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Mental health nurses in primary care ‘critical but under recognised’

Mental health nurses in primary care ‘critical but under recognised’

Mental health nurses working in primary care ‘are critical’ to ensuring patients get the support they need but are at risk of being ‘pushed out the door’ by poor pay and working conditions, Nursing in Practice has been told.

To mark Mental Health Nurses’ Day today (21 February) those among the profession have spoken to Nursing in Practice about the ‘leading role’ nurses in general practice and community settings play in supporting mental health.

Royal College of Nursing (RCN) head of nursing practice and professional lead for mental health Stephen Jones said: ‘Mental health nursing staff in primary care are critical to ensuring patients get the support they need, yet many of them tell us they are not always being recognised for their vital contributions.

‘Mental health nurses in general practice have been shown to reduce referrals to secondary mental health services and improve outcomes.

‘However, our most experienced staff are being pushed out the door by difficult working conditions and low pay – and patient care is suffering.’

As the profession marked Mental Health Nurses’ Day, Mr Jones said ministers must ‘take action to improve the retention and recruitment challenges’ within nursing.

‘In primary care, this must include the Westminster government providing ring-fenced money to fund the full 6% pay increase it promised general practice nursing staff last summer,’ he added.

It was recently revealed that almost half of GP nursing staff did not receive a pay rise last year.

Meanwhile, Georgina Callard, a mental health nurse based in general practice in Northamptonshire, highlighted the need for a mental health nurse in every GP surgery.

‘I do think there is [a] place in every surgery for a mental health practitioner,’ she told Nursing in Practice.

‘We have amazing GPNs that specialise in wound care and diabetes, really important stuff – so why don’t we have mental health nurses in every surgery? The need is there.’

Ms Callard, who championed mental health as a priority for general practice this year for Nursing in Practice’s 10-point manifesto, had always previously worked in secondary care before moving to general practice in 2018.

She highlighted the high proportion of patients presenting with mental health difficulties – one in five children and young people, and that half of the population will develop a mental health disorder in their lifetime, with general practice providing a more familiar, accessible environment than secondary care.

‘People will come and they’ll have physical health issues but a lot of the time there are underlying mental health issues as well, sometimes they won’t recognise it straight away,’ said Ms Callard.

She also emphasised how GPNs can make early intervention and potentially reduce referrals into secondary care as a result. GPNs can also provide longer appointment times and support time-pushed GPs, she added.

‘I find it a privilege to be there when someone is probably at their most vulnerable and being able to hold that hope for them until they can hold it for themselves again,’ said Ms Callard.

‘If we can have the right people in the right place, it makes all the difference for patients and your colleagues, they see the benefit of it as well.’

Meanwhile, George Coxon, a mental health nurse who is part of the Devon Integrated Care Board (ICB) mental health framework implementation group and supporting the development of an accredited mental health module, agreed that primary care nurses are ‘at the frontline’ and are often the primary contact for people in mental health difficulty and distress.

‘The earlier the support and intervention, the less entrenched a pattern of behaviour or circumstances can escalate and become established into a lifetime of struggle,’ he said.

He said mental health nursing in primary care can be overlooked when it comes to policy and esteem, however the importance of those skills – particularly at a time when people’s jobs and household budgets are under pressure – and providing relationship-focused care, are critical.

Meanwhile, Dennis Singson, advanced mental health nurse practitioner and head of mental health service at Victoria Medical Centre in Eastbourne, said that mental health nursing in primary care promotes parity of esteem between mental health and physical health service provision, and bridges the gap between primary and secondary mental health care.

‘Without GP surgeries offering mental health services, so many people fall in the gaps,’ he said.

He added that offering mental health services within general practice lessens shame, stigma and discrimination. ‘We’re preventing crises because we’re there before the crisis happens,’ he added.

Dr Crystal Oldman, chief executive of the Queen’s Nursing Institute (QNI), added: ‘Mental health nurses play a hugely valuable role in the whole health and social care system, and increasingly they are being attracted to working in primary care.

‘Since Covid, the profile of mental health has risen significantly and especially the importance of maintaining good mental health.

‘Services and society are still adapting to the need for greater access and support for our mental health. Mental health nurses working in the community and primary care have a leading role to play and it is essential that we invest more in mental health nursing education and practice.’

She added: ‘The QNI has recently published Field Specific Standards for Community Mental Health Nursing, to support universities that are offering Specialist Practitioner Qualifications in this field. This support to the system will help build greater capacity in high quality, specialist mental health nursing in the future.’

A British Medical Association report published yesterday described mental health services in England as ‘broken’, with infrastructure and systems ‘not fit for purpose’. The report concluded that mental healthcare has not been provided with the funding or staff necessary to achieve the level of improvement needed.

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