I cannot accept that the current way that mental health care is done is the best that it can be. I have tiny (sometimes larger) existential crises about the work I do in mental health fairly regularly at this point, sometimes daily. And, I would say it has transcended from a place of moral distress to a place of assertive questioning, frequently, to ponder what is and what can change.
I am on an ever-twisting and turning roller coaster that picked up an immense amount of speed when I started my nursing PhD last fall. (Is this good or bad? We will not know until I am at the end of the journey and I can reflect back on what this means in the context of my life.) I get now what the academics say about evidence, and value of it. What is evidence, really? I am increasingly supportive of the notion that, as nurses, in order to do better, as a cohesive group of a practice oriented discipline, then we have to think about the philosophy of a discipline. And, think about it I have been. And, I get why nursing needs to be more like a bull in a China shop rather than a wallflower at a dance to make positive change, not only the health care system, but in the larger social systems. If that is not our destiny, then what are we (the royal we) all doing here?
We make a lot of assumptions about the evidence and the science being able to pave the way for success, if only we were able to more quickly connect the evidence to practice. But, what is success and how do we measure it? In a weird neo-liberal driven world dominated by one way of knowing, how do we know? Is it through something we have to quantify and measure? What if the premise is wrong? What if our assumptions are wrong? What if what we are looking at as evidence is not a neutral body of knowledge from which we build guidelines and practices? What if it is thoroughly basted and baked in a structure and system that prioritizes certain ways of knowing, and certain knowledge holders are more credible than others? Who’s voices are heard? Who’s voices are silenced?
In order to identify the challenges and issues someone is having with their life, don’t we have to ask them about it? Is this how the system is organized…to embrace the notion of person as collaborator and partner in their care? If yes, how? How do we know this is so? If no, then what are we doing?
Re-conceptualize. Is it valuable to contextualize the problems, the highlights, the low points, the needs, the wants, the confusion, the challenges, in someone’s life so that we have clear understanding of what they want to improve so that we can help them with this? Is what I want in this relationship important? Should it be?
Perhaps, when someone uses substances, the challenges that they have in their life are not caused by the substance use. Is it possible that the relationship is complex? So…is the problem substance use or is it multifaceted, and connect to the context of a specific person’s life? I wonder, to what extent clinical documentation and the talk of the person who is receiving mental health and substance use services reflects problems or strengths? And, to what extent the problems that are identified are those that are relevant to the person, or those that are labelled as problematic because of the overarching social norms that exist within the greater social context? Can the people working within a interdisciplinary health care team build therapeutic alliance by being invested in learning about the person and hearing their story, learning that narrative, and not just limiting it to before they go to the service. What is the value in continuing to listen to that narrative and build that narrative, understanding that it is co-constructed? Is there value to this?
When do we take a step back and ask, is what we are doing in practice matching what we believe in theory? When we ask this question we have to first understand what we think we are doing in theory. And, when we ask these questions the best best, most useful answers may not be found in the form of a patient satisfaction survey or a job satisfaction interview. How do we know if theory matches practice unless we conceptualize what the theory we are talking about looks like when happens in practice, and then we look at the actual practice? These are not new or revolutionary ideas. Barker and Buchanan-Barker (2011) published a paper on the mismatch between how we think, conceptualize and believe in mental health nursing and the structure, organization and delivery of psychiatric services. The historical development of mental health services may prove a fruitful tool in some professional reflection. Nurses can have a powerful role in challenging and helping to re-shape mental health services, re-thinking the relationship between mental health nursing and psychiatry.
Food for Thought
Barker, P., & Buchanan‐Barker, P. (2011). Myth of mental health nursing and the challenge of recovery. International Journal of Mental Health Nursing, 20(5), 337-344.
Gray B. Psychiatry and oppression: a personal account of compulsory admission and medical treatment. Schizophr Bull. 2009;35(4):661-3.
Lakeman, R. (2013). Talking science and wishing for miracles: understanding cultures of mental health practice. International Journal of Mental Health Nursing, 22(2), 106-115.
Peace,
Michelle D.
nursingforsocialjustice 
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