The Genericization of Mental Health Nursing: A Personal Perspective

Abstract

As a mental health nurse lecturer and patient, I have grave fears over genericism eroding specialised mental health nursing education and clinical practice. Living with what mainstream psychiatry labels a severe and enduring mental illness, I have an intimate relationship with both mental distress and frontline mental health services. Working as a lecturer and educator of future mental health nurses grants me an oversight of nurse education. Contemporary mental health nurse academic literature is replete with calls to resist genericization (McKeown 2023), which in the UK is claimed to result from updated regulatory standards (Connell et al. 2022). Australia's generic pre-registration nursing curriculum has been posited as insufficient in preparing nurses for mental health clinical practice. Lakeman et al. (2023) have made impassioned calls for Australian pre-registration education to return to specialised programmes, whilst in the UK the regulatory body has been lobbied, although so far unsuccessfully, to urgently review standards for nurse education (Mental Health Deserves Better 2023).

Without my dual status as a mental health educator and patient, the inner workings of both educational standards and frontline services would otherwise be concealed under the clandestine cloak of ‘them’ and ‘us.’ This depicts nurses as exempt from mental health challenges, rendering patients as the ‘other,’ thus perpetuating prejudice. Nursing academics and frontline staff also reside in two distinct camps; educators often cannot occupy a dual educational and clinical post. This positions academic staff at risk of becoming unaccustomed to the challenging realities of working in frontline mental health services. Occupying the space between nurse and patient, educator and receiver of care, grants me a unique vantage point and insider view of academia, and frontline mental health nursing care.

The grassroots movement mental health deserves better is brimming with frustrated educators teaching generic nursing curriculums. Field-specific content is often withheld, and exclusive, to year two of the programme. With 2 years of shared (generic) learning across all fields, lecturers are desperately shoehorning mental health content into adult-centric teaching sessions. However, the shortfalls in students' knowledge, understanding and competency are a grave concern with Warrender et al. (2023) contending that mental health-specific skills have been undervalued and replaced by adult-centric physical health skills.

Should I possess the enviable liberty of walking away from mental health nursing at the end of my working day, I could abandon my professional frustrations. Genericism would be a mild irritant, a periodic office rant to colleagues and a minor occupational annoyance. However, I cannot nonchalantly separate my work and personal life. My frustrations and fears do not exclusively abide inside a university classroom. They infiltrate my entire being, as I coexist with mental distress and the messy reality of being at the mercy of frontline mental health services. During my alternative career as a mental health patient, I have experienced care that at best could be described as detached and procedural, and at worst depicted as negligent and cruel. Being on the receiving end of substandard mental health care erodes my sense of worth and value.

During one monumental period of relapse and acute distress, my dignity was stripped, compassion withheld and epistemic injustice penetrated my sense of personal agency. Apparent care masquerading as iatrogenic harm stole my dignity and forced me to beg for help. The long-lasting implications of this render me resolute to never be in a position of such vulnerability again. Yet no magic wand has removed my psychiatric history, no medication has been the panacea for distress or elixir for mental illness. I continue to exist at the crossroads of well and unwell. My life is a juxtaposition of mental wellness and chronic disability. This triggers grave concerns over the future of mental health nursing and our ability to meet the diverse needs of a 21st century population.

Despite my misgivings, in every classroom of students are individuals who embody authentic compassion, grasp the importance of holding hope for others, whilst fearlessly advocating for the needs of patients (Fisher 2023). These students merit nurturing and development to hone their strong personal values and hard-wired compassion. Otherwise, there is a risk of its suppression in clinical placements, corrupted by burnt-out staff, toxic environments and a legacy of under-funded and under-resourced neoliberal healthcare services. The nurses who have delivered substandard care to me possibly (hopefully) started out as the passionate caring students determined to make a difference. Worn down by compassion fatigue, they find themselves victims of moral injury, unable to deliver the care they desire. This is a systemic and multifarious problem, not solved by nurse education alone. Blame cannot be simply directed at one nurse or one service. Both nurses and patients are victims of the system that we call mental health care.

I hold on to moments where students describe how they have cared for someone in clinical practice and truly advocated for the patient's needs. As mental health nurses, our skills reside in the relational aspects of nursing care, in hearing and amplifying the voice of the patient. When I hear such impassioned stories and witness the proud professional identity growing within students, I have hope for the future—both their future as mental health nurses and my future as a mental health patient. As they realise the value and the privilege of holding hope for others and the art of being with someone in acute distress, I hold back prickling tears, more grateful than they will ever know.

I am fortunate to be employed by a university open to rewriting the mental health nursing curriculum. As a team of lecturers, we have been granted creative control and autonomy to write and develop a pre-registration mental health nursing curriculum. This contextualises physical health care within a mental health setting and has field-specific modules throughout the 3-year programme. Outdated assessment strategies have been replaced with real-world authentic assessments with a clear relevance to clinical practice (Fisher et al. forthcoming). During the overview provided by one module leader, I fought back tears as they described the nursing skills and values that I so desperately want to be a recipient of. This gives me hope for future experiences of mental health care and future international nursing curriculum reincarnations. Despite the fervent criticisms of regulatory bodies, they have deferred responsibility back to HEIs to decide on the amount of field-specific content. Academics must forge a new way forward, resisting genericism and reclaiming our professional identity and skill set to provide skilled and compassionate mental health nursing care.

Mental health nurses are the largest profession delivering mental health care, and their nurse education varies. However, with international discontent regarding a generic rather than specialised mental health curriculum, there are increasing fears for the future of mental health nursing and the sustained ability to respond to the needs of a 21st century population. Mental health nurses require an education that equips them with advanced interpersonal skills and sophisticated clinical decision-making ability to navigate difficult moral and ethical terrain in clinical practice.

The author declares no conflicts of interest.