INTRODUCTION

In this reflective account of my development as a mental health student nurse, I

will be discussing the knowledge and skills I have already acquired so far, and in
doing this,

I am going to apply the Gibbs (1998) reflective cycle,

which is

generally an acknowledged model for reflection to illustrate what I have made

out of my development as a mental health nursing student. According to the
Gibbs model of reflection, there are 6 processes / stages when reflecting on my
development as a mental health nurse. The use of the Gibbs reflective model
will help me to apply everything I have learnt in theory into practice as I prepare
to start my Placement in January 2017. According to the Nursing and Midwifery
Council (NMC, 2004), a reflective attitude or Practice will enable me to think
back what I have done in the past, how I did it and the needs to do it better in
the future in relation to my studies and eventual Professional Practice. In the
definition by Taylor (2006),

reflection is a very significant part of attaining

Knowledge and Understanding, to reflect on experience which could be positive

or negative allowing for self-criticism (Bulman and Schutz, 2004).
According to Baird and Winter (2005,

p. 156) who stated some reasons,

reflection is important in a reflective practice. They stated: A reflect is to

generate the practice knowledge,

assist an ability to adapt new situation,

develop self-esteem and satisfaction as well as to value,

professionalising Practice.

develop and

In addition to the above submission on reflection,

Siviter (2004, p.165) defines reflection as gaining self-confidence, identify when

to improve,

learning from own mistakes and behaviour,

looking at other

peoples perspective, being self-aware and improving the future by learning the
past.
DEFINITION OF MENTAL HEALTH ILLNESS
A recent study puts it that every 1 in 4 people will experience at least one
diagnosable mental health problem. It is very difficult to give a single definition
of mental health because of the changes that have really occurred with time in
relation to the meaning. Geography, discipline and individual perception have
shaped what it really means (2010). While a legal practitioner would give his
definition,

a psychiatric doctor would give another and the service user a

different one also.

Many scholars of thought have made various attempts in

defining mental health.

conceptual abstraction.

Preston (1943,

P112) sees mental health as a

It is a relativistic assessment of mans relations to

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himself, his society and his values.(mental health) cannot be effectively

understood in isolation from the other multifunctional phenomena that constitute
the person as he functions in the society. Eaton (1951) views mental health as
about the way human beings adjust to the world and are effective,

happy,

efficient, content and maintain an even temper, an alert, intelligence, socially

considerate behaviour and happy.

At the moment,

the legally acceptable

definition according to Mental Health Act (2007) is that any chaos,

affecting the intelligence,

reasoning,

understanding,

judgement,

handicap
sense,

perception and mentality of a person and is comprehensive enough to attract

diverse diagnostic interpretation.
Some written accounts of people who themselves suffered mental health
sickness throw awareness into the meaning,

impact and consequences of

mental health illness without being emotional or sentimental. In his account,

William Styron (2001, pp46-47) describes his depression as in a storm of
murk. Near paralysis,

psychic energies throttle back close to zero.

Ultimately, the body is affected and feels sapped, drained I began to

conceive that my mind itself was like one of those outmoded small town
telephone exchanges being gradually inundated by flood water.

One by one,

normal circus began to drown, causing some of the functions of the body and
nearly all those of instincts and intellect to slowly disconnect.
HISTORY OF MENTAL HEALTH AND ASYLUM
Madness (as mental health illness was being referred to in the past) has been
seen through history and civilisation as a domestic duty. Friends and families
were expected to deal with it.

The end of the Middle Ages witnessed the

separation from the society which was used as a management strategy with the
religious house of St Mary of Bethlehem which was known as Bethlem (Bedlam)
undertook the caring of distracted patients in London in the year 1377.
Treatment was very crude. Patients were chained to the wall with iron, whipped
and plunged in water. In early 1600, visitors were allowed to come in and watch
the patients for a penny fee.

A visit to Bethlem became entertainment for

Londoners and more than 100,000 people in a year paid to see the patients who
were displayed in cages on the gallery of the asylum.
Private madhouse practices in England started in the 1670s, and the imposition
of licensing was introduced a century later with the 1774 Madhouse Act.
Ticehurst House was among the early madhouses that allowed patients to bring
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along their personal servants and even to follow the hounds (Porter, 2002). The
year 1800 witnessed about 5000 people who were housed in private asylums
mixed economy which is far less than the state-run county asylums and
workhouses. Nevertheless,

in the 19th century,

the number of inmates and

asylum houses increased substantially.

The 1845 Lunatic Act demanded the building of more county asylums that were
publicly owned and that brought the establishment of the Lunatic Commission
which managed the performances,

inspection and licensing of the asylum

houses. Regardless of the commission, the new state asylum failed to live up to
the early expectation especially of the philanthropists and proponents of moral
therapy and non-restraints. 1911 saw the birth of National Insurance Act which
enabled workers to access free medical treatment. The National Health Service
was introduced on the 5th July 1948 after negotiation with the medical
community that Aneurin Bevan, the then Health Minister rather diplomatically
described as not..altogether trouble free (Bevan 1945).

