Every Nurse Is Not a Mental Health Nurse—Critical Reflections on Myths and Controversies About Mental Health Nursing

Myths and misunderstandings about mental health nursing are damaging not only to the discipline but also affect the quality of services experienced by people needing mental health support. Contextually, these myths and misunderstandings abound due to stigmatising attitudes towards mental health, the dominance of generalist nursing in countries such as Australia and the United Kingdom, and generic undergraduate nurse education. They are perpetuated through a lack of awareness of the history of this specialty discipline, including its professional registration, education pathways and specialist knowledge, and a loss of graduate specialist skills required for safe and effective mental health nursing practice. It is important to analyse and correct these myths and address controversies as they have ramifications for the mental health nursing profession and mental health care.

A commonly repeated myth is that all nurses are mental health nurses, including those who work in a mental health setting. While perhaps not intended, this is a damaging and inaccurate myth. It comes from a misguided, albeit well-intended, effort to acknowledge that all nurses need fundamental mental health knowledge and skills to provide care to meet patients' needs. Indeed, they do. That does not make them mental health nurses with specialist nursing knowledge and skills.

Mental health (or psychiatric) nursing is a specialty field that ‘provides holistic care to promote the physical and psychosocial well-being of individuals at risk for or experiencing mental health conditions and/or substance misuse disorders or behaviour problems’ (International Council of Nurses 2024, 24). The mental health nurse role requires specialist qualifications in mental health. Other nurses in the field without specialist qualifications are nurses working in mental health.

This damaging myth serves to undermine and invalidate the specialty knowledge and skills of mental health nursing, as it implies any nurse can provide safe, skilled and effective mental health care, including for people with complex and severe mental health problems. This also strikes at the very identity of being a mental health nurse, an identity, knowledge and skill-base that differentiates this field from all other forms of nursing. This includes an intricate enactment of technical clinical skills such as talk-based therapies, risk reduction and holistic assessments. These skills are combined with non-technical capabilities of emotional intelligence, utilising self as a therapeutic tool and holding values and practices reflective of recovery and trauma-informed care (Hurley et al. 2022).

This myth has other implications, including nurses without specialist mental health qualifications and experience being considered fit to teach mental health to students in undergraduate nursing programs, or nurses forgoing undertaking specialist postgraduate mental health nursing education, as ‘all nurses are mental health nurses’. They are not. In the same way that a General Practitioner with some mental health training who provides primary mental health care is not a specialist Psychiatrist with extensive postgraduate training who provides specialist mental health care and treatment, a comprehensively trained nurse, even one with clinical experience in the field, is not a mental health nurse. They are both valuable, but distinct, roles.

In the rise of comprehensive undergraduate education across several countries, mental health nursing has been increasingly subsumed into the wider field of nursing where it is commonly viewed and treated as one of its subspecialty areas. There is a prevailing myth that mental health nursing is simply one of many subspecialties in generalist nursing, like critical care nursing.

Mental health nursing is not and never has been a subspecialty within general nursing. It is a parallel and separate specialty field in nursing and health care with its own history. In Australia, for instance, until the early 1990s there were three separate fields that nurses could gain registration in: general, mental health and intellectual disability nursing. Each registration field had its own specialty education and preparation for registered practice—its own identity. There were multiple pathways of education where some trained directly into their specialty, or where nurses did general nursing training, then a specialist mental health nursing (or psychiatric nursing), and/or a disability course and clinical experience. They consequently earnt their specialist nurse qualifications and registration in these fields. In 1993 the registrations were combined into a single register, with removal of specialty registration and recognition in mental health and disability (Happell 2009). Importantly, mental health/psychiatry has also had a distinct health service provision from generalist health services. Mental health nurses worked within these parallel and separate health services including psychiatric hospitals, originating from the convict era (Raeburn et al. 2018). While there has been some integration of mental and general health settings and services since then, separate mental health services continue to this day, as do the mental health nurses working within them.

Another prevailing and damaging myth that is perpetuated in many undergraduate programs is that nursing graduates need to consolidate their general nursing skills in the first year of graduate practice. They are often actively discouraged from going into mental health. This myth is based on stigmatising attitudes and ignorance towards mental health nursing skills and is indicative of the dominance of generalist nursing that is positioned as superior in undergraduate programs and clinical practice. This is incorrect and harmful to recruitment of the future mental health nursing workforce.

New graduate identity as a registered nurse is formed in the first few years of clinical practice, typically where nurses receive peer recognition of growing expertise within clinical environments. Being entrenched within a generalist setting over this professionally formative period adds yet another barrier to new graduates undertaking mental health nursing and has a substantial effect on the number of nurses recruited into the mental health nursing workforce.

Perpetuating these myths is damaging to the status, specialty knowledge, and skills of the mental health nursing profession. They reflect stigma and lack of respect for the field, are a major contributor to difficulty recruiting nurses into the mental health workforce, and of most significance, affect the quality and provision of nursing care to people with mental health conditions including complex and severe mental health problems requiring advanced nursing skills and specialist treatment and management. Indeed, it is this population that mental health nurses are frequently the only nursing discipline offering specialist clinical services to (Hurley et al. 2022).

We have raised and debated these myths and controversies to highlight damaging attitudes, behaviours and outcomes for the field of mental health nursing and for mental health care. There is much at stake here. It is imperative these myths stop being repeated. The field of mental health nursing should be accorded respect and autonomy. The future of the profession is at stake. The well-being of, and quality of care for, people with mental health conditions depends on it.

Kim Foster is an Editor of the International Journal of Mental Health Nursing.