Biomaterial Database

The changing relationship between mental health nurses and psychiatrists in the United Kingdom. 2005

Neil R Brimblecombe

Mental Health, Hertfordshire Partnership NHS Trust, Mental Health Services, St Albans, Hertfordshire, UK. neil.brimblecombe@doh.gsi.gov.uk

OBJECTIVE This paper illustrates key developments in the changing relationship between the two professions over the last 200 years. BACKGROUND To understand the current relationship between mental health nurses and psychiatrists within the UK, it is necessary to understand the historical development of that relationship. METHODS Information was sought from a range of primary documentary sources, including contemporary journals, asylum documents and official governmental and health service reports. Secondary sources, such as histories of medicine, nursing and individual asylums provided further supportive information. RESULTS Psychiatry emerged as a profession at the end of the 18th century and found a power base within county asylums from the middle of the 19th century. Medical superintendents, the doctors in charge of asylums, had strict control over the activities of attendants, the justification for which was the need to protect patients from cruelty and neglect. Superintendents' desire for their own enhanced professional status led to formalized training for attendants at the end of the 19th Century, in which training materials again reinforced the importance of obedience by nurses (as attendants had become known). During the 1920s, trade unions struggled for improved pay and conditions, whilst professionalizing mental health nursing was a secondary priority. Reorganization following creation of the National Health Service in 1948 lessened superintendents' authority, and ultimately the management of mental health nursing shifted from them. The move towards community care allowed mental health nurses to develop greater independence, which was supported by changes in nurse education. CONCLUSIONS Psychiatrists in the UK remain highly influential, despite the move from their traditional power base in hospitals. Changes in mental health care, such as new nurse prescribing powers and the loss of psychiatrists' control over admission of patients to hospital, will continue to change the relationship between mental health nursing and psychiatry.

UI	MeSH Term	Description	Entries
D009732	Nursing Care	Care given to patients by nursing service personnel.	Care, Nursing,Management, Nursing Care,Nursing Care Management
D011568	Psychiatric Nursing	A specialty concerned with the application of psychiatric principles in caring for the mentally ill. It also includes the nursing care provided the mentally ill patient.	Mental Health Nursing,Nursing, Psychiatric,Psychosocial Nursing,Nursing, Mental Health,Nursing, Psychosocial
D011570	Psychiatry	The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders.
D005544	Forecasting	The prediction or projection of the nature of future problems or existing conditions based upon the extrapolation or interpretation of existing scientific data or by the application of scientific methodology.	Futurology,Projections and Predictions,Future,Predictions and Projections
D006113	United Kingdom	Country in northwestern Europe including Great Britain and the northern one-sixth of the island of Ireland, located between the North Sea and north Atlantic Ocean. The capital is London.	Great Britain,Isle of Man
D006778	Hospitals, Psychiatric	Special hospitals which provide care to the mentally ill patient.	Mental Hospitals,Hospitals, Mental,Mental Institutions,Psychiatric Hospitals,Hospital, Mental,Hospital, Psychiatric,Institution, Mental,Institutions, Mental,Mental Hospital,Mental Institution,Psychiatric Hospital
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001523	Mental Disorders	Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function.	Mental Illness,Psychiatric Diseases,Psychiatric Disorders,Psychiatric Illness,Behavior Disorders,Diagnosis, Psychiatric,Mental Disorders, Severe,Psychiatric Diagnosis,Illness, Mental,Mental Disorder,Mental Disorder, Severe,Mental Illnesses,Psychiatric Disease,Psychiatric Disorder,Psychiatric Illnesses,Severe Mental Disorder,Severe Mental Disorders
D019555	Physician-Nurse Relations	The reciprocal interaction of physicians and nurses.	Nurse-Physician Relations,Physician Nurse Relationship,Nurse Physician Relations,Nurse Relationship, Physician,Nurse Relationships, Physician,Nurse-Physician Relation,Physician Nurse Relations,Physician Nurse Relationships,Physician-Nurse Relation,Relation, Nurse-Physician,Relation, Physician-Nurse,Relations, Nurse-Physician,Relations, Physician-Nurse,Relationship, Physician Nurse,Relationships, Physician Nurse