Mental Health Nursing Career And Competence Framework

Mental Health cesContentsAboutScope of the Framework transferability across the public, independent andvoluntary sectors that is not just NHS-focused; andThe Framework sets out to define the core competenciesat each level of the health career framework, whichcovers the registered mental health nurse at level 5,through senior roles at level 6, advanced practice atlevel 7, nurse consultant at level 8 and to the directorat level 9. indicative education and training for each level of thecareer framework for health, which will also assistmental health nurses to see what is required at eachlevel to progress.What is it not?What is a competency? The Framework is not a ‘roles’ framework, butdescribes the core competencies required by anindividual across the whole framework at each careerframework level.Within the Framework, a competency articulates therequired core knowledge, skills and behaviours thatindividuals need to bring to the workplace to be able towork at a certain level of practice. This is more than justbeing able to consistently perform to defined standardsin the workplace; it means also having the requiredunderpinning knowledge and the right attitudes andbehaviours to be able to undertake the role of a mentalhealth nurse. This enables the individual to work in bothstable environments with familiar and complex problemsand, beyond this, to work effectively in situations thatmay be complex and require flexibility and creativity, astheir career progresses. There is no automatic read-across from the NHSAgenda for Change pay bands to the careerframework levels; it instead concentrates on thecareer level competencies. This makes it more flexiblefor all organisations to use, whether in the public,independent or voluntary sector. The Framework does not describe individual roles,but concentrates on the core competencies requiredfor all roles across each level with a clinical focus,demonstrating the range of opportunity for careerprogression in mental health nursing.The Framework recognises competencies as having bothcombined and separate statements about the knowledge,skills and behaviours required to work at each level as amental health nurse.Related professional and regulatory frameworks andother key documents are listed in the bibliography (seeAppendix 3).What is a career framework? (See Appendix 1)A career framework provides:Structure of the Framework consistency – as an enabling tool that provides acommon, consistent language and currency to supportcareer development;The Framework will be organised around four pillars ofpractice and will be specific to mental health nursing.These are: a definition of the career level with characteristics andattributes ascribed to it that describe, for example, theamount of responsibility, complexity of thinking andlevel of decision making required;1.2.3.4. competence – the core competencies of knowledge,skills and behaviours required at each level;The emphasis on each pillar will vary according to thecareer framework level. progression – providing individuals with a means toarticulate their achievements and identify optionsavailable to develop their core knowledge andskills and progress their careers, both vertically andhorizontally within the same or into the next careerlevel;PreviousClinical practiceEducation and the facilitation of learningLeadership and developmentResearch, evidence and development.Mental health nurses can view the required corecompetencies and education requirements at each levelof the Framework and be able to plan careers and identifycontinuing professional development and education andtraining needs.7Next

Mental Health cesContentshelp to not only attract people into the profession butalso to retain current staff by demonstrating the careeropportunities available.Organisations can also utilise the core competencies ateach level as the basis to develop new individual rolesgoing forward, with the emphasis depending on the role.So, for example, a role requiring predominantly clinicalskills at each level will use mostly core competencies fromthe clinical practice pillar and a more leadership-focusedrole will utilise mostly competencies from the leadershippillar.Related competence, capability and career frameworksexist, both currently and in development, along with otherrelevant documentation such as related education andlearning. This new Framework is intended to complement,rather than replace, these.In turn, the Framework will assist education providers inunderstanding the core competencies required at eachlevel when designing learning programmes.Leadership in mental health nursingThe Framework has been developed by level, not by role,with the focus on the core set of competencies at eachlevel of the health career framework within mental healthnursing. So, the core competencies articulated have beenexpressed for level 5 through level 9 to demonstrate thatmental health nurses can progress to this executive leveland be the clinical expert beyond their own organisation.All levels demonstrate the clinical focus of mentalhealth nursing. Within the four pillars, a leadership pillararticulates the core competencies required at each level ofthe Framework for leadership.Who is the Framework for?The main audiences for the Framework are: Registered mental health nurses – both current andpotential future nurses; Managers and employers; Education and training commissioners and providers; Practice assessors;Progression can also be via leadership roles in mentalhealth, and mental health nurses may choose to followthis route. Practice supervisors; Nurse educators; and Academic assessors.There are numerous separate leadership frameworksand related education and training packages availablethat mental health nurses can follow. These will varydepending on the individual and their employer’spreference and are too numerous to list. This Frameworkhas not focused on the leadership pathway for careerprogression but on the core competencies within mentalhealth nursing for a clinical route.How the Framework relates to otherframeworksThe need for this framework arose from the requirementto bring together a range of information about mentalhealth nursing, focussing on the core competenciesrequired for each level of the health career framework,as well as articulating the unique selling point (USP)and uniqueness of being a mental health nurse. It willPrevious8Next

