Book review: iv Critical Mental Health Nursing: observations from the inside

Following on from Part i, Part ii and Part iii.

I'll try and condense things in this review-post.

The book has a global reach and is Antipodean in chapter 4 with Darren Mill's ethnographic dialogue of a MH Crisis Team in New Zealand. The account, while fictional is based on authentic events and is still quite 'socially visceral'. This is achieved by interspersing the text with statistics on demographics, ethnicity, culture, suicide rates and government policy. Additionally the author provides reflective thoughts on the telephone dialogue FROM: the office; TO: standing at a front door (and wading in water).

Resort to the police and use of the Mental Health Act (MHA), made me reflect about westernised MH services and the export of this model to developing nations; while acknowledging that New Zealand is 'developed' of course. Despite this, as Mills shows, there are profound health care and education concerns for indigenous peoples in Oceania. As Universal Health Care and the SDGs become key drivers (added to general economic improvements, rising middle-classes...) it appears many developing (Commonwealth) nations prefer the institutional care that Westernised medicine is still trying to disassemble, change, or distil into the community (see p.779 in Persaud, et al. (2018)).

While we quite rightly (crucially) talk about the choices for patients - the public; we might ask what choices are there for services? In instances of challenging behaviour within an institution (hospital - residential, nursing home...) we seek to (alter the environment) quieten, distract, divert, de-escalate, comfort... Perhaps, the avenues, the choices that mh services have - is a measure of their person-centredness, integration, modernity? These choices then have a direct bearing on individual practitioners values (p.89 as quite nicely follows...).

Critical Mental Health Nursing

Values are key in Felton and Stacey, The Doctor-Nurse Game in acute mental health care. Addressing values, commonalities and how they are defined, held, shared should better reflect the ideals and pragmatics that 'progressive mental health nursing (and policy) demands. This would obviously reduce the contention (violence, injustice, coercion...) and very need for this book. While gut bacteria have been implicated in mental illnesses and may number in the many millions, no amount of them will account for the contested state of mental health. Not until the issues in this book are more effectively reconciled and resolved then as Felton and Stacey state mh nursing work will remain a form of 'dirty work' (p.99). Felton and Stacey provide a practitioner focus on values-based practice. Value and values permeate the literature as I have noticed over several years. The distance that Felton and Stacey identify for academia from the 'dirty work' (p.103) is an experienced reality for community nurses. Many, including myself, are aware of  a wish to 'step back' as 'your' patient becomes an in-patient. Recognising the need to maintain a therapeutic relationship you don't want to be seen as an 'agent' of this particular change (not all thresholds are conceptual). I have negotiated this on many occasions and not always successfully which I wholly respect.

Chapter 6 Gary Sidley sets a critical stall - stance in 'Colluding with prejudice? MHN and the MH Act'. A brief history is provided; Sidley discusses the MHA as being legalised discrimination, Community Treatment Orders, Advance decisions and socio-political considerations in two dubious contructs: 'mental disorder' and the 'estimation of risk' (pp.111-113). He seeks alternatives to the MHA, questions the silence of CMHNs (p.115) and offers four explanations (pp.116-117). Another factor, and not an excuse, may be the loss of beds over the past 20 years and the distance between community services and their in-patient centers.

On page 117 and explanation four regards low self-esteem and high burnout among psychiatric nurses I wrote in the margin "DATA on teams. Meetings for MHA not about". Here in the NW England there used to be (late 1980s - 1990s) evening meetings for Community Mental Psychiatric Nurses. There is less local professional cohesion these days, if any? Admittedly, it takes leadership to drive such groups. While there is data for the MHA 2017-2018; individual practitioners and teams as a whole (often?) lack the information to manage individual caseloads in a statistical manner, or as a team (and adopt a default research stance).

Sidley is optimistic (p.119) citing a survey and report by the Mental Health Alliance (2017) and the conclusion that the MHA "is not fit for purpose". The optimism arises from political commentaries that suggest an impetus and opportunity that can bring change. Sidley asks the reader if mh nurses should become political activists. (In the late 1970s-1980s you wore a 'NUPE' or 'COHSE' badge, the RCN was not considered a 'Union' back then, and mental health hospitals were far more 'industrial relations focussed' than the Royal Infirmaries and General Hospitals.) Is there a place for conscientious objection in respect to the MHA, sending a powerful message and signal for an urgent need for reform (p.118)? Is there an irony in this (an inter - h2cm - domain), a twist on parity of esteem? On twitter I have noticed The Power, Threat, Meaning Framework provoking much debate (a future post?). This is another tool for change proposes Sidley. The chapters included here highlights again the importance of a book, and well referenced too; which I would encourage students, practitioners, managers and others to read.

Critical Values Based Practice Network

Persaud, A. et al. (2018) Geopolitical factors and mental health I. International Journal of Social Psychiatry, 64(8) 778–785. DOI: 10.1177/0020764018808548
https://journals.sagepub.com/doi/abs/10.1177/0020764018808548?journalCode=ispa&