Posted July 25, 2023
In today’s episode, we will be tackling the question of whether mental health nursing students are being given adequate preparation and training in mental health.
In this insightful discussion, I talk with Dan Warrender about the challenges and concerns surrounding mental health nurse education.
He highlights the impact of the Nursing and Midwifery Council‘s future nurse standards, emphasizing the lack of protection and inadequate focus on mental health nursing.
The conversation serves as a rallying call for increased support, advocacy, and collaboration to enhance mental health care and ensure a more specialized and empathetic nursing workforce.
KEY TAKEAWAYS FROM THIS EPISODE
Dan Warrender is a mental health nurse, lecturer, and mentalisation-based treatment practitioner, and is currently undertaking a Ph.D. exploring experiences of crisis intervention for people diagnosed with ‘borderline personality disorder’.
He is a member of the executive group for the Scottish Personality Disorder Network and has contributed to best practice statements locally and nationally. Topics of his writing, speaking, and interest include ‘personality disorder’, the limitations of psychiatric diagnosis, trauma-informed care, ethics, risk, and the identity and education of mental health nurses.
Further to an MA in Philosophy and a working background in learning difficulties, Dan qualified as a mental health nurse from Robert Gordon University in September 2011, and chose to work in acute mental health. Gaining a place on the Early Clinical Career Fellowship (ECCF) 2012, he completed an MSc Nursing, undertaking primary research and disseminating this nationally and internationally. He is currently undertaking a PhD exploring peoples experiences of crisis intervention for people with a diagnosis of ‘borderline personality disorder’.
As well as his teaching and research interests, Dan is a registered Mentalization Based Therapist with the British Psychoanalytic Council and continues to practice this within the NHS, as well as providing clinical supervision for mental health staff. He has also been involved with strategic groups regarding the care of people diagnosed with ‘personality disorders’, and is an active member of the Scottish Personality Disorders Network Executive Group. Dan has been critical of the lack of autonomy for the ideological direction of mental health nursing within the nursing profession, speaking at the Royal College of Nursing congress 2022, and being selected as the keynote speaker for Mental Health Nurse Academics UK 2022, presenting “Ghost or phoenix: the disappearance or rise of mental health nursing”.
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Nathan Illman 00:00
Welcome to Nurse Wellbeing Mission Podcast everybody. Thank you so much for coming back if this is your second or third or even fourth time listening to the podcast and welcome if you are a new listener. So in today’s episode, we are going to be tackling the question of whether mental health nurses are being given adequate preparation and training in mental health. So for all of us to feel a sense of competence and satisfaction and meaning from our jobs, we need to feel confident in the skills that we have to perform that role. So it’s really important that we’re given the proper preparation, training, and support for the kinds of jobs that we find ourselves in. My guest today argues that Mental Health Nurses in the UK, and elsewhere, but the focus is on the UK today, are not being given enough specialist training in what actually is a specialist discipline or field of nursing. My guest Dan Warrender, who is at the forefront of a movement called Mental Health Deserves Better, is going to be talking to us all about the arguments in favour of the case that mental health nursing should have more of a focus on mental health, to be put simply. He talks to us about why this is crucial, not just for student well-being, but for workforce-related issues and the effect that this has on members of the public, service users, and consumers of mental health services if we’re not sending out adequately qualified mental health nurses into that workforce. So a quick bit of housekeeping before our conversation. If you don’t already know me, my name is Nathan. I’m a clinical psychologist and I founded Nurse Wellbeing Mission. I provide a range of wellbeing-related services for organisations. I’m super excited to announce my full-day workshop on compassion-based approaches for moral distress. This is a full-day workshop that is all about helping nurses and midwives understand the sources of moral distress, how to address moral distress with a self-compassion and self-forgiveness framework, and to help nurse and midwife leaders understand the organisational factors that are contributing to moral distress, helping people think about ways to overcome those. Details of that are on my website, www.nursewellbeingmission.com. Check it out, I’m super excited by it. So without further ado. I bring you this fascinating and very important conversation with Dan Warrender. Thank you so much for joining me on the podcast. I would love if we could just start by you just telling us a little bit about yourself and I would love to hear a bit more about why you got into mental health nursing in the first place.
