Critical Mental Health Nursing

I published Recovering from Psychosis: Empirical Evidence and Lived Experience in 2016 and having done that you would think that was enough and I should get on with business as usual. But no. I had already started working on a second book idea which was originally going to be a book on Recovery Oriented Nursing – a sort of how-to guide combined with a critical perspective on it. And then everything went pear-shaped. Well, no not really. I started approaching people and talking about the book looking for contributors because another solo effort seemed to be a bridge too far and one that I’ll revisit later (yes there is a Book III idea wanting to get out). Instead surely editing a book and having others write the chapters was easier? The astonishing naivete.

Now we are some 3 months into the writing process for book two. It’s not a Recovery Oriented Nursing book as you may have gathered as the conversations with contributors and gathering co-editors took shape. That and the fact that another book exactly on that topic turned out to already be in press. Instead we have a completely different animal – Critical Mental Health Nursing. Offered up in conjunction with the Critical Mental Health Nursing Network.

CMHN is a vehicle. For multiple perspectives from nurses being critical of nursing, from people who have had experience of being cared for by mental health nurses, from professionals of other disciplines working alongside nursing to be heard. It will have a strong applied to practice focus, an ethnographic and autoethnographic flavour along with empirical evidence, multiple-theoretical-analytical approaches, and is driven by the authors and not the editors. At least that’s the plan! More to come as I have it. We are looking to see it published in 2018 by PCCS.

“Parity of Esteem, No Health Without Mental Health” : Political Sloganism

I found myself tweeting this the other day, in amongst tweeting about book writing and the excitement of new Dr Who episodes and Great British Bake Off:

— Stephen Williams (@MHNurseLecturer) September 10, 2014

Looking at governmental interventions that have affected mental health we have had years of NHS staffing cuts, resource cuts, bed losses, ‘back door’ privatisation and rhetoric and tokenism. Take Nick Clegg’s  recent pledge (not a good word to associate with Mr Clegg – notorious as he is for reneging on promises) of a £50M ‘boost’ into mental health research. What does this actually do for the much vaunted ‘parity of esteem’? Well firstly from a research perspective it could help maybe fund a few randomised control trials worth of studies. This may improve understanding or enable a new therapy to be trialled. As for what this would do for the experience of the service – next to nothing I would imagine. So this kind of pledge strikes me as nothing more than a misguided and empty political piece of misdirection. Sort of – don’t look at what a terrible dangerous mess this is all in, look at the offer of shiny-shiny money – aren’t we caring and doing something about it after-all?

Remember this one? Liberal Democrats 2010 Electioneering Slogan.

 

Let’s also consider this idea of ‘parity of esteem’ – that mental health which has pretty much from its inception within medical and health care practice always played second-fiddle to physical health services in terms of image, funding and priority. Perhaps it seems, at first glance, laudable to call for a parity? When I first heard the phrase it immediately seemed to me that this was going to be another bit of ‘rhetoric’ that would never translate into meaningful action – i.e. raising resources and funding for mental health services. The disproportionate cuts between acute services and mental health services seems to bear this assumption of mine out. (See  http://www.bbc.co.uk/news/uk-england-sussex-26530733, http://www.bbc.co.uk/news/health-25777429, and http://www.bbc.co.uk/news/health-27942416 for examples of how cuts demonstrate that ‘parity of esteem’ is a hollow political promise).

Given the potentially devastating impact that mental health difficulties can have on a person’s well-being, life circumstances, relationships, emotional state, livelihood, physical health, citizenship, personal security, status, longevity and employability is it reasonable to suggest that ‘mental health’ should just be ‘on a par’ with physical health? I’m bound to argue that in some respects addressing mental health difficulties should be given priority according to its own needs and impacts, in its own right. This might mean that it needs funding above and beyond acute and physical care and that calling for a ‘parity of esteem’ is doing mental health and healthcare in general a disservice. Is acute and physical care necessarily getting the attention, funding and resourcing it needs and deserves? Somehow I doubt it given the shear depth and breadth of the services encompassed. Equality is not necessarily about “treating everybody equally”, it’s more about making adjustments that enable those persons needs to be met – tailored to obstacles that are present within that person’s life circumstances.

Ok, extended grumbling over – as you were!