Handover | Issue 42 - July 2018

Frances Hughes chaired the expert working group that wrote the national Mental Health Nursing Framework. 

It is indeed ironical and a little de ja vu that I write commentary in July 2018, on the 2006 National Mental Health Nursing Framework (herein referred to as ‘the Framework’), when we are going through a national review of addiction and mental health services. For those of us who know the history of mental health in this country, we know that reviews are the time we bring about change. Somehow things have to get pretty grim in mental health before governments and society take action. That says a lot about how we respect and value citizens with mental health needs. So, it is a great time for us now to again have our say. 

The Framework was developed for the Ministry of Health (MOH) in response to concerns and issues in mental health nursing, and the need for direction and guidance in the sector (Ministry of Health, 2006). I chaired the expert working group, Helen Hamer was the project manager and we were accountable to Dr Janice Wilson, who at the time was the deputy director general of mental health. 

The expert reference group consisted of the best minds in regard to mental health and nursing. 

  • Daryle Deering, Te Ao Māramatanga - NZCMHN, and alcohol and other drugs services 
  • Nicolas Glubb, DHB managers 
  • Kaye Carncross, chair, national directors of mental health nursing 
  • Martina Allen, council of trade unions 
  • Mike Loveman, NGOs (until October 2004) 
  • Barbara Lowen, nurse educators in the tertiary sector and representative of the Māori Caucus: Te Ao Māramatanga - NZCMHN 
  • Pepe Sinclair, Pasifika health 
  • Mark Smith, health research council – workforce group 
  • Vito Malo, service user 
  • Sam Noble, mental health commission (until January 2005) 
  • Marie Crowe, chair-New Zealand Nursing organisation, mental health section.

The Framework needs to be dusted off, updated in respect of understanding what the current situation is and informed by current evidence. We should be vocal in what we need, and support those who have a voice and are willing to use it. We must continue to do all we can to support the rights of people with mental health needs.

This group identified the following areas that needed to be ongoing in our system: 

  • Importance of mental health nursing leadership in our services and at the tables of decision making. 
  • Development of mental health nurse practitioners. 
  • Application of Te Ao Māramatanga – NZCMHN standards in our practice settings and in job descriptions of mental health nurses. 
  • Clinical career pathways into the specialty of mental health. 
  • Access and resourcing of professional supervision. 
  • Access, funding and development of new graduate and post graduate (advanced) mental health nursing programmes. 
  • Development of research and mental health nurses as researchers. 
  • Recruitment and retention strategies. 

The Framework provided an evidence-based best practice framework regarding the professional care provided by a mental health nurse. It was designed to inform our policy makers, funders, educators, our services and mainstream nurses on the importance of specialty and specialist practice of mental health nursing. 

There is no doubt that our leaders in mental health nursing and Te Ao Māramatanga - NZCMHN have worked hard, and we have had many achievements in mental health nursing. The issue is we continue to fight. Why is it so difficult to ensure people and their families have access to a registered nurse with mental health knowledge, skills and attributes when they access mental health and addiction services? Why do we continue to see people with mental health needs as undeserving of the best that services can offer? 

I have worked the last six years out of New Zealand, but whenever I have been with mental health/psychiatric nurses or organisations, the Framework we developed for New Zealand in 2006 comes up in conversation. It has been used to guide and steer many services, and for this I am proud. 

I look at the conclusion in the Framework document and I quote: 

Adherence to the recommendations made in this framework will facilitate the implementation of the Government’s strategy for mental health, including the Blueprint. It will enhance the quality of mental health care provided by district health boards and non-government organisations, and result in improved health outcomes for service users. It is imperative that stakeholders work together to develop creative recruitment and retention strategies, and new ways of working. This is particularly pertinent given New Zealand is facing increasing demands for mental health services, an alarming shortfall in mental health nurses, and increasing global nursing shortages. 
(MOH, 2006, p.70). 

I have re-read this document again in the last month, and with a heavy heart I realised the gains we made 10 years ago have gradually become whittled away, not by those who have stayed committed to mental health and mental health nursing, but by our wider nursing leaders, DHB funders, managers and educators. I then reminded myself again of our history, the way people with mental health needs are perceived and judged is also the way we as mental health/psychiatric nursing are. Thus, as mental health leadership have been eroded, so too has the importance of the professional role of mental health nursing in services. 

Our guardians, our kaitiaki, have become isolated. The Mental Health Commission has been consumed in the Health and Disability Commissioner’s office. The Mental Health Directorate was disbanded. Ring fenced funding was removed and millions of mental health and intellectual disability service funding in DHB services was taken to help the deficit bottom line of other inefficient services. The Office of the Director of Mental Health became the fourth tier in the MOH. Chairs of mental health nursing and mental health senior nursing positions are vanishing. The new graduates of nursing programmes for entry into specialist practice appears to be hanging on by its teeth, and if mainstream nursing has its way it too would be consumed into the generic programme. 

So again, we are at a time in history where we must decide what we are going to do. I believe that it is a time for a call to action. We must fight for people with mental health and addiction needs to have equal rights to support, care and professional mental health nursing when they need it. 

The Framework needs to be dusted off, updated in respect of understanding what the current situation is and informed by current evidence. We should be vocal in what we need, and support those who have a voice and are willing to use it. We must continue to do all we can to support the rights of people with mental health needs.