What does a Mental Health Nurse do?

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In this very insightful piece, find out what it takes to be a Mental Health Nurse and what you can expect from your role as one.

1 in 4 of us will experience a mental health difficulty at some point in our lifetime.

Whether that be feelings of anxiety or depression or experiencing low mood and emotional difficulties it is now widely accepted that mental illness is very common.

Nurses who specialise in supporting people with mental health issues are called Registered Mental Health Nurses or RMNs.

There are nearly 290,000 nurses registered with the Nursing and Midwifery Council (NMC) in England and 12% (34,000) of those are Registered Mental Health Nurses.

A similar percentage of the nursing profession are RMNs in Scotland and Wales.

There continues to be widely published concerns regarding the reduction of RMNs with recent media reports suggesting 2000 mental health staff are leaving their roles a month.

Working as an RMN it is impossible to ignore the impact of this reduction on our profession and the people we work with, yet it is still a highly rewarding and diverse career.

I have worked in a range of mental health settings for 17 years and have been an RMN for the last 12 years.

Throughout this article, I will outline how to become an RMN, what career pathways are open to you and consider how the changing landscape of modern-day healthcare may affect mental health nursing.

What does a typical day look like for a Mental Health Nurse?

The attraction for many who work as Mental Health Nurses is that no two days are ever the same.

Mental Health Nurses work in a vast array of inpatient and community settings, medical centres, schools, prisons, undertaking research or universities.

Mental Health Nurses work with individuals across the lifespan from specialist perinatal services, child and adolescent, working-age individuals, older adults and later life dementia care.

Some days will be structured with arranged appointments, others will be responding to emergencies and very much thinking on your feet!

The setting that you work in will, to a degree, provide variances in the role of a Mental Health Nurse.

A nurse working in the community may work in a more autonomous way than those who work in inpatient settings and once qualified the career as a Mental Health Nurse has the potential to be incredibly varied.

Across the UK there is a range of mental health services offered in the community.

Divided into Primary, Secondary and Specialist services there may be geographical variances in the way teams work, however, the core skills for a Mental Health Nurse remain the same.

Within Primary Care, Mental Health Nurses will receive referrals from GPs and A&E departments.

Following assessments, nurses will offer short-term interventions which may include anxiety management, support with depressed mood, advise on possible medications and work with a range of common mental health issues.

As a nurse, you will spend 1:1 time with individuals for a set, short period of time, 10-12 weeks for example. If a person requires longer-term support, you may refer them to Secondary Mental Health Services.

Mental Health Nurses working in secondary community services will work with people who have more complex or serious chronic mental health difficulties.

They may have been in a hospital or be diagnosed with an illness such as schizophrenia, mood disorders (serious depression or Bi-Polar Affective Disorder) or post-traumatic stress disorder.

As a Mental Health Nurse, you will carry a caseload of between 20-30 individuals and be responsible for coordinating their package of care whilst they are in the community.

You will build relationships with the people you support in order to monitor their mental health, watch for relapse signs, know what potential triggers they experience and support them to engage in meaningful activities.

By knowing the people you work with, you will be able to assess their ongoing mental health and adjust the input you offer them accordingly.

Some of the people you work with may be going through a crisis for example and you will increase your sessions, suggest adjustments in medications or arrange meetings with psychiatrists, psychologists or family members.

As a Community Mental Health Nurse, you will have received training in the Mental Health Act 1983, which is the legal framework for those who require admission to hospital.

Working in the community you may have to arrange assessments under the Mental Health Act in order to admit people to hospital.

Working in the community means you will often manage your own time and daily tasks.

You will support people to engage with other agencies and you will build close links with housing support, 3rd sector organisations, social services, education, and GPs.

Many areas of the UK have specialist community teams including memory clinics for those with dementia, assertive outreach services for difficult to engage patients, early intervention in psychosis services, crisis teams, mental health for the homeless, community forensic teams, police street triage and many more.

