Ian Wilson, Honourary Teaching Fellow in the Mental Health Field has given us an early christmas present in the form of this amazing, honest interview about his specialist field – Mental Health, specifically discussing his work in the community with dually diagnosed service users (those with mental health and substance misuse diagnoses). This is a truly insightful piece with some wonderful tips and advice for all fields of Nursing.
What do you enjoy most about working in the community?
I enjoy the autonomy of community work. I enjoy being truly collaborative with my service users and colleagues. I enjoy the flexibility and responsiveness that community work offers workers and their clients. I enjoy the equalization of the ‘power balance’ between professionals and service users that community work offers.
What do you enjoy most about working with the university?
Regular contact with students is undoubtedly the most rewarding part of my university job. I welcome the enthusiasm, creativity, professionalism and dedication to mental health nursing that I see students frequently displaying. Because of this student contact I am reassured about the future of my profession and reassured about the future of mental health services.
What do you think is the biggest challenge facing Mental Health Nurses today?
I believe that we MUST maintain and nurture our own professional identity as mental health nurses. We have a unique perspective and a unique therapeutic trust. Both of these things are a huge privilege. We must ensure that this is not diluted.
Even as Student Nurses we can sometimes neglect our own mental health, especially with dissertations looming, what advice would you give students struggling with university stress?
I manage my own stress through regular exercise. I also have a group of friends who I can trust. Some of them are nurses, most of them aren’t. I have different groups of friends for different aspects of my life; my ‘football’ friends; my ‘music’ friends; my ‘work’ friends; friends I’ve known for 40 years or more, friends who have only recently entered my life. I rely on them all for support and encouragement.
How has your role as a Mental health Nurse changed since you registered?
I commenced my career as an inpatient staff nurse (two years). I then moved into community mental health nursing and I’ve done that for 20 + years. During that time my roles have changed and my responsibilities have increased. However, my core values have changed surprisingly little. I would still recognize myself from 25 years ago!
What qualities make a great Mental Health Nurse?
Empathy, unconditional positive regard, honesty, therapeutic optimism, positivity, self-reflection, a genuine interest in other people’s lives, open mindedness, a sense of humour, resilience, resourcefulness, self-reliance.
What made you choose to work with those suffering from drug and alcohol misuse?
I have both personal and professional reasons for working with dually-diagnosed (both mental health & substance misuse) service users. Additionally, I find service users with ‘dual’ problems resourceful, resilient, insightful and challenging. This keeps me going!
What piece of advice would you give Mental Health Student Nurses today?
Take every opportunity that comes your way to promote non-stigmatising attitudes towards mental health service users. Promote acceptance and respect among your colleagues. Use evidence based practice wherever possible. Have confidence to stand up against poor practice whenever you encounter it. Always push to improve services and your own skills and knowledge as a nurse.
From your experience working with service users who smoke cannabis, have you seen a therapeutic effect from taking it as a method of self-medicating and not just for recreational use?
Yes. For instance, a man with bi-polar illness has been using cannabis to regulate his mood. He has been actively attempting to reduce his cannabis use but as soon as he starts to reduce, he experiences a relapse into distressing elevated mood. His answer to this currently is to attempt to grow his own cannabis, which, he hopes, will be high in cannabidiols (anti-psychotic and sedating) rather than high in THC (very psychosis inducing). He is proving to be partially successful. However, in my experience this is unusual. Most of the service users I’ve worked with for many years do not get a good therapeutic effect from cannabis. Quite the opposite in fact. For almost all service users with psychotic illnesses cannabis can be a disaster for their mental health prognosis.
What impact do you think there would be on mental health services if cannabis was to be decriminalised or legalised in the UK?
Taking cannabis misuse out of the legal system and into the healthcare system would enable those people who have problems with cannabis misuse to seek appropriate help and treatment. It would also remove it from the control of organized crime.
From your experience what role does excessive alcohol consumption play in the development of mental health disorders?
This is a complex and multi-dimensional issue. Demographically, 50% of people entering alcohol treatment services have a severe depressive illness. 20% of people have a psychotic disorder (Weaver et al 2003). Whether this is a consequence of drinking excessively, or whether drinking excessively is a causative factor in the development of illnesses is, of course, usually too complex to fully determine.
With the rise of “legal highs” and previously uncommon substances of abuse (such as ketamine) in Greater Manchester, has their been a notable shift in conditions patients suffer with as the popular drugs of choice have changed?
I believe that there is now no doubt that many of the newer substances, such as synthetic cannabinoids and highly potent stimulants such as PMA and methadrone are potentially far more dangerous to both physical and mental health. Synthetic cannabinoids, especially, appear to be very dangerous and unpredictable. However, their use, among mental health service users and people in general seems to be increasing year by year.
If you could give child/adult field nurses a few key points to convey to patients they may encounter that they believe might be struggling with drug or alcohol abuse what would they be?
- Be honest but non-judgmental about peoples’ lifestyle choices
- Encourage service users to discuss issues of substance misuse in an open and honest manner
- Listen to what they tell you and find ways of reflecting back what they’ve said
- Express empathy about their situation in relation to substance misuse. Be especially empathic about the difficulty their substance misuse is causing them and how it may be preventing them to achieve their goals
- Seek permission to offer information which is neutral, up-to-date, and presented in an accessible form. Check out carefully what they make of this information
- If they don’t want to change their current patterns of substance misuse, carry on discussing the issue in an open and honest manner, avoid arguing or persuading; offer harm reduction tips
- Keep the door open to possible intervention in the future