Alexander Louise, Searby Adam, Mills Cally, James Russell, Johnson Whitney
Deakin University, School of Nursing & Midwifery, Burwood, Australia.
Deakin University, Institute for Health Transformation, Geelong, Australia.
Int J Ment Health Nurs. 2025 Jul;34(4):e70127. doi: 10.1111/inm.70127.
The state of Victoria, Australia is currently in a period of mental health reform, spurred on by a recent damning Royal Commission and updates to legislation. New legislation promotes the choices and rights of consumers in the mental health system, including recommendations to eliminate seclusion by 2030. While much of this reform has been met with enthusiasm by consumer groups and nurses alike, there remains uncertainty. The aim of this paper is to describe the experiences and perceptions of mental health nurses on mental health reform in the State of Victoria, Australia. Adopting a qualitative descriptive method, mental health nurses (n = 14) working in public mental health services in Victoria undertook individual interviews, with data thematically analysed. After analysis, three themes were identified: Navigating the new Act: Overcoming Managing challenges faced by mental health nurses, Defusing the storm: Mental health nurses' safety concerns under the new Act, and Workforce strain and organisational value: The impact on mental health nurses. Nurses described distress at working in a system with increasing occupational pressures and expressed concern that the goal to eliminate seclusion by 2030 may not be achievable due to current system constraints and deficits. They also highlighted legislative barriers that prioritised consumer preferences over clinical judgement, which they perceived as contributing to a decline in consumer wellbeing and, in some cases, serious adverse outcomes. While mental health reform is essential to improving care, it must also consider the practical and emotional demands placed on clinicians within evolving legislative frameworks. This study identified that the implementation of mental health reform requires a consistent approach by health services and government that promotes the needs of consumers whilst also balancing the significant workplace stressors that nurses encounter. Plans to eliminate restrictive practices need to adopt a consistent, collaborative approach that recognises the complexity of current challenges and the importance of thoughtfully addressing the underlying factors, rather than simply removing existing responses.
澳大利亚维多利亚州目前正处于心理健康改革时期，这是由最近一份严厉的皇家委员会报告以及立法更新所推动的。新立法促进了心理健康系统中消费者的选择权和权利，包括到2030年消除隔离的建议。虽然这项改革得到了消费者团体和护士的广泛欢迎，但仍存在不确定性。本文旨在描述澳大利亚维多利亚州心理健康护士对心理健康改革的经历和看法。采用定性描述方法，对在维多利亚州公共心理健康服务机构工作的心理健康护士（n = 14）进行了个人访谈，并对数据进行了主题分析。分析后确定了三个主题：应对新法案：克服心理健康护士面临的管理挑战；化解风暴：新法案下心理健康护士的安全担忧；劳动力压力与组织价值观：对心理健康护士的影响。护士们描述了在一个职业压力不断增加的系统中工作的痛苦，并表示担心由于当前系统的限制和缺陷，到2030年消除隔离的目标可能无法实现。他们还强调了立法障碍，这些障碍将消费者的偏好置于临床判断之上，他们认为这导致了消费者福祉的下降，在某些情况下还导致了严重的不良后果。虽然心理健康改革对于改善护理至关重要，但它也必须考虑在不断演变的立法框架内对临床医生提出的实际和情感需求。本研究发现，心理健康改革的实施需要卫生服务机构和政府采取一致的方法，既要促进消费者的需求，又要平衡护士所面临的重大工作压力源。消除限制性做法的计划需要采取一致、协作的方法，认识到当前挑战的复杂性以及深思熟虑地解决潜在因素的重要性，而不是简单地取消现有的应对措施。
