It is astonishing how much mental health nursing has changed over the course of my career. Fifty years ago, we carried the prefix psychiatric rather than mental health. The initial registration had no academic value in the wider world and post registration training, albeit the traditional route into general nurse training. The prevailing attitude was that the initial training was enough for you to do the job, and you did not need any more. There was no career incentive to pursue further training, even if it were available. Once you were registered as a nurse, you did not have to revalidate every three years or pay an annual fee to maintain your registration.

 Care was delivered predominantly in large Victorian hospitals, many housing over 1,000 people. Community care was virtually non existent, and services were isolated both geographically and professionally. The work of the nurse had evolved from that of a custodial attendant. At the same time, a wave of younger people entered the profession, inspired by the growing influence of the anti psychiatry movement, epitomised by the work of R.D. Laing and Thomas Szasz. Writers such as Ken Kesey offered critical appraisals of services in works like One Flew Over the Cuckoo’s Nest.

At that time, people were patients — passive recipients of whatever care was offered, with little choice. Now, they are service users, empowered and protected by clearer legislation to prevent abuse, and expected to be fully involved in their care. Multi disciplinary working is more egalitarian and less medically dominated. Care is mostly delivered in the community, with inpatient care now the exception. Post registration training is diverse, career pathways are better defined, and a range of therapeutic trainings can lead to specialist roles.

By the 1970s, there was a crisis in care provision. Many Victorian asylums were investigated for allegations of mistreatment and mismanagement. The drive towards community care became a political imperative, and practitioners looked internationally — particularly to Italy and the USA — for alternative models and approaches. It was a significant period of change, embraced by some mental health nurses and resisted by others.

The major pioneers within adult nursing and physical health are well recognised. It is easy to trace the influence of Florence Nightingale, Mary Seacole, and Edith Cavell. Yet those who led progressive movements in mental health nursing are less visible and less celebrated. The phrase standing on the shoulders of giants describes the process of building on the work of others to enhance practice. This series of blogs is a celebration of six nurses considered to be pioneers in mental health nursing. The selection is not exclusive — there may be others who have been overlooked — and you are invited to challenge my assessment of each person’s contribution.

These pioneers share certain characteristics that can be described as truly pioneering. They were free thinkers, able to imagine a future for mental health nursing that did not yet exist, and they took practical steps to get there. They could see the bigger picture, identify opportunities for change, and articulate their vision in ways that inspired others. Their professional careers were characterised by risk taking, creativity, and passion.

Over the course of this series, I will examine the impact of:

• Professor Annie Altschul
• Hildegard Peplau
• Chris Atha
• Kevin Gournay and the PSI school
• Professor Phillip Barker
• Professor Tony Butterworth.

These leaders changed the way we think about and practise mental health nursing. Their legacy continues. You may have your own thoughts about other pioneers, and I invite you to make the case for their inclusion. Let us be proud of what we do, and praise those who have helped us better understand how we can continue to influence the lives of those we serve.