It was a happy day when we had to celebrate the end of year party with the Year 3 mental health nursing students. As a registered mental health nurse, nurse educator and nurse researcher, it was mixed feelings when I listened to my colleagues and I congratulated the students and spoke about how to decide on their career choices, including clinical, research, and academia. Soon, after speaking, my colleague, Queen Ng’ambi-Nyirenda, a learning disability nurse lecturer, spoke, and while she was speaking; I took off my mental health nurses’ hat as my mind delved into a branch of nursing that I have limited experience, learning disability nursing.
Over the years and in recent times the Royal College of Nursing, Learning Disability Today, All-Party Parliamentary Group, and Mencap have written extensively about the alarming rate of learning disability staff shortages and for learning disability student nurses, and mental health nursing students. While it is established that there are shortages of nurses in general and learning disability nurses, there is a more challenging issue, student nursing placements. Yes, placement opportunities for nursing students remains a huge challenge for universities, National Health Service (NHS) Trusts, and nursing students, especially in the era of Covid, lockdowns, and high infection rates in hospitals.
So the question remains, what is the reason for the shortage of nursing placements for mental health nursing students?
As a nurse researcher, I conducted a multimodal ethnographic PhD study that explored the place, people, and participation of an informal community mental health service. During the initial scoping review of mental health cafés and a literature review of four informal community mental health services, evidence showed that the World Health Organization highlighted the need for a paradigm shift from acute in-patient mental health care to community-based mental health care. This shift was based on the premise that community-based mental health care was: less stigmatising; can accelerate early intervention; was more cost effective when compared to the in-patient model; and respected the human rights of people with mental health challenges. However, the WHO mandate failed to consider how the closure or limited availability of in-patient acute mental health wards could affect the availability of nursing placements.
Sadly, that one decision created, and is still creating a lot of challenges for universities, NHS trust and mental health nursing students who need to acquire clinical skills for them to practice safely. More importantly, the shortage and inadequate of placement opportunities was worst during the lockdown when qualified nurses and student nurses worked and have continued to work in the few acute mental health wards and community mental health settings where they were/are exposed to Covid.
Do not get me wrong. I am fully aware that in-patient acute mental health hospitals are not the only setting where mental health nursing students can acquire the clinical skills to mee the NHS standards for proficiency. Indeed, there are community mental health services. But. Yes, there is a big but, because studies report the unavailability and inadequate number of statutory community mental health services.
There are other community mental health resources that I refer to as ‘informal community mental health services, such as day centres, the clubhouse, and mental health cafés, which I want to focus on. Admittedly, a quick search on Google and Google Scholar provides different descriptive names, such as informal mental health care, but there is no specific definition of what mental health cafés are. Therefore, using a collection of terms from published and unpublished studies on relevant databases and websites, and findings from my study, I developed a comprehensive definition: ‘A mental health café is an informal community mental health service that provides a space where anyone, with or without mental health challenges, can attend to eat and drink, socialise, and access free creative activities.’
Therefore, while in-patient acute-mental health hospitals and statutory community mental health services are available, there is an urgent call for more universities to raise awareness of alternative placement opportunities within informal community mental health services. Afterall, the same people who are admitted on acute wards and attend statutory community mental health services, also visit informal community mental health services. Credit must be given to universities that have already engaged in placing students within informal community mental health services, so hopefully, more mental health nursing students would have the opportunity to go on placements, rather than wait until there are clinical placement spaces on acute mental health ward and statutory community mental health services.
Certainly, more needs to be done, but credit must be given to universities such as the Institute of Health and Social Care (IHSC) at London South Bank University (that have already engaged in placing students within informal community mental health services
Josephine NwaAmaka Bardi, PhD is a registered mental health nurse, senior lecturer and the student engagement lead in the Institute of Health and Social Care at the London South Bank University.
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