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Author: Clelia Petracca

In recognition of Mental Health Day, I am excited to share insights from two esteemed authors in the field of mental health nursing. Their work not only highlights the critical role of mental health nurses in improving the quality of life and recovery for individuals with mental disorders, but also aligns with the United Nations Sustainable Development Goal (SDG) 3, which focuses on ensuring healthy lives and promoting well-being for all at all ages.

Vickie Howard is Deputy Programme Director and lecturer for the Mental Health and Wellbeing Practitioner Programme at the University of Hull. This programme promotes optimal wellbeing and mental health and aims to increase the range of multi-disciplinary practitioners who can support distressed individuals by using psychologically informed interventions.

Lolita Alfred’s work spans clinical practice, public health, and higher education, addressing the impact of alcohol on health which impacts 14 out of 17 of the SDGs. Her efforts in promoting health, preventing harm, and ensuring access to treatment for alcohol use disorders highlight the broad societal impact of their work.

Together, their contributions underscore the critical role of mental health professionals in advancing global health goals and improving the quality of life for individuals and communities.

I spoke to Vickie and Lolita to delve deeper into their work and the importance of mental health nursing in the wider context of SDG 3.

How does your work relate to SDG 3 and any of the other SDGs?

Vickie Howard: The United Nations SDG 3 on mental health points to the importance of good mental health and wellbeing. The Mental Health and Wellbeing Practitioner Programme at the University of Hull was developed as part of the Department of Health’s Long Term Plan, and practitioners are trained in assessment processes, collaborative care planning and specific wellbeing-focused psychologically informed interventions

My work within this programme promotes optimal wellbeing and mental health and aims to increase the range of multi-disciplinary practitioners who can support distressed individuals by using psychologically informed interventions. The specific interventions that are focused upon include: behavioural activation, graded exposure, sleep, self-help for bulimia and binge eating, medication management and support via information giving, problem-solving and confidence building.

Lolita Alfred: Alcohol is implicated in over 200 health and injury conditions, and it has a direct impact on 14 out of the 17 UN SDGs. The inclusion of a specific target on the harmful use of alcohol under SDG 3 highlights the importance of alcohol within the global development agenda. My work which largely focuses on alcohol - spans clinical practice, public health and higher education, and it has all been anchored on working towards optimising and promoting health and well-being for all across the lifespan.

For example, as a mental health nurse, my clinical work involved promoting health, providing treatment and supporting recovery for adults experiencing co-occurring alcohol/substance use and mental health challenges (dual-diagnosis). My work in public health prioritises health promotion, prevention and reduction of harm due to alcohol use. In higher education my work is twofold, firstly focusing on teaching students about supportive and collaborative approaches when working with patients regarding their alcohol/substance use and mental health. Secondly; researching ways to prevent harm due to alcohol from the pre-conception stage and right across the lifespan, including ways to enhance availability, access and pathways to treatment.

How important is societal impact to your research?

Vickie Howard: My research and writing on narcissistic abuse has a social justice intention, therefore having a societal impact is important with regards to both raising awareness of this form of abuse and for supporting victims/survivors. Victims/survivors have often experienced psychological and emotional abuse which has severely impacted on their mental health. Raising awareness of the mechanisms involved in components of narcissistic abuse, for example ‘gaslighting’ is important in my research to help people who have experienced this form of abuse to progress towards recovery and wellbeing.

My research on clinical supervision is underpinned by issues such as patient safety and mental health professionals’ wellbeing.  Often clinical supervision, which is a process which enables health professionals to discuss their clinical work whilst also expressing their own thoughts, feelings and critical outlooks has major benefits for staff development and staff retention.  It can however often be compromised due to pressure on staff time and availability to attend supervision sessions.  My research highlights and explores these barriers because they can ultimately be linked to the quality and expertise of professional practice which links to the patient experience of care received.

Lolita Alfred: Alcohol can impact not only the health of an individual who consumes alcohol, but its harm extends to others, for example through domestic violence, child abuse and child neglect. Alcohol also impacts wider society through crime and disorder, drink-driving accidents, and affects workplaces for example through lost productivity due to alcohol-related sickness/absence. In recognition of these wide-ranging negative effects, my research and collaborative work with various stakeholders is directed towards alcohol harm reduction and contributing to a more positive wider societal impact.