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Mental Health cesContentsWhat is the unique selling point(USP) and uniqueness of a career inmental health nursing?“Mental health nurses offer personcentred and evidence-basedtherapeutic interventions, create safeplaces of positive asylum and giveexpert professional help to those inmental distress and their families.”Mental health nursing is indeed a unique and variedprofession; however, MH nurses themselves often findit difficult to fully explain its uniqueness. Certainly,professional and therapeutic ways to create feelings ofsafety predominate in the literature:(Foundation of Nursing Studies, 2017)In developing this Framework, the views were soughtfrom many mental health nurses across the differentcareer levels on what had attracted them to enter,remain in and progress their career in the profession.We asked them what they would like to share withanyone thinking of entering mental health nursing,and with colleagues, about the opportunities forprogression in the field. Here are some of the thingsthey said:“I love that mental health nursing allows meautonomous decision-making and to work asan independent practitioner and that it is lesshierarchical and not task-led like other nursing.”“Mental health nursing must be one of the fewprofessions which really values your uniquenessas an individual – if you are curious, dynamic,and interested by the complexities of the humanmind, love talking to and helping people, are alistener and a thinker then it allows you a scope ofdevelopment and growth of self.”“I was inspired to become a mental health nurseas it reflects my personal values, social and ethicalviews on equality and diversity and wanted tomake a difference – I am still encouraged by thesame things that attracted me to the professionand by the positive change in the drive towardsparity of esteem for individuals.”“I entered mental health nursing because of thecollaboration, innovation, creativity and diversityof the role – I like people and working in a team andknowing that our work really does make a differenceto individuals’ lives and that of their family andcarers. When I see them recovering it is so rewardingto know ‘I contributed to that’.”“Mental health nursing is unique in that it has aholistic approach in treating the whole person andunderstanding their personal narratives usingtherapeutic skills to dig deeper. It is real patientengagement rather than just being ‘task-based’ –you don’t just ‘treat’ but help individuals grow aspeople and also enable them to have a voice tohold their mental healthcare in parity of esteemwith physical healthcare.”“I continually feel very privileged to be part ofpeople’s lives. There is no other job where I can beof use to others using the skills and experiencesthat make me me. It is an honour to work withother caring colleagues and with service usersand their families to make things better – it’s amarriage of head, heart and hands!”Previous10Next

Mental Health cesContents“Working collaboratively, forming a trustingrelationship with our patients to find hope in theirsituations, is the foundation of mental healthnursing.”“I like connecting with people across lifeexperiences from the mundane daily tasks of lifethrough to extremes of fear, distress, anger andelation and am really struck by the difference goodcommunication and compassionate nursing canmake.”“Mental health nursing is unique in that youare able to flex across professional boundaries,holding the multidisciplinary team together whilststill being a discreet part.”“Mental health nursing truly offers the opportunityto carve out a career that matches your interests,strengths and personal philosophy with the diversityand versatility of a huge range of different settings,areas of practice and branches you can work in.It also allows you to continue to progress [thecareer levels] and to move into other related areasin mental health nursing such as research andeducation, as well as higher level clinical practice orleadership.”“Mental health nursing is the best career you canhave – it enables you to engage people, seek advice,and the non-judgemental approach enables this.”“A career in mental health nursing allowscontinuous learning and development based on arobust evidence base – every day is different.”“It’s a rewarding career because you are helpingthe individual to understand their world and seektheir own solutions.”“I have worked in mental health nursing for 40years and would make the same career choiceagain!”“The service users with mental health difficultiesand problems are brilliant and are very rewarding towork with.”“Mental health nursing offers a career for life. As Ihave progressed [up the different levels] I remain amental health nurse to the core.”Previous11Next

