The last 50 years have seen considerable changes in the role of the psychiatric nurse in the United States, the United Kingdom, Australasia, and many European countries. In Eastern Europe and many countries of the developing world, psychiatric nursing is still not identified as a specific discipline, and in many countries psychiatric hospitals are still staffed by untrained 'attendants' who may have some supervision from general trained nurses. However, in some of these countries psychiatric nursing is now beginning to evolve as an independent discipline. For example, during the last 3 or 4 years a number of training programmes in Romania have at least begun to equip staff with some of the more basic skills, and some of the African countries have benefited from World Health Organization nursing initiatives.

The development of psychiatric nursing across the world has to be seen in the context of changing and evolving patterns of mental health care. Obviously deinstitutionalization with the attendant setting up of community mental health teams, has prompted a number of innovations in psychiatric nursing. However, it is interesting to note that in 1954 psychiatric nurses were sent out from Warlingham Park Hospital in Surrey to follow up patients after their discharge. (1) Their main role then was to administer medication and to monitor patients' progress. From these early days at Warlingham Park, community psychiatric nursing has grown as a discipline, and by 1998 there were probably over 8000 community psychiatric nurses employed in England and Wales. (2)

In this chapter we examine the development of community psychiatric nursing in some detail, and describe some of the techniques used by community psychiatric nurses. Although the United Kingdom community psychiatric nursing model has been followed in countries such as Australia and New Zealand, this role has not developed to any great extent in the United States. In the United Kingdom, community psychiatric nurses have recently undertaken the role of a skilled clinically focused case manager. In the United States, however, where clinical case managers also exist, this role is undertaken by social workers, psychologists, and workers from non-professional backgrounds. A chapter such as this cannot really do justice to the whole range of techniques used by psychiatric nurses, neither can it examine in any detail the differences between nursing practice across the world. However, a description of three central areas will provide the reader with an appreciation of the range and diversity of psychiatric nursing skills:

• the role of nurses in the management of serious mental illness within the community

• the role of nurse therapists in the treatment of neurotic and habit disorders

• psychiatric nursing in inpatient settings.

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