Scottish Mental Health Nursing Review

7. Theme 2: Mental Health Nursing Leadership.

7.1 What we heard

All mental health nurses are leaders in their own right. Leadership requires diverse skills that are grounded in values, personal connections, and networks, and are central to the profession’s identity. Effective leadership can facilitate meaningful changes that benefit both the person receiving care and staff (Holm and

Severinsson, 2010, Ennis et al, 2015, Sclafani et al, 2008 and Brimblecombe et al, 2019).

The importance of effective and impactful mental health nursing leadership and communication at all levels and sectors was a key theme that arose through the National Conversations. The importance of senior leaders creating the conditions to build and sustain leadership capacity and skills at all levels within the workforce, empowering mental health nurses with confidence to see themselves as leaders and with leadership skills not dependent upon title, was also emphasised.

The research highlighted that clinical leadership and mentoring are pivotal to professional development and job satisfaction for junior staff and students. This is crucial to creating a positive workplace culture, through role modelling, coaching, teaching, and creating supportive and collaborative learning environments. The supportive and collaborative learning environment, along with strong and well-defined leadership in mental health nursing was seen as essential to improving job satisfaction and retention in mental health nursing, and in turn, could lead to enhanced patient outcomes (Holm and Severinsson, 2010, Perkins et al, 2023, Sayers et al, 2015).

The studies suggested that the attributes and essential qualities for effective clinical leaders include professionalism, honesty, willingness to share knowledge, and approachability (Ennis et al, 2015). For management roles that are also undertaken by many mental health nurses, this involves well defined leadership tasks, enhancing patient care, fostering teamwork, balancing staff well-being, promoting collaboration, utilising evidence-based practices, and improving organisational communication (O'Sullivan et al, 2021).

The evidence identified nurse educators as key clinical leaders, acting as mentors, role models, and change agents who play a significant role in shaping the next generation of mental health nurses (Ennis et al, 2015). Their leadership is critical in developing a skilled, capable workforce, integrating evidence into practice, and creating holistic, patient-focused care models.

The research also highlights the need to integrate a focus on leadership qualities into the education, supervision, and development of all mental health nurses. The exploration of embedded leadership within clinical practice shows that mental health nursing leaders find intrinsic rewards in their work, value authentic connections with patients, and use creative problem-solving techniques to achieve therapeutic outcomes (McAllister et al, 2013).

Some examples of national leadership and management development programmes and opportunities available across health and social care, include:

• Leadership development - Scottish Social Services Council
• Leadership and Management Zone | Turas | Learn
• Leadership and Management Programmes | Turas | Learn
• Coaching and Mentoring | Turas | Learn
• Digital Health and Care Leadership Programme (DLP) | Turas | Learn
• The NES Scottish Trauma Informed Leaders Training (STILT) training programme https://learn.nes.nhs.scot/37902

In recognition of the above findings, our advisory groups suggested the following priority actions:

11. ACTION: Working with the Mental Health Nurse Leads Group and SEND, we will undertake an analysis of existing professional leadership structures, supports, and impacts across services and sectors.

12. ACTION: Working with the Mental Health Nurse Leads Group and HEIs, we will re-establish a sustainable student mental health nursing network to ensure connectivity, sharing of best practice, resources, and support where appropriate.

13. ACTION: Following the evaluation of the Allied Health Practitioners (AHP’s)

Careers Fellowship Scheme, we will explore the feasibility of establishing a Mental Health Nursing Careers Fellowship Scheme with the aim to test a model for implementation in 27/28.

14. ACTION: As highlighted in the Workforce Action Plan and based on the national Clinical Supervision Framework for Nursing, NES will develop, test and evaluate the Professional Nurse Advocate role, making recommendations for future workforce planning.

In line with the National Institute of Health Care Excellence guideline [NG225] guidance on the mitigation of Suicide, NHS Lothian Child and Adolescent Mental Health Services consider completing the Lothian Safety Plan with every child, or young person who presents with suicidal ideation and/or associated behaviours.

Recognising a gap in this process for parents and carers of children and young people who are expressing suicidal ideation, the Clinical Nurse Specialist in CAMHS developed ‘The Lothian Safekeeping Plan©’ as part of their Doctoral studies.

‘The Lothian Safekeeping Plan’ (Abbot-Smith, 2024) is a framework that can be used with parents and carers of a young person with suicidal ideation and/or associated behaviours. Engagement with parents and carers is following the completion of the initial safety plan. It provides an opportunity for further exploration and aims to reduce the risk of crisis occurring as a separate action to enable confidentiality and is supportive to the parent and carer around their own needs.

Developed in partnership with parents and carers it has been received positively within practice, and from parents and carers with wider plans for use across services.

Development of ‘The Lothian Safekeeping Plan’ for Patients and Carers, NHS Lothian