The National

Health Service undertook the duty for mental health which, up to that moment,
was under the sole authority of the county councils and boroughs.
In spite of the worldwide cases of mental health sickness and the adverse effect
it has on national wealth in terms of the budget on health care, a good number
of affected individuals do not receive timely or suitable treatment as a result of
communal stigma quite often associated with the sickness. The fear of the
unknown has been a barrier for people from enjoying a good state of mental
health. Such fear of stigma, what would my family/friends think of me, how
would the society view me, would I lose my job if I speak out about my mental
health condition. Labelling a person as having mental health illness has a very
detrimental damage in a lot of cultures. This often associated stigma,
people from coming out to seek the right medical treatment.

bars

Research has

shown that people who disclose their mental health state are mostly exposed to
rejection and isolation from families,

work roles and social world (Ilic et al,

2013, Wahl 2012).

Those who have experienced mental health illness in the past can be helpful to
people with mental health situation in addition to traditional mental health
services. But in most cases, they face discrimination and stigma in their roles
within and outside the organisation.

So often,

their point of view,

belief,

judgement, potentials, and judged competence are underestimated.

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A research carried out by (Louise Byrne et al) aimed at finding out the effect of
stigma and discrimination in the successful use of the lived experienced
positions from the view of those who have lived through mental health sickness.
From the 13 practitioners who have lived through mental health illness
interviewed,

the subject of discrimination and stigma were found as a

fundamental heading.

Participants said discrimination and stigma are so

common that they consider them as being normal occurrence in their working
life. Professional segregation and negative reaction from colleagues do not allow
for effective contribution from lived experience workers.
It is not an overstatement to say that people who have lived through the mental
health sickness can be a source of encouragement to the patients and their
families

thereby reducing stigma significantly. The discrimination and stigma

they face in the workplace, however, must be challenged in order for them to
contribute successfully.

Kudos to the Australian Government whose policy

mandated the inclusion of people with lived experience in the formation and
distribution of mental health services since the beginning of 1990 (Australian
Health Ministers, 1992).
As

mental

health

nursing

student,

my

first

assignment

was

in.. mental facility where I had my first

semester posting in my year one. As I shadowed a qualified mental health nurse
while we went through the ward dispensing medication, I noticed this young who
always recoiled to herself and would neither respond to the greeting by the nurse
nor myself. Having her to take her tablets was a herculean task. We spent more
than 20 minutes in a bid to ensure that she took her medication without spitting
it out as we left. As we were there I noticed that the nurse did not lose her cool.
She maintained the same passionate approach as in the start. She (the nurse)
told the girl how much she had improved since the administration of her current
medication. I was impressed by the gentle demeanour of the nurse in spite of
the pressure of her work as a result of the inadequate number of professionals in
the hospital.
FEELINGS
From her look, Clara (not real name) she is between 17-20 years of age. I felt
very disturbed and wondered why such a young girl who has so much life ahead
of her was suffering from mental illness. My investigation reveals that Clara is
suffering from Eating Disorder and Anorexia Nervosa. A further probe into her
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history revealed that Clara is a product of a single mother who was sexually
abused which resulted in the birth of Clara. The mother died when Clara was
eight years old with severe obesity complication. Her history also revealed that
Clara was raised by her grandmother.

Even before the death of her mother,

Clara was constantly bullied in school because of the unfortunate size of her
mother who at that point was confined to a wheelchair for short mobility. As the
bullying was on-going, Clara could not confide in anybody about what she was
going through in school and in social gatherings. She was scared of increasing
her plight by reporting the bullies. She gradually started withdrawing to herself
and giving excuses why she should not go to school or play with other kids. Her
love for food and sweet things started to decline.

Clara believed that her

mothers weight predicament could have been a result of her mums feeding
habit.

In the cause of my placement,

I was assigned to help Clara with her

feeding and medication on daily basis. I knew I had a daunting task on my hands
and apart from the conventional care plan already mapped out for Clara, I knew
that to be able to break into Claras confidence having diagnosed her case there
is need to also map out some therapeutic road to recovery and personal
strategical practice, which would have a patient centred approach.
EVALUATION
(Oxford Handbook of Mental Health Nursing pg. 56). For each individual, recovery
is a personal journey and very unique. It is also very important to realise that we
all require support from others at a certain stage of our lives. Knowing that we
are different from other people and that what works for us may be different from
what works for other people is privy to ones wellbeing not minding whether you
have a mental health challenge or not. The recovery I have in mind is such that
restores hope that living a meaningful life is possible despite the health
challenges. It is about increasing hope. The idea of recovery is really having a
big effect on those who use mental health services, their families, researcher in
mental health and the way services are delivered. Service users who made a
good recovery and were able to put their experience of coping with the
symptoms, getting better and recovering identity in writing in the 1980s brought
about writings on recovery. There is no single accepted definition of recovery as
it involves both clinical and personal recovery.
In (1993),

Anthony defines personal recovery as a deeply personal,

unique process of changing ones attitudes,

values,

feelings,

goals,

skills
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and/or roles. It is a way of living a satisfactory life even within the limitation
caused by illness.

