Psychiatric and Mental
Health Nursing
The craft of caring 2ND EDITION
Psychiatric and Mental
Health Nursing
The craft of caring
Second
... [Show More] edition
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Psychiatric and Mental
Health Nursing
The craft of caring
Second edition
Edited by
Phil Barker PhD RN FRCN
Honorary Professor, University of Dundee, Scotland
PART OF HACHETTE LIVRE UK
First published in Great Britain in 2003 by Hodder Arnold
This second edition published in 2009 by Hodder Arnold, an imprint of Hodder Education, part of Hachette Livre UK,
338 Euston Road, London NW1 3BH
http://www.hoddereducation.com
© 2009 Edward Arnold (Publishers) Ltd
All rights reserved. Apart from any use permitted under UK copyright law, this publication may only be reproduced, stored or transmitted, in any form, or by any means with prior permission in writing of the publishers or in the case of reprographic production in accordance with the terms of licences issued by the Copyright Licensing Agency. In the United Kingdom such licences are issued by the Copyright Licensing Agency: Saffron House, 6–10 Kirby Street, London EC1N 8TS.
Hachette Livre UK’s policy is to use papers that are natural, renewable and recyclable products and made from wood grown in sustainable forests. The logging and manufacturing processes are expected to conform to the environmental regulations of the country of origin.
Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the publisher can accept any legal responsibility or liability for any errors or omissions that
may be made. In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. For these reasons the reader is strongly urged to consult the drug companies' printed instructions before administering any of the drugs recommended in this book.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record for this book is available from the Library of Congress ISBN 978 0 340 94763 0
1 2 3 4 5 6 7 8 9 10
Commissioning Editor: Naomi Wilkinson Project Editor: Clare Patterson
Production Controller: Andre Sim
Cover Designer: Laura DeGrasse
Index: Liz Granger
Artwork: Charon Tec Ltd
Cover image: ‘After the fall’ by Phil Barker (1970). Courtesy of ‘The Charlie Barker Collection (Glasgow)’.
Typeset in 9.5/12 Berling by Charon Tec Ltd., A Macmillan Company. (www.macmillansolutions.com) Printed and bound in Spain
This book is dedicated to the memory of Mike Consedine (1940–2008) – psychiatric nurse, poet and psychodrama therapist.
Mike inspired many psychiatric nurses to embrace the most powerful kind of human helping in their work. Through his pioneering work in clinical supervision, he also helped nurses know themselves better, so that their true humanity might flower. It was my privilege to count him as a friend. There was nothing ‘worth doing’ that Mike would not do himself. Such ‘living by example’ will prove his enduring legacy as a teacher. I hope that readers of this book will discover the virtue of that same lesson in their own lives.
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Contents
List of contributors xiii
Poem: The Cleansing has Begun xvi
Gary Platz
The Space I’m in xvii
Mike Consedine
Poem: Half dead xviii
Mike Consedine
Preface to the second edition xix
Phil Barker
Acknowledgements xxi
Section 1 THE NEED FOR NURSING
Preface to Section 1 Phil Barker 2
1 The nature of nursing 3
Phil Barker
2 Getting personal: being human in mental health care 12
Phil Barker and Poppy Buchanan-Barker
3 The care and confinement of the mentally ill 21
Liam Clarke
4 Evidence-based practice in mental health 30
Hugh McKenna
5 The craft of psychiatric–mental health nursing practice 37
Peter Wilkin
6 Leading developments in the craft of caring 45
Angela Simpson
7 Recovery: a personal perspective 51
Irene Whitehill
8 Recovery and reclamation: a pilgrimage in understanding who and what we are 58
Anne Helm
Section 2 ASSESSMENT IN PRACTICE
Preface to Section 2 Phil Barker 66
9 Assessment: the foundation of practice 67
Phil Barker
10 Assessment methods 75
Phil Barker
11 The craft of interviewing 85
Phil Barker
12 Developing collaborative assessment 95
Tom Keen
