Psychiatric and Mental Health Nursing The craft of caring 2ND EDITION

Psychiatric and Mental Health Nursing The craft of caring 2ND EDITION Psychiatric and Mental Health Nursing The craft of caring Second edition This page intentionally left blank Psychiatric and Mental Health Nursing The craft of caring Second edition Edited by Phil Barker PhD RN FRCN Honorary Professor, University of Dundee, Scotland PART OF HACHETTE LIVRE UK First published in Great Britain in 2003 by Hodder Arnold This second edition published in 2009 by Hodder Arnold, an imprint of Hodder Education, part of Hachette Livre UK, 338 Euston Road, London NW1 3BH © 2009 Edward Arnold (Publishers) Ltd All rights reserved. Apart from any use permitted under UK copyright law, this publication may only be reproduced, stored or transmitted, in any form, or by any means with prior permission in writing of the publishers or in the case of reprographic production in accordance with the terms of licences issued by the Copyright Licensing Agency. In the United Kingdom such licences are issued by the Copyright Licensing Agency: Saffron House, 6–10 Kirby Street, London EC1N 8TS. Hachette Livre UK’s policy is to use papers that are natural, renewable and recyclable products and made from wood grown in sustainable forests. The logging and manufacturing processes are expected to conform to the environmental regulations of the country of origin. Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. For these reasons the reader is strongly urged to consult the drug companies' printed instructions before administering any of the drugs recommended in this book. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN 978 0 340 94763 0 1 2 3 4 5 6 7 8 9 10 Commissioning Editor: Naomi Wilkinson Project Editor: Clare Patterson Production Controller: Andre Sim Cover Designer: Laura DeGrasse Index: Liz Granger Artwork: Charon Tec Ltd Cover image: ‘After the fall’ by Phil Barker (1970). Courtesy of ‘The Charlie Barker Collection (Glasgow)’. Typeset in 9.5/12 Berling by Charon Tec Ltd., A Macmillan Company. () Printed and bound in Spain This book is dedicated to the memory of Mike Consedine (1940–2008) – psychiatric nurse, poet and psychodrama therapist. Mike inspired many psychiatric nurses to embrace the most powerful kind of human helping in their work. Through his pioneering work in clinical supervision, he also helped nurses know themselves better, so that their true humanity might flower. It was my privilege to count him as a friend. There was nothing ‘worth doing’ that Mike would not do himself. Such ‘living by example’ will prove his enduring legacy as a teacher. I hope that readers of this book will discover the virtue of that same lesson in their own lives. This page intentionally left blank Contents List of contributors xiii Poem: The Cleansing has Begun xvi Gary Platz The Space I’m in xvii Mike Consedine Poem: Half dead xviii Mike Consedine Preface to the second edition xix Phil Barker Acknowledgements xxi Section 1 THE NEED FOR NURSING Preface to Section 1 Phil Barker 2 1 The nature of nursing 3 Phil Barker 2 Getting personal: being human in mental health care 12 Phil Barker and Poppy Buchanan-Barker 3 The care and confinement of the mentally ill 21 Liam Clarke 4 Evidence-based practice in mental health 30 Hugh McKenna 5 The craft of psychiatric–mental health nursing practice 37 Peter Wilkin 6 Leading developments in the craft of caring 45 Angela Simpson 7 Recovery: a personal perspective 51 Irene Whitehill 8 Recovery and reclamation: a pilgrimage in understanding who and what we are 58 Anne Helm Section 2 ASSESSMENT IN PRACTICE Preface to Section 2 Phil Barker 66 9 Assessment: the foundation of practice 67 Phil Barker 10 Assessment methods 75 Phil Barker 11 The craft of interviewing 85 Phil Barker 12 Developing collaborative assessment 95 Tom Keen 13 The context of family assessment 105 Evelyn Gordon and Chris Stevenson 14 The assessment of feelings, thoughts and beliefs 113 Mark Philbin Section 3 THE STRUCTURE OF CARE Preface to Section 3 Phil Barker 122 15 Psychiatric diagnosis 123 Phil Barker 16 Psychiatric diagnosis: living the experience Yvonne Hayne 133 17 Nursing diagnosis Dianne Ellis 141 18 Collaboration with patients and families Tom Keen and Richard Lakeman 149 Section 