How has mental health nursing evolved in the past years? 

Vickie Howard: Mental health nursing as a profession is now much more involved in critical discussions revolving around how to advance optimal wellbeing.  There are developments in mental health nurses’ education and roles leading to Advanced Practitioner whereby mental health nurses can be instrumental in clinical decision making, involving the service user, their family and friends and wider transdisciplinary professionals. There are still challenges which require further ongoing attention and action. For example, do mental health nurses fully recognise the differences between clinical and personal recovery approaches and are these fully discussed collaboratively with the service user and documented in a collaborative care plan meaningfully?

What has continued to evolve is the high regard held for the therapeutic relationship between mental health nurse and service user/client. Mental health nursing still emphasises and prioritises the importance of establishing a meaningful therapeutic alliance which supports the service user, and places the nurse in a role of compassionate, thoughtful helper. It is difficult to quantify any outcomes regarding just how important this enabling feature of working therapeutically with an individual is, and maybe this is one reason why mental health nurses specifically do not get the recognition deserved in the highly developed skills they hold in this area.

“Historically, nurses are under-represented in research spaces”

Lolita Alfred: There have been many changes in mental health over the years, and these have had an impact on the evolving role of mental health nursing. I will talk about a few examples in a United Kingdom context. The first example is the closing down of the old asylums and the move towards mental health care and support in the community which has seen more community-based mental health nursing roles develop. Another example is the increasing recognition of the role that trauma plays in mental health, and more mental health nurses are receiving training to work in a more trauma-informed way. Wider availability and access to trauma-informed care training is however still required at mental health nursing pre-registration and post qualification levels. Another relatively recent change has been the investment in more nurses (including mental health nurses) being involved in facilitating and leading research. Historically, nurses have been under-represented in research spaces when compared to other health professions such as medicine. However, there are now more initiatives aimed at supporting the development of nurse researchers. This will have a positive impact on enhancing the diversity of health professionals involved in research, and more importantly, it will also mean an increase in capacity and ideas for research that can enhance mental health nursing and the contributions that this workforce can make to supporting mental health in the population.

Tell us a little about your textbook and the role of mental health nurses in improving the quality of life and recovery of people with mental disorders.

Vickie Howard & Lolita Alfred: Our book provides a space for mental health nurses and students to explore and think about their roles, with a particular focus on enhancing their practice and ways to support recovery of individuals experiencing mental health distress. It is also very applicable to other professionals working in areas of mental health including, psychotherapists, the psychology professions, social work and the helping professions in general.

The book explores how formulation can support an individual to look at past experiences, current problems and aims for the future. It facilitates an open conversation between helper and client, looking at how to optimise areas of wellbeing. In addition to formulation with individuals, our book also explores family-centred approaches to formulation which is particularly important when working with children, young people and their families.

It draws upon differing theoretical approaches including trauma informed care, cognitive behavioural therapy, strengths-based approaches and psychodynamic approaches – to name a few. Mental health nurses are often in care coordination/lead professional roles where they are often the lynchpin and communicating essential information between differing involved individuals who are important to a client.

Formulation is an important area for qualified mental health nurses and mental health nursing students to use their skills in therapeutic relationship development and it can facilitate further understanding around what factors have and continue to impact an individual’s mental health.  This key area of assessment can subsequently enable collaborative meaningful and person-centred care/recovery plans. 

We advocate for mental health nurses and students to optimise and more formally name and recognise the often psychologically informed approaches they are already using in their work.  By doing this, they will be able to more effectively discuss with the client the therapeutic approaches they are using to support the client to improve their wellbeing whilst also recognising the strengths they already possess.

Explore further publications on mental health that help to understand mental health issues, key to supporting individuals and communities - on our hub for SDG 3 Good Health & Well-being.

Vickie Howard is Deputy Programme Director of the Mental Health and Wellbeing Practitioner Programme (Specialist Adult Mental Health) at the University of Hull, UK. Her research interest areas are clinical supervision, narcissistic abuse and  pathological relationships, psychologically informed interventions and mental health nursing pedagogy.

Dr Lolita Alfred is a Senior Lecturer in the School of Health and Medical Sciences at City St George’s, University of London. She is also a registered Mental Health Nurse with an interest in emotional wellbeing, and alcohol harm reduction across different settings, with diverse populations from preconception and across the lifespan.