The issues we’re facing

OPINION BY JULIE LEE, QNMU RESEARCH AND POLICY OFFICER

The educational pathway to become a mental health nurse in Australia is to attain either a Diploma in Nursing (Enrolled Nurse) or a Bachelor of Nursing (Registered Nurse). There is no regulatory requirement to attain an additional graduate diploma to practice in mental health, however, employers will often prefer candidates with an additional degree in mental health.

In 2019, Australian Nursing & Midwifery Accreditation Council (ANMAC) consulted on whether there should be a discrete unit of study devoted to mental health nursing incorporated into the accreditation standards for Registered Nurses.

Despite the majority of feedback supporting its inclusion, and ANMAC recognising its importance, they “decided to highlight mental health as a key national health priority and include it in the curriculum but not specify that a discrete unit of study be devoted to the subject” (Australian Nursing & Midwifery Accreditation Council, 2019).

Therefore, while most programs in Australia include mental health content because it is one of the national health priorities, this suggests there are universities which do not include a mental health nursing unit of study at all. Some students may therefore graduate without having studied any mental health coursework in-depth or completed a single mental health clinical placement.

Inconsistency in mental health educational requirements

There is no guidance to education providers about the level and extent of mental health content required in the undergraduate nursing degree curriculum. Mental health content is generally set by the individual institutions and may be dependent on staff resourcing, perceived demand for mental health content, and the availability of mental health clinical placements for students. Typically, there is only one unit/subject on mental health nursing during the entire undergraduate nursing degree and a single mental health clinical placement. Mental health content is generally not incorporated into other units.

A literature search by Currie, et al. (2019) noted “significant variation in the number of theoretical tuition hours devoted to mental health and the number of clinical placement hours.” The issue of shorter mental health clinical placements compared to placements for other subjects was echoed in the Federal Department of Health’s report Educating the Nurse of the Future: Report of the Independent Review into Nursing Education (Schwartz, 2019).

Insufficient preparation to enter the MH workforce

Commentators have suggested that the comprehensive system does not adequately prepare undergraduate students with the skills, knowledge and competence for mental health practice (Happell, et al., 2020). The quality of mental health training is generally considered to be of poorer quality, as it may be taught by someone with limited experience in mental health nursing, or there is not enough time to cover the topic in sufficient detail.

The majority of content in the degree is not geared towards mental health nursing, as educational programs tend to emphasise acute care content instead (Currie, et al., 2019). Mental health nursing is instead seen as a specialty rather than a core component of overall nursing (Schwartz, 2019).

This creates and perpetuates a system where nurses must acquire additional skills through education to maintain excellence in the mental health nursing workforce, rather than being already equipped with work-ready skills (Hemingway, et al., 2016).

Inconsistency in mental health nursing content

The ANMAC Registered Nurse accreditation standards merely require that the course curriculum contains “content related to mental health.” This provision leaves it to education providers to decide what content to include and is described as being merely “perfunctory” (Schwartz, 2019). Further, in literature about mental health nursing education, there is no clear articulation of exactly what mental health skills are required for students to acquire (Currie, et al., 2019).

This is problematic as there is no uniformity about what nursing graduates know about mental health nursing and what they are able to do upon initial registration as a nurse. Recent graduates from courses with limited mental health content are at a distinct disadvantage if they desire to pursue a career in mental health nursing.

As ENs also encounter patients with mental health issues, the EN accreditation standards should also require instruction in mental health. A study into a transition program for ENs in a forensic mental health hospital may affect their perception and attitudes towards mental health nursing and mental health in general. Negative attitudes among students and educators towards people with mental illness perpetuates stigma towards mental health nursing. This can discourage students from pursuing mental health nursing as a specialisation (Happell, et al., 2020).

In a comprehensive program, the majority of students would not be interested in pursuing mental health nursing, and therefore those who do wish to become mental health nurses have fewer networking opportunities and support while studying.

Implications for the mental health nursing workforce

Mental health nurses are the largest occupational group within the mental health workforce. There are about 24,000 mental health nurses working across Australia, of which 4800 are employed in Queensland (Australian Institute of Health and Welfare, 2023). Mental health nurses also make up the bulk of hospital-based mental health care and prison mental health services.

