Phil Barker

Myth of mental health nursing and the challenge of recovery

Although the concept of mental health nursing has grown in popularity over the past 35 years, it remains a myth. People believe that they know what it is and value it highly, but cannot describe or define it other than in vague terms. This paper briefly charts the rise of mental health nursing, emphasizing its political implications, and in particular, the drive towards an embrace of a person-centred, recovery-focused approach to care. If nurses are to realize such ambitions, they must resolve their historical association with psychiatric nursing. The concept of the mental health nurse might signal the emergence of a new vision for human services, but might also signal the need for mental health nurses to negotiate a formal separation from the traditional psychiatric family.

The Tidal Model of Mental Health Recovery and Reclamation: Application in Acute Care Settings

The development, over the last decade, of the Tidal Model of Mental Health Recovery and Reclamation is described, and a summary of the application of the various Tidal processes of care is provided. Studies of evaluations of the Tidal Model within acute care settings are summarised and the potential contribution that the model makes to the development of person-centred care, within acute settings, is discussed.

‘Veiling sexualities’: a grounded theory of mental health nurses responses to issues of sexuality

AIMnThis paper is a report of a study to develop a grounded theory explaining how mental health nurses respond to issues of sexuality in clinical practice.nnnBACKGROUNDnThe history of sexuality and people with mental health problems has largely been a history shrouded in misunderstanding, stigma, myth and negativity. However, individuals with mental health problems may experience sexuality and relationship difficulties related to their life experiences, mental illness, or its treatment.nnnMETHODSnGrounded theory was the methodology used for the study. Interviews were conducted in 2005-2006 with 27 mental health nurses working an urban area in the Republic of Ireland. Data were analysed using the concurrent processes of constant comparative analysis, data collection, theoretical sampling and memo writing.nnnFINDINGSnThe core category to emerge from the data was veiling sexualities. This refers to participants accounts of how they responded to the sexuality dimension of clients lives. Participants main concerns about sexuality were related to feelings of personal and professional vulnerability, due to a lack of competence, comfort and confidence in this area. The theory highlights the manner in which nurses perpetuate practices that marginalize, discriminate and socially exclude clients as sexual citizens.nnnCONCLUSIONnThe theory of Veiled Sexualities may facilitate acknowledgement of the presence of sexuality in all nurse-client encounters, and promote a discourse on the sexual rights of people experiencing mental distress among mental health nurses and all involved in the delivery of mental health services.

Reflections on the philosophy of caring in mental health

The trend towards definition of the role of the nurse as therapist in mental health has resulted in clarification of what some nurses might do, with some patients, to resolve fairly specific problems of living. Not all psychiatric nurses are, however, satisfied that the developments which arise from this role definition will necessarily benefit the service overall. Indeed, the concept of the nurse-as-therapist has led, indirectly, to an expression of anxiety over the balance of care versus therapy. This is manifested at a time when nurses outwith the mental health setting are describing the need for a stronger emphasis upon therapeutic factors in nursing care, especially involving psychosocial variables.

Mental health nursing and the politics of recovery: a global reflection.

The concept of recovery increasingly dominates mental health policy and practice agendas in most Western countries. However, the many, often conflicting, definitions of recovery have led to theoretical and practical confusion. More importantly, the concept clashes with some of the established assumptions of psychiatric/mental health nursing, especially the traditional notion that the person is ill and requires treatment or some other active intervention. The implications of recovery for the further development of person-centered care, especially within a globalized form of mental health nursing, are discussed with specific reference to the Tidal Model, an international midrange theory of mental health nursing.

The convenient myth of Thomas Szasz

Thomas Szaszs original critique of the concept of mental illness is almost 50 years old. Over that half century Szasz has maintained a consistent campaign against the Therapeutic State, challenging the paternalism of coercive psychiatry and defending liberty and autonomy. Despite his widespread celebrity Szasz continues to be misread and misrepresented. In this paper we review some of Szaszs key ideas, in the light of Clarkes recent critique, setting this within the context of mental health nursing and the problems in living affecting persons worldwide.

Medical expansionism: some implications for psychiatric nursing practice

The paper discusses how health care models in general have been influenced by the authors concept of medical expansionism. Emphasis is given to addressing the impact of medical theory and practice on models of psychiatric nursing. The initial section discusses the concepts of medicalisation and medical imperialism, offering general health definitions and examination of mental health problems in more detail. From this analysis a definition is presented of a medical model in psychiatry. The effects of this model of health care on the future development of nursing models in psychiatry is discussed.

Putting the service to rights

Much philosophical debate is abstract: an objective appraisal of the fundamentals of life, yet detached from ordinary experience. Although such considerations have their place, mental health practitioners require more immediate forms of enquiry. Without ‘ordinary’ examples of ‘everyday’ ethical difficulties, practitioners could be excused for assuming that ethics are a remote concept, and beyond their province. This could hardly be further from the truth. The relative ‘morality’ of everyday actions, in everyday settings, cuts across all professional boundaries. Although no common ‘code’ of conduct exists to unite such disparate forces, such an imperative is long overdue.

Change not adjustment: the ethics of psychotherapy

Where people permit professionals to exercise influence upon them, it is often assumed that no serious ethical dilemmas exist. The traditional assumption that ethical dilemmas involve only interventions capable of causing physical harm needs to be challenged. All forms of psychosocial ‘treatment’ involve the exercise of some form of influence over people who are vulnerable, if only by virtue of their problems. This psychological vulnerability suggests that the distinction between ‘treatments’ with physical outcomes, and all others should be abandoned.

In search of ethical parameters

The ethical issues raised in the preceding chapters reflect, to a great extent, the authors’ personal ethical philosophies. It is fitting, therefore, that the editors conclude with a brief exposition of their ethical philosophy. The recommendations which follow reflect our view of ‘good behaviour’ in human services. These reflect the guiding principles which serve as the ethical parameters to our work: they are appropriate to all client groups — for example, people with learning difficulties or mental handicap, young people, older people, people with mental or physical disability.