Against the backdrop of a fragmented and challenging mental health system, compassion and understanding are central to providing quality and patient-centred care, according to one nurse. 

“Whenever you work in mental health, it’s not like you can palpate or empirically measure someone’s sadness”, explained Dr John Hurley, a mental health nurse and professor of mental health nursing at Southern Cross University.

“You can’t just put someone in an X-ray machine or a CT scanner and determine exactly what type of treatment is required”, he told HealthTimes.

“That’s the biggest challenge, really, that you have to be able to have a lot of technical knowledge, but also the non-technical skills of being able to form relationships, build trust, rapport, and have empathy.”

“And then you might move to the next person, and you sort of have to redo it all over again. There’s an excitement and challenge in that – your work is not like a production line, where you just repeat the same process with 20 different people. You have to tailor your work 20 times to meet each patient’s needs.”

Dr Hurley said that COVID-19 had exposed deep seated problems in Australia’s mental health system which nurses, and patients, must navigate daily.

“Whether it has been mental health, or vaccinations, COVID-19 has highlighted problems right across our health system.”

The problems in mental health, however, are by no means new. They have been repeatedly highlighted in several publications, including the Royal Commission into Victoria’s Mental Health System, the Productivity Commission’s report, and the
National Mental Health Commission report.

“They all say the same thing – that the system is not focused towards the person experiencing the mental health problem. It’s not consumer-focused. It’s over reliant on medication. It’s too focused towards people with mild to moderate problems, particularly in urban centres.”

“If you’re in rural Australia, or if you have a mental health condition that exceeds the needs of primary care, but doesn’t meet the threshold for state tertiary services, you’re pretty much left untreated.”

“If you’re Aboriginal Torres Strait Islander, gay or trans, you also do not get good services”, Dr Hurley said.

“COVID’s really highlighted that mental health is more than just a medical response. It’s a community issue. It’s tied in with people’s psychosocial outcomes, connectivity to others, meaningful employment, and therefore it needs a whole community response.”

He said that a crucial step towards better addressing mental health in the community was to transform the structure of nursing education in Australia.

“You’ve got to understand biological, sociological and psychological drivers of why people experience emotional stress. And you also need the knowledge about how to navigate a very complex, and frankly, broken mental health system. And you’ve got to sort of put all that together.”

“I really don’t think that you can get that level of capability in a comprehensive or general nursing approach.”

“And we’ve had general comprehensive nursing training for nearly 35 years now. And there is not one single shred of evidence anywhere that says it’s helped mental health consumers by having better prepared mental health nurses. Quite the opposite in fact.”

“We need to have a return of direct entry undergraduate mental health nurse preparation. That needs to be an option that sits alongside current nursing preparation courses, so that you can enter directly to train as a mental health nurse.”

“The Productivity Commission was unambiguous about this in its report.  Equally so, it said that all preparatory nursing courses need to have at least one discrete unit of mental health nursing. At the moment, there’s universities in this country that have no mental health content in the preparatory curriculum.”

Based on his many years of experience, Dr Hurley had some advice for anyone wanting to pursue a career in mental health nursing.

“Be passionate about what you do and be prepared to use aspects of your personal self. Collect as many skills and capabilities as you can.”

“Train in psychological therapies, be knowledgeable about pharmacology, be prepared to develop your personal self, and your professional self, because that’s a vital therapeutic tool to help others.”

“Most importantly, [mental health nursing] is about having compassion – and compassion towards what sometimes can be challenging behaviours”, Dr Hurley said.

“In many instances, the patient brings with them psychological trauma, or intergenerational psychological trauma. You need to be open to what other people are experiencing.”

“And understand that they are needing help within this fractured mental health service, that quite honestly, if you were building one from scratch, you wouldn’t even build something that remotely resembles what we currently have, would you?”