Psychiatric Mental Health Nursing: Using Our Experience to Shape Our Future Focus

1. Introduction

Over the past 50 years, there have been significant and widespread reforms to mental health care delivery. Complex service changes include a shift from institutional to community care, clear positioning of human rights, new models of comprehensive care and approaches including prevention, early intervention, person‐centred, recovery‐oriented and trauma‐informed care, and peer support networks that bring lived experience to health care and the recovery journey. Mental, social, and physical health is no longer viewed separately as distinct entities, but rather as interrelated parts of a single holistic concept of health. These and other factors have impacted psychiatric mental health nursing (PMHN) roles, with PMHNs often working in complex environments with limited resources and competing demands, whilst needing to continually enhance and improve upon their knowledge of best practice and emerging issues. Professional standards, scopes of practice and ethical codes exist for PMHN, which articulate the required knowledge, skills, and attitudes to practice.

Despite reform, in 2019, 970 million people worldwide lived with a mental disorder, accounting for 1 in 6 years lived with disability, with mortality 10–20 years less than the general population for people with severe mental health conditions (World Health Organization ²⁰²⁵). The unmet needs of people with mental illness are high in both developed and developing countries, an issue further exacerbated during the COVID‐19 pandemic, where isolation substantially impacted many people, resulting in a loneliness epidemic (Cleary et al. ^2024a, 2024).

Mental health, the foundation of health and well‐being (to everyone, everywhere), is a basic human right (World Health Organization ²⁰²²) and a priority across many nations. The sustainable development goals developed by the United Nations (UN) prioritise mental health and well‐being and recognise that “no health or sustainable development without mental health” (Goodwin and Zaman 2023, 1). Current evidence, however, suggests that we are not on track to meet the main goal to reduce premature mortality by a third, by 2030; that these goals are built upon limited indicators of success; and that the global community is failing to properly measure the accessibility of the services needed to support good mental health (Heymann and Sprague 2023).

As the need for mental health services increases, PMHN will remain an integral part of the solution (Stewart et al. 2024). This commentary provides an overview of some of the future priorities for mental health and the profession of PMHN. Topics covered include the broad roles of PMHN in the context of contemporary health care, workforce issues and education, recovery‐oriented trauma‐informed practices, and some challenges for the way forward. The commentary is by no means inclusive of all areas.

2. Contemporary PMHN Care

Mental health and well‐being are mandated international priorities. Broadly speaking, PMHNs work with the goal of enabling “people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community” (World Health Organization ²⁰²⁵, para.1). Lower resilience, social determinants, adverse conditions and circumstances such as poverty, homelessness, violence, disability, and inequality—all can contribute to the risk of developing a mental health condition (World Health Organization ²⁰²⁵).

Less than 50 years ago, PMHNs faced significant stigma and were overshadowed by negative historical narratives around their role associated with institutional care under the medical/psychiatry model, and were subsequently devalued and marginalised (Raeburn et al. 2023; Soltis‐Jarrett ²⁰²³). Today, however, PMHN is a vibrant profession in which specialised nurses provide comprehensive care across settings (e.g., hospital, community, and in partnership with other providers) to promote individuals' and communities' physical and psychological well‐being across the lifespan.

The principles of mental health nursing encompass the care of patients whose psychological state can span a continuum from well‐being to distress, including mental health problems and mental illness. PMHN often work in collaboration with other health professionals to provide interventions across this continuum (Stewart et al. 2024). Whilst our scope of PMHN practice positions us well, our roles and capabilities continue to be underutilised within the mental health workforce (Hurley et al. 2022). We need to be adequately prepared to meet the mental well‐being challenges worldwide, including the unmet needs of disenfranchised and vulnerable population groups (e.g., youth, older persons, comorbid disorders, veterans, survivors of trauma).