13 The context of family assessment 105
Evelyn Gordon and Chris Stevenson
14 The assessment of feelings, thoughts and beliefs 113
Mark Philbin
Section 3
THE STRUCTURE OF CARE
Preface to Section 3 Phil Barker
122
15
Psychiatric diagnosis
123
Phil Barker
16
Psychiatric diagnosis: living the experience
Yvonne Hayne
133
17
Nursing diagnosis
Dianne Ellis
141
18
Collaboration with patients and families
Tom Keen and Richard Lakeman
149
Section 4
SPECIFIC NEEDS FOR NURSING
Preface to Section 4 Phil Barker
164
19
The person who experiences anxiety
Eimear Muir-Cochrane
165
20
The person who experiences depression
Ian Beech
173
21
The person who is suicidal
Elaine Santa Mina and Ruth Gallop
182
22
The person who self-harms
Ruth Gallop and Tracey Tully
191
23
The person who hears disturbing voices
Cheryl Forchuk and Elsabeth Jensen
199
24
The person who experiences disturbing beliefs
Elsabeth Jensen and Cheryl Forchuk
206
25
The person with a diagnosis of schizophrenia
Tom Keen and Phil Barker
213
26
The person who appears aggressive or violent
Eimear Muir-Cochrane
230
27
The person with a diagnosis of bipolar disorder
Ian Beech
237
28
The person with a diagnosis of personality disorder
Marie Crowe and Dave Carlyle
244
29
The person who experiences mental health and substance use problems
Philip D. Cooper
252
30
The person who appears paranoid or suspicious
Denis Ryan
262
31
The person with experience of sexual abuse
Mike Smith
269
32
The person with an eating disorder
Rachel A. Keaschuk and Amanda S. Newton
278
33
The person who is homeless
Paul Veitch
286
34
The person with dementia
Trevor Adams
293
35
The person with a diagnosis of autism
Andrew Cashin
303
Section 5
SOME MODELS OF THERAPEUTIC PRACTICE
Preface to Section 5 Phil Barker
312
36
Developing therapeutic one-to-one relationships
Bill Reynolds
313
37
Developing empathy
Bill Reynolds
321
38
Groupwork with children and adolescents
Sue Croom
330
39
Psychodynamic approaches with individuals
Brendan Murphy
338
40
Psychodynamic approaches to working in groups
Phil Luffman
345
41
Using counselling approaches
Philip Burnard
355
42
Bereavement and grief counselling
Clare Hopkins
362
43
Cognitive–behavioural therapy
Paul French
370
44
Using solution-focused approaches
Denise Webster
377
45
Mindfulness
Mary E. Campbell
384
46
Therapeutic communities
Gary Winship
393
Section 6
THE ORGANIZATION OF CARE
Preface to Section 6 Phil Barker
402
47
The acute care setting
Angela Simpson
403
48
The psychiatric intensive care unit: coercion, control or care
Cheryl Waters and Andrew Cashin
410
49
Mental health nursing in community care
Denis Ryan
418
50
Crisis assessment and resolution
Clare Hopkins and Julie Mackenzie
426
51
Assertive outreach
Mervyn Morris and Mike Smith
434
52
Family support: growing the family support network
Chris Stevenson and Evelyn Gordon
444
53
The liaison psychiatric service
Chris Hart
454
54
Services for people requiring secure forms of care: a global problem
Colin Holmes
463
55
Services for children and young people
Sue Croom
477
56
Services for older people with mental health conditions
Trevor Adams and Elizabeth Collier
486
57
Early interventions in psychosis
Paul French
493
58
Services for women
Penny Cutting
501
59
Services for asylum seekers and refugees
Nicholas Procter
508
Section 7
SOME STANDARDIZED PROCESSES OF NURSING PRACTICE
Preface to Section 7 Phil Barker
518
60
Admission to a psychiatric unit
Angela Simpson and Jerome Wright
519
61
Assessing risk of suicide and self-harm
John Cutcliffe
527
62
Engagement and observation of people at risk
John Cutcliffe
536
63
Record-keeping
Martin F. Ward
545
64
Discharge planning
Martin F. Ward
553
65
The nurse’s role in the administration of electroconvulsive therapy
Joy Bray
560
66
Mental health promotion and prevention
Jon Chesterson
571
67
Mental health nurse prescribing
Steve Hemingway and David Scarrott
586
Section 8
LEGAL, ETHICAL AND MORAL ISSUES
Preface to Section 8 Phil Barker
596
68
Mental health, the law and human rights
Michael Hazelton and Peter Morrall
597
69
Ethics and nursing
Richard Lakeman
607
70
Sexuality and gender
Agnes Higgins
618
71
Freedom and consent
