Mental Health Nursing - One Career, Many Possibilities

Cheri Huggins: Welcome to the Nursing and Midwifery Health Programme Victoria podcast series, where we will be diving into issues that impact the way nurses and midwives navigate today's changing world. I'm Sherry Huggins, a registered nurse and senior clinician at the Nursing and Midwifery Health Programme Victoria, and host of this podcast. The Nursing and Midwifery Health Programme is a support service which provides care and assistance to nurses, midwives, and students by experienced nurses and midwives. NMHPV provides a space where our colleagues can bring with them any sensitive health issues impacting their wellbeing. It's free to access, confidential, and independent. Hello, and welcome to the podcast. Today we're talking about mental health nursing, a profession that makes a real difference in the lives of people, families, and communities every day. I'm joined by my guest, Chris Schilt, who has worked in mental health nursing for many years and has a wealth of experience and insight to share today. We'll be chatting about what drew him to the profession, the impact mental health nurses have, and some of the challenges and rewards that come with the role. We'll explore some of the stigma that may still exist around mental health and mental health nursing, and hear about Chris's experiences, education, and career journey, which have shaped both his professional and personal life. Let's jump right in and say good morning to Chris. Hi, Chris, and thank you for joining me today.

Chris Schilt: Hi, and thank you for having me today.

Cheri Huggins: It's a pleasure. If we just start with my first question, can you tell us a little bit about yourself and what first inspired you to become a mental health nurse?

Chris Schilt: I've been a nurse for about 18 years, and also in that time completed a postgraduate in mental health and a master's in public health. I've had a very interesting and varied career doing both direct care nursing as well as working in not-for-profit the not-for-profit space. And having done my master's in public health, I have been able to use some of that mental health, the mental health public space, but really kind of always kind of coming back to nursing. And really, nursing for me has always been the core of what I do, regardless of where I am. My journey into being a mental health nurse, it's actually a really interesting one because I think, like most people, when they are in nursing, I think that they are able to, especially in mental health, they're able to think back on time. So there are two points where they can see that they were good at being a mental health nurse or could have been a mental health nurse. And for me, after high school, I did a little bit of university and then realized that I wasn't really sure what I wanted to do. What I did do was work in a bank for 4 years, which was a lot of fun in a call center, and being able to finance that late teens, early 20s in a way that allows you to kind of explore life a little bit. But at the end of the time, or after 4 years there, I kind of had a real reflection moment and said, well, what do I want to be doing for the rest of my life? And do I want to be in a place that is predominantly focused on money and people getting really upset about money? And not minimizing that by any means, but what I did think was that it wasn't that important to me. I didn't want to be working around something that I didn't feel was that important. I had been thinking about either teaching or nursing, and I think nursing won out in the end. And it wasn't until I did my first mental health placement that I realized that I could be a mental health nurse and that I actually really, really loved it. And it was interesting for me because I had always thought that when you study nursing, you have to do your general graduate year, or you have to do a you have to consolidate those skills. People say you learn so much about acute care, and you have to be able to consolidate those skills. And I thought I had to do that as well. And so the grad year that I did, which is about 18 years ago now, was a split grad year, which not many offer anymore. But what I found when I was doing that is that because I started with the acute care placement, I actually hated it. I hated every minute of it. I was really anxious. I felt like it wasn't where I was meant to be. And then the minute I started in mental health, I was relieved, and I felt so much better, and I felt like I was almost home in a way. It had just reinforced to me that I should have done that all along. And now that I look back on all of that, I realize that I was surrounded by mental health issues my whole life, in my family. I grew up with a mum who was significantly unwell with mental health issues. Although, interestingly, I didn't know this until an adult because she would go away to hospital and then she would come home. But there was a lot of stigma around mental health, and no one told us what she was in hospital for. We just didn't see her for months on end. And now that I'm an adult and I know that and I'm able to see and understand that, it gives a lot more context. And also, it kind of just reiterates to me that this is probably why I felt at home in mental health, and that's why I always was kind of drawn to mental health.