3. PMHN Workforce

The size of the mental health nursing workforce remains a key challenge to patient care and professional resilience. Across 158 countries, there are only 3.8 practising mental health nurses per 100,000 people, with the mental health nursing workforce equating to 1.03% of the entire nursing workforce Stewart et al. ²⁰²²; World Health Organization ²⁰²¹), placing an unprecedented burden on PMHN. These rates are significantly improved in nations such as Australia, where 85.8 FTE mental health nurses exist per 100,000 people (Australian Institute of Health and Welfare ²⁰¹⁷), yet much lower in developing areas, such as Africa, with 0.9 FTE per 100,000 people (Stewart et al. 2022).

The PMHN profession experiences high rates of workplace violence compared to other health disciplines (Dean et al. 2021). They are also at increased risk of compassion fatigue, which has an adverse sequela. These challenges subsequently fuel issues of workforce shortages through absenteeism, attrition, and recruitment. Consequently, PMHN has significant staff shortages within mental health services, with urgent action required to not only retain PMHN to ensure the profession is fit for purpose but also to support future recruitment efforts (Adams et al. 2021) and create a positive workplace environment and culture that is safe and sustainable for consumers and healthcare professionals.

Deficits in pre‐registration mental health education and poor mental health workforce planning have contributed to the shortage of skilled and experienced mental health nurses (Jones 2023). With only 300,000 mental health nurses globally, the availability of qualified MHNs is a concern that cannot meet the care demands of comprehensive care. This imbalance includes the distribution of skilled staff, geographical (urban and rural settings) and across regions, countries, and varying income levels (Stewart et al. 2024).

4. Education in PMHN

With regard to identity and role, it is important that, as a workforce, we constantly develop our knowledge and skills to support career development and provide the best possible standard of care, including comprehensive psychosocial interventions (Jones 2023). The work of the PMHN includes prevention and mental health promotion, early intervention, and treatment and support for recovery. PMHNs are now specifically educated to varying degrees to perform these interventions in diverse settings, offering comprehensive care to individuals, families, groups, and communities.

However, PMHN faces challenges through both the generalisation of mental health roles as well as the absence of sufficient awareness of mental health screening and assessment among the broader nursing workforce. Generic mental health roles that do not distinguish between disciplines and the use of non‐regulated workers in support roles continue to undermine PMHN effectiveness. Additionally, the preparedness of non‐mental health nurses to assess and respond to mental health needs is impacted by a lack of sufficient education, opportunity, and confidence (McInnes et al. ²⁰²²). In an ideal professional world, all nurses, regardless of their specialisation, should possess a foundational understanding of mental health and be capable of delivering appropriate interventions within their scope of practice (Stewart et al. 2024) in recognition of the interrelatedness of physical and psychosocial health and the need to treat consumers holistically.

There is also a need to actively work towards improving mental health delivery systems, embrace constructive change, and productively collaborate and research together. Our pursuit of knowledge development is central to the profession of PMHN, as is determining who benefits from this and how best to disseminate it. Additionally, there is a need to question the practice that is not appropriate and ethical dilemmas related to treatments and practices that do not align with contemporary values, policies and regulations (Soltis‐Jarrett ²⁰²³).

Quality education in clinical practice, management, policy, and research is essential for PMHN to ensure a skilled and well‐prepared workforce that employs evidence‐based practices and is culturally competent. We must have clear education and career progression pathways, including postgraduate programs and research higher degrees, with routes to specialisations within PMHN (Cleary et al. ^2024b; Le Lagadec et al. ²⁰²³), alongside hybrid continuing professional development programs and specialty conferences. This will position us well as we grapple with challenges such as emerging mental health treatments, new technologies, and new education delivery systems.

5. Advocacy and Leadership in PMHN

Leadership is a foundational aspect of a strong future for PMHN. This includes advocacy, inclusive of policy to support consumers, caregivers, colleagues, and organisational change where appropriate. Whilst we have established PMHN dedicated leadership and professional mental health bodies advocating for mental health reform, more collective effort is needed to address systemic issues across the board. Targeted advocacy can improve services and outcomes and provide better working conditions for PMHNs supporting their therapeutic role.

