Table Of ContentAdvanced
Practice in Mental
Health Nursing
A European Perspective
Agnes Higgins
Nina Kilkku
Gisli Kort Kristofersson
Editors
123
Advanced Practice in Mental Health Nursing
Agnes Higgins • Nina Kilkku
Gisli Kort Kristofersson
Editors
Advanced Practice in
Mental Health Nursing
A European Perspective
Editors
Agnes Higgins Nina Kilkku
School of Nursing and Midwifery School of Social Services and Health Care
Trinity College Dublin Tampere University of Applied Sciences
Dublin, Ireland Tampere, Finland
Gisli Kort Kristofersson
School of Health Sciences
University of Akureyri
Akureyri, Iceland
ISBN 978-3-031-05535-5 ISBN 978-3-031-05536-2 (eBook)
https://doi.org/10.1007/978-3-031-05536-2
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Foreword
This textbook is very timely and very much needed to support the process of change
within mental health policies and services.
The history of mental health care and psychiatry has been dramatic, with its
pendulum-like shifts from theories and practices emphasizing certain elements of
the bio-psycho-social model more than other ones. Recent decades were dominated
by the biomedical model, which succeeded the previous dominance of psychoanaly-
sis. Now there is increasing evidence pointing to the limited effectiveness and pos-
sible harm of mental health care that is over reliant on power asymmetries, coercion,
and excessive use of biomedical interventions.
The bold promise, through several recent decades, has continually being that the
systematic application of the biomedical paradigm would lead, through identifica-
tion of biological markers, to effective treatment of mental health conditions,
improved quality of life, and the end of stigma and discrimination. This did not
happen. Despite new investments, huge numbers of people worldwide, including in
Europe, continue to suffer from systemic human rights violations within mental
healthcare facilities and services. Prevalence of non-consensual care is on the rise in
all regions, including Europe. This is not surprising, as unlike the rest of medicine,
the basic principles of informed consent and ‘first do no harm’ have been seriously
undermined in psychiatry.
Change is urgently needed. In this process of change, creative solutions are
emerging, as alternatives to the status quo, with attempts to prove that persons who
experience mental health conditions can be effectively supported in ways that do not
violate their human rights.
It is of crucial importance that the global mental health community creatively
explores models of mental health service provision and ways of engaging with peo-
ple that depart from the legacy of coercion, paternalism, discrimination, and exces-
sive medicalization. At this moment in time, it is imperative that we strengthen the
emerging view that psychiatry and psychiatric/mental health nursing can be empow-
ering and respectful of people’s human rights.
The role of nurses is crucial in the process of providing mental health care to
persons in need. Nurses as passionate carers are closest to everyday needs of per-
sons with psychosocial disabilities and other mental health conditions. However, in
mental health services, quite often nurses become hostages of coercive measures
and paternalistic approaches. One of the observations by experts who are critical of
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vi Foreword
the status quo is that not only users of services are disempowered by existing hier-
archies and power asymmetries. Nurses may also be affected by the prevailing idea
that only psychiatrists can be experts who make right decisions. In this regard,
nurses should be supportive of change and indeed play a key role in democratizing
services, as this needs to be the underpinning principle of all the needed change in
mental health systems.
For the process of change to be smooth and effective, nurses, as well as other
actors in the mental health scene, need to have the knowledge, skills and attitudes
that represent and reflect the principles of a rights-based approach to care, principles
that are aimed at empowerment, autonomy, and recovery. A human rights-based
approach also includes focusing on important themes, such as therapeutic alliance,
diversity, spirituality, and recovery-oriented care.
This textbook is about all these issues. By moving away from a medical way of
framing peoples’ distress, this textbook asks the reader to think differently and more
creatively and is exactly what is needed now for European and global mental health.
The book will equip nurses with knowledge and practical understanding about
how mental health services can be supporting, empowering, non-coercive and avoid
hierarchical paternalistic approaches.
I strongly recommend this book to all nurses, but also to everyone who is related
to or curious about mental health and mental health care.
Dainius Pūras
Professor, Clinic of psychiatry
Vilnius University
Vilnius, Lithuania
Former UN Special Rapporteur on the
Right to Physical and Mental Health (2014-2020)
Preface
This genesis for this book was based on the willingness of Springer and Horatio, the
European Psychiatric Nurses, to work together on a publication to strengthen
advanced practice in mental health nursing in Europe. The idea behind the book was
to fill a gap in the literature of advanced practice mental health nursing from a
European perspective. Most of the available books, describing the work and phi-
losophy of advanced practice mental health nursing, have been published in the
USA. Although these books certainly contain valuable information for nurses work-
ing in Europe, the culture of caring, including the health services and education
systems are so diverse, not only between Europe and the USA, but between coun-
tries within Europe, hence we considered that a textbook such as this was
sorely needed.