Dan Warrender 03:02
It’s always a big question. You’re not really sure where to start and I’m not sure how much of it was Carefully thought through or just a series of kind of accidents, but, um, I mean, I guess in terms of the kind of person I am, I’ve always been a very thoughtful, curious person. I can remember having a thought, or, you know, I mean, you only remember what you remember of the memory, you know what I mean, but I remember being young and being like five and looking around me and thinking like, what if everyone else was robots? And just that skin on top that looks like humans. How would I really know? So that’s the kind of kid I was. It’s the kind of human being I was. I was always that curious, really wondering what was going on, beneath the surface. That led me later on to a degree in philosophy later on in life, and I think that at the time, even though I maybe didn’t engage with that as much as I could have, you know what I mean, being, being quite young, I think at 18, 19 when I finished that, I think that really set the tone for the rest of my life, to be honest, you know what I mean, finishing that and being around about age 19. After I finished that degree, I went and I did some voluntary work in Luton and Indonesia. So it was a voluntary services overseas program. It was the first time that I’d really been working with people, in a kind of caring capacity, ended up working with people with, sort of learning disabilities here and there, and We did some interesting stuff in Indonesia, like, kind of helping out, orphanages and just like some really interesting projects really brought me in contact with communities and human beings in a way that I’d not really done before. It really got a lot of value from it, and a lot of personal satisfaction and meaning from it felt like I was doing something useful with my life. So when I came back from that. Um, I saw a job as a support worker and ended up working with people with learning difficulties, learning disabilities for about four years in a housing support and community support capacity. And it was at the stage where I was thinking, what am I going to do? I think I was early in the twenties by that point. And my mom’s actually a nurse. And she’d said to me, have you ever thought about mental health nursing? And I was like, no. Give it a punt. It really wasn’t anything more than that in terms of I’m really interested in mental health. I’ve always been that kind of curious character interested in mental health, human experiences. but it was as simple as that. I think that the support work that I was doing, I loved it. I think it still might be one of my favorite jobs I’ve ever had. But in terms of maybe just being able to expand your horizons up a little bit, you know, I mean, go into different roles. I sort of went into mental health nursing and when I went into that, I really found it’s almost like, where has this been all my life? You know what I mean? In terms of, I think this is really interesting and I think I could do a reasonable job here as well. So, that was probably the journey that kind of brought me into it. I mean, I think that. I could always empathize with people with mental health problems as well, probably given just my own experience of being quite introverted at times, quite existential, and certainly having those moments where, I’ve used this phrase before, but I can’t really think of another way to describe it, where you’re really hanging on a thin thread. And whether that’s on the cusp of potentially sort of falling into some kind of psychosis or something, you just feel that you’re so on edge that something is going to potentially kind of tip you over and that’s going to be a very, very scary place to be. So I really understood that to the, well I understood my experience of it and I cared about it and I thought that I would be something meaningful to do in my life if I could help people that were in situations that might be a bit like that for them.
Nathan Illman 06:50
And the transition to academia then obviously happened a little bit later. So just talk a little bit about why that occurred and some of the reasons around that.
Dan Warrender 06:59
So an interesting one in that it was quite quick. It was really quick for me and it’s something I’ve taken stick from, from somebody on Twitter once. So I think that I was three years in practice. Um, and then I ended up getting an academic post, and I think in my defense, I simply took the best job that was available at the time, um, I was working in an acute mental health board, um, I, I was always interested in doing more, and that’s not to belittle the nursing role and being a nurse I think is an incredibly challenging role. But I was always interested in further study, really, really curious about even sort of trying teaching. I liked sharing learning. I liked having student nurses. So I got an opportunity to apply for a scholarship and the Scottish government at the time were running this early clinical career fellowship. So a year qualified, I essentially managed to get very luckily a funded Masters kind of program that put you through a Master’s. There was action learning sets essentially, like clinical supervision with other health professionals, a few midwives, a few adult nurses on that as well. So it gave me an opportunity to do further study and to actually do a bit of primary research. I did focus groups on mental health nurses’ experiences of using mentalization approaches in acute inpatient wards. So I was almost dipping in academia while still working clinically. And there was a couple of times that I’d had opportunities or offerings that I could potentially get a secondment to psychotherapy. I was always really interested in doing that. Um, I remember my boss at the time was like, no, we just don’t do secondments. Um, so there was a