4 SPECIFIC NEEDS FOR NURSING Preface to Section 4 Phil Barker 164 19 The person who experiences anxiety Eimear Muir-Cochrane 165 20 The person who experiences depression Ian Beech 173 21 The person who is suicidal Elaine Santa Mina and Ruth Gallop 182 22 The person who self-harms Ruth Gallop and Tracey Tully 191 23 The person who hears disturbing voices Cheryl Forchuk and Elsabeth Jensen 199 24 The person who experiences disturbing beliefs Elsabeth Jensen and Cheryl Forchuk 206 25 The person with a diagnosis of schizophrenia Tom Keen and Phil Barker 213 26 The person who appears aggressive or violent Eimear Muir-Cochrane 230 27 The person with a diagnosis of bipolar disorder Ian Beech 237 28 The person with a diagnosis of personality disorder Marie Crowe and Dave Carlyle 244 29 The person who experiences mental health and substance use problems Philip D. Cooper 252 30 The person who appears paranoid or suspicious Denis Ryan 262 31 The person with experience of sexual abuse Mike Smith 269 32 The person with an eating disorder Rachel A. Keaschuk and Amanda S. Newton 278 33 The person who is homeless Paul Veitch 286 34 The person with dementia Trevor Adams 293 35 The person with a diagnosis of autism Andrew Cashin 303 Section 5 SOME MODELS OF THERAPEUTIC PRACTICE Preface to Section 5 Phil Barker 312 36 Developing therapeutic one-to-one relationships Bill Reynolds 313 37 Developing empathy Bill Reynolds 321 38 Groupwork with children and adolescents Sue Croom 330 39 Psychodynamic approaches with individuals Brendan Murphy 338 40 Psychodynamic approaches to working in groups Phil Luffman 345 41 Using counselling approaches Philip Burnard 355 42 Bereavement and grief counselling Clare Hopkins 362 43 Cognitive–behavioural therapy Paul French 370 44 Using solution-focused approaches Denise Webster 377 45 Mindfulness Mary E. Campbell 384 46 Therapeutic communities Gary Winship 393 Section 6 THE ORGANIZATION OF CARE Preface to Section 6 Phil Barker 402 47 The acute care setting Angela Simpson 403 48 The psychiatric intensive care unit: coercion, control or care Cheryl Waters and Andrew Cashin 410 49 Mental health nursing in community care Denis Ryan 418 50 Crisis assessment and resolution Clare Hopkins and Julie Mackenzie 426 51 Assertive outreach Mervyn Morris and Mike Smith 434 52 Family support: growing the family support network Chris Stevenson and Evelyn Gordon 444 53 The liaison psychiatric service Chris Hart 454 54 Services for people requiring secure forms of care: a global problem Colin Holmes 463 55 Services for children and young people Sue Croom 477 56 Services for older people with mental health conditions Trevor Adams and Elizabeth Collier 486 57 Early interventions in psychosis Paul French 493 58 Services for women Penny Cutting 501 59 Services for asylum seekers and refugees Nicholas Procter 508 Section 7 SOME STANDARDIZED PROCESSES OF NURSING PRACTICE Preface to Section 7 Phil Barker 518 60 Admission to a psychiatric unit Angela Simpson and Jerome Wright 519 61 Assessing risk of suicide and self-harm John Cutcliffe 527 62 Engagement and observation of people at risk John Cutcliffe 536 63 Record-keeping Martin F. Ward 545 64 Discharge planning Martin F. Ward 553 65 The nurse’s role in the administration of electroconvulsive therapy Joy Bray 560 66 Mental health promotion and prevention Jon Chesterson 571 67 Mental health nurse prescribing Steve Hemingway and David Scarrott 586 Section 8 LEGAL, ETHICAL AND MORAL ISSUES Preface to Section 8 Phil Barker 596 68 Mental health, the law and human rights Michael Hazelton and Peter Morrall 597 69 Ethics and nursing Richard Lakeman 607 70 Sexuality and gender Agnes Higgins 618 71 Freedom and consent Alec Grant 626 72 Providing culturally safe care Anthony J. O’Brien, Erina Morrison and Ruth DeSouza 635 73 Spirituality, nursing and mental health Stephen G. Wright 644 Section 9 THE DEVELOPMENT OF MENTAL HEALTH NURSING Preface to Section 9 Phil Barker 654 74 Clinical supervision Peter Wilkin 655 75 The possibility of genuine mental health nursing Lyn Gardner and Gary Rolfe 664 76 Building practice from research Mark Fenton 672 77 Reclamation: beyond recovery Poppy Buchanan-Barker 681 Section 10 THE FUTURE OF PSYCHIATRIC AND MENTAL HEALTH NURSING IN CONTEXT Preface to Section 10 Phil