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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.
I had the privilege of attending the Florence Nightingale Foundation Students day this year, which was an extremely enjoyable experience. It was a great opportunity to meet fellow passionate and enthusiastic students and to discuss some of the issues that our facing our profession currently and in the future.
The day commenced with a panel discussion with four inspirational nurse leaders within their own individual fields. There were a number of great discussions had around nurse education, leadership and research. The panel provided some interesting insight into all of these areas. I found that the members of the panel were encouraging and inspirational speakers, in particular the areas of leadership and management, encouraging all of the students to be the nurse leaders of the future.
There was some interesting discussion regarding nurse education with a particular focus on generic training of nurses and the proposed cuts to the student nurse bursary. I feel though however that some of the comments where misunderstood by the panel in these areas. For the generic teaching aspect the questions were answered and reflected on about a generic course for all nurses however the question was framed at not reducing specialised nurse courses but including more content from all fields within each student’s specialised field of nursing.
In regards to the bursary I feel that the panel where generally supportive however when I asked about the concerns I had for the students nurses of the future wellbeing, particularly in relation to workload, that this question was not addressed. I feel that this was an opportunity for an organisation as respected as the Florence Nightingale Foundation to take a stand with Student Nurses and help stop a series of cuts that will have a serious effect on future nurse numbers and the wellbeing of student nurses. The panel where very knowledgeable and extremely encouraging however and reignited my passion after a long three years of training.
The only addition that could have been made was more input from the devolved nations on the panel. Each member was based within England and I think a broader discussion with all parts of the health services in England, Wales, Scotland and Northern Island being represented within the panel could have given more in depth discussion around national issues.
The next part of the day included a tour of the older part of Guy’s Hospital and Florence Nightingale Museum. It was fascinating to see and hear the changes in nurse education, practice and hear stories of nursing from the Second World War within the hospital. The museum itself was fascinating to me as I did not know a lot about Florence Nightingale and I discovered why she is such an inspiration to many nurses around the world. I particularly enjoyed seeing her famous lamp which was not how I expected it to look and to see her stuffed owl that she had as a pet during her time nursing in the Crimean War.
The final organised activity was a commemoration service for Florence Nightingale at Westminster Abbey. It was a beautiful service in the most beautiful of settings and the sound of the choir singing was utterly memorising. At the service we had the chance to meet various influential people within nursing, be that NHS, government or unions. One of the most interesting parts was watching Jeremy Hunt leave the service quickly and I am sure that many of the Student Nurses would have loved to have had a conversation with him!
One of the best experiences of the whole day was having the chance to meet such fantastic student nurses from all over the UK. It was great to see such enthusiasm, commitment and passion from the future of the nursing profession.
During my time training to be a Mental Health Nurse, I have taken every opportunity given to me and I have tried my best through many roles to make the experience of Student Nurses within my University a pleasurable and empowering one. Admittedly as I approach the end of my studies my passion has waned slightly, probably due to tiredness and the continual work of a nursing student.
The chance to meet similar minded students who were continually striving for the best results for their patients, colleagues and fellow students filled me with inspiration again and has helped me build networks that hopefully in future can help improve the services we deliver throughout the UK.
Robert Murray, Student Nurse, University of Stirling
16 May 2016
I was very proud to recently being given the opportunity to represent the University of Stirling at The Florence Nightingale Foundation Students Day, which was held in London at St Thomas’s Hospital on 6th May 2015.
Different universities throughout the UK were given the opportunity to nominate nursing and midwifery students to this annual event, which is held to commemorate the life and work of Florence Nightingale. There were approximately 80 students who were invited and we all gathered in the Governor’s Hall within St Thomas’s Hospital.
There we met with the founders of The Florence Nightingale Foundation and leading healthcare professionals where we were asked to submit questions to the panel. We all gathered in small groups and were given different topics to consider. Some of the questions we raised were:
- Should skills be required be standardised through all universities and trusts?
- Do we give enough consideration to mental health in adult environments?
- Should students have more involvement in research?
- Leadership, is it just for management?
being just a few asked. The panel answered all the questions with enthusiasm, wisdom and experience valuing all questions asked.
Throughout the question and answer session we were all encouraged and supported to raise additional questions, which was a part that ended up getting very lively and gathering great enthusiasm, with great feedback received from the panel members. The panel ensured that all questions were answered, also giving us great advice for future placements and careers, as well as advice on difficult situations like escalating concerns and getting the right support and opportunities out of our placements.
The response from the panel left us all feeling very inspired as well as feeling very proud to become nurses and midwives of the future. A final note given was for us to believe in ourselves, it is always better to aim high, it is never too early to make a difference and to believe in ourselves. The panel members and founders of the Foundation made us all feel very welcome and ensured that we all felt relaxed, included and our opinions to be important.
Following on from the panel discussion we had the opportunity to watch a film about the life and legacy of Florence Nightingale before visiting the Chapel in St Thomas’s Hospital. After that we went on a tour of the Florence Nightingale Museum where we learnt more about the foundation of her nursing school and how it all began. This gave us all a good insight into Florence Nightingale’s background and the incredible research and work she achieved and the many lives she saved, as well as the impact and influence that her work still has on nursing practice today.
At the end of the day we all attended the 50th commemoration service at Westminster Abbey, with an attendance of over 2,000 people. We had the opportunity to look around the Abbey before the service began as well as being given the opportunity to visit the Florence Nightingale Chapel. Westminster Abbey was a truly magnificent building and was breathtaking to see.
The Florence Nightingale commemorative service began with a choir and the atmosphere was amazing which continued with a procession being led by a Florence Nightingale scholar carrying the lamp, which was lit and escorted by student nurses and midwifes. Upon their arrival before the altar, the lamp was then passed between Florence Nightingale scholars, which is a tradition that represents the passing on of knowledge. This service was a memorable end to a truly inspiring day.
Throughout the day I had the opportunity to meet with students studying adult nursing, mental health nursing and midwifery making many new friends along the way and learning about different students’ experiences, advice and goals.
I truly found the day to be very inspiring, educational and thought provoking. Certainly a day I will never forget and I would certainly recommend other students, if given the opportunity in the future, to attend as it is certainly an experience that will leave you feeling extremely proud to be called a nurse.
Julie Furzer, 2nd year mental health nursing student