sense of feeling actually probably quite trapped. Um, and I didn’t want to leave nursing at all, and I still don’t think I’ve left nursing and going to academia. I think I’m just doing something different. But this job came up at the university, and I think that there was a sense of being able to do something. meaningful in terms of sort of trying to educate the next generation. And there was definitely a bit of imposter syndrome, you know, I mean, with my mighty three years experience, I will kind of change the world. I will shape you in the way that you need to be shaped to do a good job. I think that I mean, again, some of the frustrations with the way these systems don’t really necessarily fit together is that I remember in my interview for the university that somebody had said, What do you want to do in terms of, I think there was two posts. You could have had a part-time post and I could have stayed in practice, or I could have had a full-time post. And my preference was to stay part-time in the NHS and be part-time at university because I didn’t want to leave clinical practice so soon. But when I did float that idea with my manager at the time, he simply said, it’s just easier if you leave. And the idea being that it was easier to fill a full-time post. So for a pragmatic perspective, didn’t take that personally, understood. But that’s what essentially pushed me in academia really, really quickly. It was a job where I certainly felt welcomed. I think it was going to give me the opportunity to come in contact with student nurses and try and teach them the stuff that I kind of wish that I knew when I qualified. I remember hitting the boards and being like, there’s so much, I don’t know what I feel underprepared for this. And maybe there’s a chance to change that. Unfortunately, your power is limited in almost any system that you go into. And I think that’s kind of…
Nathan Illman 10:33
So something that I think is worth clarifying here is the difference between mental health nursing and general nursing, right? And that’s going to be quite important for us as, for where we’re going to go with this conversation a little bit later. So you chose to go into mental health nursing. Your mum was a nurse. Just in general adult nursing, I presume.
Dan Warrender 10:53
She was, my mum was dual-trained, so she was a general nurse and she did mental health training as well.
Nathan Illman 10:59
Dan Warrender 11:00
Nathan Illman 11:01
So tell us about the difference. What is mental health nursing?
Dan Warrender: 11:05
I guess to clarify something quickly because somebody got on at me for it on Twitter is that general nursing doesn’t exist anymore. Now it’s adult nursing and mental health nursing and children’s nursing. But I think some people still use the term and some people would have been trained in that with that label years ago. I mean, I think that what makes mental health nursing different. And I guess to really emphasize my own individual perspective, which I know is shared by many, is that I would not have been as interested in nursing without the mental health nursing. But, you know, I mean, it’s the mental health that attracts me to it. That’s what I’m curious about. And that’s where I think I’ve got something to offer as well, you know, I mean, that’s what I really think that my personality, my character as a human being. I think it’s the mental health that I can offer something to. I think, and I want to be careful when I say this because I don’t want to, you know what I mean, drive a wedge between sort of mental health nursing and adult nursing and children’s nursing, learned disabilities nursing because I think that all fields of nursing really should be specializing and should have something very unique to offer the population that they serve. But that said, I think that mental health nursing has layers of complexity that a lot of other fields don’t have. I think that I would probably say that learning disability nursing is closest to us in terms of some of the complexities that they have. But I think one of the first things is the degree of uncertainty that you’ve got to work with. Now, and certainly not saying that anyone that presents with a physical health problem, it’s immediately kind of, Oh, we know exactly what this is. You know what I mean? There’s, it’s really complicated. Absolutely. But with mental health, mental health is the kind of thing that, you know what I mean? Influences on your mental health can come from the outside and come from the inside. So I could literally sit in a room by myself and think about stuff. and become upset and become distressed. So the influences on what creates a mental health problem are almost, it’s like almost infinite in terms of the kind of the pathways, these different directions, these things that can interact. And that goes the same for like a person’s recovery in terms of what is going to help. It’s not always going to be that, that same thing. So I think it’s actually quite a massive human experience. That we’re essentially trying to help people understand and there’s a few things that like I’ll try and mention colleagues’ work if it pops in my head, but the Chris Connell et al paper on nursing identity talks about connecting with people when they feel disconnected. So it could be like me and you connecting just now, but we’re both feeling reasonably okay, we’re able to kind of have this conversation, but people with mental health problems and however we describe that mental illness, mental distress, again, some of the other reasons is that the debate and complication and controversy around language isn’t the same in physical health. But, connecting with people that are disconnected is different. It takes much more effort, much more thought, and much more interpersonal skill than it does in other respects. So I think those are a