The Royal College of Nursing (RCN) in Wales has called on its government to invest in mental health nursing, amid concerns that the most acutely unwell patients are being “left behind”.
A new report by RCN Wales, Mental health nursing: a profession that must be valued, has today issued 10 recommendations to the devolved administration.
“Those experiencing severe and enduring mental illness have been left behind”
Chief among these were calls to invest more in the mental health nursing profession and in mental health services more generally, particularly higher tier inpatient and specialist teams.
The first recommendation read: “The Welsh Government must develop a clear strategy for investment in NHS mental health services to improve the provision of care for those needing secondary, acute and intensive psychiatric care.”
The RCN Wales report said the recent funding emphasis on lower level mental health and wellbeing support was “welcomed”, but that it did not address people with severe or enduring issues.
Jenifer French, RCN Wales mental health and learning disability nurse adviser, said: “Recently, the Welsh Government has been very focused on prevention and early intervention, which I’m sure has had a tremendous impact for many.
“However, those experiencing severe and enduring mental illness have been left behind.
“A lack of financial investment in inpatient services and stigma remains around severe and enduring mental ill-health, which has contributed to inequalities within mental health provision. This needs to change.”
She added: “Mental health nursing is an extremely diverse role that delivers holistic and value-based care for individuals, their families, and carers of all age groups and in a variety of settings.”
“We recognise the important role mental health nurses play”
According to the report, one in 50 people in Wales have a severe mental health condition, with the numbers on the rise.
Meanwhile, the report also cited NHS figures showing the number of NHS inpatient mental health beds in Wales had decreased from 1,857 in 2011-12 to 1,290 in 2021-22.
The second recommendation referred specifically to Child and Adolescent Mental Health Services (CAMHS), and the need to continue rolling out the level 7 CAMHS course for mental health nurses.
RCN Wales said the current figures for children being detained under the Mental Health Act, especially teenage girls, was “deeply concerning”.
It added that there was a “complete lack” of appropriately staffed facilities in Wales for children experiencing severe mental health issues, meaning they had to be cared for on adult wards or had even been sent to Scotland for care.
“Across Wales, children are often spending several weeks in paediatric wards after their physical needs have been resolved, because an appropriate CAMHS bed has not been made available for them,” warned the report.
“Children are also spending time on adult wards which are not attuned to providing services for this age group and where the experience can be frightening and damaging for young people.
“Children and young people should not be cared for on an adult ward.”
One of the recommendations in the report urged the Welsh Government to commission a report of the mental health nursing workforce to make sure all services are safely and legally staffed.
Another recommendation asked for the government to set out a “timeline” for extending Section 25B of the Nurse Staffing Levels (Wales) Act 2016 to mental health inpatient wards.
In addition, the report called on the government to increase the number of pre-registration mental health nurse places and to support more nurses following qualification to progress to specialist, advanced and consultant posts.
The RCN said: “The lack of investment in post-registration education has severely impacted on the development of expert nurse roles including consultant nurses.
“Mental health nurses, similar to other registered nurses, struggle to find time to complete continuing professional development (CPD) and struggle with progressing their careers.”
To combat this, RCN Wales asked the government to make a clear career pathway for mental health nurses in Wales.
The college praised the Welsh Government’s new mental health workforce strategy, which showed the gaps in the NHS.
However, the union said it lacked “focus” on specific roles and that the government should also implement the mental health nursing framework that was published in 2018 by the All Wales Senior Nurse Advisory Group.
Alun Thomas, chief executive of Adveraid Recover, a mental health support provider, welcomed the RCN Wales report, noting that mental health nursing was under “significant pressure”.
He said: “There are increasing demands on expanding the role of nurses and often this is without recognition that we are removing some of our most experienced and capable nurses from direct care.
“There must be an increase in pre-registration places in our schools of nursing, though this alone will not address the longer-term issues of nurses leaving the profession.
“Mental health nurses must feel that they are able to deliver the quality care they came into the profession to do, and we should include the nursing role in all our workforce planning across the health and social care sector, rather than see nursing as a separate function.”
A Welsh Government spokesperson said: “We recognise the important role mental health nurses play which is why we’ve increased training places by 29.2% in the last year.
“We are also investing £6m in the Mental Health Workforce Plan for Wales and increasing our budget for mental health services by £50m in 2022-23, rising to an extra £90m in 2024-25.
“This year we are also working on the new Together for Mental Health strategy.”