Mental health nurses are vital to the delivery of mental health services. They are not only the largest clinical profession dedicated to mental health, but they also bring unique expertise to managing both mental and physical health and in coordinating care. They are considered a priority, and last year NHS England outlined the need for 4,220 more mental health nurses by 2024.
In our new report, Laying foundations: attitudes and access to mental health nurse education, we explore the main factors that affect how likely people are to apply for mental health nursing courses. This blog highlights some of the key findings.
Even before Covid-19, it was challenging to ensure there were enough nurses in NHS-funded mental health services. There are at least 3,400 fewer full-time equivalent mental health nurses in hospital and community settings than a decade ago. In every region, mental health services currently have a higher-than-average proportion of nurse posts that are not permanently filled.
Filling these posts is harder than it is for many other clinical roles as, for example, only a small number of countries have specialised mental health nurse education like in the UK, which makes direct international recruitment less feasible. To compound matters, there is also a higher proportion of mental health nurses approaching retirement age than is the case for nurses in acute services.
The effect of the pandemic
Covid-19 has changed the policy landscape and introduced new dimensions to the discussion about recruiting the future NHS workforce. It has certainly exacerbated the pressure on services already struggling to meet rising demand – adversely affecting both the general population and in particular those with pre-existing mental health disorders.
As is clear from recent headlines, the pandemic is also changing university life, with modified teaching methods and a reduction of face-to-face life on campus adding to the well-documented impact on students’ education and experience.
However, there is evidence of more interest in health and care careers, as well as a rise in mental health nursing applications. While this is welcome, this increase in interest should not overshadow the underlying challenges of ensuring a sufficient and sustainable supply of mental health nurses.
Demand for mental health nursing courses
There appears to be a general lack of awareness of the mental health nursing role, and limited understanding about what it does and where can it work. In particular, some of the students we spoke to suggested that the most common perception among their friends, relatives and wider society was that the role would predominantly mean working with potentially dangerous people with serious mental health conditions and in forensic settings. This is a problem, and belies the wide variety of roles, settings and specialties that mental health nurses work in.
There has been a failure to promote the unique value of mental health nursing to act as a bridge between mental and physical conditions – to distinguish them from other mental health professionals and to raise their societal profile. Instead, the profession is affected by both clichéd views of “nurse” and stigma around “mental health”, which is contributing to an inaccurate image of the work.
For prospective students, the ever-growing number of psychological professions, and a general lack of clarity about the differences between them, are also a source of confusion. A recent survey reiterated that while some people are aware of long-standing professions, such as psychiatrists, few have heard of other less-known professions, like psychological wellbeing practitioners.
Supply of mental health nursing courses
Stimulating interest in mental health careers alone will not be enough. The way in which mental health nurse courses are currently distributed fails to offer equitable access to the profession for people from different regions, backgrounds and circumstances. As it stands, the provision of undergraduate courses across England is patchy. For instance, for those unwilling or unable to relocate or travel long distances, there may be limited opportunities to study mental health nursing in areas of the south and east of England.
The offer is even more limited for dual awards (including mental health), which offer more flexibility on graduation and postgraduate courses, and which are a shorter route for those already with a degree. There are currently only 14 and 37 universities with these courses, respectively. This may be particularly problematic, given that mental health nursing has typically attracted older students who may have less flexibility to travel. Given too that students are likely to work in the same region as where they studied, this geographical imbalance on where courses are offered is far from ideal.
Opportunities in unusual times but action is required
Our research nonetheless shows there are reasons to be optimistic about the future of the mental health nursing workforce. The students we spoke to were positive about their choice of course, and recognised the value of the mental health nursing role and the importance of encouraging others to consider mental health nursing as a career. But there are still areas that require action, and given the current workforce shortages and the rising demand of mental health services, that action is required now.
In our report, we make a range of suggestions for different national bodies and higher education institutions on how to improve the demand for mental health nursing, with the key areas for action summarised in the box below. Given the importance of the profession, it is vital they are addressed as a matter of urgency.
What will help to increase demand for mental health nursing?
Ensure a more accurate and realistic image of the mental health nursing role, career options, work settings and the people mental health nurses care for.
Promote the valuable contribution that mental health nurses have made during the Covid-19 pandemic, and the uniqueness of mental health nursing to be able to act as a bridge between mental and physical conditions.
Coordinate efforts to provide access to positive personal experiences of and exposure to mental health services and staff, including by sharing good practice.
Encourage mental health nursing across the breadth of the population, including different genders, ethnicities and socioeconomic statuses.
Improve understanding of the support available, routes and requirements for studying to become a mental health nurse.
Ensure that the full range of routes into mental health nursing are available across the whole country to increase numbers and broaden participation.
Leone C (2020) “Mental health nurse education: perceptions, access and the pandemic”, Nuffield Trust comment.