few things. The ethics around the use of power. is enormous. So we work within the Mental Health Act. And if I was a mental health nurse and you were my patient, Nathan, then I would potentially have the power to use nurses holding power. If we were in a ward and I would say, no, you can’t leave. I don’t believe you’re, you’re well enough. And I would get a kind of a medical practitioner or a psychiatrist to come and review you and that could remove your human rights. So there’s an enormous. Elephant in the room in the relationship in that I’ve got this power and I can use it and will we quote the great philosopher Uncle Ben from Spider-Man that said, with great power comes great responsibility. Yeah. So there’s huge things that I think are just kind of not thought about. Significantly enough in terms of how does this make relationships different, because I think that some of the arguments around probably the increasing genericism of nurse education is around, um, well, relationships are important for all nurses, and they are. I absolutely 100% agree with that, really think that actually good nursing, the underpinnings of it is good relational practice. But the context in which we have these relationships is a context where there’s a lot of mess around power. There’s a lot of mess around personal meaning. I mean, I think we even work within a diagnostic system where People might get diagnosed with things like a personality disorder, for example, and then they think that, oh, right, so my personality is disordered. So, and then certainly I’ve worked with people clinically where their perspective after getting that diagnosis is that there’s something wrong with them as a human being. So the diagnostic system might work to a degree if it’s like you get this diagnosis, then you get this treatment, which is how it’s supposed to work. But we might have to actually work with the aftermath of that in terms of what does it mean for you to have this diagnosis and how do you see yourself and how do you understand yourself now? And I don’t think that’s the same with most kind of physical health conditions. There’s not that same self-stigma or hopelessness that comes with it. You know what I mean? You think you get diagnosed with cancer and there’s normally sympathy that you’re met with. You know what I mean? And, and kind of people really care about that. If people are diagnosed with schizophrenia, there’s often a sense of. fear, misunderstanding, hopelessness, and stuff that can come with that. So it’s not just actually working with mental health, it’s actually with the system that we’ve built around that, being so messy and complicated, we almost need an extra degree of critical thinking.
Nathan Illman 17:07
We’ll get into how some of that fundamental training around that relational aspect and understanding of mental health is. You’re actually missing, you know, so I think it’d be really helpful to actually start thinking about student wellbeing. So you’re working with students, you got into this, you know, you had your own experiences, you, you, you know, you did your training and stuff and you obviously departed from that with a desire to help these students. So what are some of the unique challenges in terms of student wellbeing that you see around mental health nursing?
Dan Warrender 17:42
I think someone that is interested, I mean, I guess I shared my experience of, you know, I mean, having some mental health experiences on my own that led me to have an interest in mental health. And I think that’s true for a lot of our students as well. And certainly, there is danger. And I guess I want to be very clear, you know what I mean? That I wouldn’t be saying that anyone with mental health problems couldn’t be a mental health nurse. You know what I mean? I want to be very, very clear. I think that actually can be an asset at times. Um, but I think that people are potentially, coming on a course. And sometimes that stuff might be well processed and well understood, and people feel that they have, I guess, got a reasonable foundation that they’ve built on top of that, that they can kind of, they can kind of move forward with it. I think that sometimes people don’t potentially have that stuff processed and there might be ongoing issues that people are carrying as they come into nursing education. And then they might be much more susceptible to potential triggers for them. You know what I mean? I think working in mental health, You will see it all, you know, I mean, you will see things that will move you, you will see things that will, you will laugh with people, you will cry with people, you will feel very conflicted about some of the ethics of people being potentially restrained, people being medicated against their will. This is the system that we work in. So it’s not like, We’re just going in and I think this is maybe my misguided kind of idea of mental health nursing that I would just be talking to people, I would just be going in and just be talking to people about their, their thoughts and feelings, but there’s much more kind of complexity around that. So I think that first thing needs to be taken into account. Why is somebody went into mental health nursing? And what might they be carrying with them? And is that processed or is it not processed or whatever? That’s definitely a factor that we need to think about. I think some of the other things are the pressures on them. They’re continually being assessed, you know what I mean? So I think that’s something that’s difficult for anyone in any university degree. But I think particularly when you’ve got a lot of placement learning, there is this sense of literally being in a working environment, but the people around you have got power over you in terms of saying it’s passed or fail at the end. And I guess the self-esteem that can come with that, and