The role of mental health nurses in supporting young people’s mental health: a review of the literature
| Published date | 10 September 2018 |
| Pages | 197-220 |
| Date | 10 September 2018 |
| DOI | https://doi.org/10.1108/MHRJ-09-2017-0039 |
| Author | Jessica Louise Arnold,Charley Baker |
| Subject Matter | Health & social care,Mental health |
The role of mental health nurses in
supporting young people’s mental health:
a review of the literature
Jessica Louise Arnold and Charley Baker
Abstract
Purpose –Adolescent mental health issues are on the increase, in particular depression, which is now a
major public health concern globally. Mental health education is important and young people’s awareness of
mental health is potentially limited. This is one factor that creates barriers to seeking support. School nurses
and educational professionals recognise that they do not necessarily have the required skill base to support
emotional health concerns with young people. The purpose of this paper is to synthesise qualitative evidence
related to the nurse’s role in supporting adolescents.
Design/methodology/approach –A literature review using a systematic approach was undertaken,
predominantly through collection of primary qualitative research studies. In total, 22 published studies are
included in this review, extracted from four databases –CINAHL, Embase, Medline and Scopus.
Findings –This review shows that awareness of mental health is needed early in adolescence, while at
school, to encourage young people to access support and have knowledge of their own emotional health.
The need for further mental health education and provision is asserted.
Practical implications –Young people benefit from someone who is accessible and familiar to them in
schools so that they can access emotional support as and when needed. Careful involvement of families
(including extended families) is noted. It is proposed that this role should be a mental health nurse role, who
should be accessible within the school environment.
Originality/value –This paper is original and adds to existing knowledge that mental health challenges are
increasing, and more needs to be done in schools to promote mental health and reduce the stigma
associated with seeking support.
Keywords Young people, Adolescents, Mental health, Depression, Mental health nurse
Paper type Literature review
Introduction
All types/fields of nurses have a role to play in supporting young people who present with emotional
difficulties. Haddad and Gunn (2011) asserted the importance of clinicians’skills being “robust”and
“up to date”with evidence-based practice, and that appropriate clinician knowledge of depression is
vital for effective treatment. Merrifield (2015) asserted that every school should have a designated
mental health nurse assigned as a point of contact by 2020; yet the RCN (2015) has noted a depletion
in school nurses since 2010 in the UK, which might be a barrier to overall holistic nursing provision in
school settings. Shocket and Ham (2004, cited in Walsh 2009) raised the importance of mental health
promotion within the curriculum in order to reduce stigma, reinforcing the view that a collaborative
approach is needed between mental health nurses and schools. This literature review aims to address
a gap in knowledge around young people’s mental health help seeking and the role of mental health
nurses in this area, through a systematic review and narrative synthesis of existing research.
Background
Mental health conditions –and depression in particular –are common among adolescents
yet one of the most overlooked and undertreated areas of mental health (Maurizi et al., 2013).
Received 3 September 2017
Revised 29 May 2018
Accepted 30 May 2018
There was no funding in the
undertaking of this study.
Jessica Louise Arnold is Mental
Health School Nurse at
Department of School Health,
Derbyshire Healthcare NHS
Foundation Trust, Derby, UK.
Dr Charley Baker is Mental
Health Lecturer at the Faculty
of Medicine and Health
Sciences, School of Health
Sciences, University of
Nottingham, Nottingham, UK.
DOI 10.1108/MHRJ-09-2017-0039 VOL. 23 NO. 3 2018, pp. 197-220, © Emerald Publishing Limited, ISSN 1361-9322
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Garmy et al. (2014) stated that depression may not only affect a young person’s mood, but also
academic performance and social relationships, potentially causing isolation. The symptoms of
depression are broadly defined, consisting of emotional upset and anxiety, both of which may be
expected during adolescence; this indicates the difficulty of effectively defining clinical thresholds
for diagnosis where there are concerns (National Institute of Clinical Excellence (NICE), 2013;
Knapp et al., 2016). McCann et al. (2012) found an absence of information available to
adolescents concerning the signs and symptoms of depression and found nurses not effectively
responding to adolescents. Similarly, Doyle et al. (2017) identified mental health professionals’
poor understanding of the motivators behind self-harm in adolescence being a concern, they
additionally asserted; professionals responding negatively towards young people having a
detrimental impact on the engagement process as a result. Furthermore, O’Reilly et al. (2016)
identified quality of communication between a practitioner and young people being a complex
area to master.
Adolescent depression is a national and global concern (World Health Organization (WHO), 2014;
Reeves and Riddle, 2014). Kieling et al. (2011) argued that mental health resources and policies are
scarce worldwide and that promotion of mental health is a “worldwide challenge”. Bustreo (2014)
further asserted that there has been insufficient investment and attention given to the provision of
adolescent health globally. Thornton (2015) stated that 10–20 per cent of young people will
experience depression in their youth. This highlights the importance of the need for health education
and its provision (WHO, 2014; Kieling et al., 2011; McCann et al., 2012). It is also significant that
WHO (2014) recognise that prevention programmes reduce depression in children. An unacceptable
70 per cent of young people with mental health problems are not offered intervention (McDougall,
2011), with potentially serious implications –suicide is the third most common cause of death in
adolescents (WHO, 2014; Auerbach et al., 2015; Avenevoli et al., 2015; Bauman et al., 2013).
Early intervention and collaborative working is seen to empower young people’s resilience and
maximise their inner resources to prevent problems in later life (McDougall, 2010). This is a view
shared by Kieling et al. (2011) who all advocated early intervention and prevention as vital to avoid
mental health difficulties progressing into adulthood. Despite this there is still a gap between
needs and resources (Belfer, 2008) and limited availability of trained nurses and appropriate
services to support adolescents remains an ongoing concern (Kaye et al., 2009).
In America, integration of mental health centres within schools in under-served areas resulted in a
reduction of stigma which empowered adolescents to access support earlier (Parasuraman and
Shi, 2014). This view from the USA reinforces Merrifield’s (2015) view that UK clinicians need to
be “visible”within schools. Hunt (2008) also concluded that a united approach is significant when
educating adolescents about the signs and symptoms of depression. Mental health problems
during adolescence are an important public health issue. The Chief Nursing Officer’s Professional
Leadership Team (2012) recognise that nurses in universal services are crucial to positive mental
health, off-setting potential future health inequalities that can stem from poor mental health.
Health Education England planned to put a specialist perinatal mental health clinician into every
birthing unit by 2017 (PHE, 2015); not only does this confirm key roles for nurses at a universal
level, but also the need for coherent services for all to access mental health support (PHE, 2015).
Despite its need, mental health support in schools by specialist mental health nurses is restricted
to certain areas and far from a common finding. Historically, the call for closer co-working has
been clearly stated –Hunt (2008) outlined the importance of raising awareness of mental health in
schools and emphasised collaboration between school professionals and nurses. However, he
pointed out that stigma associated with mental health is a factor in adolescents not seeking
support. It could be that such stigma reduces the perceived role for (specifically mental health
trained) nurses in school settings. As Wolpert et al. (2015) noted, the three-year project Targeted
Mental Health in Schools only targeted areas of socio-economic deprivation. McDougall (2011) is
emphatic that depression in young people is still not being recognised or treated in the UK until it
becomes advanced. While strong local working relationships may be present it may be
challenging to work interactively and across disciplines while there are fiscal pressures on both
the health and education sectors. Additionally, ambiguity faced by nurses who lack skills or
experience in mental health presents barriers to supporting young people emotionally (Giandinoto
and Edward, 2014; Arnold and Mitchell, 2008).
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