Hey everyone, I was hoping I could start a discussion around mental health nursing and the use of MHA or what ever variation there is in your country. I would love to know how the mental health system works in different parts of the world.
Part explanation and part rant:
I am a new graduate nurse working in Mental Health. I love Mental health but I hate the Mental Health system. I currently feel very conflicted in my practice and two main points of conflict for me are the mental health act and the use of seclusion/ restraint.
In New Zealand (where I work) people can be placed under the mental health act if they meet two criteria: 1. They have a mental disorder (Axis I diagnosis) and 2. They are at risk for harm to themselves or others (this includes perceived neglect or vulnerability).
While under the act people are not able to refuse medical treatment for their mental illness, this includes medications, procedures (eg. ECT, although if they don't consent a 2nd health professional is required), and interventions. It is the only piece of legislation in my country (besides the crimes act) that allows us to uproot people and force them to stay in a chosen environment and it is the only piece of legislation that forces people to have treatment. I find this challenging because it disempowers, restricts, isolates and stigmatises people, the complete opposite to what I want to achieve with service users.
In addition people under the act are reviewed in court, the responsible clinician, a second health professional (normally nurse but sometimes OT), the person under the act and their lawyer are required to testify to the judge as to weather they should remain under the act. When I testify I feel like the trust and therapeutic relationship I have developed with the individual under the act is completely destroyed and it's so difficult (impossible) to get back. There is a real sense of betrayal and my relationship moves from being the nurse who wants/ tries/ does help to the mean nurse who is conspiring and forcing them to stay in an unpleasant ward.
In addition to the MHA acute inpatient wards are locked, and restraint and seclusion are still used in an inpatient setting. Holy hell I am so so so uncomfortable with this. We get trained how to restrain people, and in situations where people become violent I understand the need but I have seen it used to force an IMI. I feel it was incredibly traumatic for the person who was restrained by four people and had her trousers pulled down. Yes she was unwell, yes she was under the act and so can't refuse treatment, yes she was disturbing others on the ward with intimidating behaviour (slamming doors shouting at staff). But there is no way forcibly restraining her and injecting her was the best option. Was it?
I can see why in this individualistic, risk-adverse society that there is a need for a MHA but I guess I would just like to hear others opinions and suggestions for a conflicted new practitioner.
Mental Health Act and forcing people to have treatment doesn't sit right with me. What happens in your country, and do you have any suggestions to help me deal with this internal conflict.