I’ve been guilty of this in the past, where the meaning that we give to that is like, if I fail, I am a failure, you know, I mean, you really internalize that. Um, so there’s a lot of complexities on that. I think one of the unique things for mental health nursing as well with the current state of mental health nurse education is, the practice education document that across the United Kingdom has been shaped in a way that probably suits adult nursing more than other fields of nursing, but they’re still under enormous pressure to tick all the boxes to sign off all these skills, whether it’s blood transfusions, catheterization, manual evacuation, I’ve got a massive list of skills and a lot of them that are just not done in mental health environments because That’s not really the reason that people are in those environments. So I think people can feel an enormous amount of stress to perform in these environments. And actually, it can actually distract from their placement experience because they’re so focused on ticking all the boxes so that they can pass. And you understand that you know what I mean? There’s a. pragmatism that’s involved in getting through the course as well. When I think about students, you know, I mean, I really, I really enjoy working with students. And one of the things that has always made me feel a little bit sad or concerned for them is that I don’t think that we get nearly enough time with them in academia. If you think about the split between placement and academia, it’s supposed to be 50-50, but within academic modules, you’ll have time for directed study, you know what I mean, you’ll have time for assessments, time for this, time for that. So the actual contact, you know what I mean, the actual in-the-room contact is much less, but at least within the room, within reason, you have a degree of control in terms of their experience. Now, once students go out in placement, I know that as an academic, and you know, I mean, I’ll act as a personal tutor, you know what I mean, so I sort of look after pastoral care of 20 to 30 students at a time and stuff as well. And there’s this sense of, I have no idea what they’re going into and I have no idea how well supported they’re going to be. Um, and I’ve written some stuff around, the theory-practice gap in mental health nursing, but I think it’s true in nursing as well. We know that a lot of these environments are on their knees. You know what I mean? People are incredibly burnt out. I mean, it’s probably led you to do what you’re doing is recognizing that. So students are going at environments and there’s no guarantee that one, they’re going to be getting taught, you know, I mean, because that’s the idea is that they get taught by people in practice as well, although I think a lot of the kind of responsibility is sorry keeps getting thrown back at university, why don’t they know this and there’s like well. You know, you can teach them stuff as well. So you don’t know if they’re learning, but you don’t know if they’re getting supported as well. Sometimes they’re just thrown into very busy environments, but sadly as well, I think with the pressure to find placements, because the NMC have an enormous amount of clinical hours, like the most in the world, 2, 300 hours, um, no real evidence base for it as far as I can see. So there’s enormous amount of pressure on finding placements so students can end up in placements where they’re not actually really quality learning environments or they’re not learning that much or they’re actually feeling bored and understimulated and this is, I guess I have to be clear about this, this is sort of reports that I’ve heard across the United Kingdom, you know, I mean this is not a, certainly not a local issue to me, this is across the board, um, so there’s a lot of systemic issues that are not supportive of student wellbeing from the start, I would say. And I think within academia, sometimes the more generic a course is, then the less consistency you’ll get in terms of your relationships. So I can remember a few years ago, I would teach a class quite a lot. So I would get the same class and I would see them, I would see them quite a lot, maybe one module per year, but I would build up a relationship with them. With us. In big sort of generic courses where there’s core learning, where all students of all fields are doing the same. It can end up feeling like a factory. It’s like a conveyor belt. It’s just like next, next, next. And then actually when you see students, you know, they’re just grateful. They say, Oh, hi, I’ve met you before. That’s lovely. And it’s horrible for me. And it’s horrible for students as well to not have that consistent relationship building up.
Nathan Illman 24:32
Yeah. I mean, it’s so interesting. You’re right in terms of why I went into this work and with this mission. But I’m really interested in preventative mental health, right? And that’s what we’re talking about here, isn’t it? It’s, you know, obviously we’ve both been trained to work doing therapeutic stuff and to go in and kind of almost fight fires a bit when issues have happened. But actually, we need to take a hard look at these systemic issues. from the outset that are not setting people up for success in their education and in their jobs. If people have a diluted learning, they’re not getting adequate technical skills, or like you say, like developing relationships that are going to support them, that are going to lead them to have a sense of self-efficacy, confidence in themselves, which obviously contributes to people’s well being. Um, so just tell us a little bit more then about Some of what you’ve actually seen or heard from people and, where you see things going so the downstream effects of this dilution of mental health nursing curricula. What are some of your fears and what are you doing about it?
