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

Following on from Part i and Part ii.

Alec Grant's chapter 2 presents a 'critical meta-autoethnographic performance'. The chapter uses a dialogue approach, as with chapters 3,4 and 9. While not needed this does break up the prose format for the reader. For a 'nursing' book it is good that Grant puts the initial accent on the future and the classroom. There's a conversation with a Deputy Head on establishing debating societies (p.34), another highlights how skills in reflection, critical thinking and critique are never complete at undergraduate level, but applied through narrative inquiry and critical autoethnography at masters research level (p.40).

The first classroom 'chat' begins with a question: What is the student's "understanding of the following social psychological phenomena: confirmation bias, fundamental attribution error and actor-observer effect?" (p.30).

Critical Mental Health Nursing

On fundamental attribution error, taking a couple of patients to Goodison Park and while the final score eludes me I can remember the change in the patient's behaviour while 'outside' away from the ward. Likewise, going to a nearby pub to 'find' a patient, his speech, disposition and humour were as liberated as his taste buds and that wasn't just the 'alcohol talking'. On the actor-observer effect, judgemental terms would often presage the arrival of; if not an admission, but a re-admission. Even then I would take cognizance of what was said, but also derive my own conclusion. I discuss 'attention seeking' and manipulative (p.31) and other pejorative terms with students. Also explained is our then Director of Nurse Education, who stated that "All behaviour is significant". Grant reflects on 'narrative entrapment' and how things are in community mh services, as surely that is better? The quality of referrals is raised. I've always thought that referrals, or more accurately, reasons for referral need to be qualified. That said, this has improved over the past 10-15 years, but there are still examples were the 'problem' and the level of information provided is missed / lacking.

Throughout the text, there is much for students to learn and reflect upon. Grant is Socratic in approach, creates discomfort and signposts how learners can become students for change and change agents. There are insights on 'ideology',  Žižek and efforts to find a position in the world that is 'ideologically neutral' (p.37). Even now, I continue to see h2cm as, if not, ideologically neutral [impossible], then it is 'ideology' stripped back to absolute basics; a fundamental stucuture that can represent and encompass a[ny] situation. That can include, as Grant notes, time, place, people, events, institutions, culture and professional groups.

Grant's critique of the Tidal model is brief (p.37), but the way to which the Tidal model is challenged within the average busy acute ward, can be extended if the health AND justice 'care' context is considered. While there are only two references to Hodges' model within health justice, I am sure there are potentially many more. Without change, Grant suggests that mhn is "condemned to be the constant administrative and social policing arm of institutional psychiatry." (p.37).

A section on reader - response theory takes us - in a sense - back to where we started. The final dialogue may be 'heavy' for some (me too?) on the neoliberal agenda and its impact upon education - professionally, institutionally, mental health nurse education and curricula. Universities as institutions for learning and learning institutions have been called into question (safe spaces, freedom of speech, value for money, quality...), as by Grant also:

"With regards to mental health nursing, a technical rational training, as opposed to education curricula, fails to adequately address the skilled, multi-contextual knowledge and skills needed by students to help them engage in the unruly and complex identities, relationships, and life and treatment environments of contemporary mental health service users (Grant, 2015c)." (pp.41-42).

"... we put forward the argument that such engagement requires an explicit, un-apologetic educational curriculum." (p.42).

 Grant calls for 'professional artistry' through the literature, which -

"... requires increasing levels of critically reflexive organisational and political awareness. This is because, in all of its aspects, mental health nursing practice is political, historically contingent and socially and environmentally contextual." (p.42).

Finally (here at least), Grant references Alvesson and Spicer's (2012) "functional stupidity theory of organisations"

(In the margin - my pencil notes: Is it really about who has the keys?)

The functional stupidity theory of organisations argues that such organisations have, "a cognitively- and affectively-informed unwillingness or inability to employ reflexivity, justification and substantive reasoning in work organisations." (p.43). Grant expands on each, but of substantive reasoning:

".. constitutes the act of engaging thinking as broadly as possible in relation to professional practice and related work problems." (p.43).

Mental health nurse education, according to Grant exhibits functional stupidity.  (p.44). Oh! I wince at the sound. Finger nails scraping all the way down the ivory of the tower.

As a critique of this and other reviews on W2tQ will no doubt show, my quotes are quite obviously  selective. Precarity has also become obvious over the past decade, as austerity has bitten and even now continues to 'chew'. Grant's references show his work in this area. As many people, academics and practitioners (across all professions including social work and the chapter's author) reach retirement, it will be interesting to see (to say the least) if precarity also applies to:

• mhn
• the mhn education system
• the reasons and values that students bring to the profession

Paradoxically, will this loss of experience in academia, practitioner and management, bring the positive change that this book calls for?

Just two chapters and buy, buy...

More (still) to follow and apologies for the unconventional review...

Part i 

Part ii

Part iv

Bull, P., Gadsby, J., Williams, S. (Eds.) (2018) Critical Mental Health Nursing: observations from the inside, Monmouth: PCCS Books. ISBN 9781910919408