Barker 692 78 The United Kingdom context Jon Allen 693 79 The European context Seamus Cowman 698 80 The Japanese context Mami Kayama 707 81 The United States context Shirley A. Smoyak 710 82 The Canadian context Nancy Brookes, Margaret Tansey and Lisa Murata 716 83 The Australian and New Zealand context Jon Chesterson, Michael Hazelton and Anthony J. O’Brien 721 84 The politics of caring Phil Barker 731 Index 741 This page intentionally left blank List of contributors Trevor Adams MSc PhD RN Cert Ed Lecturer, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK Jon Allen EN RMN BA (Hons) MSc MBA Director of Nursing and Clinical Governance, Oxfordshire, UK Phil Barker PhD RN FRCN Honorary Professor, University of Dundee, Dundee, UK Ian Beech MA BA (Hons) RMN RGN PGCE Head of Mental Health Division, University of Glamorgan, Pontypridd, UK Joy Bray RN RMN ENB650 RNT MA PhD Mental Health Specialist Nurse, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Nancy Brookes RN MSc(A) CPMHN(C) PhD Nurse Scholar, Royal Ottawa Health Care Group, Ottawa, ON, Canada Poppy Buchanan-Barker Director, Clan Unity International, Fife, UK Philip Burnard PhD RN Professor of Nursing, Cardiff School of Nursing and Midwifery Studies, Cardiff University, Cardiff, UK Mary E. Campbell RN MSN CS Psychiatric Mental Health Clinical Nurse Specialist, Capital District Mental Health Program; Adjunct Professor, School of Nursing, Dalhousie University, Halifax, NS, Canada Dave Carlyle RcompN PG DipHealSc Lecturer, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Andrew Cashin RN MHN NP DipAppSci BHSc GCert PTT MN PhD FACMHN Associate Professor Justice Health Nursing, The University of Technology Sydney, Faculty of Nursing, Midwifery and Health, Sydney, NSW, Australia Jon Chesterson RN MHN DipCPN BAppSc FACMHN MRCNA Promotion & Prevention, Hunter New England Mental Health, NSW, Australia Liam Clarke DipNurs DipEd DipTheol DipMed Phil BA MSc MA PhD Reader in Mental Health, University of Brighton, Eastbourne, UK Elizabeth Collier BSc RMN MSc PGCE Lecturer in Mental Health, University of Salford, UK Philip D. Cooper RN AdvDip MSc Practice Educator, Suffolk Mental Health Partnership NHS Trust, Education and Workforce Development, St Clements Hospital, Ipswich, UK Seamus Cowman PhD MSc FFNMRCSI DipN (London) RNT RPN RGN Professor, Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland Sue Croom PhD MSc BA (Hons) RN HV PGCUTL Senior Lecturer/Research Fellow, Northumberland and North Tyneside Mental Health Trust, Berwickshire, UK Marie Crowe RN PhD Associate Professor, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand John R. Cutcliffe RMN RGN RPN RN BSc (Hon) Nrsg PhD David G. Braithwaite Professor of Nursing, University of Texas (Tyler); Adjunct Dean Psychiatric Nursing, Stenberg College, Vancouver, Canada; Visiting Professor, University of Ulster, UK Penny Cutting RGN RMN BSc (Hons) Nursing MA Counselling and Psychotherapy Clinical Co-ordinator/ Women’s Lead, Croydon Adult Integrated Mental Health Services, Bethlem Royal Hospital, Beckenham, UK Ruth DeSouza DipNurs Grad DipAdv Nurs Prac MA Centre Co-ordinator/Senior Research Fellow, Centre for Asian and Migrant Health Research, National Institute for Public Health and Mental Health Research, AUT University Te Wananga Aronui o Tamaki Makau Rau, Auckland, Aotearoa/New Zealand Dianne Ellis RMN PGCE MSc Senior Lecturer Mental Health, Centuria Building, Teesside University, Middlesbrough, UK Mark Fenton RMN MA Editor – Database of Uncertainties about the Effects of Treatments (DUETs), James Lind Initiative, Oxford, UK Cheryl Forchuk RN BA BScN MScN PhD Professor, University of Western Ontario; Assistant Director & Scientist, Lawson Health Research Institute, London, ON, Canada xiv List of contributors Paul French RMN PhD Psychology Services, Mental Health Services of Salford, Manchester, UK Ruth Gallop RN PhD Professor Emeritus, Faculty of Nursing, University of Toronto, Toronto, ON, Canada Lyn Gardner RMN PGCEA BSc MSc Lecturer, School of Health Science, Swansea University, Swansea, UK Evelyn Gordon MSc (Psychotherapy) MSc (Systemic Management) RPN Lecturer in Mental Health and Psychotherapy, School of Nursing, Dublin City University, Dublin, Ireland Alec Grant PhD MA BSc PGCTLHE Cert Res Meth RMN, ENB650 Cert