As you move through your training and career it is likely you develop an interest in a particular field of mental health.

Whether you work in the community or an inpatient unit will depend on your personal preference and local opportunities.

The national strategy for mental health, The Five Year Forward View published in 2016 places emphasis on preventive and early intervention for mental health issues with funding now focused on community services.

With a reduction in hospital beds, inpatient mental health units now admit people who are in acute stages of serious mental illness, with a high percentage being detained legally under the Mental Health Act 1983.

As a Mental Health Nurse working in an inpatient unit, you will work as part of a ward team to deliver care and treatment to those in crisis.

Inpatient settings often mirror services within the community, with child and adolescent units, working-age acute mental health wards, specialist dementia wards and Psychiatric Intensive Care Units.

There are also national units for psychosis, eating disorders, mood disorders and therapeutic communities for those with personality disorders and emotional difficulties.

There are longer-term inpatient settings for patients involved in the criminal justice system (forensic mental health) and rehabilitation units where people can stay for up to two years.

Historically, Mental Health Nurses would always begin their careers working in hospitals.

The skills you develop working in acute wards are transferable to all settings and help nurses build confidence and knowledge.

You will be required to assess people admitted to the ward and develop plans of support accordingly.

You will work closely with Psychiatrists and other professionals to establish pathways for individuals and maintain a therapeutic environment on the ward through group work, 1:1 time and facilitating time off the ward.

What kind of person and soft skills make a good Mental Health Nurse?

Working in mental health requires a level of emotional resilience and self-awareness.

As nurses, we walk alongside individuals in their darkest and scariest times.

Often people’s behaviour can be difficult to understand or explain and can cause distress.

Mental Health Nurses try and help individuals find meaning and understanding of their experiences and build coping mechanisms to prevent further relapses.

You will need compassion and empathy, qualities which you may have developed from your own experiences in life.

Although not always the case, many Mental Health Nurses have gone through experiences which have motivated them to want to support others.

Human beings are fragile and as a Mental Health Nurse, there will be a recognition that anyone at any time can be susceptible to vulnerability and mental illness.

Listening is a skill, we can all sit and have a conversation, but to actively listen to another person requires patience, a non-judgmental attitude and the ability to put our own minds and thoughts out of the way.

As a Mental Health Nurse, you will receive on-going supervision in order to support you developing these skills and help you make sense of your own mind and lives so that you can support others.

What hard skills and qualifications are required to become a Mental Health Nurse?

Alongside the soft skills required to be a Mental Health Nurse, which can often seem intangible, there are specific qualifications and quantifiable skills needed.

Nurse education has changed substantially over the last decade, with a move to university degree courses.

Undergraduate Mental health Nursing degrees are offered at most universities across the country with applications via UCAS.

You will usually need A Levels or complete an access course.

Previous experience in a healthcare setting is an advantage so it is always beneficial to work as a Support Worker or Health Care Assistant prior to applying if possible.

Mental Health Nursing degrees are three years long and are split between academic modules at university and practice placements in a variety of community and inpatient settings.

The first year of any nursing degree is a common foundation program (CFP) which all nurses do no matter what the speciality.

The final two years will be solely mental health and you will learn about mental illness theories, practical assessment skills, pharmacology, physical health and treatment approaches.

Whilst on placement you will be supernumerary, meaning you won’t be counted as part of the nursing numbers.

This gives you an opportunity to develop your interpersonal skills, write care plans, use assessment frameworks and learn how to document all interactions professionally.

The experiential learning which occurs whilst on practice placements is invaluable and as the course progresses you will discover which area of mental health interests you and help you build an idea of the career ahead of you.

You will have a combination of academic essays to complete alongside practice portfolios which match your placement skills with the Nursing and Midwifery Council competencies.

The Nursing and Midwifery Council (NMC) are our professional body and once you have completed and passed your degree you will join the NMC professional register.

Once on the register, you will receive a unique pin number, allowing you to legally work as a Mental Health Nurse.