Dan Warrender 25:40
Yeah, so there’s a lot in there that I guess. A little bit of context for anyone that’s maybe never heard of these, these arguments before. So I think that the Nursing Laboratory Council in 2018 introduced future nurse standards, which kind of had to, meant that nurse education programs had to change to meet these standards. These were influenced by the Willis Report in 2015, The Shape of Caring, and some of the fundamental underpinnings of that were that mental health nurses didn’t learn enough about physical health and adult nurses didn’t learn enough about mental health. So there was a sense of kind of, we want a parity of esteem in education. I think it’s important to point out that like within the future in our standards, the nurse and midwifery council, um, have given Probably from my perspective, too much autonomy to universities because there has ended up with a postcode lottery. And I think that’s important for any student listening, your course is not going to be the same as another university’s course, even if it’s like 30 miles away, it’s going to be different. It might be reasonably similar in some ways, but with universities essentially given license to shape things in their own way, there has ended up with an enormous amount of variation. And I think for a variety of reasons, I think that future nurse standards, from my perspective, they don’t protect mental health nursing in terms that they don’t assert that this needs to be in for mental health nursing. They don’t assert that this is the key content that mental health nurses need. So some universities have managed to interpret it in a way that has really protected mental health nurse education. some have managed to interpret in a way that means that there is a lot of shared learning. So a lot of nurses from all fields doing exactly the same modules, exactly the same study, little contextualization to their field. And I think that the potential implications of this, I guess the practice education document, important to get that in as well, is that’s the same for all fields of practice. So even though people are training to be an adult nurse, training to be a mental health nurse, they’re ticking off the same skills in their practice environments. And for me, it’s a different role that they’re going into. But I think that some of the wellbeing implications for students are going into environments where, like I said, I think that within mental health, within anything that is fundamentally a relational practice, you know, I mean, that’s what we do. We use ourselves in terms of relationships, we work in a wider system, there is use of medication and stuff, but that’s fundamentally the kind of the role of psychiatry. So if we have to work relationally, then. What we need is a fundamental self-awareness of who we are as people. And it’s like you’re talking about in the terms of the preventative stuff. It’s that whole, you put on your own oxygen mask before you put on that of the person sitting next to you. You need to really know yourself and that takes time. So I think that needs to be the fundamental underpinning of what we do. And then we need to train people in terms of therapeutic skills. And that needs to be properly done. It can’t be tokenistic. And I think there’s… There’s the danger in, and I think it’s not just true of nurse education or education, I think it’s true of the world that we can fall into this tick box bit where we can say, you know, I mean, we’ve done therapeutic relationships. Like it was, it was on a, it was on a PowerPoint slide. There was three points that we’ve done it. Um, but I think what’s missing, it’s that sense of being able to sit with uncertainty, being able to sit in silence with someone being able to say, I don’t know. It’s a really difficult thing for someone to say when they’re just being trained as a professional, because there’s this illusion of, as a professional, you need to have the answers, you know what I mean? I don’t know, you know what I mean? Because it means that we don’t fall into this sort of false certainty where we go down the wrong path, you know what I mean, based on the wrong assumptions. We try and keep curious and we try and keep open all the time as well. And I think we need to be able to be in a place where. We can really think critically about the ethics of what we’ve done, and that’s a real, really complicated thing. I mean, some of my experiences of working in an inpatient ward were quite harrowing, but they must have been much more harrowing for the people that were patients there. And some of these things, particularly people being escorted into the hospital against their will, detained under the Mental Health Act, You know, I mean, people restrained and medicated on the ward against their will. These things, I guess I want to be clear, were justified in terms of improving a person’s mental health or justified in terms of risk at the time. But I think that sometimes these environments actually can exacerbate these issues, you know, I mean, actually, sometimes if people are distressed, it’s because of the power in the environment, it’s not necessarily just the mental health problem, and the ethics of that means that if we’re being true philosophers, and I think there’s definitely an element of philosophy that we need within mental health nursing, is that we have to be able to look at these situations critically and say, I guess, look at a, look at ethics from a consequentialist perspective in terms of, Were the consequences ethical based? We might have done a bad thing. I think it’s always a bad thing to restrain people, to remove people’s human rights. Always a bad thing. But are the consequences moral? You know what I mean? Is there, can we sort of see the ethics in that? And I think that we have to be able to see that we get it wrong sometimes. We have to be able to do that. I’ve certainly been part of things that have been justified at the time, but then you think the outcomes of this. Where actually we just maybe traumatized this person a bit more and actually there wasn’t a net benefit at the end of it. There wasn’t this amazing outcome that we would have predicted. Sometimes there is, sometimes people are grateful. I wasn’t myself. I might have done something I might have regretted. I’m really actually grateful for that, but that’s absolutely not guaranteed. And I think something that we’re not good at within mental health nursing is. within sort of teams saying, you know what, we messed that up. We potentially did more harm than good