The things I've seen as a mental health nurse

By Andrew Saint

In this series, ACMHN members talk about their passion for mental health nursing and how they have grown professionally. This time, Andrew Saint shares with us his many years of experience, his perspective how how things have changed over time, and what he has planned for 2023.

My mental health career began ten years after ‘general nurse training’ at St George Hospital Sydney (1983-86); followed by ‘mental retardation nurse training’ and employment at the Riverglade Centre (Gladesville). I thoroughly enjoyed several years in disability, rising through the ranks to Clinical Nurse Specialist (CNS) & Nurse Unit Manager, but once the NSW institutions began closing in the 1990’s, following recommendations of the Richmond Report, the writing was on the wall (Richmond 1983). The era of nurses employed in the sector was drawing to a close. Under principles of ‘normalization’, care delivered by nurses was also deemed too medical model to continue (Wolfensberger 1972). Even though the specialty course had as much to do with education and social care as it did with health.

I was at a career crossroad. Having sampled behavioural nursing I now felt more drawn to the idea of psychiatry than returning to general. Many of my clients had comorbid mental illness, and I knew colleagues ‘from the other side’ (ie psychiatric nurses working casually with us from their side of Victoria Road). Having upgraded to a Bachelor of Nursing (University of Technology Sydney), I was eligible for emerging tertiary qualifications, but opted instead for the hands-on phase 1 psychiatric nursing certificate; moving 6 kilometres to Rozelle Hospital to facilitate this. Here I worked in numerous specialty practice areas, including Intensive Psychiatric Care (IPCU), 2 x 40 bed acute admission units, psychogeriatric admissions, rehabilitation, a medicated detox, & Department of Veterans Affairs (DVA) wards. As at Gladesville, I learnt a great deal from the experienced staff and patients I had the privilege to work with. Some older staff could even recall practice prior to psychotropic medication. Study blocks were taught by charismatic, and oftentimes eccentric, educators with passion for the field. My timing was fortunate, no simulation lab can replicate this!

Both Gladesville and Rozelle Hospitals were situated on undulating, waterfront acreage. Along with sandstone heritage buildings, both had commanding views and manicured gardens. Australia lost tens of thousands of long-stay beds when the stand-alone psychiatric hospitals began closing in the late 1990’s, in response to the Burdekin Report and the move toward community care (Burdekin et al., 1993). Some estimate the reduction as being from 30 000 in the 1960’s to 8 000 today – significant considering population growth throughout this period (AIHW 2022). Transinstitutionalisation, whereby thousands with severe illness have trended toward homelessness and incarceration, in the absence of long-stay beds & adequate community care, has been well documented. Prisoner populations with mental illness and disability have subsequently increased. This is frequently cited as the catalyst for the emergence of specialist forensic services within prison systems.
My first community experience, with the Redfern mental health team, followed on from Rozelle. This was an incredible period of professional growth – assisting the rich tapestry of characters inhabiting the towering public housing blocks of Redfern and Waterloo (colloquially referred to as ‘suicide towers’, in reference to the very evident social disadvantage). I worked as a CNS with this small experienced and supportive team. It was the best possible induction. There were minimal OH&S protocols to follow in the day, with discretion, intuition and gut instinct highly regarded.

Fast forwarding, my family relocated to northern Tasmania in 2000.

Upon arrival I was surprised (aka horrified) to learn that my psychiatric certificate wasn’t recognised here (this was prior to national registration through AHPRA). I could work inpatient, but not community, settings without a Graduate Diploma. Inconvenient with a young family, I completed my studies through Deakin, courtesy of a College of Nursing scholarship. I worked 18 months at the Launceston General Hospital prior to returning to the community sector I sorely missed.

I worked a total of 15 years with the Community Forensic Mental Health Service (CFMHS) prior to resigning in July. Working across rural & remote northern Tasmania was markedly different to my experience in inner Sydney. No high-rise towers, but instead of clients living within close proximity of the health centre, home visits were often vast distances apart. It was rewarding fostering therapeutic relationships with clients in their homes over many years. Assisting individuals to achieve & maintain wellness, & live fulfilling lives, whilst minimising hospital admissions; and within the forensic context - avoiding re-offending - was my objective. I also acted in the Court liaison role, supporting the Courts through provision of reports and recommendations as requested. During my four-year break from CFMHS I completed my master’s degree (University of Tasmania) and taught undergraduate & postgraduate students. I also worked casually in psychiatric rehabilitation at the Howard Hill Centre, Longford (since closed), and briefly in correctional health at the remand centre.

In 2013 I seized my opportunity to visit the Lagankhel mental health facility in Nepal with colleagues from the Australian College of Mental Health Nurses (ACMHN). This was a fascinating cross-cultural experience. I have attended numerous ACMHN conferences throughout my career (presenting at a couple), reviewed chapters of international textbooks to assist adaptation to the Australian & New Zealand context, published a couple of short stories, and sat with several committees (most notably the Inaugural Sentencing Advisory Council in Tasmania, and the Social Science Human Research Ethics committee (UTAS)). I have long been a Credentialed member of the College.

Whilst providing ongoing support for the University, and watching the Football World Cup, I’m researching opportunities to undertake interstate & offshore mental health contracts in 2023.

Australian Institute of Health & Welfare (2022) Mental Health Services in Australia (viewed 24th November 2022)
Burdekin, B, Guilfoyle, M, & Hall, D 1993, National Inquiry Concerning the Human Rights of People with Mental Illness (Australia), Human Rights and Equal opportunity Commission. Canberra
Richmond, D. T 1983, Inquiry into health services for the psychiatrically ill and developmentally disabled, Department of Health NSW, Division of Planning and Research, 1983
White, P & Whiteford, H, Prisons: mental health institutions of the 21st Century?, Medical Journal Australia, vol. 185, no. 6, 2006
Wolfensberger, W.P. The principle of Normalization in Human Services. National Institute on Mental Retardation. Toronto, 1972


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