Recovery principles in mental health: new graduate mental health nursing programmes are giving those wanting to gain experience in mental health a valuable pathway for acquiring new clinical skills within a supportive structure.

Auckland registered nurse (RN) Lyn Kanapi's first career choice was mental health, but it took her five years following her graduation to begin working in this area.

Kanapi was first attracted to mental hearth following undergraduate placements at Auckland's regional forensic psychiatry service, the Mason Clinic, and Auckland District Health Board's Cornwall House Community Mental Hearth Centre. For her first five years as an RN, she worked in order adult care--being a mother of young children didn't allow her to work varying shifts. Last year, she was ready for a change when she noticed an advertisement for the Waitemata District Hearth Board (WDHB) mental hearth internship programme. She applied immediately and was accepted. Kanapi feels the internship programme has made a great impact on her nursing practice, especially the time she spent in a small community-based mental hearth service, Mind Matters. The WDHB programme is one of eight new graduate mental hearth nursing programmes provided across the country. The programmes are open to new graduate nurses and nurses new to the mental hearth specialty. They provide support for the development of clinical skills and a guided introduction to the practice environment. In addition to postgraduate study, nurses receive preceptorship and supervision from experienced nurses, and spend time in different clinical settings. Kanapi's programme has been different to that of her classmates. White most interns gain clinical experience in WDHB mental health services, Kanapi has spent half her clinical time at Mind Matters, a small non-government organisation (NGO) in Titirangi.

"There is great team support, the staff are approachable, and I could see the recovery principles working," she said. Recovery is a relatively new mental health care philosophy, which emphasises hope, resilience and attending to the experience of the person using mental health services. As part of her programme, Kanapi is studying towards a postgraduate certificate at the University of Auckland. The study teaches integration of recovery principles with traditional skills of assessment, care planning and negotiation of goats. At Mind Matters, Kanapi was able to apply these skills to clinical practice. More experienced staff, nurses and occupational therapists provided support and feedback.

Alternative service for young people

Established as a service provider in 2003, Mind Matters is set on two acres of bush land in west Auckland and is administered by a charitable trust set up by the founding trustee, Angela Paykel. Paykel's vision was for a community-based alternative to acute admission for young people with severe mental illness. The focus is young adults aged 16 to 30 who are experiencing difficulties with either mood or psychosis. Most service users are under 20, and there are options of day and residential programmes. A typical stay is from one to three weeks. From its beginnings, family involvement has been integral to the service.

Experience at Mind Matters has given Kanapi a different perspective on mental hearth service delivery, and the opportunity to experience firsthand the changing approaches to mental health care. As an intern, she has been able to apply recovery principles in nursing care. This includes skills in helping young people manage "voices", brief focused interventions, and anxiety management. An example was her involvement in the care of a young man with disabling anxiety. In addition to participating in the activity-oriented programme of social and living skills, Kanapi assisted him in goal setting and in applying a range of techniques to help him manage his anxiety.

Nursing care took the form of playing table tennis, social outings, and walks to the local village on personal errands. In addition, she provided individual solution-focused counselling, teaching and rehearsing skills, and supported the young man to attempt new behaviours. This experience was helpful for the client and important learning for Kanapi, helping her gain confidence in her clinical skills.

"It was satisfying working with this man for the three weeks he was resident at Mind Matters. We built a good rapport and I could see the change in him as he gained a better insight into his illness. It was great to be able to build a therapeutic relationship and use the toots I had been given," Kanapi said.

'Hands-on' learning

The small scare of Mind Matters means that clinical skills are learn "hands on". Interns spend up to six hours of their working day in Interpersonal contact, including supporting service users in physical activities, household tasks and social programmes. Kanapi also had the opportunity to learn skills of medication management, assessment and liaison between different health services.

As well as receiving supervision at Mind Matters, Kanapi also had the benefit of meeting one day each fortnight with the other 17 nurses on the WDHB new graduate programme.

The mental health sector is changing rapidly. The Mental Hearth Commission (2007) envisages a future in which mental hearth services will be more closely linked into communities, and more accessible by those communities. (1) There is particular interest in home-based services and other alternatives to hospital admission. Experience in NGOs that are providing new and innovative services helps interns such as Kanapi gain essential clinical skills, as well as expanding their perspective of the range of mental hearth services provided.

Kanapi is now completing her internship programme at the Mason Clinic, the service that first inspired her to follow a career path into mental hearth. At the end of this year, she will graduate with a postgraduate certificate and as a revel two nurse, and plans to build on her experience to develop a career as a mental hearth nurse.

Reference

(1) Mental Health Commission (2007) Te Hononga 2015. Connecting far greater well being. Wellington: Author.

Anthony O'Brien, RN, BA, MPhil (Hons), is a senior lecturer in mental hearth at the University of Auckland's school of nursing. He is also on the board of Mind Matters.