MHNAUK respond to ‘The future of the mental health workforce’ report

This response is also available in PDF format.

Mental Health Nurse Academics UK (MHNAUK) welcomes this report, commissioned by the NHS Confederation’s Mental Health Network and carried out by the Centre for Mental Health. As an independent report it both contrasts with, and complements, Health Education England’s recent workforce plan for England (Stepping forward to 2020/21). We also thank the Centre for Mental Health for inviting MHNAUK representatives to its consultations and the report’s launch.

We absolutely agree that there should be a concerted, positive recruitment campaign for careers in psychiatry and mental health, including mental health nursing. We add that this should happen as soon as possible. We are particularly worried about recruiting mature students into mental health nursing since the bursary changes and would welcome an exploration of financial or other incentives to keep this valuable group interested in our profession.

The call for a renewed focus on mentorship of, and clinical supervision for, trainees and existing staff is to be welcomed. This can only enhance the wellbeing of staff and development of ‘compassionate organisations’. We also agree there needs to be significant investment in the upskilling of the existing workforce – including investment in postgraduate courses and in clinical/academic careers – yet this is likely to be difficult given the recent disinvestment in nursing CPD and the ‘downbanding’ of posts.

We were surprised to see comments about newly qualified mental health nurses not being adequately trained. As a group, we are certainly aware of specific issues such as a need to improve physical health training among mental health nurses (and our members have been taking action to resolve this) but, in an already crowded, three-year curriculum, what employers now expect of newly qualified mental health nurses may be unrealistic. There is an opportunity to address this within the review of the NMC standards but, as we have argued elsewhereadobe_pdf_file_icon_24x24 the additional generic curriculum demands that could be imposed by the NMC leave less room for the consultation, formulation and risk-assessment skills that are essential to mental health practice. We are, however, broadly in favour of a UK-wide mental health nursing practice assessment document which may go some way in reducing perceived variability in the quality of our graduates.

The focus on career pathways in inpatient and crisis care is welcome. These services care for some of the most severely ill people yet are often staffed by inexperienced or support staff. However, we have some scepticism here since similar recommendations (that were not acted on) were made almost twenty years ago in Addressing Acute Concerns adobe_pdf_file_icon_24x24.

We welcome the increased role of those with lived experience in the delivery of care through, for example, peer support roles but these roles should be complementary to the traditional workforce not substitutes. Indeed, it may be more equitable to provide opportunities and support for those with lived experience to enter the traditional professions like mental health nursing rather than offer what could be seen as a subsidiary role.

New roles in the mental health workforce should be considered alongside an exploration of the utilisation and under-utilisation of traditional roles. For example, mental health nursing is often equated with acute, inpatient care yet most mental health nursing graduates have the skills to work in a variety of community and hospital settings, in primary, secondary and tertiary care, and across providers in the NHS, private and third sectors.

We are unsure how the proposal for shared core competencies differs from past work such as the Ten Essential Shared Capabilities adobe_pdf_file_icon_24x24. Moreover, mental health nurses should be involved in any call to define a ‘mental health practitioner’ as such a role has the potential to both threaten and strengthen our profession.

We are disappointed that the report does not say much about patient safety in relation to workforce skills or skill-mix. In particular, there is no recommendation as to how workforce developments can contribute to safe staffing, especially in inpatient areas.

Finally, we agree that mental health commissioning should be recognised as requiring specific skills and expertise and be afforded the same status as other aspects of healthcare commissioning.