NurseClick

 by Jessica Pham, ACN Media Officer

 

On October 10 (10/10) of every year, people all around the world recognise global mental health education, awareness and advocacy.

 

That day is also known as World Mental Health Day and has become a day where we can take stock of how we self-care and our personal mental wellbeing, something that we often take for granted.

Dr Michael Roche MACN, Associate Professor of Mental Health and Drug and Alcohol Nursing at the Australian Catholic University, is an expert in the field, having started his career as a nurse and finding his passion in mental health.

We got a chance to chat with Dr Roche and got his thoughts on his journey and where he sees mental health will be in the future.

 

What inspired or motivated you to become a nurse?

I wanted to be a nurse from my teens. Although nobody in my extended family worked in health, I had been exposed to first aid from an early age, and I always had a strong interest in the health sciences. I was keen to apply any knowledge I picked up – I was always the one with the bandages and ointments, and my friends in the surf club were always consulting me when it came time to sit our regular basic life support tests. Nursing therefore seemed to provide a great opportunity, but it turned out my family disagreed with my choice. So, good son that I was, I followed their advice and worked in a hardware store for a few years. This was frustrating and in my early twenties I enrolled in the Diploma of Applied Science (Nursing) at Sydney College of Advanced Education. We had some great educators there with a strong mental health team who influenced my direction.

 

How long have you worked in mental health and what motivated you to work in mental health?

I first moved to mental health near the end of my new graduate year. At that time NSW hospitals were not accustomed to the needs of ‘College Nurses’, and Prince Henry Hospital had decided that we could only be placed on a select few medical and surgical wards. I found an opportunity to move to mental health towards the end of my new graduate year. It was a significant change in the way I approached nursing and I worked with a very experienced group of mental health nurses in an authentic multidisciplinary model. These colleagues were great teachers and role models, particularly in circumstances that were challenging for neophytes such as me, and it cemented the view that mental health was my area. I was very lucky to have experienced this support and it was sad to see the team diminish over the years as Prince Henry moved towards closure. This was not all bad for me personally though as it led to opportunities in community mental health, which led me to a much better understanding of the breadth and variety in mental health nursing.

 

What is your biggest career achievement in mental health?

I’ve been very lucky and at each stage of my career have had the opportunity to achieve impact relevant to the context in which I was working. I find it hard to separate these achievements out as they are all relevant, so I’ll just try to list some examples.

As a community mental health nurse, I first observed in detail the types of positive outcomes that working collaboratively with consumers, carers and other services could bring – like improved accommodation, simplification of medication regimes, and reduced hospitalisation. These outcomes, alongside great nursing leadership, collaboration within the multidisciplinary team in which I worked, the new-found depth of engagement with consumers and carers in a different environment, and the autonomy of the role, also led to very high job satisfaction.

In another service as a more senior nurse, I was able to develop approaches to use everyday data to understand our service, and to help clinical staff understand their own work. This was a big shift for the service and I think it was influential for a number of my colleagues who went on to work more intensively in health information systems.

Later, when I was seconded to a mental health research position, I coordinated several studies across NSW that expanded our understanding of clinical supervision and of mental health nursing education – the first formal work that had been undertaken in the area. From there I moved outside mental health to explore the work of nurses in medical and surgical settings in several studies across Australia. Much of this work has been influential internationally, particularly that related to nursing skill mix, leadership, turnover, and the work environment. I also completed my PhD during that time and developed new approaches to undergraduate nurse education.

However, all of that said, I think I would see the breadth of activities I am undertaking in my current role as a great achievement. The capacity I now have to engage mental health nurses across many settings in developing questions, and in undertaking research to answer those questions, has led to work that will impact the clinical care we undertake and the way services support that care. I am currently bringing the approaches and knowledge from my non-mental health research to this field, and I think this will lead to some very useful outcomes over the next few years.

 

What are the biggest challenges that nurses face in mental health care?

There are a raft of challenges facing all healthcare systems, and they’re complex and tangled, so it’s difficult to bring it down to one or two. However, I think nurses working in mental health have two interrelated challenges we need to address to ensure an optimum mental health system.

