Blending nursing with psychology

Malta is one of the few countries in Europe that has specialist degree-level mental health university education.

Horatio - European Psychiatric Nurses, the Netherlands-based representative body of Europe's estimated 300,000 mental health nurses, says the level of preparation for nurses training to work in this highly specialist area is a crucial indicator of the ability of national health services to deliver appropriate high quality care to its most vulnerable people.

Estimates of the numbers of people with general mental health problems in the Western world range from one in 10 up to one in six, with those having serious mental illness being one in 16.

Even at its most conservative this suggests that up to 40,000 people in Malta have mental health difficulties of some kind with a large proportion of those having serious problems requiring specialist help.

Malta currently has only 30 degree-trained mental health nurses among its nursing workforce, with a further 41 in various stages of training, but this figure is growing.

In 2004 we started the first postgraduate degree programme to convert diploma or general nurses working at Mount Carmel Hospital to degree-level psychiatric/mental health nurses. That programme has been so successful it was three times oversubscribed with applicants last year.

Graduates are currently leading many new services for mental health care in Malta, specifically in the community. They also engage in a variety of roles, such as management and policy development, research and the psychiatric nursing development unit.

Employment opportunities for this professional group are very good. As with most countries in the world, we have a real nursing shortage in mental health and it is vital we generate our own nurses from scratch as well as converting existing ones. To that end we developed a direct entry B.Sc. Mental Health Nursing which opened for the first time last October.

The students on this programme have just completed their first year. One of the students, Janice Agius, 19, from St Paul's Bay, comments, "You realise mental health nursing is about caring for those who are not able to cope with situations the same way you do. It's all about being there for the patients, listening to them, and showing them there are people who can help them get through their situation."

Psychiatric, or mental health nurses, are members of the core group of professionals who constitute the mental health multi-disciplinary team.

Along with psychiatrists, psychologists, social workers and occupational therapists they provide the basic care necessary to support all types of mental health cases.

But unlike other professional groups, they have direct contact with patients both day and night, 24 hours a day, 365 days a year.

They have to attend to every aspect of patient care, from personal activities of daily living - many patients just do not have the physical ability or motivation to look after themselves - right up to the complexities of care planning and delivery.

They deliver group and individual therapies, counselling, monitor the effects of medications, undertake mental health status evaluations and use interpersonal skills to deal with psychiatric symptoms such as hallucinations and delusions.

They are trained to develop highly skilled therapeutic relationships with patients and it is through these actions that most of their care activities are undertaken.

Mental nursing is a blended mix of psychology and nursing. To prepare students for their work, the three-year degree programme covers a wide variety of subjects designed to provide them with skills and subject knowledge that act as a personal tool kit in practice.

Topics include psychiatry, psychology, sociology, psychopharmacology, ethics, the law, human behaviour, communication and psychiatric nursing skills.

The ability to develop a working and trusting relationship with a person who may be very disturbed or who simply does not want to communicate, is at the heart of the work of these nurses.

The course focuses on personal strengths and weaknesses and teaches students how to use interpersonal skills at a very high level. Without this ability their work would be impossible.

Research guides the students' studies throughout, and a wide range of group and individual assignments build both the students' skills base and their confidence to work as a practitioner. The three years are divided evenly between theory and eight supervised clinical based placements in different mental health settings.

As mature student Anthony Pace observed, "you learn how to develop your communication skills to be able to get your message across, and how to understand other people and help them using counselling skills."

There are so many different mental health illnesses that require specialist attention. It is the intervention of skilled mental health nurses that often means the difference between life and death, or perhaps just having a life.

No two days at work are ever the same: one day you could be dealing with day-to-day activities; another day you could be dealing with psychiatric emergencies and highly disturbed individuals.

Helping someone wash themselves can be just as rewarding as helping them gain weight or stop self-harming. All require skill and sensitivity if they are to be undertaken effectively.

Mark Vassallo, a mature student from Swatar, puts it this way: "The job of helping people back to mental health is every bit as valuable and satisfying as caring for those with a physical illness."

Who should consider this type of career? To begin with, they have to be positive and optimistic in their outlook and really believe they can make a difference in other people's lives. They have to be prepared to look inside themselves and consider their own strengths and weaknesses, and be flexible enough to change and develop where necessary. They have to care about people and be prepared to work hard, very hard.

The B.Sc. Mental Health Nursing course will open again this October. It is open to both A-Level students, as well as mature students aged 23 or over.

For details of entry requirements and more information about the work of mental health nurses visit the website at www.um.edu.mt/ihc.

Mr Ward is chair of the European Expert Panel of Psychiatric Nursing and coordinator of Mental Health Nursing programmes at the University's Institute of Health Care.