Principal Lecturer, University of Brighton, Eastbourne, UK Chris Hart MA RMN RGN Nurse Consultant in Liaison Psychiatry and Principal Lecturer, School of Nursing, Faculty of Health & Social Care Science, Kingston University & St George’s University of London, London, UK Yvonne Hayne RN BScN MEd PhD Faculty of Nursing, University of Calgary, Calgary, AB, Canada Michael Hazelton RN BA MA PhD FACMHN Professor of Mental Health Nursing and Head of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW, Australia Anne Helm BEd Consumer Consultant and Educator, Aorearoa/NewZealand Steve Hemingway RMN V300 BA (Hons) MA (Couns) PGDE Senior Lecturer in Mental Health, Department of Health and Human Sciences, University of Huddersfield, Huddersfield, UK Agnes Higgins PhD MSc BNS RNT RPN RGN Associate Professor of Mental Health Nursing, Trinity College, Dublin, Ireland Colin A. Holmes BA (Hons) MPhil PhD Professor of Nursing, School of Nursing Sciences, Midwifery & Nutrition, James Cook University, Townsville, QLD, Australia Clare Hopkins RMN MSc MA Primary Care Mental Health Worker, Newcastle Primary Care Trust, UK Elsabeth Jensen RN PhD Assistant Professor, School of Nursing, York University, Toronto, ON, Canada Mami Kayama RN PHN MN PhD Professor, St Luke’s College of Nursing, Tokyo, Japan Rachel A. Keaschuk PsyD Rpsych Psychologist, Pediatric Centre for Weight and Health, Stollery Children’s Hospital, Edmonton, AB, Canada Tom Keen RMN RNT MSc Formerly Senior Lecturer, University of Plymouth Institute of Health Studies, Exeter, UK Richard Lakeman DipNsg BN BA (Hons) PGDip (Psychotherapy) Doctoral Candidate JCU Lecturer, School of Nursing, Dublin City University, Dublin, Ireland Philip Luffman RMN Dip Gp Psych Hywel Dda NHS Trust, West Wales, UK Hugh P. McKenna CBE PhD BSc (Hons) RMN RGN RNT DipN (Lond) AdvDipEd FFN RCSI FEANS FRCN Professor and Dean, Faculty of Life & Health Sciences, University of Ulster, Coleraine, UK Julie Mackenzie RMN CPN Cert Cert Family Therapy Dip Social Work and Social Policy MA in Systemic Practice Nurse Consultant Crisis Service, Ravenswood Clinic, Newcastle upon Tyne, UK Peter Morrall PhD MSc BA (Hons) PGCE RN Senior Lecturer in Sociology and Health, School of Healthcare, University of Leeds, Leeds, UK Mervyn Morris RN Professor of Community Mental Health, Centre for Community Mental Health, Birmingham City University, Birmingham, UK Erina Morrison RCpN BHSc MN Clinical Nurse Director, Nursing, Mental Health and Addiction Health, Waikato, Hamilton, New Zealand Eimear Muir-Cochrane BSc (Hons) RN RMN Grad Dip Adult Education MNS PhD FACMHN Professor of Nursing (Mental Health Nursing), School of Nursing and Midwifery, Flinders University, Adelaide, SA, Australia Lisa Murata RN BScN MEd CPMHN(C) CSFT Clinical Nurse Educator, Royal Ottawa Mental Health Centre, Ottawa, Canada List of contributors Brendan Murphy MA RMN South Trent Training Dynamic Psychotherapy, Department of Psychotherapy, Derbyshire Mental Health Service Trust, UK Amanda S. Newton PhD RN Assistant Professor and Clinician Scientist (Child and Adolescent Psychiatry), Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Anthony J. O’Brien RN BA Mphil Senior Lecturer, Mental Health Nursing; Nurse Specialist, Liaison Psychiatry, School of Nursing, University of Auckland, Auckland, New Zealand Mark Philbin RPN DipN (Lond) BSc MA Lecturer in Nursing, School of Nursing, Dublin City University, Dublin, Ireland Gary Platz Strategic Advisor, Wellink Trust, Wellington, New Zealand Nicholas G. Procter PhD Grad Dip Adult Ed BA RPN RGN CertAdvClinNsg (SACAE) MACMHN MRCNA FGLF Associate Professor, School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia William J. Reynolds RN PhD Former Reader in Nursing, University of Stirling, and Turku University of Applied Sciences; currently Freelance Educator and Researcher, Salo, Finland Gary Rolfe RMN PGCEA PhD MA BSc Professor of Nursing, School of Health Science, Swansea University, Swansea, UK Denis Ryan PhD BSc RPN RGN CAC Cert BT Dip Prof Studies Senior Lecturer, Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland Elaine Santa Mina RN BA BAAN MSc PhD Associate Professor, Ryerson University, Toronto, ON, Canada David Scarrott RGN RMN V300 BA (Hons) Team Manager, Crisis Resolution and Home Treatment Team, Rotherham, UK