Our national Chief Nursing Officer (CNO), Ruth May, visited several teams in my Trust this week. She left us with some key messages, one of them being an urgent need for registered nurses to further develop their skills for caring for patients with mental health needs. This was across all specialties—emergency care, care of adults, children, and midwifery care. My colleagues shared their concerns relating to their patients' safety as well as their own personal safety.
The impact on patients of this knowledge gap has been examined for several years. Muir (2017) was a case reviewer for the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report Treat as One: Bridging the gap between mental and physical healthcare in general hospitals (Cross et al, 2017). This report acknowledged that the acute care pathway is an important part of healthcare experienced by people with mental health conditions. However, it confirmed the long-standing concerns about the disparity between the treatment of mental and physical health conditions, and the undue emphasis, in healthcare, on physical health. When patients with a mental health disorder are admitted to acute general hospitals, their mental health problems are often overlooked, misunderstood or neglected.
The Care Quality Commission (CQC) (2020) reported that the acute hospital setting may not be the most appropriate place for patients with mental health needs, as they are often in a vulnerable position and require compassionate care that provides a feeling of safety and upholds their human rights. Perry et al (2020) wrote that patients with mental health conditions can be stigmatised in the acute care system due to a lack of understanding, knowledge and an associated burden of responsibility felt by clinical staff. One of Perry et al's (2020) key recommendations was that all hospital staff in contact with this group of patients should receive training in mental health conditions.
‘Although mental health first aid has its place, this does not equip registrants who are caring for patients for extended periods’
Herbert and Hetherington (2021) undertook a project to understand the learning development needs of their local nursing workforce around mental health care. Undertaking a multi-trust online questionnaire, Herbert and Hetherington received 412 responses from band 5 to band 7 nursing staff. The results showed that planning for patient safety and knowledge of mental health sections and sectioning were the two main areas of concern reported by nurses. Nurses reported that having access to mental health anticipatory care planning in the event of a crisis, as well as competence-based training, would enable them to improve care in this area.
Like several other trusts, we have taken up several short-term options such as mental health first aid courses. The aim of these, typically, has been to understand the risk factors and warning signs for mental health and addiction concerns, strategies for how to help someone in both crisis and non-crisis situations, and where to turn for help. Latterly, we have piloted and are about to roll out at scale the ‘We Can Talk’ (2021) programme in the Trust. This programme aims to improve the experiences of young people who attend hospital because of issues with their mental health and the staff who support them. It has been co-produced between young people with lived experience, hospital staff and mental health experts and is working towards changing the culture of acute hospitals through community building and training.
These short sessions have been extremely well evaluated by colleagues. However, when further discussing our knowledge gaps with our psychological medicine lead, he shared his concerns that we are caring for this complex group of patients in a variety of settings, for a range of timescales. And although mental health first aid has its place, this does not equip registrants who are caring for patients for extended periods of weeks or months. Also, although the acute setting may not be the most appropriate place of care for these patients, we must seek to support the development of postregistration training to improve patient safety and the psychological and physical safety of our staff. This was clearly part of the national CNO's agenda as she shared that this gap is a national one and all options should be considered.