Prologue
Towards Innovation and a Partnership Future for Mental Health Nursing
Nicholas G Procter
Professor and Chair: Mental Health Nursing, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide SA
Angela Frederick Amar
William F Connell School of Nursing, Boston College, Chestnut Hill, MA, United States of America
PP: 131 - 133
Abstract
This year's announcement of psychiatrist Professor Patrick McGorry as Australian of the Year has brought mental health into the spotlight. In a public sense, the award represents a significant acknowledgement of mental health as a growing national concern. After all, 30 per cent of the Australian population experience a mental health problem at any given time. With this in mind, it is important to realise that as few as one-third of them receive adequate treatment. Those treatment figures drop to 25 per cent for young people and just 12 per cent for young males in rural and remote areas.
Article Text
This year's announcement of psychiatrist Professor Patrick McGorry as Australian of the Year has brought mental health into the spotlight. In a public sense, the award represents a significant acknowledgement that mental health is a growing national concern. After all, 30% of the Australian population experience a mental health problem at any given time. With this in mind, it is important to realise that as few as one-third of them receive adequate treatment. Those treatment figures drop to 25% for young people and just 12% for young males in rural and remote areas.
The World Health Organization (WHO) has recently launched an initiative on Depression in Public Health (2010). The WHO estimates that by 2020 mental illness will be the second leading cause of death and disability. The prevalence of mental illness in any period is higher for people who are disadvantaged, whether measured by educational qualification, equivalised household income or living in more disadvantaged areas. These social determinants of health do not cause mental illness; rather they exacerbate prevention and treatment efforts. Recognition of mental health problems is a key first step to accessing treatment but often people are not well informed about the signifiers of mental health issues or where to get treatment and support.
A leading international researcher, clinician and advocate for the youth mental health reform agenda, Professor McGorry's work is pioneering a new frontier: early recognition of mental illness, and prevention and treatment of untoward consequences. His work with young individuals with emerging illness uses a proactive approach. Many psychiatric providers applaud this work as many have felt the sting and heart tug of working with a young person and their family during the first episode of mental illness. All hope that it is only one episode and that this talented, bright individual in front of you has a smoother path than that of other clients in the clinic waiting room or occupying adjacent rooms on the inpatient unit. Yet mental illness is disproportionately an illness of the young, with common onset in the teen years and symptoms emerging as early as school age.
It is counterintuitive to think that prevention and intervention regarding mental illness, one of the oldest illnesses on the planet, would be seen as innovative. What is it that prevents a full spotlight on mental illness? While many factors play a role, arguably, stigma is the biggest distracter to the recognition of mental illness. In an era where little is private, mental illness is not talked about in social conversations. Public forums often present mental illness problems in an unflattering light, such as insensitive portrayal in movies and television, or stories in the news only when a horrendous crime occurs. Stigma places a mark of disgrace and for many shames not only the person diagnosed with mental illness, but also the family and significant others of the person. Stigma leads individuals not to speak of mental illness but to keep it hidden from public view. Most of all, stigma and the resulting silence contributes to fear, mistrust, and inadequate health coverage. It keeps people, many of whom already live on the fringes of society, from seeking professional help, which compounds discrimination. How many individuals would be recognised and seek help earlier without the barrier of stigma? Challenging the notion of stigma is akin to challenging the status quo; it has existed for so long in mental health care that is accepted as a reality.
Such stark realities have not gone unnoticed. In recent times, mental health nurses around the globe have called for collaborative action between government and non-government organisations to improve early intervention and access to services for people with mental illness. Improved access and advocacy are linked to improved consumer voice and choice. Right now there are worldwide reforms underway to help ensure tailored assistance to people with mental illness and mental health problems living in the community. Such reforms address core issues related to parity of mental health treatment such that differences do not exist in the care of physical and mental illness. True parity in access to care and service delivery will go far in decreasing the stigma and silence associated with mental illness. Nursing leadership can take many forms. But what really counts is that every mental health system must enable recovery, prevent and detect mental ill health early, and ensure the best possible treatment in the least restrictive environment. The goal of all of these steps is to create a flexible, recovery orientated consumer driven approach so that individuals and families affected by mental illness can lead flourishing and fulfilling lives.
The papers in this special issue of Contemporary Nurse (ISBN 978-0-9775242-6-6) celebrate an ambition for better mental health care and improved support for people who are involved in service delivery. Their research contributes to ongoing reform in mental health scholarship, leading to an improved knowledge base and evidence base in mental health care. Each author demonstrates a commitment to advancing the body of knowledge held by the discipline. Each seeks to identify and communicate a best practice research and policy initiative to improve the lives of people with mental illness and the people who care for them. While the papers may vary in their nature and scope, they all have in common key actions that can make meaningful progress towards fulfilling the vision of optimal client care and outcomes. The collection has the potential to change the reality of mental illness for patients and their loved ones and, in time, to change societal perspectives.
Like many physical illnesses, mental illnesses are frequently chronic and relapsing and therefore require a multidisciplinary approach to detection, early intervention and treatment. Now more than ever the future of mental health nursing is one that must embrace innovation and imagination. We need imaginative and creative people to become mental health nurses. New models of care are imperative to address emerging issues related to the care of the mentally ill. Partnerships of patients, families, and providers are essential to shed light and decrease silence regarding mental illness. To change models of healthcare delivery for the mentally ill requires consideration of social determinants of health. The system needs energetic and creative individuals who will challenge the status quo and explore, pilot, and advocate for changing models of care delivery. Creative individuals and carers will speak out against stigma by educating patients, family members, and the public.
Why is this important? Because we need to embrace the dynamic principal of building upon multidisciplinary knowledge, skills and attributes while simultaneously ensuring that we retain nursing's body of knowledge. More and more, imagination, innovation and partnership are critical for system wide success. As the prevalence of mental illness is set to rise over the coming decades the demand for creativity will continue to grow. In particular, there will be increased demand for services that challenge taken-for-granted practice and policy, nurture creativity and promote partnerships between all stakeholders so that they are of an enduring nature. While nursing is critical to change, sustained change will only come about through a united effort across all of the disciplines that are responsible for mental health care.
Too often, we say we have tried something before and are not willing to have another go. Too often, we are willing to accept the past as inevitable and not look to creative approaches to change the status quo. To generate new thinking we must not only be open and accepting of divergent viewpoints, we must seek them out. We must be comfortable with the conflict this brings and realise that trust (in ourselves and others) is a fundamental requirement for mental health nursing's innovation enterprise. New ideas can come from the fringe - the margins - just as readily as the mainstream. Often the static nature of the status quo requires that innovation arise from the fringe and grow until the organization cannot help but notice it. One challenge is to nurture the systems of creativity and out of the box thinking to provide fertile ground for new solutions to old problems.
Lao Tzu says, 'By letting go, it all gets done. The world is won by those who let it go.' To affect change for mental health nursing practice and mentally ill patients and their loved ones, the challenge is to show confidence in letting go of the past and knowing how and when to move in new ways.
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