Angela Simpson RMN BA MA PGCE PhD Lecturer in Mental Health/Research Fellow, University of York, York, UK Mike Smith RMN BSc (Nurs) MA PhD Director, CrazyDiamond, Shirley A. Smoyak RN PhD FAAN Professor II at Rutgers, the State University of New Jersey; Professor, Continuous Education & Outreach, Edison, NJ, USA Chris Stevenson RMN BA (Hons) MSc PhD Chair in Mental Health Nursing, School of Nursing, Dublin City University, Dublin, Ireland Margaret Tansey RN MSc(A) CPMHN(C) Vice President Professional Practice and Chief of Nursing Practice, Royal Ottawa Health Care Group, Ottawa, Canada Tracey Tully RN MSc PhD Independent Consultant, Toronto, Canada Paul Veitch RMN MSc Team Manager and Senior Nurse, Early Intervention in Psychosis Service, Newcastle & North Tyneside Trust, Newcastle upon Tyne, UK Martin F. Ward RMN DipNurs RNT Cert Ed NEBSS Dip Mphil Independent Mental Health Nursing Consultant and Coordinator of Mental Health Nursing Studies, University of Malta, Cheryl Waters RN BSc (Hons) PhD MACMHN MCN Senior Lecturer, Faculty of Nursing Midwifery and Health, University of Technology, Sydney, Australia Denise (Denny) Webster RN PhD CS Professor Emerita, University of Colorado at Denver and Health Sciences Center, Denver, CO, USA Irene Whitehill BSc PhD Independent User Trainer and Consultant, Section 36, Northumberland, UK Peter Wilkin RMN MA Formerly Clinical Nurse Specialist with the Complex Cases Mental Heath Team in Rochdale, UK Gary Winship PhD MA RMN Dip Gp Psych Associate Professor of Human Relations, University of Nottingham, School of Education, Nottingham, UK Jerome Wright MSc RGN RMN PGCE Lecturer, Department of Health Sciences, University of York, York, UK Stephen G. Wright MSc RN RCNT RNT DipN DANS RPTT FRCN MBE Chairman and co-founder of the Sacred Space Foundation, Associate Professor, Faculty of Health and Social Care at the University of Cumbria, Carlisle, UK The Cleansing has Begun Chest deep in the Wainuiomata stream Earth’s energies combine with mine Me the mighty super-conductor Here to do God’s will Yes, the cleansing has begun With Jehovah’s name reverberating from the hills Wainui’s demons go screaming to the abyss Ah Wainuiomata, New Jerusalem River of life The cleansing has begun The cries of my disciples from the asylums of the world Keep tearing at my soul Hold on my followers, I’m coming The cleansing has begun Strapped to a sterile bed Spiritual poison in my veins Encrusting my heart, fogging my head I’ll keep fighting, my disciples The cleansing has begun Through days of haze Hospital food I keep sitting, A god hunched Looking for answers on the wall Through days of haze Hospital food I see the answer It’s written in their eyes I’m no god Just a fool Raped by heart and soul The cleansing has begun Then a power to be Said you may go free (I’ll be tethered to him With a chemical chain) Oh try to get yourself a job The cleansing has begun Through days of haze Timeless sleep I lick my violated brain Ah Wainuiomata The cleansing has begun Somehow I am much better now I have taken that to be’s advice I’m searching the papers Up dated my c.v. Brought myself some shoes Hey, wait a minute You, out there Do you have an opening For a part time god The cleansing has begun Gary Platz Gary Platz is Strategic Advisor, Wellink Trust, New Zealand. Gary has been involved in the service user movement since 1993. He is an advocate of peer services and has been successful in the setting up of several peer services including a peer recovery house, which is an alternative to acute hospitalization. He is a poet and writer of short stories. The Space I’m in Mike Consedine* Recently, I have been privileged to sit in the small garden at the rear of our house nearly every day. It is warm and sheltered here, and a small rock pool provides the soothing sound of running water. Apart from the low hum of distant traffic nothing much else disturbs. So I can experience the flowers growing, the insects buzzing, the birds chirping, the cat sleeping, and of course the water. Such a special honour. This time to be with myself. And in that time experiences buried deep have an opportunity to emerge, flooding my senses with feeling beyond expression: with life that had seemed lost forever. And I know again the passion I have for the