Developing advanced mental health nursing practice: a process of change.

In the current economic climate of restructuring and rationalization it is important for mental health nurses to define their realm of expertise in order to demonstrate professional accountability and to validate their position in relation to unqualified but cheaper caregivers. If mental health nurses are to act in the best interests of patients and the community, they need to challenge current trends in health-care delivery that are preoccupied with economic efficiency and lack of consideration of broader social issues. To substantiate mental health nursing practice and defend against the undermining of clinical expertise by policies and service delivery that advances economic interests, mental health nurses need to corroborate their claims to expertise by articulating a patient-centred rationale for their practice. The ideas presented in this paper have evolved through the development of two postgraduate programmes for advanced mental health nursing practice--one in Australia at Griffith University and the other in New Zealand at the Department of Psychological Medicine, Christchurch School of Medicine.