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The Development of Community Mental Health Nursing Services in Western Australia : a History (1950-1995) and Population Profile

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The Development of Community Mental Health Nursing Services in Western Australia : a History (1950-1995) and Population Profile Edith Cowan University Research Online Theses: Doctorates and Masters Theses 1-1-1996 The development of community mental health nursing services in Western Australia : A history (1950-1995) and population profile Phillip M. Maude Edith Cowan University Follow this and additional works at: https://ro.ecu.edu.au/theses Part of the Psychiatric and Mental Health Nursing Commons Recommended Citation Maude, P. M. (1996). The development of community mental health nursing services in Western Australia : A history (1950-1995) and population profile. https://ro.ecu.edu.au/theses/935 This Thesis is posted at Research Online. https://ro.ecu.edu.au/theses/935 Edith Cowan University Copyright Warning You may print or download ONE copy of this document for the purpose of your own research or study. The University does not authorize you to copy, communicate or otherwise make available electronically to any other person any copyright material contained on this site. You are reminded of the following: Copyright owners are entitled to take legal action against persons who infringe their copyright. A reproduction of material that is protected by copyright may be a copyright infringement. Where the reproduction of such material is done without attribution of authorship, with false attribution of authorship or the authorship is treated in a derogatory manner, this may be a breach of the author’s moral rights contained in Part IX of the Copyright Act 1968 (Cth). Courts have the power to impose a wide range of civil and criminal sanctions for infringement of copyright, infringement of moral rights and other offences under the Copyright Act 1968 (Cth). Higher penalties may apply, and higher damages may be awarded, for offences and infringements involving the conversion of material into digital or electronic form. THE DEVELOPMENT OF COMMUNITY MENTAL HEAL TH NURSING SERVICES IN WESTERN AUSTRALIA: A HISTORY (1950 to 1995) AND POPULATION PROFILE. BY PHILLIP MICHAEL MAUDE A Thesis Submitted as Partial Fulfilment of the Requirements for the Award of Master of Nursing at the School of Nursing, Edith Cowan University Perth, Western Australia. Date of Submission: 28th March, 1996 USE OF THESIS The Use of Thesis statement is not included in this version of the thesis. iii Abstract This descriptive study discusses the development of community mental health (CMH) in Western Australia (WA) and describes the current practising population of CMH nurses. The study explores literature pertaining to the emergence of the CMH movement and the deinstitutionalisation of the mentally ill. A conceptual framework was developed by adapting Lewin's change theory. CMH nurses practising in WA (n= 130), were invited to participate in the study and were asked to complete a survey questionnaire. This resulted in a 66% responce rate (n = 86). Quantitative data was analysed using the Statistical Package for the Social Sciences (SPSS). Open ended questions were analysed using Colaizzis steps. The study found that mental illness has been treated according to contemporary beliefs. In the 1950s multiple forces within society led to the movement away from institutionalisation of the mentally ill toward deinstitutionalisation. The first community clinic was established in 1956 to manage the deficit between the ever expanding population needing mental health care and the paucity of available hospital beds. The need for follow up of clients in the community resulted in the development of CMH nursing. The study also provides a profile of the current practicing population of CMH Nurses in WA, demographic details. qualifications, the work environment, educational needs, work role and job satisfaction have been described. Recommendations have been developed from the findings and are directed towards, the dissemination of information, the need for role identification/development, staff development needs, future education needs, industrial issues, clinical practice issues and areas for further nursing research. - iv Declaration "I certify that this thesis does not incorporate, without acknowledgment, any material previously submitted for a degree or diploma in any institution of higher education and that, to the best of my knowledge and belief, it does not contain any material previously published or written by another person except where due reference is made in text." Phillip Michael MAUDE Date: 1i \s\�lo V Acknowledgments I wish to sincerely thank and acknowledge the following people and organisations who have assisted me with this study: All the community mental health nurses who responded to the questionnaire. Maxine