Nurses need to step up to improve child and adolescent mental health globally

Nurses are often the first point of contact for children and adolescents experiencing mental health challenges. Those nurses may be located in perinatal services, schools and general practices and have the advantage of enjoying a role that is familiar to, and trusted by, many.

Early intervention is essential for young people who, in a global environment that is rife with war, poverty, violence and other forms of instability, are at risk of anxiety, depression, self-harm, eating disorders, drug and alcohol misuse and suicide (Malla et al., 2018). Without appropriate intervention, young people are at increased risk of developing chronic mental disorders that interrupt dreams to live a fulfilling and contributing life (Gore F et al., 2011). But youth mental health as a specialty struggles for fair funding. It remains marginalised and under-resourced in many parts of the world (Ravens-Sieberer et al., 2015). Services are often adult and treatment-oriented, rather than youth, family-centred, and preventative (Pearce, Dundas, Whitehead, & Taylor-Robinson, 2019).

Some countries, such as Australia, have endorsed a National Mental Health Plan with strategies targeting children (Collins P, Insel T, Chockalingam, Daar, & Maddox Y, 2013; National Mental Health Commission, 2019). Nurses, particularly those located in community and primary care settings, are key to the success and integration of these plans and strategies, but they need focused professional development and greater career opportunities within this subspecialty if they are to maximise their potential (Maughan, 2018).

To thrive in childhood and adolescence, individuals need stable, responsive nurturing relationships and communities that provide safety, support, friendship, and stimulation so that they can fulfil their potential. In reality, however, many young people do not live in safe, nurturing environments. Globally, almost 1 in 7 actually had a diagnosable mental disorder in the last 12 months (Kieling et al., 2011). In Australia, almost three quarters of young people experiencing mental distress do not seek or receive help in a timely way, because of a combination of shame, lack of knowledge, and lack of access to limited services (Lawrence et al., 2015).

The long-term effects of this inadequacy are devastating because society’s most precious resource – children – may needlessly suffer and die. In 2017, Australian statistics indicated that suicide accounted for 32.9% of deaths among 15 –19-year-old females and 30.6% of deaths among 20 –24-year-old females (https://www.lifeinmindaustralia.com.au/about-suicide/suicide-data/suicide-facts-and-stats).

The World Health Organisation Comprehensive Mental Health Action Plan 2013–2020 (https://www.who.int/mental_health/action_plan_2013/en/) highlights the urgent need in developed and developing countries to increase the accessibility and responsiveness of mental health services located within the community. Nurses trained in collaborative ways of working with families and young people are a vital inclusion in this plan.

Internationally, however, many nurses are not sufficiently equipped to provide targeted, effective mental health care to vulnerable young people (Delaney & Karnik, 2019). In many cases, nurses are prepared for practice with a three-year generic nursing degree, which offers only a basic understanding of mental health issues (Happell & McAllister, 2015; Logan, 2018). Across the world, there is variation in adequate benchmarks for effective education requirements for child and adolescent mental health, and nurses often do not have the skills, capabilities and depth of knowledge to navigate the counselling or psychosocial skills required to communicate engagingly and effectively with these young people (Salberg, Bäckström, Röing, & Öster, 2019).

Nursing leadership in child and adolescent mental health

Nursing needs to show leadership in ways that will meet needs, rather than preserve the status quo. The status quo involves keeping the pathway to nursing unitary and generic. The status quo involves seeing mental health nursing as a post-graduate specialty, available only to a few. In contrast, I believe we need to diversify pathways to nursing. Nursing needs to be allowed to diversify so that it can reach the vulnerable communities it is so well placed to serve. A three-year generic Bachelor of Nursing studied at university and separated from industry is no longer sufficient. True partnerships between university and health services, where learning is co-located is required. Currently, undergraduate programmes are crammed with content that skates across the surface of specialised disciplines, doing justice to none. Specialisation in priority health areas at undergraduate level ought to occur.

The expectation that nurses must all gain post-graduate qualifications to work in mental health needs to be revisited, as many mental health courses do not get large enrolments. This is compounded by fees for tertiary studies in some countries which prohibit continued education as it is an expensive undertaking. It also makes social sense. Nurses – the majority of whom are women – are already working and paying off student loans, supporting families and caring for children and aging parents. For them to study further to get the required post-graduate qualification to become a mental health nurse is patently wrong. It also is not working. Our mental health services across the nation are staffed by unqualified nurses, and they are becoming dangerous, limited places, where bio-technological approaches are the norm, and preventative, psychosocially driven care is minimal.

Allowing flexibility with a nursing degree, including co-location with industry, a variety of work-integrated learning opportunities that develop students’ familiarity with vulnerable communities tackling mental health challenges using many strategies will build skills, empathy, awareness, and passion for the specialty. It would see a community being served by nurses who have graduated from a degree with a work-ready specialisation, prepared to work effectively in perinatal services, general practices and schools as qualified mental health nurses.

Nursing education should place equal emphasis on bio-technical as well psychosocial skills training, students should study the sciences as well as the arts, and learn as much about nursing’s history and achievements as they do about social history, struggles and movements. In this way, students will develop a wide vision to understand the struggles and solutions necessary to achieve mental health and well-being for all. The vision is to create countries where children and young people everywhere have the possibility to maintain, develop and restore strong mental health, regardless of circumstance.

ORCID

Margaret Mcallister http://orcid.org/0000-0003-1181-1610