The Nursing Contribution

Up to 80% of direct NHS care is provided by nurses, working in all settings, and across all age ranges. In mental health, nurses are the largest occupational group both in relatively new services, such as assertive outreach, community forensic, criminal justice and crisis teams, as well as in established services such as inpatient units, community mental health teams, specialised drug and alcohol services and child and adolescent mental health. Nurses work across the plurality of service provision and hence provide professional continuity throughout the entire patient pathway. Nurses frequently play key roles in the non-statutory and independent sectors as well as within the NHS.

In inpatient, and increasingly in community settings nursing is provided 24 hours a day, 365 days of the year. For the vast majority of such "out of hours" services; nurses are the major direct care providers. Such extended and close contact with service users leads to an intimate knowledge of the individual and their significant others.

95,000 nurses are able to practice as registered nurses in mental health across the UK (NMC March 2003), however many do not currently work in mental health settings or within the NHS. In England, there are now 47,000 registered nurses within the speciality in the NHS. The ratio of women to men is nearly 2:1.

The title "nurse" is legally protected, however, definitions of nursing tend to be broad and do not clearly distinguish a unique role as compared to other professions:

The personal concept of what nursing is, what it is for and how do we do it is rarely put into words, and cannot therefore be easily communicated… Nursing is the use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death. (RCN 2003).

Mental health nursing can potentially provide truly holistic care, with a range of interventions, from intimate physical care to formal psychological approaches, and from directly applying constraints under the Mental Health Act to spending extended periods of unstructured time with service users. Additionally, the two-thirds of qualified nurses who work in inpatient care areas also have direct health and safety responsibilities and responsibility for managing the environment.