Additionally, the dwindling numbers of PMHN continue to be a present‐day concern, with more needed to identify potential leaders and grow nurse leaders of today and tomorrow. Whilst professional organisations can support emerging PMHN leaders, facilitate lifelong learning, and professional networks, they do, however, need to ensure they work inclusively, professionally, and with integrity and not become a silo (Cleary et al. 2013). Engaging broadly and equally with transparency, building alliances, and working constructively and productively with others is paramount to achieving change. Affordability of memberships, conferences, and professional development is an important consideration, as is access to such events (Soltis‐Jarrett ²⁰²³).

In addition to leadership across clinical settings, PMHNs continue to provide research leadership, undertaking novel and important research using a range of methodologies and focused on diverse topics with strong programmes to improve mental health. Strong leadership and quality research outputs cannot be achieved without clear pathways for not just academic researchers, but all PMHNs, so that we can all contribute to and lead research to improve mental health care and address priorities and unmet needs across the community (Le Lagadec et al. 2023). This includes articulating what we do as PMHN, knowing what works and what does not work in support of mental health and well‐being (Hurley et al. 2022; Soltis‐Jarrett ²⁰²³), with the transfer of knowledge from the clinical setting to the research setting imperative in achieving this. It is also important to forge meaningful international collaborations and research mental health across all population groups, including middle‐ and low‐income countries, to meet the UN's sustainable development goals (Alavi et al. 2024). Such collaborations can increase research capacity and mitigate barriers to promoting and accessing psychosocial and physical health (Alavi et al. 2024).

6. Looking Forward

6.1. Trauma‐Informed Care

Trauma disrupts our normal mechanisms for coping and presents a risk to the person's or system's capacity to cope and respond. When we look to the future, trauma is one of the key challenges. The current state of geopolitical conflict with mass fatalities, forced migration, destruction, and other crisis events (Ventriglio et al. 2024); the experience of individual and intergenerational trauma within population groups; experiences of psychological or emotional impacts from adverse events or events; and natural disasters, result in further distress or ‘re‐traumatisation’. The impact of these events on individual, community, and global mental health will be felt in the years ahead (Ventriglio et al. 2024). With trauma, it is not only in those whose lives and livelihoods are threatened or who experience significant life events but also among those who work or volunteer at the frontline who may experience trauma in a way that adversely impacts their mental well‐being.

Consideration must also be given to recovery and complexity in instances where there are sequential or systemic exposures to trauma, such as in the case of intergenerational trauma (Bryce and Collier 2022; Eads ²⁰²³) and maladaptive responses to everyday stress after trauma and loss. This is more prevalent in the post‐COVID world, including the current loneliness pandemic, and thought must be given to the PMHN role in this context. Particularly since the pandemic, structural weaknesses within mental health services have been identified (Hurley et al. 2022).

It is important to acknowledge that trauma is experienced differently by individuals and across systems (Bryngeirsdottir and Halldorsdottir 2022). It is encouraging to see in recognition of this, the implementation of trauma‐informed care practices which recognise trauma and its impacts on survivors and their caregivers, integrating this understanding into the support provided during the recovery process and their post‐traumatic growth. See, for example, a clinical case study led by a PMHN, in a community mental health team providing brief intensive treatment comprising risk interventions, brief counselling, collaborative formulation, and pharmacological treatment (Moloney et al. 2018). This not only enabled nurses to better understand how to engage service users but improved their sense of self‐efficacy as well.

The trauma‐informed care approach acknowledges the trauma survivors' experience and incorporates this into the treatment and recovery. This approach aims to reduce trauma responses whilst minimising the risk of re‐traumatisation. As we move forward, TIC training must be prioritised and models developed across all health care (e.g., burns care; Cleary, Kornhaber, et al. ²⁰²⁰; Cleary, West, et al. ²⁰²⁰) and population groups (e.g., autism; Cleary et al. ²⁰²³).

