I was honoured to contribute a foreword to the final edition of the Hive (the Australian College of Nursing’s quarterly publication showcasing member’s experiences) for 2014. The issue focuses on mental health, both on the importance of nurses looking after their own mental health and profiling the work of mental health nurses. I’m particularly interested in the issues of epistemology and ontology in psychiatry and mental health; the social determinants of mental health and care including gendered and cultural aspects (more about my background in the bio at the bottom), and the ethical and political including peer support and family involvement.
Reproduced with permission: cite as DeSouza, R. (Summer2014/15). Passion and knowledge: The craft of being a mental health nurse. The Hive (Australian College of Nursing), 8(10-11).
Mental health nursing has a colourful and somewhat contentious history. Attendants, coercion, abuse, stigma and asylum are words associated with the field of psychiatric nursing. The re-branding to mental health nursing and focus on recovery provides opportunities to respond more creatively and therapeutically to the person experiencing mental ill health. Philip and Poppy Barker advocate for a “craft of caring”, where the mental health practitioner integrates both the aesthetics and knowledge of nursing to meet the needs and expectations of clients and their own aesthetic and technical desires (Barker & Barkin 2011). The Barkers suggest that caring takes diligence, time and effort combined with creativity and resourcefulness.
This brings me to the stories of the nurses that are contained in this issue. Nurses need these stories for several reasons. Many nurses feel anxious and unprepared for working effectively with people experiencing mental health issues. This gap, combined with stigmatising and hostile views, impact on the quality of care provided. This is concerning given the high prevalence of mental health issues in the general population and the disempowerment that often accompanies a change in health status. However, mental health nursing is a marginal career choice for students entering a Bachelor of Nursing degree. Frequently, they are dissuaded from choosing it as a career option with classmates, faculty and family members not viewing it as ‘real’ nursing and many students are afraid of people experiencing mental illness (Happell et al. 2013). This is why I was so heartened to read Meg’s story. Meg has just completed her final year of her Bachelor of Nursing and is about to embark on a career as a mental health nurse. Her enthusiasm and passion offer great hope that we are already reversing these barriers. I hope that more early career nurses, like Meg, choose the career path so many of us mental health nurses have embraced, through engaging with high quality theory and having positive clinical experiences.
Karen’s passion for mental health nursing is evident in her belief that “… it is crucial that mental health nursing education remains clearly identified within undergraduate curricula in stand-alone units and is delivered by academics that are specialists within this field”. Here is where future mental health nurses have their seeds of interest sown,
nurtured and grown, then reinforced through clinical practice. Although nurses are implicated in psychiatric care, treatment and processes that valorize vigilance and surveillance to minimise risk, nurses like Christopher deftly work within psychiatry’s reductive gaze while attending to the unique lived experience of the person who
is experiencing “problems of living” (Barker). Christopher carefully manages the ethical dilemmas of care and control, by remaining client focussed, using the family as a model of care, he tries to create a more equitable world despite nursing in a context of community fear. This attempt to cultivate an ethical disposition and maintain hope and trust in themselves and in their clients requires that mental health nurses address their own psychological wellbeing amidst an environment of “moral distress” (Barker 2011, Barkin 2011). Barbara’s story shows how, in order to promote good mental health, her relationship with colleagues is fundamental for support but equally her relationship with herself also requires nurturing in the form of self-care. What’s important about these stories is that they show how central passionate people are to entry to the profession. Edy began her career in orthopaedics but became inspired by passionate educators when undertaking further study. She found herself in an environment where she saw mental health nursing being valued and came to consider it as a career option. “Being fascinated” provided the spark for her to take up mental health nursing which has resulted in her being versatile, enjoying herself and learning to deal with what is.
The rewards of crafting are evident in Brett’s story, both in being inspired to take up an apprenticeship in mental health nursing and being inspired by highly skilled practitioners, and in the ways he pits his skills against levels of acuity and risk. The lifetime apprenticeship is also evident in Barbara’s story; her work with people at various parts of the lifespan, in different contexts and settings brings richness to her craft. Entrepreneurship and new paths are evident in both Barbara and Christopher’s stories, offering further autonomy and creativity. Whether the passion for mental health nursing starts in the blood like it did for some or appears later in their career for others, what is a resounding theme in these stories is the desire to help others to get the most out of life using innovation and creativity. The caring part is important too; although caring is a human activity, what makes the care that mental health nurses give different is that it happens in the context of competing demands, with people who might have been forsaken by others or difficult to care for (Barker 2008). Importantly, caring must occur by learning about yourself, countering stigma, being a leader and a role model, recognising that mental distress impacts on all aspects of life.
These stories have a common vision of mental health nursing practice as both art and science. Moving beyond a medically dominated view of mental health, these exemplary nurses articulate a philosophy of practice that sees people in the context of their culture, family and society. Motivated by a philosophy and practice of compassion and advocacy in the context of complexity, their narratives reveal mental health nursing to be a craft that is challenging, rewarding and innovative.
