Reflecting on 30 years as a Mental Health Nurse

To celebrate her 30th anniversary as a Mental Health Nurse, Debbie Kay shares her story and experiences along the way. 

This week marks my 30th year since qualifying as a nurse. I only realised when renewing my nursing registration! I’m not sure how many of my compatriots are still practicing and on the register.


Here is my certificate of Mental Health Nursing dated 21 July 1992. I trained at Derby in the School of Nursing (not university) based at the Rykneld site. I started in January 1989, I didn't know if I would like it but I thought I'd give it a go and my goodness...I'm still here!

Throughout my training I was paid a wage, I was included in the numbers and most of my placements were at Pastures Hospital, which covered the whole county of Derbyshire (it even had an avery for the ward budgies!), and also at Kingsway Hospital which covered the city of Derby. 

I did a general placement too on a general medical ward at Derby Royal Infirmary which had six beds for skin conditions which were mainly leg ulcers. 

Around 1992 there were huge changes within nursing and mental health services. Student nurse training was moving towards 'Project 2000' diploma level training. I'm 'only' at certificate level. Mental health services were moving out of the asylums towards 'care in the community' within the hospitals. There was a standing joke that if your ward was decorated you were earmarked for closure. There seemed to be a few wards it happened to. 

Unfortunately, this meant very few vacancies for newly qualified nurses due to impending redeployments and ringfenced posts. On qualifying I joined the bank and went where I had done my final placement - a 'long stay continuing care of the elderly' dementia ward. It was named 'Fairway' and it had beautiful views across the golf course. 

I picked up regular shifts but there was no preceptorship back then. I wanted to work in dementia care, to enhance peoples' care. It was sometimes task orientated and there were people on that ward who had been 'committed' to the asylum for delinquency, moral insanity and sadly probably never had mental ill health. 

This ward had a reputation among students that you didn't want a placement there. It held the poorer institutionalised practice in my head that I'd experienced in my training and vowed I would never practice. This includes on-mass toileting, meals as quick as possible and some questionable restrictive methods of fall prevention. The doors weren't locked (no magnetic locks) and there were lots of exits. The staff meant well and tried their best. There were no cognitive enhancers and there were a range of sedative medications in liquid or tablet form. I can still smell it and can always recall the smell of procyclidine syrup/liquid bubble gum. 

I applied for permanent posts and was successful at the ward where all students wanted to be placed. It had a really good reputation, giving person centred care before the phrase was even coined. It was a Ilkeston Community Hospital on the Woodside Ward. After my first shift there I cried on the bus home. It was so different to the institutionalised care I had experienced previously. Even things like individual toileting was different with the use of incontinent pads.

"Just simple humane caring acts - it was amazing."

When assisting people to eat the staff would tell the person what was on their implement. There was a choice of tea or coffee. Just simple humane caring acts - it was amazing. We would take four people to Skegness each year and sometimes we would take a spouse too. That was hard work but the quality of care and quality of life we could provide was immensely satisfying. Day trips to shops and local fairs were other highlights. Again, the doors weren't locked, once we had a chap who spent his whole day walking and down the corridor saying hello to folks and he would always come back. Cognitive enhancers were introduced but were initially only available on private prescriptions. 

Debbie Kay

After a change in leadership I moved back to Derby to Kingsway Hospital on the 'organic' acute admissions ward - a female only ward aiming to be person centred. To the side is my picture from the ward's 'who's who' board.

I moved onto the long stay ward at 'F' grade, which sadly I felt had stepped back in time. It was very task orientated. I managed to change a few things, challenging practice before moving back as 'F' grade to the admissions ward. I followed my (then) husband up to Sheffield coming to Woodland View in 1999 which was great.

On 2 August this year I'm also celebrating 20 years of being a Community Mental Health Nurse in Sheffield, mainly working in older adults, but also a brief spell in perinatal. 

I came to the South East B Older Adult Community Mental Health Team on a three month secondment. I was very scared as I had only worked with dementia in older adults, even in my training. It was a really busy team. There were many referral meetings where everyone would look at the floor in thinking 'please don't allocate to make as I don't know how I'm going to provide the quality or level of care and service I aim to' but the team members helped each other out as best they could. 

Being a Community Mental Health Nurse has been incredibly rewarding and a privilege. To be let in to someone's home with all their life and photos around them. They've tried everything else and are needing support. Holding their hope and belief in the human spirit on their behalf. Guiding and facilitating to a better quality of life, accessing services and support. I have loved following people through the times when they have gained functioning and optimism, but also the times where things have gone wrong for them and walking with them through this. Having the support of other teams when people have needed extra help. I've worked with amazing people, brilliant, cohesive, striving teams, who have welcomed challenges and want to do the best for the people they are providing care to. I've made some wonderful friends along the way.

Intermediate Care Mental Health Team

Now to the present day. I'm so incredibly fortunate to work as a Senior Nurse Practitioner within the Intermediate Care Mental Health Team (pictured). It's a small, fabulous, supportive team of Community Mental Health Nurses employed by Sheffield Health and Social Care NHS Foundation Trust.

We work exclusively into Sheffield Teaching Hospitals NHS Foundation Trust's Intermediate Care Services. These services are the Integrated Care Team - Therapy, Active Recovery, Intermediate Care Bed Units and the Stroke Assessment and Rehabilitation Pathway Centre. I love the variety of people that I come into contact with.

It's an all age service, so we see older and working age adults, all with different mental health issues. This can be anything from memory issues and anxiety, to depression or severe mental illness (SMI). We work with staff of all disciplines, physiotherapists, occupational therapists, GPs, nurses and a whole host of other teams.

There's no staring at the floor when referrals are discussed here 

I enjoy that we are open to repeat referrals and we are happy to start interventions again after someone falls. There's no starting at the floor when referrals are discussed here. For the team our main focus is addressing mental health needs in order to facilitate engagement with the person's physiotherapy programme. Its making a real link with mental and physical health - truly bringing parity of esteem and equity. There are very few intermediate care mental health teams nationally. 

I wonder how many other, including new students or newly qualified nurses will be celebrating 30 years in the future? Here's some advice for staying the course.

To keep motivated, think about if the person you are caring for was you, or a love one - what care would you like to receive? Pre-empt when someone is slipping or deteriorating. The deeper they are the longer it takes to come back. Hold that hope for them on their behalf. If you are becoming unhappy or cynical in the team you are in, raise it, change it or look elsewhere to find a team that you will enjoy. 

If you lose your compassion for someone else, ask yourself if you should be doing this. Why did I come into this career?

It's a tough but rewarding job. Be happy, look after yourself and give good care. 

Debbie Kay

By the way. I can still get in to my silver buckled nurse's belt from qualifying. Although it is a very tight squeeze.

Thanks for reading.