Mental Health cesContentsAreas of practice withinmental healthbasic healthcare needs are met, or in an outpatienttherapy and daycare service.A career in mental health nursing provides theopportunity to work with a wide spectrum of ages andmental health needs, and in an extensive range of areasof practice, branches and different settings.Examplesare provided below, which are not intended to be anexhaustive list, but to give a flavour of the diversityavailable for a career in mental health nursing.Additional information: Royal College of Nursing. Mental health nursing NHS. Child and adolescent mental health servicesOlder peopleOlder people, like the wider population, may wellexperience mental health issues. These may be longstanding acknowledged mental health conditions ormore recent developments, such as depression relatedto bereavement, chronic conditions and dementia. Onein four people annually will experience mental healthdifficulties, that can often be mistakenly attributed tothe ageing process. Older people can find accessingservices that meet their needs difficult, but nurses are wellplaced to identify the impact of mental health difficultiesand signpost or support people to access the help theyneed. Increasingly, the divisions between mental andphysical health services are being overcome, and themultidisciplinary approach to care for older people meansmental health nurses have an increasing role in workingcollaboratively to improve mental wellbeing.Perinatal mental health (PNMH)PNMH problems are those that occur during pregnancyor in the first year following the birth of a child. Perinatalmental illness affects up to 20% of new and expectantmums and covers a wide range of conditions. There arenow specialist PNMH community services in all local NHSareas in England.Good quality, evidence-based perinatal mental healthcarepathways are shown to improve access to evidence-basedtreatment with greater detection and improved recoveryrates, improving outcomes for women, their children andthe family.Mental health nurses working in the specialist PNMHenvironment, whether that be in a mother and baby unitor in a specialist community team, have an opportunityto work with whole families, and concentrate especiallyon the pivotal attachment between parents and theirchildren, improving outcomes for not only this generationbut the next. Collaboration with maternity and healthvisiting colleagues, as well as a wider multidisciplinaryteam, makes this an especially cooperative role for themental health nurse.Mental health nurses will be skilled in recognising theeffects of mental health issues on the lives of older adultsand help them to gain assistance with the most healthbenefit.In addition to reducing the impact of mental healthproblems on daily activities, it is important that mentalhealth nurses also support older people in preventivestrategies.Additional information: Royal College of Nursing. Mental health in later eople/mental-health-in-later-lifeAdditional information: NHS England. Perinatal mental health: /Child and adolescent mental healthservices (CAMHS)Urgent and emergency careAn individual can experience a mental health crisis whenthey have feelings or experiences that feel very painful ordifficult to manage, which can include suicidal feelings,self-harm, panic attacks, flashbacks, psychosis (suchas paranoia or hearing voices) or other feelings. Somepeople feel in a crisis as part of ongoing mental healthissues, or due to stressful and difficult life experiencessuch as abuse, bereavement, addiction, money or housingproblems.CAMHS teams work with children and young peoplewho have mental health needs or difficulties with theiremotional or behavioural wellbeing. Young people andtheir parents and carers receive direct support.Mental health nurses are trained to care for and supportyoung people. This could be in an inpatient care unit andinvolve the general day-to-day running of the unit, as wellas delivering clinical and therapeutic support, ensuringPrevious12Next

