Feature

Service user seeks trusting relationship

The future of community psychiatric nursing is in the spotlight as the Department of Health’s mental health nursing review gets under way. Jo Lucas reports on the user’s view

At a conference I attended recently someone stood up and said that the only thing that distinguished nurses from other mental health service workers was that they administer drugs. While that may have accurately reflected one user’s experience, it is a limited view of the role of nurses. Mental health nurses have a distinct role in both community and residential settings.

There is no doubt that the quality of the relationship between the nurse and mental health service users has a significant impact on the quality of life of those individuals. In institutions this is self evident: they are with people 24 hours a day, 7 days a week; they manage an environment that is without doubt very powerful and can be damaging. Though the role of the community psychiatric nurse (CPN) is perhaps less intense it is equally important.

But MIND, which is an active participant in the Department of Health’s current review of mental health nursing, would like to see some fundamental changes in this area in the future. These are, first, that the quality of the relationship between nurse and service user is emphasised and is one of care, containment, listening and respect - not of control and authoritarianism; second, that users should have an input into all mental health nurse training, both curriculum development and teaching; third, that management systems are established that encourage nurses to spend time with the people they are there for, rather than in the office or in the sluice room; and fourth, that users have the choice of a woman key worker, care manger or CPN.

The feedback MIND has had from mental health service users indicates that nurses are, on the whole, viewed positively. They are usually seen as caring and nurturing. Their minimal impact on prescription patterns is recognised as reflecting a lack of power rather than a lack of will.

The recently published survey Experiencing Psychiatry sought the views of 500 service users on all aspects of mental health care. This research gave a very varied view of nursing which ranged from views such as ‘psychiatric nurses are totally dedicated and the best caring staff you could want’ to ‘some are more institutionalised than the patients’. Overall, 59 per cent of respondents were satisfied or very satisfied with nursing care, while 22 per cent were dissatisfied or very dissatisfied.

A complaint I often hear about CPNs is that they sometimes use a person’s living room as a makeshift Modecate clinic. All community based workers are chastised for treating people’s homes as if they were their offices, using the phone, moving furniture or turning off the TV without asking.

Service users have also talked to MIND about the lack of honesty of some nurses, particularly in times of crisis, when people are at their most vulnerable. They have told of nurses promising to be their friend, that their children will not be taken away, that they will not be forced to take medication and so on. But many of these things may be outside the control of the nurse. While it is understandable that nurses want to protect users from distressing facts, there is no doubt that such dishonesty damages both the individual and the relationship.

The recent Stress on Women campaign brought to light the experiences of many women abused while in psychiatric care, either by other patients or by staff. Many of the individuals who spoke to us had not told their story to anyone before. Those who had were often not believed. Some of the abusers, whether in hospitals or the community, were nurses. Given the increasing evidence that a significant number of women who use mental health services are survivors of childhood sexual abuse, this kind of experience is doubly damaging.

Lack of information is a very common complaint, most often relating to drugs or choice of services. People are rarely given sufficient information about prescribed medication, its side effects and the implications of not taking it. The notion of informed consent must be much more positively implemented by both nurses and doctors. CPNs have a critical role here. They may well be the user’s only real source of information.

Experiencing Psychiatry painted a picture of disregard for people’s rights to information. Fifty two per cent of respondents had received unwanted treatments, mainly drugs, 84 per cent were offered no choice of treatment and 70 per cent felt they had been given insufficient information on the side effects of treatment.

One specific and often valued contribution of nurses is their knowledge of psychopharmacology as well as their understanding of more general health issues. A practical response to people’s problems should be offered. The essential skills of CPNs are the ability to develop a relationship of trust and respect away from the intensity of the institution and the ability to understand health problems in a way that can establish a real partnership with their client.

Experiencing Psychiatry and the Stress on Women campaign pack are available from MIND Publications, Kemp House, City Road, London.