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Is mental health nursing being diluted?

Dr Stephen Jones 27 Jul 2023

Stephen Jones, our Professional Lead for Mental Health, discusses the concerns of nursing staff about the future of mental health nursing in the UK. 

Mental health nursing staff are voicing concerns from various clinical and non-clinical backgrounds about the future, role and identity of mental health nursing in the UK.

In recent years mental health nursing professionals have voiced concerns over:

  • a perceived deficiencies in pre-registration education
  • a lack of opportunities for ongoing professional development beyond preceptorship
  • and inadequate mental health workforce planning leading to a system-wide shortage of skilled and experienced mental health nurses. 

To date, these concerns have been primarily anecdotal. In February 2023, the RCN mental health forum committee set out to understand the issue and what is causing a devaluation or weaking of mental health. We asked our 14,000-strong forum membership, ‘are we seeing the dilution of mental health nursing?’.

Our findings have led to two key conclusions. Firstly, that getting more involved in campaigning activity already taking place in the RCN could help us build a better future for our discipline; and secondly, that due to the unique position and often undefined nature of mental health nursing we must do more to speak up, and speak out about the expertise and role our profession plays in nursing, and in society.

The questionnaire also sought member views on the three issues they see as most critical facing mental health nursing’s role and identity to identify the priority areas in which we can strategically influence and bolster the position of mental health nursing now and in the future.

Within the space of two weeks, we received a total of 951 responses from members in England (738), Northern Ireland (26), Scotland (104), Wales (67) and other locations within the UK (16). Most members reported seeing the dilution of mental health nursing (63%). 

A pie chart with the heading 'Are you seeing the dilution of mental health nursing?' and the results 63% 'yes', 24% 'unsure', 12% 'no'

We provided members with a choice of 11 ‘most critical issues’ and the space to add others that were not considered. The findings showed the top five critical issues are:

  1. Recruitment and retention (i.e. not enough nurses in practice)
  2. Pre-registration nurse education has become too 'generic' (not focused enough on mental health)
  3. Lack of understanding amongst the public and other professional groups around the role of mental health nursing 
  4. Generic titles such as 'care coordinator' or 'mental health practitioner' fail to capture the role of mental health nursing
  5. A lack of career development opportunities outside of managerial pathways (i.e. senior clinical roles)

Recruitment and retention are the cornerstone priorities of the RCN’s Fair Pay for Nursing and Safe Staffing campaigns. Mental health nursing must remain central to this work, understanding and responding to our profession’s unique challenges.

How are we working on these critical issues?

The RCN mental health forum committee continue to engage with and influence multiple external partners on the concerns raised around pre-registration nurse education. As set out in the NMC’s Standards of Proficiency for registered nurses, communication and relationship management skills (Annexe A) must receive equal, if not greater, attention within mental health nursing curriculums to those more technical nursing procedures (Annexe B).

Mental health nursing lacks a universally agreed evidence base and is often challenging to define. Not only is this an issue within the profession, but it has led to a lack of understanding amongst the public and other professional groups about the role and incredible capabilities of the mental health nurse. As a result, we must collectively do more to promote this unique and indispensable profession.

As stated in NHS England’s commitment to the growth and development of mental health nursing, services must avoid creating generic practitioner roles that fail to distinguish between regulated and non-regulated workers or indirectly undervalue the unique contributions of mental health nurses. This message should be replicated UK-wide and embedded within all national and local workforce planning.

The lack of clinical career development opportunities in mental health nursing is widely acknowledged. Members responding to this questionnaire have accentuated this as a critical issue facing our identity and role. We must ensure mental health nurses develop their knowledge and skills, advance their careers and be enabled to provide the best possible care.

Number six overall, members working in academia (123) and students (58) raised that mental health nurses lack the skills and knowledge to provide comprehensive psychosocial interventions as one of their top five critical issues. The RCN is reviewing and will be relaunching from 2024 the Psychosocial Interventions programme for mental health nursing.  

- Stephen Jones, Professional Lead for Mental Health, in collaboration with the RCN Mental Health Forum Committee .
Stephen Jones

Dr Stephen Jones

Head of Nursing Practice, Royal College of Nursing

Page last updated - 25/12/2023