Public have outdated impression

It's nothing like One Flew Over the Cuckoo's Nest. Psychiatric nursing is not about people in white coats jumping on top of people to put them in straightjackets. And yet, according to a new study, this outmoded impression persists.

The study (see panel), published earlier this year, finds that many young people continue to believe that a career in psychiatric nursing will catapult them into a violent, custodial world where it's better to be big and tough rather kind and caring. "It's far from those days," says John Wells, mental health lecturer at Waterford Institute of Technology and co-author of the report.

Martin Farrell, chief nursing officer in Dublin's Northern Area Health Board, which includes the areas of Cabra, Finglas and Blanchardstown, points out that more and more psychiatric nursing services are based in the community. When he started his training in St Brendan's Hospital in 1973 it had over 1,000 patients; today there are approximately 180 patients. More and more, he says, the work of a psychiatric nurse involves working on a one-to-one basis in small hostels where there is nursing support of varying levels.

One important change has been made in the nursing application procedure, which second-level students will notice. Applications are made to psychiatric courses through the Central Applications Office for the first time next year.

The more streamlined nursing application system procedure is already having an impact. Until recently, it was difficult to fill all of the available psychiatric nursing places. One reason cited was that individuals had to apply to individual hospitals.

In 1997-98 less than half the places being offered were taken up. Once the new streamlined application procedure kicked in, it had a positive impact on acceptance levels. According to a spokesman at An Bord Altranais, this year 64 per cent of places in psychiatric nursing were filled following Round 1 offers, and it is expected that the remaining 69 places will now have been filled, as the deadline for acceptance of Round 2 offers was yesterday.

This year a total of 302 places in psychiatric nursing are available. Last year there were 254 places available in psychiatric nursing and all places were filled. The number of candidates applying for psychiatric nursing is still much smaller than for general nursing, and yet psychiatric nursing services are provided across a range of settings from acute hospitals to high support hostels. The 1999 Report of the Commission on Nursing explains: "The hospital, health centre, day hospital and high-support hostels are seen as options of care for clients . . . Psychiatric nurses can be based in any of these facilities. They manage a case load and provide a wide range of nursing services including rehabilitation, social skills training, individual counselling, group work, psycho-education, family support, liaison work and mental health education."

The report points out that "in recent decades there has been a huge transformation in the pattern of services for persons with mental illness". In the late 1950s there were over 21,000 patients residing in the district mental hospitals. Five years ago, the number was under 6,000 in all psychiatric hospitals and units. "A notable change in the treatment of mental illness has been the increasing integration of services for the mentally and physically ill reflected by the inclusion of psychiatric units in the larger general hospitals," it says.