Alec Grant
626
72
Providing culturally safe care
Anthony J. O’Brien, Erina Morrison and Ruth DeSouza
635
73
Spirituality, nursing and mental health
Stephen G. Wright
644
Section 9
THE DEVELOPMENT OF MENTAL HEALTH NURSING
Preface to Section 9 Phil Barker
654
74
Clinical supervision
Peter Wilkin
655
75
The possibility of genuine mental health nursing
Lyn Gardner and Gary Rolfe
664
76
Building practice from research
Mark Fenton
672
77
Reclamation: beyond recovery
Poppy Buchanan-Barker
681
Section 10
THE FUTURE OF PSYCHIATRIC AND MENTAL HEALTH NURSING IN CONTEXT
Preface to Section 10 Phil Barker
692
78
The United Kingdom context
Jon Allen
693
79
The European context
Seamus Cowman
698
80
The Japanese context
Mami Kayama
707
81
The United States context
Shirley A. Smoyak
710
82
The Canadian context
Nancy Brookes, Margaret Tansey and Lisa Murata
716
83
The Australian and New Zealand context
Jon Chesterson, Michael Hazelton and Anthony J. O’Brien
721
84
The politics of caring
Phil Barker
731
Index
741
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List of contributors
Trevor Adams MSc PhD RN Cert Ed
Lecturer, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
Jon Allen EN RMN BA (Hons) MSc MBA
Director of Nursing and Clinical Governance, Oxfordshire, UK
Phil Barker PhD RN FRCN
Honorary Professor, University of Dundee, Dundee, UK
Ian Beech MA BA (Hons) RMN RGN PGCE
Head of Mental Health Division, University of Glamorgan, Pontypridd, UK
Joy Bray RN RMN ENB650 RNT MA PhD
Mental Health Specialist Nurse, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Nancy Brookes RN MSc(A) CPMHN(C) PhD
Nurse Scholar, Royal Ottawa Health Care Group, Ottawa, ON, Canada
Poppy Buchanan-Barker
Director, Clan Unity International, Fife, UK
Philip Burnard PhD RN
Professor of Nursing, Cardiff School of Nursing and Midwifery Studies, Cardiff University, Cardiff, UK
Mary E. Campbell RN MSN CS
Psychiatric Mental Health Clinical Nurse Specialist, Capital District Mental Health Program; Adjunct Professor, School of Nursing, Dalhousie University, Halifax, NS, Canada
Dave Carlyle RcompN PG DipHealSc
Lecturer, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
Andrew Cashin RN MHN NP DipAppSci BHSc GCert PTT MN PhD FACMHN
Associate Professor Justice Health Nursing, The University
of Technology Sydney, Faculty of Nursing, Midwifery and Health, Sydney, NSW, Australia
Jon Chesterson RN MHN DipCPN BAppSc FACMHN MRCNA Promotion & Prevention, Hunter New England Mental Health, NSW, Australia
Liam Clarke DipNurs DipEd DipTheol DipMed Phil BA MSc MA PhD Reader in Mental Health, University of Brighton, Eastbourne, UK
Elizabeth Collier BSc RMN MSc PGCE
Lecturer in Mental Health, University of Salford, UK
Philip D. Cooper RN AdvDip MSc
Practice Educator, Suffolk Mental Health Partnership NHS Trust, Education and Workforce Development, St Clements Hospital, Ipswich, UK
Seamus Cowman PhD MSc FFNMRCSI DipN (London) RNT RPN RGN
Professor, Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
Sue Croom PhD MSc BA (Hons) RN HV PGCUTL
Senior Lecturer/Research Fellow, Northumberland and North Tyneside Mental Health Trust, Berwickshire, UK
Marie Crowe RN PhD
Associate Professor, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
John R. Cutcliffe RMN RGN RPN RN BSc (Hon) Nrsg PhD David G. Braithwaite Professor of Nursing, University of Texas (Tyler); Adjunct Dean Psychiatric Nursing,
Stenberg College, Vancouver, Canada; Visiting Professor, University of Ulster, UK
Penny Cutting RGN RMN BSc (Hons) Nursing MA
Counselling and Psychotherapy Clinical Co-ordinator/ Women’s Lead, Croydon Adult Integrated Mental Health Services, Bethlem Royal Hospital, Beckenham, UK
Ruth DeSouza DipNurs Grad DipAdv Nurs Prac MA
Centre Co-ordinator/Senior Research Fellow, Centre
for Asian and Migrant Health Research, National Institute for Public Health and Mental Health Research, AUT University Te Wananga Aronui o Tamaki Makau Rau, Auckland, Aotearoa/New Zealand
Dianne Ellis RMN PGCE MSc
Senior Lecturer Mental Health, Centuria Building, Teesside University, Middlesbrough, UK
Mark Fenton RMN MA
Editor – Database of Uncertainties about the Effects
