The diversity of mental health nursing is enormous - Q&A with Monica Taylor

Tuesday 26 April 2022


This article was originally written by The Nurse Break team and published on The Nurse Break. It has been republished here with permission. 


About
Monica Taylor has been a mental health nurse (MHN) for 30 years and was one of the first community-based MHNs in the Western Australian rural sector. Monica has expertise in emergency psychiatry and undertook state projects where she led the development of the Western Australia framework for clinical supervision in public mental health services and was project lead for national forensic benchmarking. Monica has held leadership roles including clinical, project management, clinical redesign, nursing, and hospital administration.


After 30 years in mental health nursing, what keeps you going?
Wow that 30-year number makes me feel old…. I’ve always tried to seek positions where I can influence service access and change attitude surrounding people with mental health presentations. Unfortunately, our internal health system can be one of the worst offenders in how they speak about people with mental health presentations…..


What major shifts have you seen over the last 30 years in this field?
One thing that stands out is safety, although I know safety is still to be at the point it needs to be, I never quite realised early in my career how vulnerable we were in the community as mental health nurses. It isn’t about the person with the mental health presentation but the many many interdependencies; driving by yourself, fatigue, access to talk to a colleague promptly, and someone checking medication administration to name but a few issues.


I was nursing in the community prior to the days of a mobile phone (argh there’s that 30-year thing again) and then in the early days of having a phone and not having service to support the mobile. Sitting on the side of the road reading a hard copy street directory in the middle of nowhere….and also finding a clean public toilet….some of the challenges.


The other major change I’ve seen is the ceasing of the hospital-based nursing to university training. So many benefits of the productivity inquiry report, mental health, recently recognised that we still haven’t got it quite right yet with the recommendation of the reconsideration of an undergraduate MHN program.


They stated a new curriculum standard for a three-year direct-entry undergraduate degree in mental health nursing should be developed. In addition, a discrete unit on mental health should be included in all nurse training courses - it’s a no brainer really - irrespective of where you are nursing, you will interact with people who have experienced and/or are experiencing a mental health presentation.


What do your current / recent roles involve?
I’ve recently taken a complete shift in my career - from being in public service for all of my career to now moving to the private sector and commissioning mental health services. The drawcard to #SJOG Murdoch where they are developing mental health services on their campus; is enacting a true system change of private sector access for the youth and adult range.


A complete fortunate happening and opportunity to be involved at an early point with a great vision from board to floor along with a true co-design model. I’m also the consortium lead for the recently opened headspace Cannington #archehealth. It’s great to be able to bring multiple agencies together to deliver comprehensive mental health, drug and alcohol, physical health and work and study support for young people.


What is your role within the Australian College of Mental Health Nurses (ACMHN)?
The ACMHN is the peak professional mental health nursing organisation in Australia and works to promote public confidence in and professional recognition of mental health nursing. I have been the ACMHN Western Australia Branch Chair for four years and have been surrounded by a great diversity of committee members volunteering their time to deliver education and the mental health nursing voice into the Western Australia health sector.


Just over a year ago I was nominated onto the ACMHN Board where I am one of the Vice Presidents, and am very privileged to be able to develop and drive the strategic plan for mental health nurses across the nation.


What common misconceptions exist about mental health nursing that you’d like to bust?
If I had a dollar for everytime someone asked if I was analysing them, I may be wealthy enough to not be working …I think we are just having a conversation…..he he. A great misconception is that if you can’t see a ’task or busyness’ happening, like a MHN sitting and talking to someone, then you aren’t productive.


The MHN has an amazing skill set in building a therapeutic relationship, at times with rapidness in an acute setting, making informed decisions about risk and safety, using their knowledge and skills for interventions in line with a person as a whole (mental and physical) and playing a pivotal role in the person recovering and being the best they can be.


The diversity of mental health nursing is enormous from the enrolled nurse, registered nurse and the nurse practitioner; child and adolescent, adult, older adult, community, inpatient, emergency departments, consultation-liaison, perinatal, forensic, police co-response, drug and alcohol, education, research, psychotherapists working across many platforms in private, public, and primary health. I would encourage all reading this interview to respect the breadth and achievements of the speciality. The systems would simply be inadequate without us.


What are the biggest ‘issues in mental health nursing’ / current affairs – currently in 2022?
Politicians announcing beds with little consideration of workforce to enable - this gives a false hope for the community who we serve. Beds only have a sliver in the person’s journey and outcomes; with beds must come enhancement in the community and primary health sector.


Retaining mental health staff and creating environments where they are included, respected, and safe are priorities. Involving mental health nursing in consultations of reforms; many a 50-page strategy/plan document I have read which mentions the word ‘nurse’ one or two times is not only insulting but disrespectful. No one profession makes a mental health service; MHNs know that, but don’t forget we are there 24:7 and often the eyes and ears of the systems we work within.


What does the future of mental health nursing look like as a result of COVID-19?
We know some of the impact already: isolation, fear, exacerbation of current illness, physical health such as myopia progression, financial impact, family dislocation, disruption to education and employment, smashing of families together and smashing families apart, the political tolerance of the national suicide rates, and demand on services.


The promotion of campaigns such as ’R U OK’ have been positive and now we are talking about our mental health - the complete mismatch in assistance to navigate and access across the primary sector to specialist mental health services is even more apparent. The future of mental health nursing is complex, however full of great opportunities.
Red tape in the healthcare system you want to see removed?


The MBS guidelines desperately need review! Having a skilled, experienced (at the ready), and recognised credentialed mental health nursing workforce who are hamstrung with inadequate access to MBS item numbers.


The extension of MBS item numbers for mental health nurses would immediately provide expanded, readily available mental health care across the nation - surely people are deserving of being able to access care rather than being on a waitlist for months and months.


What are your top tips to finding balance in a nursing career and avoiding burnout?
I’ve always either studied or been involved in other interests apart from mental health nursing. I have a strong interest in governance and so have always kept the principles of safety and quality at the heart of how I undertook my role, irrespective of whether it was clinical, managerial or project.


I’ve been involved with other organisations and committed to building and maintaining relationships consistently and always try and do what I say I’m going to do. I also had people around me that I trusted and would let me know if I wasn’t recognising indicators of burnout….and to take a break and reset.


What do you wish you knew as a junior mental health nurse?
What advice would you give to your younger self? I don’t know if I wished I knew more as a junior mental health nurse, you never know everything and I still don’t to this day. The advice I would give my younger self is: days will be hard and days like that will pass, and your day will often not be as bad as someone else’s.


You will cry, and laugh, and your heart will hurt at an unexpected outcome related to the person you are caring for and you will smile for the same unexpected reasons. You will think about people you nurse many many years later.


Being a manager is a balance of reward and challenge but not everyone gets a chance to be in these positions, so roll with it, get good support and as a wise person once told me, what people say about you behind your back is not your business but hey, pay attention and be open to different views when people are talking to you.


Your colleagues across all disciplines will become some of your closest friends, don’t be siloed in your speciality or your profession.


What are the greatest lessons you’ve learnt over your career so far?
What a journey and I’m not at the end yet….not for one minute have I ever thought I may not be in mental health at the end of my career. Committing to clinical supervision is my greatest lesson - there is just no excuse to not reflect on your clinical interventions for both you, your colleagues and the people you care for.


Tags

ACMHN Board, mental health nursing, The Nurse Break


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