Mental health articles

OF mental health care and mentally ill

Mental health nursing – consultation, facilitation, advocacy

Mental health nurses need grounding and information in order to question practice, to contribute to decision making in multi-disciplinary teams, and to draw on research-based knowledge in the delivery of care and the development of mental health services. It is hoped that much of this chapter contributes to meeting such needs. Thus, how ‘grounded’ nurses are depends on themselves at a personal level; in relationships at work with patients, colleagues, supervisors and managers; in their sense of themselves within the institution/organization and, more broadly, within the culture (see Table 2.2). Information with which both to question and to contribute to practice comes partly from individual resilience (coherence and personal integration) and partly from supportive environments, both physical and intellectual (of which this chapter hopefully forms a part). There are many forms of research-based knowledge from the objective to the subjective and simply knowing this may support the practitioner to question the hegemony of certain forms and frames of knowledge, research and ‘evidence’, as in ‘evidence-based research’, which usually refers to ‘objective’ empirical evidence. In advancing this kind of reflective and critical practice in action, the practitioner, in this case the mental health nurse, may – even must – become consultant, facilitator and advocate.

The term ‘mental health consultation’ dates back some 30 years to the work of Gerald Caplan who viewed it as ‘one of the essential ingredients of an organized program of community mental health’. Caplan’s views on mental health consultation are set out in his own work (and summarized and discussed in Tudor 1996b); nevertheless several points are worth making here:

the relationship between the two professionals involved (i.e. consultant and consultee) is ‘coordinate’, i.e. non-hierarchical in terms of management authority;

the consultant has no administrative or coercive responsibility as regards the client; and

the consultant has no liability for outcome. While there are many different personal styles of consultancy, the term facilitation (meaning rendering easier, helping forward) implies a certain philosophy about the role of the consultant/nurse/etc. and their relationship to the client (whether an individual, group or organization). Rogers (1983) describes the best facilitator in the words of the Chinese philosopher Lao Tse and author of the Tao Te Ching:

A leader is best

When people barely know he exists,

Not so good when people obey and acclaim him,

Worst when they despise him.

But of a good leader, who talks little,

When his work is done, his aim fulfilled,

They will say ‘We did this ourselves’.

If a facilitator is, at best, self-effacing, the good advocate is often ‘in your face’. Commonly defined as someone who is called in as a witness, one who pleads or speaks for, or who intercedes on behalf of someone else, advocacy also carries a sense of argument and recommendation. Both fields – of mental health and mental illness – need advocates who have the personal resilience to stand up for themselves and the people for and with whom they are advocating, as well as (ideally) the supportive environments, networks and groups in which to operate. The emphasis in recent years, again in both fields, on participation and on citizenship is significant. Campbell (2000) argues that it is more important, for instance, for mental illness service users to be talking and acting in terms of rights and citizenship than in tinkering with the review of the Mental Health Act. He goes on to observe increased activity among ‘mental health’ service users in the consortium Rights Now since the passing of the Disability Discrimination Act 1995 (which for the first time included people with a mental illness diagnosis). Within mental health, alongside the notion of healthy environments, schools, hospitals, communities and cities, the concept of ‘civic well-being’ (Stewart 1998) is developing. Consultation, and to a lesser extent, facilitation, implies that the practitioner has been approached by someone to act as a consultant or facilitator; the advocate generally needs no invitation! As mental health is for all then it is the business of all and in this the mental health nurse, with the help of education and training, can and must play their part.

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