of Treatments (DUETs), James Lind Initiative, Oxford, UK
Cheryl Forchuk RN BA BScN MScN PhD
Professor, University of Western Ontario; Assistant Director & Scientist, Lawson Health Research Institute, London, ON, Canada
xiv List of contributors
Paul French RMN PhD
Psychology Services, Mental Health Services of Salford, Manchester, UK
Ruth Gallop RN PhD
Professor Emeritus, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
Lyn Gardner RMN PGCEA BSc MSc
Lecturer, School of Health Science, Swansea University, Swansea, UK
Evelyn Gordon MSc (Psychotherapy) MSc (Systemic Management) RPN
Lecturer in Mental Health and Psychotherapy, School
of Nursing, Dublin City University, Dublin, Ireland
Alec Grant PhD MA BSc PGCTLHE Cert Res Meth RMN, ENB650 Cert
Principal Lecturer, University of Brighton, Eastbourne, UK
Chris Hart MA RMN RGN
Nurse Consultant in Liaison Psychiatry and Principal Lecturer, School of Nursing, Faculty of Health & Social Care Science, Kingston University & St George’s University of London, London, UK
Yvonne Hayne RN BScN MEd PhD
Faculty of Nursing, University of Calgary, Calgary, AB, Canada
Michael Hazelton RN BA MA PhD FACMHN
Professor of Mental Health Nursing and Head of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW, Australia
Anne Helm BEd
Consumer Consultant and Educator, Aorearoa/NewZealand
Steve Hemingway RMN V300 BA (Hons) MA (Couns) PGDE
Senior Lecturer in Mental Health, Department of Health and Human Sciences, University of Huddersfield, Huddersfield, UK
Agnes Higgins PhD MSc BNS RNT RPN RGN
Associate Professor of Mental Health Nursing, Trinity College, Dublin, Ireland
Colin A. Holmes BA (Hons) MPhil PhD
Professor of Nursing, School of Nursing Sciences, Midwifery & Nutrition, James Cook University, Townsville, QLD, Australia
Clare Hopkins RMN MSc MA
Primary Care Mental Health Worker, Newcastle Primary Care Trust, UK
Elsabeth Jensen RN PhD
Assistant Professor, School of Nursing, York University, Toronto, ON, Canada
Mami Kayama RN PHN MN PhD
Professor, St Luke’s College of Nursing, Tokyo, Japan
Rachel A. Keaschuk PsyD Rpsych
Psychologist, Pediatric Centre for Weight and Health, Stollery Children’s Hospital, Edmonton, AB, Canada
Tom Keen RMN RNT MSc
Formerly Senior Lecturer, University of Plymouth Institute of Health Studies, Exeter, UK
Richard Lakeman DipNsg BN BA (Hons) PGDip (Psychotherapy) Doctoral Candidate JCU
Lecturer, School of Nursing, Dublin City University, Dublin,
Ireland
Philip Luffman RMN Dip Gp Psych
Hywel Dda NHS Trust, West Wales, UK
Hugh P. McKenna CBE PhD BSc (Hons) RMN RGN RNT DipN (Lond) AdvDipEd FFN RCSI FEANS FRCN
Professor and Dean, Faculty of Life & Health Sciences,
University of Ulster, Coleraine, UK
Julie Mackenzie RMN CPN Cert Cert Family Therapy Dip Social Work and Social Policy MA in Systemic Practice
Nurse Consultant Crisis Service, Ravenswood Clinic,
Newcastle upon Tyne, UK
Peter Morrall PhD MSc BA (Hons) PGCE RN
Senior Lecturer in Sociology and Health, School of Healthcare, University of Leeds, Leeds, UK
Mervyn Morris RN
Professor of Community Mental Health, Centre for Community Mental Health, Birmingham City University, Birmingham, UK
Erina Morrison RCpN BHSc MN
Clinical Nurse Director, Nursing, Mental Health and Addiction Health, Waikato, Hamilton, New Zealand
Eimear Muir-Cochrane BSc (Hons) RN RMN Grad Dip Adult Education MNS PhD FACMHN
Professor of Nursing (Mental Health Nursing), School
of Nursing and Midwifery, Flinders University, Adelaide, SA, Australia
Lisa Murata RN BScN MEd CPMHN(C) CSFT
Clinical Nurse Educator, Royal Ottawa Mental Health Centre, Ottawa, Canada
List of contributors
Brendan Murphy MA RMN
South Trent Training Dynamic Psychotherapy, Department of Psychotherapy, Derbyshire Mental Health Service Trust, UK
Amanda S. Newton PhD RN
Assistant Professor and Clinician Scientist (Child and Adolescent Psychiatry), Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
Anthony J. O’Brien RN BA Mphil
Senior Lecturer, Mental Health Nursing; Nurse Specialist,
Liaison Psychiatry, School of Nursing, University of Auckland, Auckland, New Zealand
Mark Philbin RPN DipN (Lond) BSc MA
