethnic groups, is a recognised national marker of service performance.

Within UK NHS mental health services, nurses make up the largest proportion of the workforce. In 2004, 96 269 mental health nurses were registered in the UK (NMC, 2004a), their predominance within mental health services providing them with a pivotal role in the delivery of the NSF. In the foreword to their White paper consultation document, 'A first class service: quality in the new NHS' (DH, 1998), the UK government emphasised their commitment to ensuring that standards of professional self-regulation are rigorous and in line with the valid expectations of service users. Reviewing mental health service user and carer expectations is, therefore, one important factor in advancing understanding of the contribution qualified mental health nurses can make to the modernisation of UK mental health -care provision.

The importance of engaging service users in the development, organisation and delivery of healthcare is being increasingly recognised (Sitza and Wood, 1997). Over the past 15 years, the NHS has experienced a general shift towards a more consumerist ethos in which consumer satisfaction has gained widespread recognition as a key quality indicator. A growing desire to collate users' perspectives has led to an increased emphasis on people-centred services and public involvement in the planning of statutory health care (NHS Executive, 2000).

Prior to the rise of consumerism, however, the assessment of service satisfaction amongst people with severe mental health problems had been relatively neglected. A concern of clinicians and researchers alike was that a lack of insight in many service users may ultimately compromise the validity of their self-reported views (Fitzpatrick, 1991). Much of this concern has since been discounted with clear evidence that service users do have opinions about their care, and that it is possible to elicit valid and useful views from the majority of individuals ([Noble et al., 1999] and [Noble et al., 2001]). Credence has been given to the fact that as consumers of health services, users can usefully contribute to quality assurance both by directly evaluating care and by providing information to others (Donabedian, 1992). Irrespective of the method that is adopted, it can be argued these people remain the most appropriate individuals to inform nurses about the quality of their care (Reynolds et ...