- Barker 2008, Psychiatric and Mental Health Nursing: The
craft of caring, CRC Press, Boca Raton, FL.
- Barker & Barkin 2011, ‘Promoting critical perspectives in
mental health nursing education’, Journal of psychiatric and
mental health nursing, vol. 21, no. 2, pp. 128-137.
- Happell, B., & Gaskin, C. J. 2013, ‘The attitudes of undergraduate
nursing students towards mental health nursing: a
systematic review’, Journal of Clinical Nursing, vol. 22, no. 1,
For those of you who don’t know, I’ve worked in a range of mental health settings in New Zealand and England. I started my career in the addiction field, then worked in acute mental health in-patient units; community mental health services, regional hospitals and developed a new Maternal Mental Health Service. I am also a therapist having completed a Graduate Diploma in Counselling. I developed the content (with Andy Williamson) for the New Zealand Mental Health Foundation’s Postnatal Depression brochure. I am also advisor to Perinatal Mental Health NZ.
I have been actively involved in the development of the New Zealand mental health workforce through leading and developing all seven of the courses making up the National Certificate in Mental Health Support Work (Treaty of Waitangi, Relationships, Communication/Code of rights, Demonstrating knowledge and theory, Challenging incidents/Legal implications, Community and lifestyle planning, Concepts of health, Integrating knowledge) and co-ordinating the Graduate Certificates in Forensic Mental health; Child and Adolescent Mental health and Dual Diagnosis. I am a former Auckland branch Chair of the College of Mental Health Nurses and was seconded to the New Zealand Committee. I was also the Co-ordinator of the Master of Health Practice in Nursing (Mental Health) at AUT University.
I am a former co-ordinator of the Auckland Central Mental Health Forum and served as a Board Member and Deputy Chair of the West Auckland Living Skills Homes Trust Inc (WALSH Trust) who offer support services that promote recovery for people whose lives have been affected by an experience of mental ill health. More recently I’ve had strategic roles in mental health including the NZ Mental Health Literacy Programme Reference Group and National service specifications for specialist mental health and addictions- Asian and Refugee services. I have contributed to workforce and strategic planning through my roles on the Waitemata DHB mental health strategic workforce development plan steering committee; Waitemata DHB District Mental Health Addictions Plan – Asian Chapter Development and Counties Manukau DHB Mental Health and Addiction Network Committee. I co-ordinated NUR2207 – Mental Health Clinical Practice in Semester 2 of 2014 at Monash University, School of Nursing and Midwifery Berwick.
Recent mental health publications
- Wood, P., Bradley, P., & De Souza, R. (2012). Mental Health in Australia and New Zealand. In R. Elder, K. Evans & D. Nizette (Eds.), Practical perspectives in psychiatric and mental health nursing (Third edition). New South Wales: Mosby, Elsevier Australia.
•DeSouza, R (2012). Power dynamics in communication. In S. Shaw , A. Haxell and T. Weblemoe (Eds.), Lifespan development and commmunication. Auckland: Oxford University Press.
•McNeill, H., Paterson, J., Sundborn, G., DeSouza, R., Weblemoe, T., McKinney, C., et al. (2009). Culture health and wellbeing. In S. Shaw & B. Deed (Eds.), Health and environment in Aotearoa/New Zealand (pp. 95-124). Auckland: Oxford University Press.
•O’Brien, T., Morrison-Ngatai, E., & De Souza, R. (2009). Providing culturally safe care In P. Barker (Ed.), Psychiatric and mental health nursing: The craft of caring (Second ed., pp. 635-643). London: Arnold.
•Wood, P., Bradley, P., & De Souza, R. (2008). Mental Health in Australia and New Zealand. In R. Elder, K. Evans & D. Nizette (Eds.), Practical perspectives in psychiatric and mental health nursing (Second ed., pp. 86-107). New South Wales: Mosby, Elsevier Australia.
•Pavagada, R., DeSouza, R. (2007). Culture and mental health care in New Zealand: indigenous and non-indigenous people. In K. Bhui & D. Bhugra (Eds.), Culture and mental health (pp. 245-260). London: Hodder Arnold.
•DeSouza, R. (Jan, 2007). Multicultural relationships in supervision. In D. Wepa (Ed), Clinical supervision in the health professions: The New Zealand experience. Auckland: Pearson Education.
•DeSouza, R. (2006). Sailing in a new direction: Multicultural mental health in New Zealand. Australian e-Journal for the Advancement of Mental Health 5(2).
•DeSouza, R. (2005). Postnatal mental health. In A. Hodren (Ed.), Royal New Zealand Plunket Society National Resource Manual. (pp. 99-113) Wellington: Royal New Zealand Plunket Society.
•Wood, P., Bradley, P., & De Souza, R. (2004). Mental Health in Australia and New Zealand. In R. Elder, K. Evans & D. Nizette (Eds.), Practical perspectives in psychiatric and mental health nursing (pp. 80-98). New South Wales: Elsevier Australia.