Lecturer in Nursing, School of Nursing, Dublin City University, Dublin, Ireland
Gary Platz
Strategic Advisor, Wellink Trust, Wellington, New Zealand
Nicholas G. Procter PhD Grad Dip Adult Ed BA RPN RGN CertAdvClinNsg (SACAE) MACMHN MRCNA FGLF
Associate Professor, School of Nursing and Midwifery,
University of South Australia, Adelaide, SA, Australia
William J. Reynolds RN PhD
Former Reader in Nursing, University of Stirling, and Turku University of Applied Sciences; currently Freelance Educator and Researcher, Salo, Finland
Gary Rolfe RMN PGCEA PhD MA BSc
Professor of Nursing, School of Health Science, Swansea University, Swansea, UK
Denis Ryan PhD BSc RPN RGN CAC Cert BT Dip Prof Studies Senior Lecturer, Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
Elaine Santa Mina RN BA BAAN MSc PhD
Associate Professor, Ryerson University, Toronto, ON, Canada
David Scarrott RGN RMN V300 BA (Hons)
Team Manager, Crisis Resolution and Home Treatment Team, Rotherham, UK
Angela Simpson RMN BA MA PGCE PhD
Lecturer in Mental Health/Research Fellow, University of York, York, UK
Mike Smith RMN BSc (Nurs) MA PhD
Director, CrazyDiamond, www.crazydiamond.org.uk
Shirley A. Smoyak RN PhD FAAN
Professor II at Rutgers, the State University of New Jersey; Professor, Continuous Education & Outreach, Edison, NJ, USA
Chris Stevenson RMN BA (Hons) MSc PhD
Chair in Mental Health Nursing, School of Nursing, Dublin City University, Dublin, Ireland
Margaret Tansey RN MSc(A) CPMHN(C)
Vice President Professional Practice and Chief of Nursing Practice, Royal Ottawa Health Care Group, Ottawa, Canada
Tracey Tully RN MSc PhD
Independent Consultant, Toronto, Canada
Paul Veitch RMN MSc
Team Manager and Senior Nurse, Early Intervention
in Psychosis Service, Newcastle & North Tyneside Trust, Newcastle upon Tyne, UK
Martin F. Ward RMN DipNurs RNT Cert Ed NEBSS Dip Mphil Independent Mental Health Nursing Consultant and Coordinator of Mental Health Nursing Studies, University of Malta, www.mwprof-development.com
Cheryl Waters RN BSc (Hons) PhD MACMHN MCN
Senior Lecturer, Faculty of Nursing Midwifery and Health, University of Technology, Sydney, Australia
Denise (Denny) Webster RN PhD CS
Professor Emerita, University of Colorado at Denver and Health Sciences Center, Denver, CO, USA
Irene Whitehill BSc PhD
Independent User Trainer and Consultant, Section 36, Northumberland, UK
Peter Wilkin RMN MA
Formerly Clinical Nurse Specialist with the Complex Cases Mental Heath Team in Rochdale, UK
Gary Winship PhD MA RMN Dip Gp Psych
Associate Professor of Human Relations, University of Nottingham, School of Education, Nottingham, UK
Jerome Wright MSc RGN RMN PGCE
Lecturer, Department of Health Sciences, University of York, York, UK
Stephen G. Wright MSc RN RCNT RNT DipN DANS RPTT FRCN MBE
Chairman and co-founder of the Sacred Space Foundation,
Associate Professor, Faculty of Health and Social Care at the University of Cumbria, Carlisle, UK
The Cleansing has Begun
Chest deep in the Wainuiomata stream Earth’s energies combine with mine
Me the mighty super-conductor Here to do God’s will
Yes, the cleansing has begun
With Jehovah’s name reverberating from the hills Wainui’s demons go screaming to the abyss
Ah Wainuiomata, New Jerusalem River of life
The cleansing has begun
The cries of my disciples from the asylums of the world Keep tearing at my soul
Hold on my followers, I’m coming The cleansing has begun
Strapped to a sterile bed Spiritual poison in my veins
Encrusting my heart, fogging my head I’ll keep fighting, my disciples
The cleansing has begun
Through days of haze Hospital food
I keep sitting, A god hunched
Looking for answers on the wall
Through days of haze Hospital food
I see the answer
It’s written in their eyes
I’m no god Just a fool
Raped by heart and soul The cleansing has begun
Then a power to be Said you may go free (I’ll be tethered to him With a chemical chain)
Oh try to get yourself a job
The cleansing has begun
Through days of haze Timeless sleep
I lick my violated brain Ah Wainuiomata
The cleansing has begun
Somehow I am much better now I have taken that to be’s advice I’m searching the papers
Up dated my c.v.
