Chapter 1:The context and nature of mental health care in the 21st century

Case Study: Roberta

Roberta is a second year mental health nursing student. She worked as a health care assistant before taking up her place on the course and is really enjoying the chance to learn and apply her knowledge to practice. She has two young children so also has to balance her studies with her home life. In her previous work, Roberta was active in one of the large public sector trade unions and is interested in the social and political aspects of health and health care services. Since joining the course she has had to limit her union activism, but does like to bring some politics into the classroom and group discussions. She feels frustrated with some of her peers because they don’t always see these contributions as relevant. There isn’t always enough time for discussion and debate, and Roberta is keen to find the time and space for deeper and longer deliberations.

Recently, a teaching session involved a number of service users who had a range of different views on the value of mental health services. One of them was very critical of services, and stated that he was anti-psychiatry. Roberta found herself sympathising with this person’s criticisms of care he had received, including being forced to take medication. At the same time, Roberta felt she should defend the actions of staff because she didn’t think they were bad people or motivated to inflict harm. This resulted in a quite difficult exchange of views were Roberta began to feel personally attacked and increasingly upset. Again, the session had to finish before there was a chance to talk more about the issues and what she was feeling. Most of all, she felt bad that the discussion was curtailed before she could repair what she felt was a damaged relationship with the visiting service user.

How do you feel about the position Roberta found herself in? What, if anything, might you have done differently? If you were a student peer of Roberta, what sort of conversation could you imagine having after this teaching session?

How might the political ideas developed in this chapter help to inform group discussions involving critical service users in the classroom or other settings?

› Possible answer

Roberta is correct to bemoan the lack of time allocated for discussion and debate. Having sufficient time may be most important when there is the likelihood of controversy or contentious issues are at stake.

We all have to develop our capacity to listen carefully to the views of others. This means taking care to listen properly and doing so with a disposition full of care. It is not always necessary to rush to defend ourselves, colleagues or services in the face of legitimate criticisms. We do, however, need mutual support to be able to sustain ourselves, and cope with all the mixed emotions generated, when our personal ethics or politics appear at odds with cultures and practices in services. We also need the practical and intellectual tools to work out what we should think when faced with criticism, and to develop our own criticisms, or seek progressive changes. Groups like Critical Mental Health Nurses (https://criticalmhnursing.org/) are a good resource for relevant knowledge and, perhaps, accessing a network of critical peers.

Students like Roberta may look into the possibilities of organising some extra-curricula discussion groups, with the support of peers and tutors.   This may present its own difficulties in terms of work/life/study balance – but could also help sustain and strengthen ongoing learning.

Becoming more active in trade unions may also open up possibilities for deeper political discussions and debate.