First is the ongoing shortage of specialist mental health nurses and the difficulty we have had, and continue to have, in attracting greater numbers of new nurses to the specialty. That is, we cannot be content with simply replacing our current numbers – we need to increase the number of nurses joining us to grow service capacity. This is even more crucial in the light of the higher-than-average age of mental health nurses, and the consequent expected number of retirements over the next few decades. Health services, universities and professional organisations are working hard to address this, but we need to expand these efforts and be open to flexible options in undergraduate curricula and in the workplace.

The related challenge is that have not always articulated our expertise, the fundamental place of mental health nursing skills in all nursing contexts, the variety of roles we undertake, and the professional satisfaction our close relationship with consumers and carers brings. This absence of a strong image of mental health nursing can of course impact potential mental health nurses, who are also sometimes encouraged to choose a medical or surgical setting as a first placement rather than mental health. We need to be stronger in our message that mental health is a great first choice to develop skills that are transferable to other setting, to show there is significant opportunity for career progression in a wide range of settings, and to demonstrate more effectively that our work with consumers and carers leads to positive outcomes and great job satisfaction.

 

What would you like to see change when approaching mental health care?

Mental health services are now much more inclusive and engaging than when I first started in the area. The past few decades have seen a substantial focus on working with consumers and carers in a range of early intervention models and many of these appear to be effective. We need to build on this progress across all of our services, for example to address the needs of people with mental health problems combined with intellectual disabilities or drug and alcohol problems, and people who are homeless, to name a few specific groups. This work will include a lot of cross-sector engagement, which we have always found challenging at a systemic level, but at which nurses often excel.

We also need to improve the engagement of mental health nurses in developing and applying research evidence, and in using existing data. For the latter, although we have come some way in routine data collection these datasets are not always relevant to all stakeholders, and aspects are lacking, particularly around providing timely, clear, and practical feedback to the frontline. In regard to research, I see mental health nurses generating and answering questions every day, but we need to improve our capacity to approach these questions in a more formal research manner. Importantly, we need to give ourselves the time to do this. That means accessing grants and scholarships, and ensuring services understand the benefits of taking the time to complete a research study or a research degree. Roles like mine are here to support these endeavours and I am pleased to say there is fantastic organisational support at all levels. In short, mental health nurses are in a great position to be the leaders in using data and research evidence to guide our services.

 

Where do you see mental health care in Australia, and in general, in the next 20 years?

I would like to see equitable access to an open, engaging, and collaborative range of mental health services, with a strong focus on person-centred recovery from first contact, and a well-established understanding of the trauma that can be experienced by consumers and carers. Peer workers will be embedded in services alongside nurses and other mental health professionals. We will have a good understanding of outcomes that are relevant to consumers, carers, professionals and the service, based on routinely collected data. Many services are moving towards this type of care and have made huge strides, but we need to ensure we apply it universally, and to develop this approach in our partner organisations.

We will, no doubt, need expansion in funding to address growing need, but if mental health care is conducted according to these principles, and is operated efficiently with the strong coordination that nurses in particular can bring, I believe savings, alongside better and more clearly identified outcomes for consumers and carers, will be clearly demonstrated.

 

Our thanks to Dr Roche again for his time and for his continuing work in recognising the importance of and improving mental health.

Let us know if there’s someone that you would like us to chat with and you might see them on NurseClick soon!

 

 

2 Comments

  1. Dr Roche’s expectations for MH service performance in the next 20 years is spot on. My own work in MH focused on coercion minimisation in inpatient settings but I always felt like that was ‘ambulance at the bottom of the hill’ territory. If we begin with collaboration among clinicians, peer workers, and consumers, from the very first contact where service delivery is co-designed with consumers, and commit to transparent collection and sharing of outcomes measures, the likelihood that services will ever need to be coercive can truly fade into the past the same way the institutions have.

  2. Dr Roche’s vision for the next 20 years in MH services is spot on. My own work in MH had a focus on coercion minimisation but that always felt like ‘ambulance at the bottom of the cliff’ territory. When we co-design services with consumers and peer workers and commit to the transparent and shared collection of outcomes measures then coercion, as a feature of our services presently, will fade into the past the same way other inhumane treatments have disappeared.

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