experiences of being alive. Sitting with this I see my social atom: the network of significant relationships both past and present, surrounding me. What riches! My wife, my former wife and our children, my brothers and sister, friends – relationships that have developed over many years, and colleagues with whom I have been intimately involved, as we strive to make a better world. All here, in my social atom. And I know without doubt that this was all generated in my family of origin – my mother and father and the wider whãnau.a And as I sit with this I feel the tears again: tears of gratitude for the good people they were/are. Not famous, just good. Doing what good people do; loving those around them and committing themselves without fuss to helping all. These values are embedded in the current social atom which surrounds me and is my life. In this place I cannot fail. Like Jean Valjean I know who I am and that allows me to live with dignity, and the comfort of truth. I know that values, like most truths in life, are not taught, they are developed. They are developed through good doubling, mirroring, modelling, role reversal and discussion. Through these processes they are internalized and their life conserved. They are the cornerstones. They inform the roles we enact in the world. Personality may be thought of as a series of roles and role systems. In a healthy individual life, development is always a work in progress. When I wept over my inadequacies as a parent, Harry, my old therapist, would always say ‘every day is an opportunity to do it differently’. There is no need to keep on recreating the original social atom. Poetry enables me to do it differently. Through it I am able to express myself fully in the world without self- aggrandisement, self-pity or harm to others. It’s just the way things are for me at any given moment. It may express my delight and joy, or my sorrow anger and despair. The expression of who I am enables a full life. And I do want a full life. Christchurch, New Zealand 3rd April 2007 *Mike Consedine was one of New Zealand’s most respected psychiatric nurses. He had previously worked as a probation officer and then developed a successful career in psychodrama, operating an Independent Training Consultancy based in Christchurch, New Zealand. Mike was a past President of the Australian and New Zealand Psychodrama Association. a Wh˜anau (Maori): extended family. Half dead Sometimes he awoke aware only that he was half dead. his body lay side on half buried in the rubbish tip his mouth and throat were full of decay seagulls circled awaiting their turn to feast. the early morning light boosted the smell and the soft breeze increased reflected light half his head was dead and he did not know what to do except persevere. Mike Consedine March 2007 Christchurch, New Zealand Preface to the second edition George Bernard Shaw said ‘The only man I know who behaves sensibly is my tailor; he takes my measurements anew each time he sees me. The rest go on with their old measurements and expect me to fit them.’ The same is true of the world in which we live. It keeps changing, growing in some ways and shrinking in others. We, the inhabitants of that world, need to understand this, if we are to adapt ourselves to fit our changing circumstances. There has been a lot of growth and perhaps some significant shrinkage, since we published the first edition of The craft of caring. Economics and its obsession with cost containment continues to dominate most services, and science and its fascination with evidence continues to tantalize us. What we would like to do, we cannot afford; and what we have been doing, apparently successfully, for a long time, we find has no proper ‘evidence base’. What to do? In the Western world, economics continues, ironically, to dominate the agenda, pushing the demand for more ‘evidence’ and a stronger scientific base for practice. In the rest of the world, we have finally woken up to the fact that everyone experiences the kinds of problems in living called ‘mental illness’ in the West, but we may call them by different names or give them a different significance. Slowly, we are beginning to ask how do people in war-torn or economically ravaged countries cope with such problems. And, where do nurses fit