Specialist nurse practitioners in mental health: the Shropshire experience

Abstract

Alison Marpole BSc (Hons), RMN, NP, is specialist nurse practitioner, Shropshire County Primary Care Trust, Mental Health and Learning Disability Services, Shrewsbury Mental health services for older people vary widely in structure, settings and activities undertaken. The relationship between adult mental health services and mental health services for older people are affected in many areas by limitations of resources in older people’s mental health and inadequate liaison and support between the service types (Draper et al 2003). Some areas continue to support patients into old age because of resource deficits, only transferring care of the patient with enduring mental health needs if cognitive functioning declines and physical frailty increases. Within our area, because of the differences between the teams’ structures, patients would traditionally be transferred from a community mental health team to either a community mental health nursing team or a generic social work team for older people, depending on the discipline of the patient’s care co-ordinator. On occasion this has led to reduced services for the patient as far as either care and social support or review of mental health and psychosocial interventions were concerned. It has also meant that sometimes the support of two teams has been required to provide services that were managed by one team before transfer. Within the new way of working, specialist nurse practitioners will take the lead for many of the clinical decisions, taking the initial referrals from all disciplines within the community mental health teams and having responsibility for assessment, management and onward referral to the most appropriate service. This should help communication between teams and ensure appropriate timely care for the patient. The psychiatrist would only become involved with the most complex and challenging cases, thus empowering the specialist nurse practitioner to take on the role of assessor or gatekeeper (Royal College of Psychiatrists 2003).