TONL Monthly
February 2020

I Didn’t See it Coming: Mental Health Preparedness for Nurses

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By Kit Bredimus

In 2018, nearly one in five Americans experienced a mental health condition, yet only half of those living with mental illness received treatment (1). The rate of mental health conditions continues to rise as the funding and resources for treatment continue to decline (2). In the hospital setting, nurses are increasingly exposed to patients with mental illness but are not well prepared to manage the needs of this population (3). Furthermore, rates of an acute mental health crisis presenting in the emergency and acute care setting are increasing. Giving nurses the tools to better manage patients during a mental health crisis, both in clinical and non-clinical settings, can improve patient outcomes and nurse satisfaction. Through the implementation of a structured mental health training course, clinicians can gain confidence in treating patients experiencing a mental health crisis. Studies found that standardized training enhanced mental health literacy, reduced stigma of mental health patients and changed attitudes reducing social distancing (4,5). Nurses have limited education in mental health during nursing school with shortfalls in comprehensive and uniform curriculum related to mental health content (6). Most hospitals do not have a formally structured program in place to train nurses on how to care for those experiencing an acute mental health crisis (6,7).

Nurse leaders are in a unique position to interact with staff and patients who may be having an acute mental health crisis. Patients presenting to the hospital or clinic setting may not be directly seeking help for mental health conditions and thus the need for increased training on identifying possible mental health issues. Staff may also be experiencing mental health issues that can exacerbate due to stressful work environments or other external factors. Nurse leaders must understand the need to prepare staff to interact with mental health patients and be educated themselves to observe for mental health conditions and how to respond appropriately to maintain safety for the patient and staff. Producing or implementing a mental health education program has shown positive results in preparing staff to address the needs of someone in crisis (7,8). These training programs can be made sustainable by incorporating the verbiage and exercises into the department’s culture and practice. 

Within my organization, we aimed to address the need for mental health education in our Emergency Department staff. ED nurses described a lack of skills or comfort in dealing with the acute mental health crisis population due to a myriad of factors including the inability to identify mental health patients presenting with general medical complaints, inexperience in dealing with patients in a mental health crisis and limited resources within the ED, among others. Through further discussion at interdisciplinary leadership meetings, it was determined that inpatient nursing staff similarly reported low confidence and competence in treating mental health patients in the medical-surgical setting. Rather than build a program from the ground up, we decided to implement the Mental Health First Aid Course (MHFA) (9). MHFA is an eight-hour structured program designed for the layperson to be able to identify the warning signs for mental health and addiction concerns, strategies for how to help someone in both crisis and non-crisis situations and where to turn for help. The course content was examined and determined to meet the educational needs within the emergency department. MHFA also had implications to be utilized not only in the ED but throughout communities and educational institutions as well. Our implementation program included a pre-and-post survey to quantify the impact of the course. The course was open to any hospital employee, and interprofessional classes were encouraged. Through these classes, staff gained the tools to identify mental health concerns and develop action plans to intervein.

We found through the implementation of the MHFA course that staff in the ED and throughout the facility showed a significant increase in overall self-reported competency after attending the class. Staff reported improved confidence in interacting with patients who have mental health problems, maintaining a safe environment for patients who have a mental health condition and effectively managing conflicts caused by patients who have mental health problems. Staff also reported feeling more confident in helping to reduce stigma around mental health conditions and using patient-centered language.

The findings of this project support and build on previous studies that mental health education for nurses, along with all staff, can improve confidence and competence in caring for patients who may be experiencing a mental health disturbance. By educating staff on recognizing and treating possible mental health patients, potential escalation behaviors and interventions, the results indicated that staff became more confident in caring for this vulnerable population. From a simple in-service to structured programs, leaders need to support mental health education for staff and provide resources to help nurses prepare to encounter mental health conditions in a variety of settings.

  1. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. 2019; HHS Publication No. PEP19-5068, NSDUH Series H-54.
  2. Cummings Institute. How budget cuts are affecting mental health care, 2016. Published August 2016.
  3. Winokur EJ, Loucks J, Rutledge DN. Effect of concentrated psychiatric education on perceived competence to care for behavioral health patients. J Emerg Nurs. 2017;43(5):419-425.
  4. Burns S, Crawford G, Hallett J, Hunt K, Chih HJ, Tilley PJM. What’s wrong with John? A randomised controlled trial of mental health first aid (MHFA) training with nursing students. BMC Psychol. 2017;17(1):111.
  5. Alexander V, Ellis H, Barrett B. Medical-surgical nurses' perceptions of psychiatric patients: A review of the literature with clinical and practice applications. Arch Psychiatr Nurs. 2016;30(2);262-270.
  6. Ayano G, Assefa D, Haile K, et al. Mental health training for primary health care workers and implication for success of integration of mental health into primary care: evaluation of effect on knowledge, attitude and practices (KAP). Int J Ment Health Syst. 2017;11:63.
  7. Giandinoto JA, Stephenson J, Edward KL. General hospital health professionals' attitudes and perceived dangerousness towards patients with comorbid mental and physical health conditions: Systematic review and meta-analysis. Int J Ment Health Nurs. 2018 Jun;27(3):942-955.
  8. Hall A, McKenna B, Dearie V, Maguire T, Charleston R, Furness T. Educating emergency department nurses about trauma informed care for people presenting with mental health crisis: A pilot study. BMC Nurs. 2016;15:1-8.
  9. The National Council on Behavioral Health (NCBH). Mental health first aid homepage; 2020. Accessed Jan 14th, 2020.

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