Serrell, Rhonda Marriot and Dr Nancy Hudson-Rodd for their guidance as my supervisors. Their sense of humour and patience helped me achieve far more than I hoped for. Amanda Blackmore, research consultant, for her assistance with the instrument development and constant encouragement. To the people who tested the instrument for validity and to all the nurses who participated in the pilot study. To my fellow Master of Nursing students who were always at the end of the telephone when I needed them. To Rosalie Van Aken who commenced me on this winding path, Noreen Foy (I could not have had a better clinical role model) and Dianne Wynaden for believing in me. These people will probably never be aware of the inspiration they have given me. This research was supported by the Western Australian School of Nursing (WASON) Association Trust. Finally, I would like to express my sincere thanks to Kim Wood for being there. I know this was a disruptive exercise. I love you more than ever. Phil Maude. vi Table of Contents Page No: ABSTRACT iii DECLARATION iv ACKNOWLEDGEMENTS V TABLE OF CONTENTS vi LIST OF APPENDICES Xiii LIST OF FIGURES xiv LIST OF TABLES xv CHAPTER ONE • INTRODUCTION Background 3 Significance of the study Purpose of the study 4 Research questions 4 Assumptions 5 Definition of terms 5 Organisation of the thesis 7 CHAPTER TWO - REVIEW OF LITERATURE Locus of mental health care throughout history 8 Background and history of CMH nursing 12 Deinstitutionalisation 13 Mental health and the health care system 14 Summary 17 CHAPTER THREE - CONCEPTUAL FRAMEWORK Social model of CMH nursing 18 vii CHAPTER FOUR - METHOD Study design 22 Study population 22 Study setting 22 Instrumentation 25 Validity and reliability 25 The pilotstudy 28 The main study 29 Data analysis 30 Elimination of bias 31 Ethical considerations 31 University approval 32 Consent to proceed 32 Confidentiality 33 Information provided to participants 34 Right to withdraw 34 Storage of data 34 CHAPTER FIVE - THE DEVELOPMENT OF COMMUNITY MENTAL HEALTH NURSING IN WESTERN AUSTRALIA The 1900s and the evolution of the social model of CMH 35 The emergence of CMH nursing in WA 38 1950s 38 1960s 41 19705 44 1980s 48 1990s 52 viii CHAPTER SIX - POPULATION PROFILE OF COMMUNITY MENTAL HEALTH NURSES PRACTICING IN WESTERN AUSTRALIA Introduction 55 Questionnaire responses 55 Population profile 56 Age of respondents 56 Gender 56 Current work location 56 Length of time employed in current position 57 Current employment contract 57 Experience as a registered nurse in a community setting prior to current position 58 Accessibility to other CMH nursing colleagues 59 Major ways CMH nurses who work alone make contact 60 CMH nurses first choice of consultation with other health care workers 60 Nursing qualifications 61 Courses completed by CMH nurses 62 Courses that CMH nurses are currently studying 64 Perception of staff development availability 64 Perception of how staff development received has enhanced the role of the CMH nurse 65 Perception whether tertiary based education was available to assist in providing advanced CMH nursing practice 65 Perception of whether education has adequately prepared CMH nurses for their current position 66 - ix Work activities 67 Activities CMH nurses performed in the previous week Liaison with other services 67 Follow up of community clients 67 Admission of clients to hospital 67 Report writing 67 Telephone counselling 67 Travelling to appointments 68 Meetings 68 Group work 68 Nursing procedures 68 Case review 68 Home visits 68 Primary assessment of clients 69 Supervision of staff 69 Supervision of student nurses 69 Client education 69 Carer support 69 Liaison 70 Additional activities not listed 70 Activities that are perceived by CMH nurses to go beyond their current responsibilities and job description Facilitating therapy groups 71 Facilitating support groups 71 Research 71 Public speaking 71 Quality assurance programs 71 Client satisfaction surveys 72 Carer support services 72 - X Self help groups 72 Social outings designed to rehabilitate clients 72 Advise to other professional re the prescribing of psychotrophics 7 2 No indication of an expanded service 73 Other activities not listed 73 Perception of effective orientation to CMH nursing area 73 Availability of policy & procedure manuals at CMH nursing work sites 74 Access to a current job description 75 Job satisfaction 76 Level of job satisfaction 76 CMH nurses prediction as to whether they will continue to practice with in this role in twelvemonths time 78 General comments made by metropolitan respondents 79 General comments made by rural respondents 80 Summary 81 CHAPTER SEVEN - DISCUSSION Population profile 82 Gender 82 Length of time employed in current position 83 CMH nurses first choice of consultation with other health care workers 83 Education and training 84 Courses completed by CMH nurses 86 Perception of staff development availability
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