Brought myself some shoes
Hey, wait a minute You, out there
Do you have an opening For a part time god
The cleansing has begun
Gary Platz
Gary Platz is Strategic Advisor, Wellink Trust, New Zealand. Gary has been involved in the service user movement since 1993. He is an advocate of peer services and has been successful in the setting up of several peer services including a peer recovery house, which is an alternative to acute hospitalization. He is a poet and writer of short stories.
The Space I’m in
Mike Consedine*
Recently, I have been privileged to sit in the small garden at the rear of our house nearly every day. It is warm and sheltered here, and a small rock pool provides the soothing sound of running water. Apart from the low hum of distant traffic nothing much else disturbs. So I can experience the flowers growing, the insects buzzing, the birds chirping, the cat sleeping, and of course the water. Such a special honour. This time to be with myself. And in that time experiences buried deep have an opportunity to emerge, flooding my senses with feeling beyond expression: with life that had seemed lost forever. And I know again the passion I have for the
experiences of being alive.
Sitting with this I see my social atom: the network of significant relationships both past and present, surrounding me. What riches! My wife, my former wife and our children, my brothers and sister, friends – relationships that have developed over many years, and colleagues with whom I have been intimately involved, as we strive to make a better world. All here, in my social atom.
And I know without doubt that this was all generated in my family of origin – my mother and father and the wider whãnau.a And as I sit with this I feel the tears again: tears of gratitude for the good people they were/are. Not famous, just good. Doing what good people do; loving those around them and committing themselves without fuss to helping all.
These values are embedded in the current social atom which surrounds me and is my life. In this place I cannot fail. Like Jean Valjean I know who I am and that allows
me to live with dignity, and the comfort of truth. I know that values, like most truths in life, are not taught, they are developed. They are developed through good doubling, mirroring, modelling, role reversal and discussion. Through these processes they are internalized and their life conserved. They are the cornerstones. They inform the roles we enact in the world.
Personality may be thought of as a series of roles and role systems. In a healthy individual life, development is always a work in progress. When I wept over my inadequacies as a parent, Harry, my old therapist, would always say ‘every day is an opportunity to do it differently’. There is no need to keep on recreating the original social atom.
Poetry enables me to do it differently. Through it I am able to express myself fully in the world without self- aggrandisement, self-pity or harm to others. It’s just the way things are for me at any given moment. It may express my delight and joy, or my sorrow anger and despair. The expression of who I am enables a full life. And I do want a full life.
Christchurch, New Zealand
3rd April 2007
*Mike Consedine was one of New Zealand’s most respected psychiatric nurses. He had previously worked as a probation officer and then developed a successful career in psychodrama, operating an Independent Training Consultancy based in Christchurch, New Zealand. Mike was a past President of the Australian and New Zealand
Psychodrama Association.
a Wh˜anau (Maori): extended family.
Half dead
Sometimes he awoke aware only that
he was half dead.
his body lay side on
half buried in the rubbish tip
his mouth and throat were full of decay seagulls circled awaiting their turn to feast.
the early morning light boosted the smell
and the soft breeze increased reflected light
half his head was dead
and he did not know what to do except persevere.
