by Michelle Danda, MN MPN RN CPMHN(C)
Globally psychiatric and mental health nurses have been struggling with a changing health care landscape in which large mental health institutions that once provided care for people diagnosed with mental illness are closing with the intention of community-based services and programs assuming care. The notion of mental illness is changing, with increased public motivation to destigmatize mental health issues like psychosis, depression, suicide, and addiction. A spotlight has been turned on the value of mental health professionals to provide care for people in crisis because of highly publicized atrocities like violence by police towards people of colour in mental health crisis, mental distress resulting from Covid-19 and the opiate poisoning crisis.
With the spotlight on mental health, the Canadian Federation of Mental Health Nursing is primed to take a lead in advocating for the integration and meaningful inclusion of mental health nursing in all levels of health care. However, a critical lens must be used to explore the history of mental health nurses in participating in some of the problems we now need to lead solving. A cohesive and engaging approach with the association members is required to understand where we have been as mental health and psychiatric nurses in Canada, and where we need to go to carve out our role in healthcare. We need to embrace our role as advocates and activists within our workplaces, making our knowledge and expertise known at the federal level.
Earlier this year nurse historian Kylie Smith from Emory University in Atlanta, Georgia published a book titled “Talking Therapy: Knowledge and Power in American Psychiatric Nursing”. She focused on psychiatric nursing from the 1930s to the 1970s. She highlighted the influences of social forces like the understanding of mental health in that era, relationships between nurses and other mental health professionals, and political forces of that time (for example World War II) on the development of psychiatric nursing in the United States. The underlying assumption of her perspective is that mental health and psychiatric nurses today approach their work and the institutions they function within as if they have always existed in their current form. Smith’s work emphasizes that American psychiatric nurses take for granted the history of ideas that inform their practice, and structure the system. Psychiatric and Mental Health nurses must understand that the current context of their workplace has shifted over time, the result of persistent pursuit by dedicated nurses to carve out of place in a system rife with constraints.
Asking Historically Focused Questions
Over my 13-year nursing career I have begun to see a nuanced healthcare system in which psychiatric and mental health nurses are still finding their footing. I began to wonder about the history of big influences on practice, like the mental health act, use of coercion in care, the gap between ideals of trauma informed and person-centered practice and actual practice that did not seem to fully embrace these ideals. I began to wonder about the rift between mental health nurses. But, I did not seriously pursue finding the answers to these questions until I took a nursing history course in my PhD studies.
Historical Perspective to Understand Mental Health Nursing
Nursing history courses are not routinely part of undergraduate nursing education. In discussion with my Registered Psychiatric Nursing (RPN) peers and in review of course curriculum at school that offer RPNs programs nursing history does not seem to be a stand-alone course. The absence of nursing history courses does not mean that understanding nursing history is not valuable. I would argue that more than ever we need to understand the history of mental health and psychiatric nursing in Canada because of important politically charged human rights movements taking place now, like Black Lives Matter, the calls for defunding of police, and calls for increased funding for mental health services. Where does psychiatric and mental health nursing in Canada fit with this? The does current model, that seems to reinforce a dichotomy between mind and body, mental and physical health best serve current health needs of people in Canada? Does this model help the discipline and profession of nursing gain clearer understanding of the role of mental health nursing and mental health nurses?
The value of a historical lens can be valuable in helping to unpack the taken for granted, bringing to light questions about the nature of underlying assumptions of mental health nursing (Smith, Brown, Crookes, 2015). We need to ask these questions to understand where we have been, and how it influences where our future is going. The value in understanding the history of the connection of mental health nursing to historical contexts now viewed as human rights atrocities that we want to forget, like eugenics and the mental hygiene movement (MacLennan, 1987) will help to clarify our role. By probing our history we can understand how concepts like recovery focused practice, trauma and violence informed care, and person and family centered can be translated from wishing thinking into direct care practice. Similarly we can see how mental health nursing extends beyond dedicated mental health spaces and into all nursing and healthcare practice. There is value in both exploring the history of mental health nursing in Canada, and including this knowledge in undergraduate nursing curriculum and professional development in the workplace.
MacLennan, D. (1987). Beyond the asylum: Professionalization and the mental hygiene movement in Canada, 1914–1928. Canadian Bulletin of Medical History, 4(1), 7-23.
Smith, K. M., Brown, A., & Crookes, P. A. (2015). History as reflective practice: A model for integrating historical studies into nurse education. Collegian, 22(3), 341-347.
Smith, K. (2020). Talking Therapy: Knowledge and Power in American Psychiatric Nursing. Rutgers University Press.