Today is to be celebrated for many different reasons, especially when looking at the history of nursing. It is 21 years since the very first intake of nursing students to the University of Stirling, 50 years since the University itself was created, and soon will be 70 years since the creation of the NHS. Not just that, but it’s recognised as Mental Health Awareness day. With all this to celebrate, I thought it provided an exciting opportunity to look back on the history of mental health nursing, and views on mental health to see how it has changed and developed. But just how much progress has been made from the conception of the role of the mental health nurse?
For almost two centuries, mental health nurses have struggled to win recognition for their unique contribution to the health and wellbeing of those in their care. Nolan (1993) has well documented the historical timeline of mental health nurses, as well as how they have been viewed by society. From very early on nurses rarely had access to resources which would have enabled them to fully care and treat those suffering. It was the doctors who employed the nurses that taught, trained, examined, and decided what their role should be.
Because of this and the constant development of theory and practice, nursing experienced frequent therapeutic shifts over the decades causing even nurses themselves to feel confusion about their own role and name. During the 18th-19th centuries, they went by the term ‘keeper’, and had a small role of domestic duties, caring for ‘patients’ and keeping them manageable for the doctors. It wasn’t until after 1845 with the emergence of the asylum systems and implementation of the medical model, which attributed all mental illness to biological errors, that they then shifted to ‘attendants’ to seem more humanitarian and gained more responsibility.
From the mid-19th century, the term ‘nurse’, widely recognised today, began to be used. This helped to push for ‘mental nurse’ to become an official title in 1923. The model of practice then shifted to the new field of psychology, bringing forward interventions that are still used, such as psychoanalysis and behaviourism. The medical model remerged later in the century when famous treatments like electro-convulsive therapy became popular. It wasn’t until the late 20th century that models pushed for treatment to be done out in the community thanks to the NHS Care and Community act (1990). At this point nurses were encouraged to be autonomous in their profession and develop their skills to lead and solely deliver care and treatment, with the aim to re-skill and empower those with mental illness.
Despite all this growth, development, and therapeutic shift, this is not how mental health nurses were seen by the general public or even some health professionals. Nolan (1993) commented that the historical view of mental health nurses is that they are lazy, lacking in motivation, compassion, and intelligence. The stigma that clouds mental illness has fogged public perceptions of those who suffer from it, and those that try to ameliorate those suffering.
An early example of this is obsessions with witchcraft, which developed during the medieval times. Countless numbers of people (mostly women) were executed as they were believed to be witches. In 1682, Temperance Lloyd was the last person accused and executed in England, but recent research suggests that she suffered from dementia (Wright, J. 2010). The stigma fed into the fear and paranoia of the supernatural, leading to the deaths of too many. Just think, if these ‘witches’ had been alive today, how would they be treated? Would they still be ‘witches’, or people needing help for a mental illness?
Today, mental health nurses aim to work alongside those experiencing mental ill health while promoting independence, advocacy, and person-centred care. Mental Health Nurses are a caring constant for those in need during the lonely and enduring experience of mental illness; supporting their recovery, providing the essential aspects of treatment not many realise are vital: support, comfort, and presence.
Today’s nurses work long, hard, hours to help a person feel themselves again. But yet both are faced with the same dark cloud fogging perceptions. The stigma looming over mental health is still very much present, and can be an obstacle to accessing care. The historical view on mental health nurses remains to be held by many, including health professionals. The amount of comments like “they’re not real nurses” for example I have heard is disheartening for a 3rd student nurse like myself.
However, it is not just the staff that this view effects. Wright (2010) found that when the NHS Care and Community act (1990) came into place the public protested against those with mental illness living and being treated in the community, in fear for public safety. Yet, it is 6 times more likely that those with mental illnesses are to be murdered than commit murder. Such views like this create a vicious cycle leading to discrimination, low treatment effect, or high relapse rates which reinforce stigma (Sartorius, N. 2007). This could be detrimental to those experiencing mental health, and could possibly be linked to the rise of suicides in Scotland in 2016 (728) from the previous year (672) (ChooseLife. 2017). To me, this highlights the importance of further work being done to raise awareness of mental health with the aim to eradicate stigma, but is this enough?
Improvement is always possible; Wright (2010) suggested bringing in mental health nurses to schools as a potential opportunity to increase awareness and knowledge, and for possible early intervention work. Evidence on the impact of mental health nursing is at its strongest in decades, with a drive for more nurses to be recognised for being a key resource in effective delivery of services (Barker. 2009). More is being planned to tackle these issues too, but this is something anyone can help with. Charities supporting mental health are out there offering fund raising events and education, so anyone can help, even if it’s just through being open minded.
Devon Buchanan, Student Nurse, University of Stirling
10 October 2017
- Barker, P. (2009) Psychiatric and mental health nursing : the craft of caring. 2nd ed. London: CRC Press.
- Chooselife.net. (2017). Chooselife -Statistics suicide in Scotland. [online] Available at: http://www.chooselife.net/evidence/statisticssuicideinscotland.aspx [Accessed 6 Oct. 2017].
- Nolan, P. (1993) A history of mental health nursing. 1st ed. London: Chapman & Hall.
- Sartorius, N. (2007) Stigma and mental health. [online] Available at: http://search.proquest.com/docview/199002822?pq-origsite=gscholar [Accessed 4 Oct. 2017]
- Wright, J. (2010). A history of mental health and wellbeing, part 2. British Journal of School Nursing, 5(8), pp.458-459.