Keeping your nursing registration up to date Mental Health Nursing is a journey of lifelong learning.

It is both a professional and personal responsibility to keep up to date with the ever-changing evidence base in nursing practice.

You will be required to pay a registration fee yearly to the NMC and you will be asked to provide evidence of continuing professional development (CPD) every three years when you revalidate.

CPD can be the range of essential training your employer requires such as intermediate life support, moving and handling, health and safety, infection control and information governance training.

It is a good idea to keep your own records of any training completed so you can provide evidence to the NMC if requested.

As a Mental Health Nurse, you can develop more specialist advanced assessment skills, undertake courses in the Mental health Act 1983, specific treatment approaches such as cognitive behavioural therapy or dialectical behavioural therapy or return to university to undertake a Masters or PhD.

Becoming a registered mental health nurse or RMN is often just the beginning.

It is an excellent qualification to have and often provides the foundation for many other career pathways.

Many Mental Health Nurses undertake further training to become therapists, teachers, lecturers, managers or researchers.

What Causes Schizophrenia?

If you know someone with schizophrenia, you probably want to know why they have it. The truth is, doctors don’t know what causes this mental illness.

Research shows it takes a combination of genetics and your environment to trigger the disease. Knowing what increases the chances can help you put together a better picture of your odds of getting schizophrenia.

Is Schizophrenia Genetic?

Think of your genes as a blueprint for your body. If there’s a change to these instructions, it can sometimes increase your odds for developing diseases like schizophrenia.

Doctors don’t think there’s just one “schizophrenia gene.” Instead, they think it takes many genetic changes, or mutations, to raise your chances of having the mental illness.

They do know that you’re more likely to get schizophrenia if someone in your family has it. If it’s a parent, brother, or sister, your chances go up by 10%. If both your parents have it, you have a 40% chance of getting it.

What Are Your Chances of Getting Schizophrenia Genetically?

Your chances are greatest — 50% — if you have an identical twin with the disorder.

But some people with schizophrenia have no history of it in their family. Scientists think that in these cases, a gene may have changed and made the condition more likely.

Genetic Causes of Schizophrenia

Many genes play a role in your odds of getting schizophrenia. A change to any of them can do it. But usually it’s several small changes that add up and lead to a higher risk. Doctors aren’t sure how genetic changes lead to schizophrenia.

Environmental Triggers

Genetic changes can interact with things in your environment to boost your odds of getting schizophrenia. If you were exposed to certain viral infections before you were born, research suggests that your chances may go up. This could also be true if you didn’t get proper nutrition while your mother was pregnant with you, especially during her first 6 months of pregnancy. These are both theories, but they haven’t been proven by scientific studies.

Studies show that taking certain mind-altering drugs called psychoactive or psychotropic drugs, such as methamphetamine or LSD, can make you more likely to get schizophrenia. Some research has shown that marijuana use has a similar risk. The younger you start and the more often you use these drugs, the more likely you are to have symptoms like hallucinationsdelusions, inappropriate emotions, and trouble thinking clearly.

The Role of Brain Chemistry and Structure in Schizophrenia

Scientists are looking at possible differences in brain structure and function in people with and people without schizophrenia. In people with schizophrenia, they found:

  • Spaces in the brain, called ventricles, were larger.
  • Parts of the brain that deal with memory, known as the medial temporal lobes, were smaller.
  • There were fewer connections between brain cells.

People with schizophrenia also tend to have differences in the brain chemicals called neurotransmitters. These control communication within the brain.

Studies of brain tissue in people with schizophrenia after death even show that their brain structure is often different than it was at birth.

Additional Risk Factors for Schizophrenia

  • An older father
  • Problems with your immune system, like inflammation or an autoimmune disease
  • Taking mind-altering drugs as a teen
  • Complications during pregnancy or birth such as:
    • Low birth weight
    • Premature labor
    • Exposure to toxins, bacteria, or viruses
    • Lack of oxygen during birth
  • Living in a low-income urban area