Today is to be celebrated for many different reasons, especially when looking at the history of nursing. It is 21 years since the very first intake of nursing students to the University of Stirling, 50 years since the University itself was created, and soon will be 70 years since the creation of the NHS. Not just that, but it’s recognised as Mental Health Awareness day. With all this to celebrate, I thought it provided an exciting opportunity to look back on the history of mental health nursing, and views on mental health to see how it has changed and developed. But just how much progress has been made from the conception of the role of the mental health nurse?
For almost two centuries, mental health nurses have struggled to win recognition for their unique contribution to the health and wellbeing of those in their care. Nolan (1993) has well documented the historical timeline of mental health nurses, as well as how they have been viewed by society. From very early on nurses rarely had access to resources which would have enabled them to fully care and treat those suffering. It was the doctors who employed the nurses that taught, trained, examined, and decided what their role should be.
Because of this and the constant development of theory and practice, nursing experienced frequent therapeutic shifts over the decades causing even nurses themselves to feel confusion about their own role and name. During the 18th-19th centuries, they went by the term ‘keeper’, and had a small role of domestic duties, caring for ‘patients’ and keeping them manageable for the doctors. It wasn’t until after 1845 with the emergence of the asylum systems and implementation of the medical model, which attributed all mental illness to biological errors, that they then shifted to ‘attendants’ to seem more humanitarian and gained more responsibility.
From the mid-19th century, the term ‘nurse’, widely recognised today, began to be used. This helped to push for ‘mental nurse’ to become an official title in 1923. The model of practice then shifted to the new field of psychology, bringing forward interventions that are still used, such as psychoanalysis and behaviourism. The medical model remerged later in the century when famous treatments like electro-convulsive therapy became popular. It wasn’t until the late 20th century that models pushed for treatment to be done out in the community thanks to the NHS Care and Community act (1990). At this point nurses were encouraged to be autonomous in their profession and develop their skills to lead and solely deliver care and treatment, with the aim to re-skill and empower those with mental illness.
Despite all this growth, development, and therapeutic shift, this is not how mental health nurses were seen by the general public or even some health professionals. Nolan (1993) commented that the historical view of mental health nurses is that they are lazy, lacking in motivation, compassion, and intelligence. The stigma that clouds mental illness has fogged public perceptions of those who suffer from it, and those that try to ameliorate those suffering.
An early example of this is obsessions with witchcraft, which developed during the medieval times. Countless numbers of people (mostly women) were executed as they were believed to be witches. In 1682, Temperance Lloyd was the last person accused and executed in England, but recent research suggests that she suffered from dementia (Wright, J. 2010). The stigma fed into the fear and paranoia of the supernatural, leading to the deaths of too many. Just think, if these ‘witches’ had been alive today, how would they be treated? Would they still be ‘witches’, or people needing help for a mental illness?
Today, mental health nurses aim to work alongside those experiencing mental ill health while promoting independence, advocacy, and person-centred care. Mental Health Nurses are a caring constant for those in need during the lonely and enduring experience of mental illness; supporting their recovery, providing the essential aspects of treatment not many realise are vital: support, comfort, and presence.
Today’s nurses work long, hard, hours to help a person feel themselves again. But yet both are faced with the same dark cloud fogging perceptions. The stigma looming over mental health is still very much present, and can be an obstacle to accessing care. The historical view on mental health nurses remains to be held by many, including health professionals. The amount of comments like “they’re not real nurses” for example I have heard is disheartening for a 3rd student nurse like myself.
However, it is not just the staff that this view effects. Wright (2010) found that when the NHS Care and Community act (1990) came into place the public protested against those with mental illness living and being treated in the community, in fear for public safety. Yet, it is 6 times more likely that those with mental illnesses are to be murdered than commit murder. Such views like this create a vicious cycle leading to discrimination, low treatment effect, or high relapse rates which reinforce stigma (Sartorius, N. 2007). This could be detrimental to those experiencing mental health, and could possibly be linked to the rise of suicides in Scotland in 2016 (728) from the previous year (672) (ChooseLife. 2017). To me, this highlights the importance of further work being done to raise awareness of mental health with the aim to eradicate stigma, but is this enough?
Improvement is always possible; Wright (2010) suggested bringing in mental health nurses to schools as a potential opportunity to increase awareness and knowledge, and for possible early intervention work. Evidence on the impact of mental health nursing is at its strongest in decades, with a drive for more nurses to be recognised for being a key resource in effective delivery of services (Barker. 2009). More is being planned to tackle these issues too, but this is something anyone can help with. Charities supporting mental health are out there offering fund raising events and education, so anyone can help, even if it’s just through being open minded.
Devon Buchanan, Student Nurse, University of Stirling
10 October 2017
- Barker, P. (2009) Psychiatric and mental health nursing : the craft of caring. 2nd ed. London: CRC Press.
- Chooselife.net. (2017). Chooselife -Statistics suicide in Scotland. [online] Available at: http://www.chooselife.net/evidence/statisticssuicideinscotland.aspx [Accessed 6 Oct. 2017].
- Nolan, P. (1993) A history of mental health nursing. 1st ed. London: Chapman & Hall.
- Sartorius, N. (2007) Stigma and mental health. [online] Available at: http://search.proquest.com/docview/199002822?pq-origsite=gscholar [Accessed 4 Oct. 2017]
- Wright, J. (2010). A history of mental health and wellbeing, part 2. British Journal of School Nursing, 5(8), pp.458-459.
“As a mental health professional, how do you deal with a struggling family member? Mental health student nurse Leanne describes her experience.
