Preparing Mental Health Nurses To Work In Community

Since the first post-registration education programme, preparing mental health nurses for practice in a community setting, appeared in 1970 at Chiswick Polytechnic, there have been significant changes in the nature of and academic level at which Community Mental Health Nurse (CMHN) courses have been offered. In 1988, almost all educational centres offered courses at certificate level. However, by 1995, virtually all centres offered a relevant course at diploma level.

The introduction of Project 2000 in the late 1980s brought pre-registration nurse education to diploma level, and has encouraged post-basic education, like the CMHN course, to degree level, as enshrined in the United Kingdom Central Council for Nursing and Midwifery’s PREP (Post-Registration Education and Practice) policy proposals of 1994. At this time, the UKCC issued new standards for the post- registration preparation of community nurses.

Such standards allied the preparation of community nurses, CMHNs included, to specialist practitioner learning outcomes, and to academic achievement at degree level.

Courses were to maintain a 50:50 balance between theoretical and clinical practice based elements, and were to combine shared learning between the different branches of community nursing with branch-specific learning.

The past 10 years has seen the development of “Thorn” nursing courses (sponsored by Thorn/EMI) that focus on the perceived knowledge and skills necessary to implement psychosocial interventions with the seriously mentally ill.

Interventions are aimed at families of such clients in order to reduce the rate of relapse.

National Health Service policies and priorities have continued to shape the role, expectations, and training needs of CMHNs. Such initiatives include Working in Partnership: A Collaborative Approach to Care, the National Service Framework for Mental Health Services, the instigation of the Care Programme Approach in Wales, the Review of Health and Social Care in Wales, Designed for Life and the revised National Service Framework for Adult Mental Health Services.

Such initiatives encourage CMHNs to assess and meet the needs of people with serious mental health problems as a priority, provide a range of clinically effective, evidence-based interventions, provide care in a collaborative, user-focused manner, work effectively within a community mental health team, and practise effectively across discipline and agency boundaries, including working with primary care professionals, and potentially delivering mental health care to individuals in prison.

The drive towards evidence-based healthcare has been championed by the guidelines for practice issued by the National Institute of Health and Clinical Excellence (Nice).

With specific relevance to mental health, a number of guidelines have been recently published which include core interventions in the treatment and management of schizophrenia in primary and secondary care, core interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and related disorders, and cognitive behavioural therapy for anxiety and depression.

In light of the aforementioned changes in CMHN education, and the concurrent policy developments, a robust review was undertaken by the Mental Health Field at the University of Glamorgan to ascertain if the training needs of CMHNs were being appropriately met.

The review entailed a critical exploration of policy drivers in mental health, the needs of service users, the needs of service providers, an examination of current mental health education programmes and current literature relating to the efficacy of mental health education programmes.

Findings from the critical review concluded that post-registration education has to be linked to specific service requirements and service user needs.

Such needs are inextricably linked to and directly determined by recent NHS and Welsh Assembly Government policy directives, and result in the preference towards skills-based education, that would facilitate the provision of clinically effective, evidence-based interventions.

Service providers felt that there was a need to be trained in specific skills-based strategies such as cognitive behavioural therapy and psychosocial interventions, which would facilitate the ability to deliver evidence-based interventions as recommended by recent Nice guidelines.

Specific areas highlighted as a priority included the need to be trained in the assessment and engagement of individuals experiencing difficulties associated with substance misuse, personality disorder, and “dual diagnosis” (individuals who experience both mental health and substance misuse problems). The existing Mental Health Pathway on the BSc (Hons) Community Health Studies course was perceived as having too little focus on skills development and, as such, had experienced a lull in interest and a broad lack of recruitment (a perception that mirrored national findings in the late 1990s).

As a result of the review, the aim was to introduce a new competency based mental health education pathway at degree level, which would replace the mental health pathway on the existing BSc (Hons) Community Health Studies.

A proposal was made for the development of a new BSc (Hons) in Community Mental Health Practice Award and was delivered to the Welsh Assembly Government in March 2005.

An initial meeting was held in June 2005 detailing the process and findings of the report undertaken by the Mental Health Field, following which a series of core planning team meetings were held at the University of Glamorgan.

Membership of the Core Planning Team included both service providers and service users – its remit being the development of the award and assorted modules. The award consists of a programme of both core and optional level three modules targeted at mental health professionals working in the community.

This includes community mental health nurses, social workers, occupational therapists and voluntary sector workers, and is aimed at promoting the principles of inter-agency working and encouraging shared learning between professionals practising in the speciality of community mental health care.

The award is flexible and part-time in nature and will enable participants to gain a BSc (Hons) in Community Mental Health practice over a study period of between two and six years.