After meeting her first client on placement as a student nurse, Fiona Kumar knew that she found the specialty that would animate the rest of her career.
“I had done some acute, some aged care placements, and going into mental health was an eye-opener at that time,” Fiona explains of the three-week student place-ment at Royal Melbourne’s John Cade Unit, which took place nearly 20 years ago.
“It was a different environment, [with] a lot of emphases, at that point, around under-standing the client’s presentation, their experiences, what makes them come to mental health services.”
“The complexity of the human mind, it’s not researched enough, it’s very difficult to study in-depth, how we have experienced, what makes us who we are… From the day that I walked out of John Cade, that was it. I knew I wanted to become a mental health nurse,” she says.
Since becoming a mental health nurse, Fiona’s has worked across the public and private sectors, including acute and community psychiatry, drug and alcohol reha-bilitation, and has worked as a nurse unit manager. Based on her experience, she says the type of work in mental health will vary based on its setting.
Fiona says that for nurses working in acute settings, the processes in psychiatric settings are primarily dictated by the Mental Health Act, specifically concerning fac-tors such as discharges, bed numbers (including seclusion beds), and volun-tary/involuntary clients.
The shift starts with a traditional handover where mental health status, medication, and care plans are discussed. The remainder of the shift focused on monitoring the client and maintaining their structure of activities and reviews.
“The role of a mental health nurse in an acute setting is to be able to assess risk of a client on every shift, and also be able to document their mental status,” Fiona says.
She adds that communication with the client, their family and a “multidisciplinary” team, including social workers, psychiatrists and registrars, is critical in acute set-tings.
In comparison, mental health nurses in the community setting will treat clients in their own homes or clinic appointments. The involvement of multidisciplinary teams is also essential to care, Fiona says.
According to Fiona, nurses will work a nine to five roster instead of shift work in these settings.
Each day will begin with a meeting (usually at 8.30 am) about the current in-patients and incoming referrals that the clinic’s team is managing. From there, the clinician often has a lot of autonomy in terms of managing what their day looks like.
“It is based on your client’s availability… It is really variant on your client load,” Fiona says.
“You will be out driving, some days, from nine to maybe three, depending on the cli-ent, or some days, maybe, you’ll have clients coming in to see you.”
Additionally, Fiona, who currently teaches mental health nursing at Deakin Univer-sity, says clients in the community setting will fall into one of two categories, with services emphasising elements such as recovery and vocational support.
“The clients that we generally see in community are discharged from the acute in-patient ward on a community treatment order, so they need to have ongoing support and monitoring,” she explains.
“We [also] have clients who have remained on the books because they have a chronic condition that cannot be managed without the expert help of community mental health services.”
As a result, the community mental health clinician will often be someone who usu-ally takes on various multidisciplinary roles, such as cleaning, social work, counselling and psychology.
However, while the focuses of both acute and community mental health practice promise a diverse and busy portfolio of work, Fiona cautions those considering working in mental health nursing to be self-aware about their own mental health and be flexible and willing to follow their client’s lead.
“Communication is key: That is our bread and butter,” she says.
“If individuals are reluctant, or don’t have very well-developed communication skills, that is probably a dilemma in mental health nursing.”
Nevertheless, despite these considerations, Fiona, who urges those who are curi-ous to “come and try it out,” describes the rewards of the clinical area as “immense” for those who embrace its unique requirements.
“You get to help people in the most vulnerable period of their life, whether it be grief, whether it be trauma, whether it be [a] situational crisis, get through and really see the value of life,” Fiona says.
“You get to be on people’s journeys and really see the impact of your therapeutic communication and your helping hand.”
To find out more about mental health nursing, visit the Australian College of Mental Health Nurses, and contact mentors and supervisors.