While the field of mental health is without doubt a field of contestation and
debate with various agendas and voices, the focus and tone of the book was strongly
influenced by human rights and recovery approaches to mental health care. We are
strongly of the view that the practice of advanced mental health nursing is, or should
be, guided by a philosophy grounded in a humanistic approach, collaboration,
coproduction, and inclusiveness. This approach is relational based and gives pri-
macy to the voice and personal epistemology of the person seeking care and is one
that challenges the privileging of one theoretical perspective over another, including
the privileging of the biomedical model. Emphasis within the book is therefore on
providing insights, from around Europe, on how to work ‘for’ and ‘with’ people
with lived experiences and their families, while maintaining the rigorous and ethical
standards advanced practice mental health nursing demands.
The period in which we edited this book became extraordinary in a way no one
could have foretold. The worldwide pandemic and war in Europe affected us all,
editors and authors, in different ways. Professionally, we all faced significant chal-
lenges at work, and personally many grieved the loss of loved ones without the
usual support. On a positive note, we met many new people and developed new
friendships and relationships in the process; and we all shared feelings in a way no
one could have predicted.
Additionally as editors, hundreds of hours of discussions in online meetings
about the text gave us a unique opportunity to work and learn from each other. We
not only got an opportunity to share the challenges of teaching and practice during
a pandemic, but we also got to discuss and debate the various aspects of advanced
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viii Preface
level mental health nursing in different countries. We told stories, compared tradi-
tions both within and outside of mental health nursing, found similarities and differ-
ences, agreed to disagree, and discovered the power of humour and laughter. During
the shared enterprise of the book, we developed a sense of belonging and formed
lifelong friendships, just like we see with nurses in mental health settings around
Europe. The feeling of camaraderie and acceptance kept us going, while the world
around felt like it was collapsing.
Completing this book was only made possible because of our excellent, commit-
ted colleagues who wanted to share their unique knowledge, strength, and experi-
ence by contributing to this book. We would like to thank them sincerely, as we
know how hard it has been during these extraordinary times. We would also like to
thank Professor Pūras, former UN Special Rapporteur on the Right to Physical and
Mental Health (2014–2020), for writing the foreword for the book and for his strong
human rights message to all of us who work in mental health.
To you the reader, irrespective of your role, position or discipline, we hope this
book not only supports critical thinking and debate but is of practical relevance as
you engage in your work alongside people with lived experiences and their families.
Today more than ever, people require services that are underpinned by human rights
and recovery principles, principles which we consider belong to the highest level of
clinical competence.
Agnes Higgins
Dublin, Ireland
Nina Kilkku
Tampere, Finland
Gisli Kort Kristofersson
Akureyri, Iceland
Acknowledgements
First and foremost, we, the editors, would like to acknowledge all of the people with
lived experience of mental health problems and their family members who we have
met throughout our journey in the mental health system and who have inspired and
motivated us to strive to make a difference. It was out of this desire that the idea for
this book was born.
We would like to extend a heartfelt thank you to the 25 people, from more than a
dozen countries in Europe, who have authored or co-authored the various chapters.
Your commitment to writing throughout all the challenges and demands of the
Covid-19 pandemic is really appreciated. The rich text and analytic approach
towards the writing of each chapter will be an invaluable source of information and
learning for all mental health professionals, including Advanced Practice Mental
Health Nurses.
A huge thank you to the people who generously provided case studies and exem-
plars to enrich the relevant chapters. These exemplars not only ground the material
in the realities of everyday practice but help to remind us that the ultimate raison
d’etre of mental health nursing is to support people’s recovery journeys.
A sincere thanks goes to Professor Dainius Pūras, the Special Rapporteur of the
United Nations (2014–2020), our foreword writer. We really appreciate the generos-
ity of spirit in your comments and insights.
To Natalie and Siva at Springer, a big thank you for your patience and timely
advice throughout the whole writing and production process, and to the Board of
Horatio for their collaborative support. Finally, a huge thank you to our families and
friends, who witnessed and supported us in the ups and downs involved in bringing
this book into being.
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Contents
Part I Theoretical and Historical Perspectives
Landscape of Advanced Practice Mental Health Nursing in Europe . . . . . 3
Nina Kilkku, Gisli Kort Kristofersson, and Agnes Higgins
Role and Competencies of Advanced Practice Mental Health Nurses . . . . . 19
Gisli Kort Kristofersson, Agnes Higgins, and Nina Kilkku
Perspectives and Frameworks Underpinning the Practice
of Advanced Mental Health Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Agnes Higgins, Nina Kilkku, and Gisli Kort Kristofersson
Part II Foundations for Collaborative Working
Therapeutic Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Nina Kilkku and Gisli Kort Kristofersson
Advanced Mental Health Nursing Assessment, Formulation
and Decision-Making . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Diana Polhuis and Annmarie Grealish
Integrative Care Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Gisli Kort Kristofersson and Merrie J. Kaas
Part III Therapeutic Engagement in Different Contexts
Collaboration with Families, Networks and Communities . . . . . . . . . . . . . . 149
Eydís Kristín Sveinbjarnardóttir and Nina Kilkku
Advanced Practice Mental Health Nursing and Mental
Health Promotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Louise Doyle
Trauma and Trauma-Informed Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Jean Morrissey and Agnes Higgins
xi
