What does a mental health nurse do?
Most of a shift goes on watching and listening. A nurse notices that someone has stopped sleeping or has gone off their food, then records what has changed since the last contact. Plenty of this happens outside any formal assessment. A person who said nothing in the interview room may mention a frightening thought while walking down the ward afterwards.
Medication takes up a large part of the role too. Nurses give it and watch for side effects, and in community clinics they often give the long-acting antipsychotic injections that release slowly over weeks or months. Clozapine, used when other antipsychotics have not worked, comes with regular blood tests because it can lower the white blood cell count. Some antipsychotics also cause weight gain and raised blood sugar, so nurses check both and refer the person on when results change.
Psychiatrists are the doctors on the team. They diagnose and prescribe, while psychologists handle testing and talk therapy. Nurses usually spend the most time with the person, at least on an inpatient unit, and in a community team the nurse is often the case manager who coordinates everyone else. Nurse practitioners, with advanced training, can prescribe in some jurisdictions.
Where do mental health nurses work?
People tend to picture a locked ward, though plenty of these nurses never work on one. Community teams see people at home or in clinics. Emergency departments employ mental health nurses to assess whoever arrives in crisis, and consultation-liaison nurses help staff on general wards care for someone admitted after self-harm, for instance. Forensic nurses work in prisons and secure hospitals.
An inpatient nurse may see a person many times in one shift and can check a hunch by lunchtime. In the community that person might get one short visit a week, and the nurse has to judge how they are from that.
What does recovery-oriented care mean?
Ask a GP what recovery means and you would probably hear that the symptoms have gone. Mental health services use the word more broadly. William Anthony, a US psychiatric rehabilitation researcher, described it in a 1993 paper as living a satisfying and hopeful life within the limits of an illness. By that definition, someone who still has symptoms and takes medication every day can be in recovery. Australia set the idea out in a national framework for recovery-oriented services in 2013.
So the person's own goals steer the plan. Say a man with schizophrenia still hears voices, and what he wants most is his part-time job back. The voices may not come first. If his medication leaves him too drowsy for a morning start, the nurse takes the dose timing to the prescriber, and the team arranges job support while symptom care carries on. The formal name for weighing options together like this is shared decision-making. Many services also employ peer workers, hired for their own experience of mental illness.
Involuntary treatment is where this gets awkward. Each Australian state and territory has its own mental health law, and a person under an order made through it cannot refuse all treatment. The nurse can still offer smaller choices, such as the time of an injection or who gives it. The order stays in place regardless, and some people treated this way doubt that a service using it can be recovery-oriented at all. It's a fair objection, and a choice of injection time does not answer it.
What does trauma-informed care mean?
Many people who use mental health services have lived through trauma such as abuse or violence. Trauma-informed services assume any person may have this history, and they organise care to avoid repeating the loss of control that trauma involves. In 2014 the US Substance Abuse and Mental Health Services Administration published a framework for this, with six principles that include safety and collaboration.
Much of it looks small on the ward. A nurse explains a procedure before starting and asks before touching anyone. At admission she might ask what helps when the person becomes distressed, then write the answer into the care plan. Units also review each use of seclusion and restraint, because being held down can repeat the experience of an assault.
None of this requires a nurse to ask what happened, and pressing for details can cause harm. Therapy aimed at the trauma itself, trauma-focused cognitive behavioural therapy for one, belongs with staff trained to deliver it. Evidence on trauma-informed programs is still limited, partly because studies measure different outcomes.
What do other common terms mean?
You will hear these at handover and see them in care plans.
- A mental state examination records how a person presents at that moment, from appearance and mood through to thought content and insight into their own illness.
- Risk assessment estimates possible harm to the person or to others. Risk can change within hours, so nurses repeat it. Treat any score with caution: a 2022 self-harm guideline from the UK's National Institute for Health and Care Excellence advises against using risk scales to predict future suicide.
- De-escalation comes before any use of force. Staff try to calm a distressed person through conversation and physical space.
- Least restrictive care means the fewest limits on freedom that still keep someone safe, so a community order comes ahead of a locked ward if it can do that.
- Dual diagnosis is shorthand for a mental illness and a substance use disorder occurring together.
How do nurses move into mental health nursing in Australia?
Most Australian nurses complete a Bachelor of Nursing that covers all areas of nursing and specialise afterwards, unlike the UK route. They register with the Australian Health Practitioner Regulation Agency (AHPRA), the national regulator for health professions, and pick up much of the vocabulary above on the job.
Registered nurses who want formal training in this specialty can complete a postgraduate certificate in mental health nursing, such as the one Victoria University teaches online. Applicants to Victoria University's Graduate Certificate in Mental Health Nursing need a nursing degree and registration as a registered nurse or midwife. They must also be employed in a health setting, so the study runs alongside shifts. What a nurse reads about de-escalation one night can be tried at work the same week.