Mike Consedine March 2007
Christchurch, New Zealand
Preface to the second edition
George Bernard Shaw said ‘The only man I know who behaves sensibly is my tailor; he takes my measurements anew each time he sees me. The rest go on with their old measurements and expect me to fit them.’ The same is true of the world in which we live. It keeps changing, growing in some ways and shrinking in others. We, the inhabitants of that world, need to understand this, if we are to adapt ourselves to fit our changing circumstances. There has been a lot of growth and perhaps some significant shrinkage, since we published the first edition of The craft of caring. Economics and its obsession with cost containment continues to dominate most services, and science and its fascination with evidence continues to tantalize us. What we would like to do, we cannot afford; and what we have been doing, apparently successfully, for a long time, we find has no proper
‘evidence base’. What to do?
In the Western world, economics continues, ironically, to dominate the agenda, pushing the demand for more ‘evidence’ and a stronger scientific base for practice. In the rest of the world, we have finally woken up to the fact that everyone experiences the kinds of problems in living called ‘mental illness’ in the West, but we may call them by different names or give them a different significance. Slowly, we are beginning to ask how do people in war-torn or economically ravaged countries cope with such problems. And, where do nurses fit into this picture, if at all.
Although the catalogue of ‘mental disorders’ has grown, in leaps and bounds, since attempts were first made to classify ‘insanity’ a century ago, no ‘new’ forms of mental disorder have been added to the list in the past 15 years. However, all around us, ‘mental health problems’ appear to be on the increase, especially in affluent countries. We appear to have no end of resourcefulness in developing new ways of expressing misery and despair, fear and trembling. Is this to do with the pressures we impose upon ourselves, which we now call stress? Or is this to do with the sheer artificiality of our lives. Who knows? However, the more affluent a society becomes, the more miserable and angst ridden it also becomes. Little wonder so many seek the dream of a simpler life.
In this second edition, we have tried to reflect some of the changing world we see around us, not least within the field of nursing itself. All the original chapters have been revised and updated and we have added around a dozen new chapters, covering important new developments in mental health care or exploring areas of practice that represent a refinement of some of the key concepts in nursing practice.
We have extended our consideration of the naming of psychiatric disorders, trying to help the reader gain a sense of history but also an appreciation of what it might
mean to receive a psychiatric diagnosis. In keeping with our core aim – to explore the concept of the craft of caring – we keep the focus on people and persons. How does diagnosis affect people?
The person with a diagnosis of autism has attracted a lot of public attention in the past few years, with a number of books written by people with different experiences of the autistic spectrum. Autism is a classic challenge for mental health nurses, since the people concerned have a very unusual concept of ‘mind’. Mental health nurses could extend themselves greatly by exploring how to respond to people with autism.
We have also developed the section on services, by including liaison psychiatry, therapeutic communities, services for the older person, nurse prescribing and services for women. These represent exciting examples of how nurses are rising to the challenge of developing more innovative care, or trying to find new ways of ensuring that people too receive personally meaningful care, whatever their situation.
The focus on rights is developed further in a new chapter on the support of refugees and asylum seekers – two groups of people found now in every developed country on earth. The special problems encountered by these groups will stretch mental health nurses, and may also, in time, help them understand better the needs of people experiencing other forms of exclusion or marginalization.
We have also revised substantially the chapter on the law and mental health care, providing readers with not only a history of the development of ‘mental health legislation’ but also an appreciation of how this differs from one country to the next.
Finally, we have included a vital consideration of the concept of spirituality, conspicuously absent from the first edition. Given that the original mission of psychiatry was to study the soul or spirit, it seems fitting that nurses are finally turning their attention to this, the most abstract aspect of our common humanity.
This edition is significantly bigger than the first, but I hope, despite its size, that it retains a sense of human scale. It is all too easy to lose sight of the person, the family and the community of origin. It is all too easy to be overwhelmed by the sheer volume of concepts, theories, models, principles and various practices. I hope that you will find that the person makes an important appearance on every page of this book. Perhaps this anonymous person will become your guide, helping you to explore the text, with a view to clarifying your own concept of ‘the craft of caring’.
Phil Barker
Newport on Tay, Scotland
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Acknowledgements
Grateful thanks to Clare Patterson and Naomi Wilkinson at Hodder Arnold for all their support during the preparation of this second edition, and to all the authors for their commitment to the book and to the mental health field.
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