Recovery involves the development of new meaning and

purpose in ones life as one grows beyond the catastrophic effects of the mental
illness.

This definition identifies the fact that most currently services are

focused on the goals of meeting clinical recovery.

Policies,

in contrary,

on

mental health around the globe stress support for personal recovery.
In order to maintain personal recovery, the following task, according to Slade
Mike page 8 in Rethink Mental Health, need to be identified and implemented.
Task 1.

Development of a positive identity. The onset of recovery involves

developing a helpful conduct other than being a person with mental health
challenges. The element of identity may vary from individual to individual
depending on socio, cultural and religious inclination.
Task 2.

The second duty in the recovery stage is the ability to develop a

personally acceptable meaning to support the encounter that the professionals

would identify as mental health illness.

This means making sense of the

encounter enabling it to be imputed as part of the person but not as the totality
of the person which would be expressed in the form of diagnoses otherwise, it
might not have to be handled with professional models.
Task 3. The third assignment involves taking responsibility. Identifying mental
health challenge as part of ones life encourages the development of selfmanagement which is a transition from clinical control to being personally
responsible through self-management which also include looking for help and
support when required.
Task 4. The fourth task which also is the final stage in the recovery process is to
develop cherished social duties. These duties that have nothing to do with
mental health

sickness. Treasured social duties give necessary steps to the

evolving identity of the recuperating person. Supporting the individual in their

social life is vital, more importantly in a period of cataclysm when demand from
friends and family might have been overstrained or stretched.
Encouraging personal recovery brings a shift from focusing on illness treatment
to supporting wholesomeness.

Account of people who lived through mental

illness testified that personal recovery involves evolution that makes professional
models as part of the persons larger understanding which would be guided by a
framework of hope, self-identity, meaning and personal responsibility which is
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away from the traditional approach which is value-free instead of value-centred,

professional accountability as against personal responsibility,

control oriented

instead of choice-oriented, power over people and not awaken peoples power.

ANALYSIS

ACTION PLAN

To work effectively and be able to deliver result oriented and person centred care
to Clara as a member of the inter-professional team that would guide Clara
through the road to her recovery, there is need for the qualified nurses and
myself to significantly improve the practice core skills competence for mental

health nursing popularly known as the six Cs of nursing but not limited to as
developed by Roach (2002)
COMMUNICATION:

Other than being a means of which information is

transmitted from one person to other, it is a way in which care and compassion
are displayed. It is also very vital in initiating, forming and also maintaining a
relationship for an effective caring to take place. A good teamwork is achieved
through

effective

communication,

communication.

In

emphasising

the

importance

of

Stein-Parbury (2009) identifies listening as an active process

that requires focus and endeavour to develop appropriate communication skill.

(McCorrry and Mason 2011,

p6) define communication as the successful

transfer of a message and meaning from one person or group to another. It can
be through the written word, gesture or body language. This skill is important
as I cared for Clara whose journey to recovery requires constant communication
with her even when she is unwilling to communicate back.
CARE: The business of nursing is about Caring. Care is the fundamental duty of
a nurse.

When Care is effectively delivered,

it helps the individuals and

improves their health. Our work and who we are is defined by the quality of Care
we give. The Care we give is expected to be right and consistent to the Patient.
COMPASSION: Compassion is the empathy with which Care is delivered.
Dignity, Patience and Respect in the course of giving Care should be uppermost
in the mind of a nurse.
COMPETENCE: This is the ability to understand the Patients needs being if
social,

cultural,

religious,

health wise and also the clinical and technical

expertise knowledge of delivering effective care treatment that is based on

evidence and research.
COURAGE: Decision making could be daunting in some situations but because
peoples lives are vested in Care. It is very important to be Courageous in taking
some difficult steps and to speak out when we notice some concerns and
Courage to apply new innovation,

have visions and adapt to new ways of

working.

COMMITMENT: We sincerely owe people in our Care unreserved Commitment.

The launching of the Social Care Commitment (2012) by the department of
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health was a practical way to improve the standard of care thereby increasing
the confidence of the Public in the Services.

Commitment is one of the

evidences of meeting Care Quality Commission Standard.

A Nurse must be

Committed to the treatment and recovery Journey of the patient.