Mental Health cesContentsExperiencing mental distress and a deteriorating mentalstate requires urgent care to prevent a decline in themental state that can result in harm.adequate nutritional intake. In addition, they will helpindividuals to develop a more realistic and self-affirmingbody image and help educate family members on theirrole in recovery maintenance.The mental health nurse can provide crisis support. In theimmediacy, A&E liaison, walk-in centres and street triagestaff are able to provide ‘blue light’ responses to mentalhealth crises. Further assessment and ongoing support isprovided more often at home, which could be as part ofa community crisis resolution team, who may also offerintensive home-based treatment. This support enablesindividuals, who may otherwise have gone into hospital,to remain in their home or elsewhere in the communitysuch as a crisis house offering short-term support, or aday centre. Such crisis support can also help individualsalready in hospital to be discharged more quickly. Supportcan include assisting with self-help strategies, medication,practical support with housing and childcare, and careplanning to prevent this happening again. Mental healthnurses are increasingly based in GP surgeries and othersettings such as hospital A&E departments.Additional information: Mental Health UK. Eating disordersAddictionsThere are many areas where individuals developaddictions. Devastating socioeconomic consequencesof addictions to gambling and debt are only justbecoming fully recognised, alongside the psychologicalconsequences. Mental health nurses are providing careand treatment in specialist teams, together with theircolleagues offering help for perhaps the more commonlyknown problematic alcohol and drug misuse. Manyindividuals have ‘dual diagnoses’, where addictionproblems are formally recognised alongside other mentalhealth problems.Mental health nurses can work in many settings, suchas primary and secondary care, A&E departments, policecustody suites, prisons, needle and syringe programmes,and homelessness services. Nurses working in addictionservices can make positive contributions to achieving arange of health and social care outcomes by delivering aseries of interventions which, alongside evidence-basedpsychological interventions, can also include: physicaland mental health triage, assessment and care – nursescan bring enhanced awareness of mental and physicalhealth comorbidities; the management of infectionsand adverse effects relating to poor injecting practice;hepatitis B vaccination and blood-borne virus (BBV)testing; dispensing, monitoring and reporting on effectsof medicines (with non-medical nurse prescribers beingable to prescribe medicines); the identification andmanagement of alcohol-related liver disease; and themanagement of alcohol-related dementia.Outside of the crisis response, mental health professionalsnow routinely occupy roles within acute physical caresettings. Liaison teams provide advice, support andeducation within physical care environments, and mentalhealth nurses are employed in the majority.Additional information: Case study of a mental health nurse working in a crisisteam – Jill Lewis, mental health nurse: s-storiesEating disordersAn eating disorder is when a person’s eating habits andrelationship with food become difficult, affecting physicalhealth, and can also be detrimental both emotionally andsocially. The most common eating disorders are: anorexianervosa (restricted food intake and/or excessive exercise),bulimia nervosa (binge eating followed by deliberatepurging), and binge eating disorder (BED) (episodes ofovereating in a short space of time). Eating disordersoften occur alongside other mental health conditions,such as anxiety, depression, panic disorder, obsessivecompulsive disorder and substance misuse disorders.Additional information: Royal College of Nursing (RCN) and Public HealthEngland (2017). The role of nurses in alcoholand drug treatment services: A resource forcommissioners, providers and cliniciansMental health nurses can assess, treat, develop care plansand carry out reviews for individuals. Settings in whichthey work include an outpatient, community-based, ageappropriate eating disorder service, medical inpatient orday patient service for medical stabilisation and to ensurePrevious13Next

Mental Health icesContentsLevelsThe competencies and education indicative minimumprofessional/educational and training requirements for levels 5–9Level 5Overviewmake sense of their experiences in a way that

Mental Health Nursing Introduction The Framework assists both people considering entering the mental health nursing profession and existing mental health nurse registrants to see how they can gain additional, clearly defined core competencies to enable them to progress in their careers, and to see that this is an inspiring career.