Evaluation of mental health services in the free state Part II. Training, attitudes and practices of generalist and psychiatric nurses

Objectives. The objective of this study were: (i) to describe the training, attitudes, the practices of nurses relevant to the decentralisation of the Free State Mental Health Service (MHS); and (ii) to assess how adequately nurses were being supported in their new role. Design and subjects. A descriptive study was performed in which 29 generali st nurses from 16 clinics and 6 psychiatric nurses from 3 regions were inte rviewed using a comprehensive semi-structured interview schedule. Outcome measure. These consisted of indicators of training (duration and co ntent), attitudes towards decentralisation ( perceptions of competence and stress) and drug practice. Indicators of support included telephonic consul tations, emergency and referral practice, and drug availability. Results. One-sixth of the generalist nurses had not yet received essential training and over two-thirds wanted more training. While half of the nurses felt that their added psychiatric responsibility was stressful, half of th em also felt competent to do mental health work. No nurses prescribed medic ation and only 10% would change drug regimens of their own accord. With reg ard to support given to clinic nurses, one-third felt that telephonic consu ltation with the tertiary hospital was not working well, and that emergency and referral systems were problematic. Forty-five per cent of the nurses s aid that drug availability was poor. Generalist nurses believed that specia lly trained psychiatric workers should be responsible for the psychiatric w ork at the clinic. Conclusions. While the Free State has made positive steps towards decentral izing its service, mental health is not yet fully integrated into the prima ry health care (PHC) service. In order to achieve this it is recommended th at there be increased training of generalist nurses, a reorientation of the ir attitude toward one of taking greater responsibility for mental health w ork, and an increase in their scope of practice with regard to drug use. A critical recommendation is that greater support be given to generalist nurs es to equip them for their role in the MHS.