Across Australia, only 7% of nurses work in a mental health setting (Australian Institute of Health & Welfare, 2016). Workforce trends and projections suggests the current state and predicted growth of the mental health nursing workforce is insufficient to meet population needs now and for the future. There is projected to be an undersupply of 18,500 mental health nurses by 2030 based on data from 2014 (Health Workforce Australia, 2014). After factoring in current and future demand arising from global changes, population movement and the pandemic, the true deficit figure is likely to be much higher.

As described by some QNMU members, the integration of mental health nursing into a comprehensive degree designates it as merely a subject or unit to be taught, rather than acknowledging the range of specialist skills and different approach to patient care required, which some believe is eroding the mental health nurse identity. This perceived loss of identity has further led to the “perception that the mental health sector was not a great place to work – a perception that is still held by some” (Larouche, 2022).

This is echoed in studies showing that undergraduate nursing students routinely rank mental health nursing as one of the least preferred career options, a trend that has been largely unchanged in 50 years (Happell & Gaskin, 2012). More concerning, however, is that the change to comprehensive nursing education has apparently coincided with a decrease in the number of students motivated to undertake mental health nursing as a career choice (Hemingway, et al., 2016),

Mental health education must become a national priority

Given the mainstreaming of mental health services into the general healthcare system, non-mental health nurses come into contact with people with a mental illness much more frequently, meaning that a basic knowledge of mental illness and its associated care and treatment is fundamental for all nurses.

Therefore, ANMAC must set guidelines on minimum mental health nursing education requirements for all providers of nursing education, general nursing or mental health nursing. Reform to current educational programs, and development of future programs, ought not be bound by shortcomings of the past.

As it stands, many of the concerns towards nursing education could be managed by reforming the way mental health content is taught (for example, mandatory mental health units, guidelines on depth of mental health content, and mental health clinical placement requisite hours), and addressing the ongoing stigma towards mental health and mental health nursing within the nursing profession and in the wider community.

References

Australian Institute of Health & Welfare, 2016. Mental health nursing workforce 2016, Canberra: Australian Institute of Health & Welfare.

Australian Institute of Health and Welfare. (2023). Mental health: Workforce. Canberra: Commonwealth of Australia. Retrieved from https://www.aihw. gov.au/mental-health/topic-areas/ workforce

Australian Nursing & Midwifery Accreditation Council, 2019. Registered Nurse Accreditation Standards 2019, Canberra: ANMAC. Currie, J. et al., 2019. Topic 3: Clinical skill development, s.l.: Centre for Health Service Development.

Happell, B. et al., 2020. Mental health nursing education in undergraduate and postgraduate programs: Time for change. Australian Nursing & Midwifery Journal, 26(9), pp. 42-43. Happell, B. & Gaskin, C. . J., 2012. The attitudes of undergraduate nursing students towards mental health nursing: a systematic review. Journal of Clinical Nursing, Volume 22, p. 148–158.

Health Workforce Australia. (2014). Australia’s Future Health Workforce – Nurses Overview Report. Canberra: Commonwealth of Australia. Retrieved from https:// www.health.gov.au/sites/default/ files/documents/2021/03/ nurses-australia-s-future-healthworkforce-reports-overview-report. pdf

Hemingway, S., Clifton, A. & Edward, K.L., 2016. The future of mental health nursing. Journal of Psychiatric and Mental Health Nursing, Volume 23, p. 331–337.

Larouche, E., 2022. Attracting and retaining mental health nurses must start with early exposure to sector pathways, says UC Professor. [Online] Available at: https://www. canberra.edu.au/about-uc/media/ newsroom/2022/june/attractingand-retaining-mental-healthnurses-must-start-with-earlyexposure-to-sector-pathways,says-uc-professor

Masso, M. et al., 2019. Topic 1: Fit for purpose / work ready / transition to practice, s.l.: Centre for Health Service Development.

Schwartz, S., 2019. Educating the Nurse of the Future: Report of the Independent Review into Nursing Education, Canberra: Commonwealth of Australia.