into this picture, if at all. Although the catalogue of ‘mental disorders’ has grown, in leaps and bounds, since attempts were first made to classify ‘insanity’ a century ago, no ‘new’ forms of mental disorder have been added to the list in the past 15 years. However, all around us, ‘mental health problems’ appear to be on the increase, especially in affluent countries. We appear to have no end of resourcefulness in developing new ways of expressing misery and despair, fear and trembling. Is this to do with the pressures we impose upon ourselves, which we now call stress? Or is this to do with the sheer artificiality of our lives. Who knows? However, the more affluent a society becomes, the more miserable and angst ridden it also becomes. Little wonder so many seek the dream of a simpler life. In this second edition, we have tried to reflect some of the changing world we see around us, not least within the field of nursing itself. All the original chapters have been revised and updated and we have added around a dozen new chapters, covering important new developments in mental health care or exploring areas of practice that represent a refinement of some of the key concepts in nursing practice. We have extended our consideration of the naming of psychiatric disorders, trying to help the reader gain a sense of history but also an appreciation of what it might mean to receive a psychiatric diagnosis. In keeping with our core aim – to explore the concept of the craft of caring – we keep the focus on people and persons. How does diagnosis affect people? The person with a diagnosis of autism has attracted a lot of public attention in the past few years, with a number of books written by people with different experiences of the autistic spectrum. Autism is a classic challenge for mental health nurses, since the people concerned have a very unusual concept of ‘mind’. Mental health nurses could extend themselves greatly by exploring how to respond to people with autism. We have also developed the section on services, by including liaison psychiatry, therapeutic communities, services for the older person, nurse prescribing and services for women. These represent exciting examples of how nurses are rising to the challenge of developing more innovative care, or trying to find new ways of ensuring that people too receive personally meaningful care, whatever their situation. The focus on rights is developed further in a new chapter on the support of refugees and asylum seekers – two groups of people found now in every developed country on earth. The special problems encountered by these groups will stretch mental health nurses, and may also, in time, help them understand better the needs of people experiencing other forms of exclusion or marginalization. We have also revised substantially the chapter on the law and mental health care, providing readers with not only a history of the development of ‘mental health legislation’ but also an appreciation of how this differs from one country to the next. Finally, we have included a vital consideration of the concept of spirituality, conspicuously absent from the first edition. Given that the original mission of psychiatry was to study the soul or spirit, it seems fitting that nurses are finally turning their attention to this, the most abstract aspect of our common humanity. This edition is significantly bigger than the first, but I hope, despite its size, that it retains a sense of human scale. It is all too easy to lose sight of the person, the family and the community of origin. It is all too easy to be overwhelmed by the sheer volume of concepts, theories, models, principles and various practices. I hope that you will find that the person makes an important appearance on every page of this book. Perhaps this anonymous person will become your guide, helping you to explore the text, with a view to clarifying your own concept of ‘the craft of caring’. Phil Barker Newport on Tay, Scotland This page intentionally left blank Acknowledgements Grateful thanks to Clare Patterson and Naomi Wilkinson at Hodder Arnold for all their support during the preparation of this second edition, and to all the authors for their commitment to the book and to the mental health field. This page intentionally left blank