“Today, the Scottish Association for Mental Health (SAMH) launched the Going To Be campaign that raises awareness about the number of children affected by mental health problems and how lack of support impacts their goals, dreams and ambitions for the future. ”
For the full post, published 11 May 2017 please visit Leanne’s Nursing Times blog online.
15 May 2017
Today is International Nurses’ Day and this year we are marking it with this film.
Thanks to all students involved, both on camera and behind it.
12 May 2017
The term, ‘hard to reach groups’ is often heard in health and social care research conjuring up images of insurmountable barriers, and populations who are somehow tantalisingly inaccessible to the researcher. Yet, we have no difficulty in using terms such as person-centred, relation-centred or meaningful activities, recognising the importance of each when it comes to support needs and care planning with individuals.
So how do we match the person for whom we have very little evidence of their needs and preferences, with appropriate support that claims to address just that? Surely it is time to change the focus and acknowledge that ‘hard to reach’ groups are actually ‘under-researched’ and that, as researchers, we need to take some responsibility for this?
In 2016, I was part of the Dementia and Equalities group led by the NHS Health Scotland and Alzheimer Scotland. This focused on five particular population groups with characteristics protected by the Equality Act 2010, where a range of challenges might arise in the context of dementia:
- Age – younger onset dementia (under the age of 65 years)
- Race and ethnicity – black or minority ethnic (BME)
- Learning disabilities
- Lesbian, gay, bisexual and transgender (LGBT)
- Disability – sensory impairment
We know that such groups are under-represented in terms of the numbers of people diagnosed with dementia, and current services do not fit specific needs. Yet, without knowledge of the specific characteristics of such populations, the cycle of under representation will continue with a subsequent lack of evidence-based support in practice.
For example, we know that at least 1 in 3 people who have Down’s syndrome are estimated to have a type of dementia by the time they reach mid-50s. This leaves the potential for a period of ageing with increasing cognitive impairment whilst not ‘fitting’ into older persons or dementia care services which are typically for people aged over 65, or into learning disability services where the long-term focus in the UK is commendably on independence and self-determination.
Recent media coverage has focused on areas of dementia care that are becoming more evidence in care homes, day centres and hospitals across Scotland – sporting reminiscence, doll therapy, assistive technology or telecare are just a few examples. Whilst much evidence was originally anecdotal, research and evaluation have followed with a steadily growing evidence base for non-drug interventions. Even where we live with dementia has received attention – who knew fifteen years ago that colour contrast and the design of a room could be so important in supporting people with dementia to make sense of their environment? Yet this growing evidence of non-drug interventions has not included people with a learning disability and dementia.
My current research is a three-year project funded by the Alzheimer’s Society, one of two national implementation grants funded in the UK, and the only one in Scotland. Along with Dr Kate Mattheys, Research Fellow, and a team of co-researchers and advisors including people with a learning disability, we will conduct a participatory action research study in two cycles. The aim is to implement non-drug interventions with people who have a learning disability and dementia. The first cycle will include participants with a recent diagnosis of dementia, whilst cycle 2 will focus on people with advanced dementia.
Taking a collaborative approach and including co-researchers with a learning disability, we hope to challenge the notion of ‘hard to reach’ groups in research and instead demonstrate that participatory and inclusive research can open doors that are otherwise firmly shut for individuals who are typically not invited to take part.
Under-researched populations such as people with a learning disability and dementia are not hard to reach; it is up to us to enable and facilitate inclusion in research using appropriate, and where necessary, adapted research and communication methods. Without this, the cycle of under-representation will continue with a subsequent lack of evidence-based support in practice.
Dr Karen Watchman, Senior Lecturer in Ageing, Frailty and Dementia.
- Karen is Programme Director of the new online MSc Global Issues in Gerontology and Ageing due to launch on September 2017. One of the core modules: Health and Wellbeing of People with Dementia will include a focus on support for people with dementia in marginalised groups.
- Karen’s new book Intellectual Disability and Dementia: A Guide for Families was published on World Down Syndrome Day, 21 March 2017.
- For more information about learning disability and dementia please see Learning disabilities and dementia factsheet written by Karen Watchman and Andre Strydon (University College London) for the Alzheimer’s Society UK.
- Images show actors from a 2015 dissemination project, Jenny’s Diary, a resource to support conversations about dementia with people who have a learning disability, developed by Karen Watchman and colleagues with the support of an Alzheimer’s Society Dissemination Grant. Jenny’s Diary is also available in German, Mandarin Chinese, Italian and Norwegian.
Dr Karen Watchman has blogged for the Alzheimer Society:
“People with Down’s syndrome are at an increased risk of dementia. Dr Karen Watchman is a researcher, based at the University of Stirling, who specialises in understanding how to help people with learning disabilities to manage their dementia. For World Down’s Syndrome Day (March 21), Dr Watchman discusses myths around Down’s syndrome and how research can help people with both Down’s Syndrome and dementia.”
21 March 2017
Fiona Dobbie, Research Fellow in the Institute of Social Marketing has blogged in the Times Higher Education:
“I turned 40 this year, and rather than indulge in the clichéd symptoms of a mid-life crisis (getting a tattoo, having an affair, Botox) I am in my second year of a part-time PhD.
“It’s not that my life isn’t fulfilling or challenging enough. I am typical of my age: happily married with an energetic 6-year-old, fortunate to have friends and family and a full-time job as a university research fellow. So why am I doing a part-time PhD?”
Click here for the full article, published 12 March 2017.