The Guardian (UK ed), 29 Sep 2014
There was an article in The Guardian (UK edition) recently where a nurse described how ill-equipped they felt to support patients experiencing mental health difficulties. The article included the startling information that, “My nursing course, which I think was excellent, contained no more than three days structured education on caring for patients with mental health problems.”
Umm. That wasn’t an excellent nursing course. That’s a crap nursing course.
Look, us Aussies like to tease the Brits about their weather and cricket team every chance we get, but I’m not accustomed to criticising their nursing courses. The truth is, I do not know enough about nursing courses in the UK to hold any strong opinions about how good or bad they are.
That said, I wonder what the general public would think of hospitals being staffed by nurses who had undertaken, as reported, a three year nursing course that includes only three days of teaching in mental health. I am glad that doesn’t happen in Australia.
Dumbing Down is Dumb
Since July 2000 most of my work has been about supporting mental health care in the general health settings as Consultation Liaison CNC (more about that here) and as Perinatal Mental Health CNC (more about that here). These roles have direct clinical input, but also have a lot to do with supporting general nurses and midwives to feel more confident and become more skilled at providing direct clinical care to people experiencing mental health difficulties. It’s inevitable that they’ll need these skills – a significant proportion of people who access general hospitals and/or maternity services also experience symptoms of depression, anxiety etc. Dumbing-down mental health education for general nurses and midwives is dumb.
In August 2012 a Mental Health First Aid (MHFA) instructor proposed using MHFA as inservice education for hospital-based nurses. I mounted my high horse to defend the depth and quality of nursing education sprouting the opinion that MHFA is not suitable training for RNs. My rant went along the lines of it’s great training for many community and professional groups, but it’s inadequate for those working in health role. Undergraduate nursing programs have more than the 12 contact hours that MHFA offers, and we should re-awaken/build-on that education. Nurses in particular need to know a bit about:
- symptom detection
- meanings/implications of diagnostic groups
- medication effects and side-effects
- the biopsychosocial model of mental health
- social determinants of health
- risk assessment/management
- emotional intelligence and therapeutic use of self
To give MHFA their due, they have never claimed their training to be an alternative to formal nursing education (others have). MHFA does a good job at informing first responders, but does not address mental health in a manner suitable for a frontline clinician. There is a community expectation that nurses and midwives will have a depth of understanding of mental health beyond that of the general community, beyond basic fist aid.
This conversation started off as a discussion in the workplace, then became a topic of discussion on the Australian College of Mental Health Nurses e-lists, then morphed into a conference presentation and, more recently, was articulated as this journal article:
Happell, B., Wilson, R. and McNamara, P. (2014) Undergraduate mental health nursing education in Australia: More than Mental Health First Aid. Collegian (2014), http://dx.doi.org/10.1016/j.colegn.2014.07.003
Anyway, I guess there are two points to this blog post:
One: Quality Control
Let’s make sure that we continue to defend the quality and depth of undergraduate nursing and midwifery training in Australia. We must never let it slip like the UK example of just three days training in three years. That is woefully inadequate.
Two: Speak Up
If you’re a nurse or midwife with strong opinions about a subject, it doesn’t hurt to discuss these opinions online. As per this example, a discussion held online morphed into a conference presentation and a journal article. For me, anyway, the difference between it being a rant and a paper was the interest and input from a couple of Nursing Academics: Brenda Happell (@IHSSRDir on Twitter) and Rhonda Wilson (@RhondaWilsonMHN on Twitter).
References
Happell, B., Wilson, R. L. & McNamara, P. (2013). Beyond bandaids: Defending the depth and detail of mental health in nursing education. Paper presented at the Australian College of Mental Health Nurses 39th International Mental Health Nursing Conference Perth, Western Australia, Australia. Abstract in International Journal of Mental Health Nursing, Vol 22, Issue Supplement S1, pp 11-12 http://onlinelibrary.wiley.com/doi/10.1111/inm.2013.22.issue-s1/issuetoc
Happell, B., Wilson, R. L. & McNamara, P. (2014) Undergraduate mental health nursing education in Australia: More than Mental Health First Aid. Collegian (In Press) http://dx.doi.org/10.1016/j.colegn.2014.07.003
End
Thanks for reading this far. As always, your feedback is welcome in the comments section below.
Paul McNamara, 21st October 2014
Short URL: meta4RN.com/defend
meta4RN 
I think the author writing about the Mental Health First Aid courses has missed the point that these courses have never been written for health professionals. They are community education courses, just like regular First Aid courses for interested members of the public. There is a MHFA course for nursing students and medical students, funded by the Australian Government, to help these tertiary students recognise and give support and help to fellow students. It is not a course teaching clinical practice guidelines! Unfortunately, few nursing undergraduate courses teach students how to help each other with depression, anxiety, suicidal thoughts, non-suicidal self injury or eating disorders, although these illness are very common in this cohort of young people. Betty Kitchener CEO Mental Health First Aid Australia http://www.mhfa.com.au
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Thanks for you comments and clarification Betty – it’s heartening to know that I share the same view as the MHFA CEO.
To clarify: I am aware that MHFA is a community education course. The genesis of this paper came from a MHFA instructor proposing MHFA as inservice education program for hospital-based nurses. When I argued, as you have, that it was not designed for health professional education, she pointed to the fact that some nursing/midwifery professional bodies have endorsed MHFA for CPD. That ambiguity is where the discussion started.
The discussion has since morphed into a conference presentation and now a journal article. None of this is to criticise MHFA – the journal article cites a lot of literature that shows that it is fit for purpose. The purpose of the paper is to as you have done: clarify MHFA’s intent, usefulness and limitations.
Kind regards,
Paul
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If you’ve read this far down the page (thank you Ms/Mr Nerdypsnts), you may also find this of interest:
Kitchener, B. & Jorm, A. (2016) The role of Mental Health First Aid training in nursing education: A response to Happell, Wilson & McNamara (2015), Collegian http://dx.doi.org/10.1016/j.colegn.2016.06.002.
Abstract:
This article responds to concerns Happell, Wilson and McNamara (2015) have raised about the role of Mental Health First Aid (MHFA) training in undergraduate mental health nursing education in Australia. MHFA training was developed in Australia to improve the capacity of members of the public to provide initial help to a person with a mental health problem or in a crisis. In 2012, the Australian government provided funding for MHFA training of frontline workers, including nursing students. From mid 2012-mid 2016, over 15,728 nursing students received the training. An evaluation study found positive effects on intentions to provide MHFA and confidence in helping a peer, improvements in MHFA knowledge and a reduction in stigma. Contrary to Happell, Wilson and McNamara’s concerns that MHFA training will become part of the core nursing curriculum at the expense of mental health nursing content, MHFA training is primarily aimed at peer support. The program has been standardized to preserve fidelity and quality, and the curriculum content follows an evidence-based rather than medical model. We agree with Happell and colleagues that MHFA training would be a valuable prerequisite to nursing education, but that it is not sufficient for professional training.
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Hi Betty,
Please try again, I believe the wording says it all and they have interpreted the MHFA certification as a Level 3 Mental Health certification at a registered training organisation instead of the MHFA addressing the gap in the market between mental health patient and the mental health professional.
I would like the see all Mental Health RN who specialise in the field of mental health to have the Mental Health First Aid Certification and it be renewed every 3 years simple to the St Johns First Aid Certification.
Thanks
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