Community Mental Health and Community Psychiatric Nursing

Pierre Galea

Community Mental Health A Historical Perspective

Institutional neurosis

Role of medication

Closing down of psychiatric hospitals

Community Mental Health

What are the benefits of providing mental health care in the community?

• De-institutionalization

• De-stigmatization

• Normalization (least disruptive)

• Taking the service to those who need it the most! (revolving door syndrome)

• Promotion of good mental health in the population

What is the role of the Psychiatric nurse in the Community?

• Psycho-social support

• Link between patient, family and MH services

• Monitoring / observation

• Medication Management (education, administration, monitoring)

• Assessment (risk, mental state, social support/situation)

• Psycho-education

• Making the service adaptable to the patient

• Home visits

The research study: The Role of the Community Psychiatric Nurse in

Malta

• How is the role of the Community Psychiatric Nurse evolving in Malta?

• What are the challenges and difficulties experienced by the CPNs in their role?

• How are psychiatric nurses coping with the new challenges and changes to their role from hospital based nurses to community nurses?

Method

• Single Case Study Method - the study of the particular (Simons, 2009)

• Sample – (n=5)

• Single, face-to-face, semi-structured, qualitative interviews

• Thematic Analysis

• Ethical issues

Main Themes

CPNs are working effectively as independent and dedicated practitioners

• The therapeutic relationship

• Activities with patients

• Being flexible and working independently

• Working as part of a team

• Knowledge and experience to perform the role

• Qualities to perform the role

CPNs are struggling in the role • Uncertainties about the role

• Difficulties in performing the role

• A struggle to be recognized

Activities of the CPNs

• What activities do psychiatric nurses engage in the community?

The role is vague and difficult to describe, but flexible

(Kudless & White, 2007 and McKenna et al., 2000)

o The development of a therapeutic relationship

o Medication Management

o Monitoring of effects and side-effects

o Monitoring of mental state

o Education

o Family work

o Therapeutic individual sessions / homevisits

The therapeutic relationship

• Guided the participants in their work

• Helped in the transition from hospital based work to community

(Barlow, 2006)

(Ryan et al., 2006)

(Shattell, et al., 2006)

• Beyond the illness…towards recovery

• Focus on the person

• “Walking the journey” with the patient

The Tidal Model (Barker, 2001)

• “therapeutic friendliness” (Gardner, 2010)

Challenges and difficulties

Uncertainties about the

role

Struggle to be

recognized

Difficulties in performing

the role

Recommendations

• Clinical supervision

• Involvement in decision making

• Role recognition

“MHNs have consistently identified the therapeutic relationship and the therapeutic use of self as the hallmarks of their practice, while simultaneously recognizing the difficulty of describing these in nursing documentation in any way that does not reduce the complexity of these phenomena to something approaching the banal.” (Hurley, Mears & Ramsay; 2009) Thank you

pierregla@yahoo.co.uk

References:

• Adam R., Tilley S. & Pollock L. (2003) Person first: what people with enduring mental disorders value about community psychiatric nurses and CPN services. Journal of Psychiatric and Mental Health Nursing, 10: 203-212

• Barker P. (2001) The Tidal Model: developing an empowering, person-centred approach to recovery within psychiatric and mental health nursing. Journal of Psychiatric and Mental Health Nursing, 8: 233-240

• Barlow K. (2006) Perceptions of the role of the community psychiatric nurse. Nursing Times, 9 (102): 34-42

• Burns T. (2004) Community Mental Health Teams. Oxford University Press

• Crawford P., Brown B. & Majomi P. (2008) Professional identity in community mental health nursing: A thematic analysis. International Journal of Nursing Studies, 45: 1055–1063

• Cunningham G. & Slevin E. (2005) Community psychiatric nursing: focus on effectiveness. Journal of Psychiatric and Mental Health Nursing, 12: 14-22

• Edwards D., Burnard P., Hannigan B., Cooper L., Adams J., Juggessurt T., …Coyle D. (2006) Clinical supervision and burnout: the influence of clinical supervision for community mental health nurses. Journal of Clinical Nursing, 15: 1007-1015

• Gardner A. (2010) Therapeutic friendliness and the development of therapeutic leverage by mental health nurses in community rehabilitation settings. Contemporary Nurse, 34 (2): 140–148.

• Hurley J. (2009) A qualitative study of mental health nurse identities: Many roles, one profession. International Journal of Mental Health Nursing, 18: 383–390 doi: 10.1111/j.1447-0349.2009.00625.x

• Hurley J., Mears A. and Ramsay M. (2008) Doomed to fail: the persistent search for a modernist mental health nurse identity. Nursing Philosophy, 10: 53-59

• Kipping C.J. & Hickey J. (1998) Exploring mental health nurses expectations and experiences of working in the community. Journal of Clinical Nursing, 7: 531-538

• Kudless M. & White J.H. (2007) Competencies and roles of community mental health nurses. Journal of Psychosocial Nursing, 45 (5): 36-44

• McKenna H., Keeney S., Bannon D. & Finn A. (2000) An exploration of community psychiatric nursing: A Northern Ireland Perspective. Journal of Psychiatric and Mental Health Nursing, 7: 455-461

• Ryan R., Garlick R. & Happell B. (2006) Exploring the role of the mental health nurse in community mental health care for the aged. Issues in Mental Health Nursing, 27: 91-105 doi: 10.1080/01612840500312902

• Shattell M., McAllister S., Hogan B. & Thomas S. (2006) “She took the time to make sure she understood” Mental health patients’ experiences of being understood. Archives of Psychiatric Nursing, 20 (5): 234-241

• Simons H. (2009) Case Study Research in Practice London, Sage Publications

• Simpson A. (2005) Community psychiatric nurses and the care co-ordinator role: squeezed to provide ‘limited nursing’. Journal of Advanced Nursing, 52 (6): 689-699