Archives

Guest Editorial

Leadership and mentoring for mental health service reform

Nicholas G Procter
Associate Professor, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, City East Campus, North Terrace, Adelaide SA

Article Text

The Mental Health Council of Australia's Out of Hospital, Out of Mind report released in April this year says that at least 62 per cent of those people with a mental illness are not accessing any kind of mental health care. The report asserts that current community-based systems are failing to support recovery from illness or protect against human rights abuses. Change is urgently needed and to simply continue with the current inadequate pace of reform, perpetuate the same inadequate resource base, utilise the same governance structures and fail to invest in innovation is to condemn many of the most disadvantaged and ill members of our community to many more years of abuse, neglect and very poor mental and physical health. In addition the report argues that support for carers of people with mental illness is grossly inadequate.

While governments must commit to real monetary investment, real intent, coordinated national leadership, real accountability to help rectify this shocking situation, it will be mental health professionals – many of whom are nurses at grass roots level – who will be called upon to respond. One component of a coordinated response will be in the form of decisive leadership. There will be, among many things, the need to self-question. Leaders at all levels can begin by reflecting upon what it is they do and to what extent it is in the best interest of their clients and staff. Are they primarily a leader or a manager? Do they make long-term decisions about their development or does their employer? Do they have the opportunity to challenge? Do they have the right to challenge? Do they have the obligation to challenge what is happening within their jurisdiction? (adapted from Birkinshaw and Crainer, 2002 and Goldsmith, 2003).

In a stressed, crisis driven and over-stretched service regular debriefing and implementation of peer support mechanisms offering leadership and mentoring opportunities must be made available. This involves the execution of a well-articulated and scrutinised vision for clinical practice and what clinical outcomes can be realistically achieved. Empowerment is, in this sense, being used to mean 'being able to do more than simply voice and opinion (although clearly that is important too); it gives a broad range of people the authority to make decisions that matter' (Kets de Vries, 2001 p. 272).

Viewed this way mentoring and leadership in mental health teams is seen to be a reciprocal process whereby people learn from each other the political, social, cultural and personal systems at play in order to recognise mistakes in the offing and prevent them. The idea being advanced here is of inter-subjective performance feedback to help identify inadequate governance structures and practices and provide a pathway for their understanding and resolution. At the same time mentoring is seen as an effective way of encouraging and developing team members with particular emphasis upon their creativity and imagination. This in-turn encourages risk taking, identifies depth and encourages mutual benefit as it allows the manager to look at her/himself and learn about self motivation and drive to successfully abandon ineffective governance structures and systems (Giugni, 2001). Moreover effective mentoring of clinical staff becomes a crucial means through which to help maintain the clinical team's safety, interest and ethical comportment in practice.

Formal and informal networks and supports, which are mutually beneficial and incentive building for both clinicians and managers, will serve to strengthen the professional partnerships, existing skills, knowledge and expertise. In meeting these issues and providing support leaders may take into consideration ways to:

• Remain accessible to consumer representatives and carers as well as clinical staff – by phone, email and in-person for ongoing encouragement and support to achieve service reforms;
• Generate via negotiation and consultation a professionally appropriate feedback loop for stakeholders to present their views and experiences;
• Ensure development of initiatives aimed at targeting modifiable risk factors to effective service delivery for vulnerable clients and their families;
• Enable senior government officials, senior managers and administrators to support leaders and reward innovation as appropriate;
• Provide clinical staff with opportunities for professional exchange and support with each other, community members, members of their profession and other mental health professionals;
• Demonstrate emotional intelligence. Successful leaders know how to manage their own emotions and read the emotions of others. Possessed of a good sense of reality, they're aware of their strengths and weaknesses, know what they stand for, and know how to establish and maintain relationships for the better (adapted from Kets de Vries, 2001 p. 224);
• Provide clinical staff with a regular opportunity for confidential debriefing with managers and/or mentors about the nature and scope of their involvement with their clients, their families and other mental health professionals;
• Be actively involved in succession planning without the need for rigid over control.

This approach is therefore, a reflective dynamic one with scope and potential for autobiographical connections being made between clinical practice, mentors and mental health service reform. Importantly, the staff development opportunities afforded clinical staff are 'up close' rather than far removed from the day-to-day realities of clinical work.

Viewed this way leadership and mentoring are an effective means of encouraging personal and professional growth of team members towards service reform (Rosenblum and Oats, 2003). At the outset of this process it is important for clinical staff to join with their mentors to discuss professional and personal goals. These initial discussions, (later incorporated into a individualised professional development model), are designed to explore the range of various perceived needs before planning any specific learning objectives. In addition, there should be scope and freedom to review goals and re-think direction in light of feedback from key stakeholders. The main purpose is to create a cohesive, dynamic team in which people feel valued and involved without the burden of unrealistic expectations – either self imposed or originating from an external source. Mentoring is, in this sense, a means to identify personal characteristics, enhance inherent skills and to improve individual and organizational reform (Belasco, 2003).

Additional funding alone for mental health services will not be enough to remedy what is a crisis in our health system. Innovative clinical leadership and mentoring practices can be of mutual benefit to both the design and delivery of a service leadership model as well as the individuals who work in it. It will be executive myopia and arrogance, a refusal to listen to new ideas, a lack of challenge to existing paradigms and a lack of urgency to get things done (to change things for the better) that causes continued organisational disaster (Kets de Vries, 2001). People who embrace new ways of effective leadership and mentoring will grow to understand the dynamics of their leadership and the role it plays. If an effective leadership dynamic is not properly understood in the context of client, caregiver and employee need, then leadership is a mere illusion. The synergies of resourceful leadership in a learning and professional development context are all about investing in mental health service reform. And money alone will not be enough to bring the innovations urgently needed to benefit to the most disadvantaged and ill members of our Australian community.

Toggle references

Navigate: Archives | Contents | Top of page

Related Publications from eContent Management