Handover | Issue 40 - September 2017

By Helen Hamer

Dr Helen Hamer, project lead and report author of the 2006 framework, recalls great optimism in the sector about the framework development as it got underway – and she was very excited to be involved.Helen Hamner

Creating a framework opened up the opportunity to do two things, she explains. “One was to develop the workforce of mental health nursing by giving managers and leaders recommendations to help them provide a workforce environment that promoted the maximum leadership, governance, professional and clinical best practice from the mental health nursing workforce. It was also to describe and clarify the role and function of the mental health nurse in the post-institutional environment.”

At the time Helen was working in a joint role as clinical nurse consultant for Auckland District Health Board and senior lecturer at the University of Auckland, where she was leading the mental health component of the new Bachelor of Nursing programme.

“Writing the framework was also a great opportunity to articulate my thoughts and those of other nurses, and to incorporate what research was telling me and say: this is what we do as nurses, and here are the recommendations that will support the profession to articulate the role as well as we can.”

Over a period of 18 months, she talked to many different sector groups, including nurses, nurse leaders, educators and unions to ensure the framework truly represented what the sector was saying.

“The reference group didn’t want the report to sit on a shelf and never see the light of day. We wanted to make sure it was a living document that nurses would read, a snapshot of mental health nursing and of the things we needed to have in place for the future of the profession.”

How did it impact?

After publication, there was a desire to quickly implement tangible changes, says Helen. The Ministry of Health convened a meeting of key stakeholders to advise and help determine the next steps, including prioritising recommendations. Part of that involved developing a specific nurse-led role at Te Pou, to lead the implementation of the framework recommendations.

Professional supervision was the first recommendation to be implemented, as advised by Helen. A literature review and recommendations on supervision practice were undertaken by the Centre for Mental Health at the University of Auckland’s School of Nursing. Substantial supervision documentation was written and placed in Te Pou’s resources; documentation that is still current and available to guide managers, nurses and professional leads on providing a supervision structure.

“Momentum quickly grew,” says Helen. “The new graduate nursing programme was strengthened and developed nationally through the Skills Matter programme.” Postgraduate funding was allocated for experienced mental health nurses to match their peers in physical health settings by developing academic and research pathways that complimented their clinical expertise, such as the nurse practitioner endorsement in mental health and intellectual disability settings.

As well, Te Ao Māramatanga – New Zealand College of Mental Health Nurses and New Zealand Nurses Organisation (NZNO) also reviewed the standards for mental health nurses.

“Such initiatives sent a signal to the mental health sector that there were a variety of roles and career pathways available for mental health nurses, including a leadership programme.”

“The framework was supported from inception to implementation by Frances Hughes who was the Ministry of Health’s chief nurse advisor, and embraced by the Directorate of Mental Health Nurses’ group, who continue to support it,” says Helen.

Looking forward

Whilst these successes are making a huge difference to the mental health nursing sector, at times, Helen feels some momentum has been lost; possibly due to funding and election cycles, making it important to revisit the framework.

“When I began this framework project, my commitment was to consult widely and listen to the sector. I think it’s time to hear their views and voices again. The review needs to consider contemporary national and international changes, and the direction for nursing as a whole.”

Other gains over the last 10 years include:

  • salary incentives for mental health nurses to work in under-served geographical areas
  • successes in the role of mental health nurses in the primary care arena, such as shared care approaches
  • increased physical health screening by mental health nurses for people presenting to secondary services with mental health problems
  • continued growth in some DHBs for the role of clinical nurse specialists and educators
  • extending the mental health nurses role into new services such as home-based treatment approaches, non-government organisation settings and as responsible clinicians within the legislative requirements of the Mental Health (Compulsory Assessment and Treatment) Act 1992.

Life after the framework

After the framework was completed, Helen turned her sights to PhD study. She completed this in 2012 while still working in her clinical nurse consultancy and university teaching roles. Her PhD topic ‘What does citizenship mean for people who have serious mental illness?’, explored the structures in society that marginalise some citizens and privilege others, which leads to social exclusion particularly for people labeled with a mental illness.

“When you feel included in the dominant group you don’t question your citizenship – it is often taken for granted because ‘you don’t know what you’ve got ‘til it’s gone’. It isn’t as easy to express its deeper meaning unless you have experienced exclusion and marginalisation,” says Helen.

After completing her PhD, Helen worked on Stories of Successful Social Inclusion, a Like Minds, Like Mine research project that was published in 2014. The study found that many of the people accessing services whom were interviewed described mental health professionals as champions who fostered their inclusion.

"We wanted to make sure it was a living document that nurses would read, a snapshot of mental health nursing and of the things we needed to have in place for the future of the profession.”

Her PhD thesis led to an honorary appointment at Yale University which she took up in 2015. She is now completing further research at Yale University, exploring the practices of social inclusion by mental health staff in everyday clinical practice settings. These acts of citizenship by mental health staff make a claim for justice, and support the rights of people in their care.

“They are often small gestures, embedded in practice, that have enormous positive impact on people’s recovery journeys and are sometimes described as ‘turning points’ on their journey, that foster their sense of social inclusion as full citizens.”

Primary care and mental health

Now an independent practitioner, Helen also contracts to DHBs, primary health organisations and other health and education providers. She is currently contracted to Counties Manukau Health as nurse lead for a project dear to her heart – primary care integration.

Helen has a long-standing interest in promoting closer relationships between DHB mental health and addiction staff and primary care general practice clinicians, to increase prevention and provide earlier intervention for people presenting with mental health and addiction problems.

“These partnerships will help to reduce the health disparities and earlier mortality for people accessing services and help to reduce stigma and discrimination.”

Helen regards such initiatives as, “The third decade, and hopefully final stage of the deinstitutionalisation of our mental health services, and the opportunity to future-proof mental health nursing as we extend our practice to embrace a primary care approach to our specialist roles.”