The future of mental health nursing: are we barking up the wrong tree?

Dear CMHNN,

Those of you who attended the conference in Birmingham may have met Mick McKeown, who has been a supporter of the Network since its early days (that’s right, several months ago!). He has a new co-written article (reference and PDF below) published in the Journal of Psychiatric and Mental Health Nursing which we know will be of strong interest to the Network. The article addresses themes surrounding professionalisation and alienation, capitalism and labour, responding to the Shape of Caring Review and resulting concerns about the possible loss of a branch-specific mental health nurse identity. In the article our attention is widened to the identity crises which face mental health nurses more profoundly than the proposed changes to training.

Many critical mental health nurses may be familiar with the multi-authored article published in 2012 written largely by Phillip Thomas and Pat Bracken, Psychiatry Beyond the Current Paradigm (also below). It arguably represents a defining moment in critical psychiatry in the UK. It is to be hoped that this new article, written by two nurses and published in our own mainstream journal, might represent something as significant. The two articles are different in a number of ways and yet share a sense that, governed by the dominant logics of biomedical explanation and the industrial techniques of delivering it, mental health services have become a failing project in need more than just adjustment. McKeown and White describe nurses as facilitators of the current service while at the same time articulating its abuse of us. In fact, the article pulls together many of the themes which authors and commentators on this website have also introduced; Gary Sidley’s grave concerns about practices of coercion; the manner in which we have facilitated the dominance of biomedicine; the increasing awareness that we have been far too ready to view psychiatric drugs as broadly helpful and too trusting of the bodies which exist to create, research, licence and prescribe them; the manner in which uncritical mental health services may be seen as a perfect conduit for a style of neoliberal individualisation which suits the status-quo which may be found here in Mark’s Story. There are Alec Grant’s ‘already damaged bodies’ within the article also. McKeown and White’s critique of professionalisation seems to tessellate remarkably with Karen’s Story. They call for ways of working which reflect democratic values, such as Soteria and Open Dialogue, and beyond such approaches to a more general view that it is in solidarity with service-users and survivor movements where we will find our professional identity.

We welcome this new article and are excited about the possibilities for discussion that will follow. We have also had a preview of a forthcoming article by Alec Grant, written in his capacity as Reader in Narrative mental health at Brighton University, which will address the needs of nurses to disentangle themselves and their education from the corporate production of our work and gain new skills. We will post that here when it is published too.

Please be encouraged to leave comments, questions and feedback which Mick will read.

McKeown, M., White, J., 2015. The future of mental health nursing: are we barking up the wrong tree? J Psychiatric & Mental Health Nursing 22, 724–730.
for the PDF: McKeown et al
Bracken, P., et. al, 2012. Psychiatry beyond the current paradigm. BJP 201, 430–434.
For the PDF Bracken-et-al

2 thoughts on “The future of mental health nursing: are we barking up the wrong tree?

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  1. Hi Mick,

    I really enjoyed this article, thanks for writing it. It is amazing to see this article in this journal and I congratulate you on your achievement.

    I see mental health nursing as the ‘sleeping giant’ of the mental health professions. I think we translate between the languages of other disciplines really well, but we are not particularly well able to articulate or represent what we do. I would like to see more truthful analysis of mental health nursing’s role and responsible ownership of our disciplinary status. I would like to engage in a discovery of language and concepts that will enable us to describe what we do in authentic terminology. I would like to see us cast off our inferiority complex and stop seeing ourselves as lacking that capacity to ‘treat’ which psychiatrists and psychologists claim to possess. I would like to see us honour, resist and acknowledge discourses around power and oppression.

    I would like to ’embrace alternatives to bio-psychiatry’ , consider alternative ways of working, stand up for our professional status, resist complicity with iatrogenic bio-psychiatry, find ways of better facilitating compassion and get better at physical health care. I think lots of nurses would.
    I wonder why it hasn’t happened yet? What do you think are the barriers to change in mental health nursing?

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  2. Pete, thanks for kind words and critical engagement with the piece. We were hoping that it would provoke some interest, and the CMHN network is a great place to start some discussions. In answer to your question about barriers, I suppose there are many, and some of these are big and powerful. Not least the powerful vested interest in psychiatry and how this is wedded to the state and big business. The whole neoliberal polity and current fetish for austerity and politicised antipathy to welfare are all hugely problematic for those wishing to see alternatives. I am a big fan of the potential for social movements, including survivor groups and trade unions, preferably in alliance, to make a difference. One concern is that the left do not properly appreciate mental health as a politicised domain, with a need for a politics of its own. Hence, I concur with Peter Sedgwick’s call for the development of such a psychopolitics and broadly based alliances to prosecute this.

    Having said all that, I am not sure we should start or deliberations with a focus on what is against us. We should start with our strengths. Back to Sedgwick, the task of transforming psychiatry is the same as that facing society as a whole – we need a mass, humanising socialisation. The means and the ends are of necessity intensely relational. I like to think that the best of nursing practice is the place to look for these relational skills that we need to support a new politics of mental health, new alternative non medical practices, and the community, union and social movement organising practices that will get us there.

    Despite the obvious power of psychiatry and neoliberalism, this is not omnipresent. There will always be places and spaces were we can act differently and pursue our goals somewhat beneath the radar. There are plenty of grounds for optimism, not least the current changes in the Labour Party. It may be opportune for CMHNN to make overtures to the new shadow minister for mental health to begin the task of plotting out what radical possibilities may indeed be before us. Of course, there will also be perils, but these need not put us off.

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