there. So I think too, can I go back to your question, like what implications are there for wellbeing for people is that if they’re not prepared for this and they go into this incredibly uncertain, unpredictable environment where there’s no clear kind of etiology or cause of mental health problems, there’s no one thing. There’s no clear answer in terms of what’s going to support a person’s recovery and I mean what works for somebody might actually be damaging to another person, it can end up being, you can feel an absolute sense of helplessness, and I mean I think that can, I know that some of my experiences of not feeling prepared had an impact on my self-esteem, you know what I mean? I was feeling like I’m, I think I’m a crap nurse, you know what I mean? I’m, I’m trying to connect with this person and I don’t know what to say. I don’t know what to do. I think I might be making things worse. And, and you don’t feel good about yourself. When I was thinking about an analogy, actually, because like I am terrible with anything sort of DIY or practical or anything like that. And my wife got a flat tire a couple of weeks ago. I’m just totally useless. totally useless. And, we, like, I went to swap cars with her, she had to go somewhere else, but we phoned her dad so he could come and do it. And I was just sort of standing behind him, essentially watching him do it, trying to kind of pick up, how do I change a tire? And like actually feeling a sense of shame in a way in terms of, Christ, I should really be able to change a tire. And you know, I mean, I can’t help out my wife in the way that I would want to. And I think that maybe that’s a silly example, but I think in the same way, I mean, you’re a human being, you go into the job because you really want to be able to help people. And if you’re not prepared well enough for that, you’re potentially going to feel really crap about it. And, um, I think that definitely in the mix in terms of, in terms of burnout, but then sometimes in terms of why people might become a bit kind of hardened or desensitized or potentially that compassion fatigue, you know, I mean, actually losing empathy for people as well. There is that, I think I’ve used that phrase before that sometimes what we end up is with traumatized people looking after traumatized people and that is a mess for everyone.
Nathan Illman 34:21
Yes, yeah, I think that’s one of my concerns about all this as well, is that, as you mentioned earlier in this conversation, there is a higher rate of previous mental ill health in nursing in general. There’s some research, you know, there’s a good paper, I think a few years ago, that looked at the number of adverse childhood experiences in, this was in adult nursing, I don’t think it was even in mental health nursing, but certainly from experience. People who go into mental health, you know, there’s that term, the wounded healer, people have their own experience, you know, myself included, you know, I have previous experiences that kind of led me to want to work in mental health, but then if people aren’t given this opportunity, like you say, to understand themselves, to reflect on things, reflect on some of these really difficult ethical, moral issues, and then be working with people who, very, very challenging environments, and issues you’ve got to work with, then, yeah, yeah. People might already be carrying a deep sense of shame from previous experiences and then there’s going to be all these, these triggering things. It’s, it really is, really is a tricky one, isn’t it? And the attrition is one thing, but like you say, the potential effect that that’s going to have on service users, consumers of mental health services as well. Yeah. It’s just really concerning, isn’t it?
Dan Warrender 35:42
Yeah, absolutely. I mean, I think that’s the biggest thing behind the sort of mental health deserves better movement is that we want to prepare our students as well as possible so that when they graduate they’re in the best position to support people with mental health problems. And I think it is difficult because no matter what education does, there’s still a bit of going into very difficult cultures and context, you know, I mean, that sort of what’s that phrase that strategy, no culture, the strategy for breakfast. So we can prepare people as we would as well as we can. There’s still that theory-practice gap, you know, I mean, sometimes the stuff that we teach in university is actually bashed at people when they’re on placement sometimes, you know, I mean, it’s not necessarily consolidated. Yeah. So I think there is a lot of mess around that, but education definitely is in the mix and it definitely has a responsibility. And when you think about, you know, there was a horrific kind of panorama program last year about really, really poor mental health care. And you can look at that and think, right, there’s a lot in there is like cultural probably unique to that place or whatever, but education needs to take a bit of responsibility. And I think a couple of folk in that were new graduates as well, and they just fell into it. There was no sense of actually being bold, being brave, trying to stand up against it. And I know that’s really difficult, actually. And I think it’s very difficult. To be a lone person going against a herd is really, really difficult, but I think that that’s another thing that we need to prepare people for is to be able to really, really advocate for the people that you’re caring for. And sometimes that means disagreement with people that should be on your side. And I’m kind of saying side and inverted commas there because I don’t think it should be about sides. But I think that you know what I mean, we’ve got the uniforms on, you don’t, that kind of thing can lead us into this sense of like, I always stick with my team or whatever. And actually, we should always remember that we’re there for the people that we care for. So actually, some of our preparation needs to be for that discomfort of you might raise something, you might be ostracized. Again, there’s wider systemic issues around whistleblowing and stuff like that. We know that you know what I mean, people often experience negative impacts of that themselves. I mean, as well, it’s not necessarily welcomed. There’s a, there’s not really a duty of candor culture sometimes within the NHS of saying, you know what, that’s a really good point. Never noticed that. We’re sorry. Let’s change it in a sense of Hang on, you know what I mean? You’re going to make us look bad if we’re not having that.