We can also learn from and adapt the trauma‐informed care model so we might mitigate compassion fatigue, burnout, moral injury, and vicarious traumatisation among ourselves, other healthcare staff, and other services. Notwithstanding, evidence identifies the need for a positive workplace culture, education, workforce development, and interventions to address the demands of everyday work of PMHN (Marshman et al. 2022). We must also make time to support ourselves, self‐care, and seek mentors or clinical supervision, given the intense pressure and constant exposure to distress and stress (Najmabadi et al. 2023).

6.2. Resourcing and Quality Care

One of our greatest challenges for PMHN is the delivery of quality care, given the nature of the role and how this impacts mental health service resourcing. PMHNs care for populations who have high rates of co‐occurring disorders, including physical conditions and substance use disorders.

With years of consistent under‐resourcing across mental health services and the continued workforce issues, there is compromised quality of care, compounded by stigma, discrimination, and human rights violations for those living with and experiencing mental health conditions. This absence of resources is shortsighted from a financial viewpoint, with the productivity losses related to mental health exceeding the direct costs of care (World Health Organization ²⁰²⁵).

In addition to adequate resourcing, governance, community‐based care, promotion and prevention strategies, information systems, evidence, and research need to be prioritised and strengthened (World Health Organization ²⁰²⁵). These priorities ensure equitable access, uphold the principles of cultural safety, have a skilled, well‐resourced workforce and clinical leadership, partner with people with lived experience, support decision‐making, use recovery‐oriented trauma‐informed practice, and provide responsive, compassionate, person‐centred care.

Integrated and collaborative models of care are integral to our future as providers of mental health services as we work in partnership with individuals and communities across the lifespan. Given our commitment to social justice and equity, our PMHN role and education, we are well positioned to lead and collaborate on initiatives that bridge the gaps in mental health care for at‐risk populations and those with unmet needs ( Stewart et al. ²⁰²⁴). However, the promotion of mental well‐being and targeted prevention is an area that is often overlooked, with a lack of pathways to care and early intervention (Duffy et al. 2023; Singh et al. ²⁰²²).

That said, best practice requires PMHNs to systematically adopt inclusive recovery‐oriented care and reorientate our focus from diagnosis, medication, and symptom reduction to take a more inclusive approach that accounts for the social determinants that can influence mental health and work towards the achievement of sustainable development goals. Otherwise, we may inadvertently continue to perpetuate distress and trauma. There is scope to innovate further and opportunities to develop and expand emerging and current roles, including nurse practitioners, advanced practice nurses, medication prescribing, telemedicine, research, nurse‐led care models, and navigators, to enable a greater impact on our practice, including symptom management and improved quality of life, PMHN leadership positions, and scope of education and specialist roles (Stewart et al. 2024).

Moving forward, we can build a better future for the discipline and do more, including speaking and sharing information about our role and expertise and what we, as professionals, can do. This includes building an evidence base further to increase understanding among the public and other professional disciplines about the role, skills and capabilities of PMHN, which is necessary for any advancement towards promotion and prevention. In turn, this may mitigate any stigma among the community around mental health and mental health professionals. It is therefore important that we demonstrate constancy of purpose as to where we are heading as a collective profession.

7. Conclusions

The need for mental health care has never been more pressing, with geopolitical conflict, trauma, and fallout from the pandemic, among other factors. Whilst our workforce has the knowledge, skills, and attributes required to work within contemporary recovery‐oriented trauma‐informed frameworks, which include strength‐based and person‐centred approaches, the sustainability of the workforce is an issue. Education differs across countries, as do mental health resources, including services and delivery systems; there are, however, many similarities (Thomas 2023). Together, we must work to achieve integrated, comprehensive, people‐centred care. Most importantly, “Our greatest collective strength continues to be the fact that we have adhered to the most important principle: never losing sight of the patient as the central figure” (Fitzpatrick 2005, 204).

Conflicts of Interest

The author declares no conflicts of interest.

Cleary, M. 2026. “Psychiatric Mental Health Nursing: Using Our Experience to Shape Our Future Focus.” Journal of Advanced Nursing 82, no. S2: S55–S59. 10.1111/jan.16980.

Data Availability Statement

Data sharing is not applicable to this article.