Nathan Illman 38:26
Well, again, I mean, this is sort of an aspect of leadership, isn’t it? Being able to advocate and it’s almost self-leadership as well, right? You’re in a situation thinking about what your values are and then, um, working out what the best action is to take in a given situation. And yeah, I mean, these are, these are all things that. Absolutely fundamental to prepare people, aren’t they, for going out into the hard world of work. Yeah. So it’d be great if you could just tell us, summarize what Mental Health Deserves Better is, and where people can find out more about it, and the kind of, the aims of that movement.
Dan Warrender: 39:06
So mental health is, it’s a grassroots movement. So, um, started off in January 2022, by myself and a group of mental health nurse academics. You’re essentially frustrated at the dilution of mental health nurse education, so essentially seeing less mental health-focused education for mental health nurses. And every time I say that, it sounds very absurd and that’s, that’s the place that we’re coming from. You know what I mean? People are getting educated for a specialist role to work in specialist environments, skillset. So the group has been going for, I mean, since January 2022, and the idea is to connect with one another. We’ve done bits of academic writing, we’ve developed a manifesto and some aims, and the idea is to continually campaign through lobbying key stakeholders, through trying to engage with the Nurse and Midwifery Council. Essentially to try and draw attention to this, you know, and part of the reason that I’m here is to sort of plug this and like let people know about this because I think it’s an absolute scandal, to be honest, but we’re really keen on anyone that’s interested in this like anyone that cares about mental health and anyone that’s listening that thinks that, hang on, mental health nurses not getting enough mental health training, that sounds a bit stupid and wants to support that in any way that they can. Would really encourage them to get in touch. And in terms of getting in touch, there’s a dedicated email address, which is email@example.com can be added to a mailing list. You can follow us on Twitter. That’s @MH_DeservesBett. B-E-T-T, because, too long for a Twitter handle, and we really, we’ve got the representation from, um, academics, from some students, from people in clinical practice. We’ve got a couple of folk with lived experience of mental health problems, got, you know, I mean, others that are just really interested in, um, the aims, of it as well. So, like, We’re really a broad church and we’re really welcoming of anyone that essentially shares this aim of kind of really think that we need to protect the specialism for mental health nursing. And I think it’s a, it’s probably There’s a bit of shifting sands in terms of what we’re doing because the landscape around this is always changing a little bit as well. I think that courses in mental health nurse education or nurse education generally, they often change on these sort of five-year cycles and we’re kind of heading up to this cycle just now. So we’re hoping that actually the stuff that we’ve done so far is going to have an impact and people are going to start to shift. In the opposite direction, but I think that we still have some of those systemic issues in the under the future nurse standards from the nursing with the council, some of these courses were still really bad in terms of mental health content. So, that system exists that still allows. some of these, these flaws to kind of perpetuate. So, so to encourage anyone to kind of, get in touch and, can get involved in any kind of, um, grassroots activism that they have time for and enthusiasm for, to be honest, and we’re very much open to ideas and. It’s really about sort of people power and trying to do what we can with the time we have and everyone’s busy. we understand that I’m busy. Um, but, we really believe in it. So that’s what’s kind of keeping us going.
Nathan Illman 42:42
I’m really inspired by and admire, your sense of purpose with this. I think it really demonstrates your commitment to the profession, the people that you work with, the students, and also service users, the people who are going to be those consumers of mental health services. So thank you for doing what you do and thanks for sharing that. And yeah, I would strongly encourage people to follow Dan and Mental Health Deserves Better. And we’ll put all the links to all that information in the show notes. So I think we’ll, we’ll leave things there for today, Dan. I just want to say thanks for coming on the podcast.
Dan Warrender 43:15
Yeah. Thanks for having me.