Cheri Huggins: So it sounds like there were a number of factors that kind of drew you into mental health nursing. But it's interesting that you say that you didn't really realize until you did your first placement that you felt that you'd found your tribe, so to speak.

Chris Schilt: Yeah. And I think for me, I was trying to think about what it was about that moment or that placement that really kind of drove it home to me. And I think there's a number of things. I think for me, I feel like I probably, in a lot of ways, could empathize with feeling like a person that was stigmatized or a person that was a little bit different in their life and that had been on the outer. And so for me, it was like understanding a little bit about what some of the consumers are experiencing and feeling and being able to empathize with them on that. And I think also for me in general and acute care nursing, for me, it just didn't feel as natural. And I think that's probably part of the way that my brain works, is that they're having to do task after task and having to remember things like what a certain blood pressure might mean or what this elevated level of serum markers means or all of that stuff and what to do if someone's having a low blood pressure. It didn't feel like it came naturally to me. And maybe after 10 years, it might have felt natural, but it didn't automatically feel natural and actually caused me a lot of anxiety. But when I was working in mental health, it wasn't about all of those tasks and it wasn't about remembering those things. It was about being present in the moment and it was about talking to the consumers and about understanding what's going on for them. And I feel we often get so caught up in that solution-focused mindset, but mental health, as I've learned over the years, it's not always about being solution-focused. Sometimes it's just about sitting in the space with someone. Sometimes it's just about kind of acknowledging that things are feeling pretty terrible and that anybody else in their situation would probably be feeling the same way. And then that's okay. You need to sit with a person in that space for a while until they're ready to come out of it. And I kind of like that about it because it felt natural. And it feels natural to me. It feels natural to be able to not always try and solve things, but just be empathetic and compassionate. And those are things that I think have personal values in mind and have always just come kind of naturally to me. So I feel like it actually, now that I look back on it, it kind of made sense. But I feel also at the beginning of it, I just felt in some ways, I just fell into it.

Cheri Huggins: I think that's very helpful in the context of this conversation, and we might pick up on that a bit more later on. So what I'm interested to know is, when you began your nursing career, did you have a clear idea of where it might lead? Or has the profession taken you in unexpected directions?

Chris Schilt: It's definitely taken me in unexpected directions. I feel like I had no idea where I wanted to be when I began. I was very fortunate enough to, in my grad and postgrad, to do rotations that I really, really wanted to do and to kind of explore lots of different areas. I did community, I did youth inpatient, I did acute care, and I also did adult inpatient. And it really gave me a broad variety of different areas. And for me, community felt like the place that I wanted to be, but then there were all these changes in the mental health system and things kind of got harder to do the therapeutic work, and it became more and more task-focused. And so that was one of the things that inspired me to do the master's in public health. But along the way, I ended up doing a year working in an aged care mental health inpatient unit in Switzerland. So in Zurich, I did one year working there. And that was a very interesting experience and kind of grew me incredibly as a clinician. But yeah, when I came back from that experience, when I came back to Australia, that's when I thought, I'll do my master's in public health while I was working as a mental health nurse. I think during that process, just being able to, I guess, think more broadly about my skills and what I bring. And the thing about mental health nurses, we often have really good communication skills. We can be really good at behavior change. We can be great at organization. And a lot of these skills helped me to get a role in a suicide prevention trial with the Primary Health Network. And that was with the LGBTI community, and it was a short-term funded role where we co-designed suicide prevention services for the LGBTI community. And that role just gave me almost free rein of being able to design and develop and then tender out services that would help to reduce suicide in the LGBTI community. It gave me a more holistic view and a systemic view of contributing factors and barriers that minoritized communities experience. And the level of co-design in that was also really eye-opening and interesting and just understanding the impact that engaging people and taking people along on the journey really has. And that is also a skill in mental health nursing, right? It's about how do we engage people? How do we build that connection and that rapport? And how do we bring them on a journey of something that might help them, but also to help them kind of help themselves in a lot of ways or define what's going to help them. Yeah. And then I guess a few other places, things that I was really proud of doing was I worked at Beyond Blue for a number of years. I worked at Beyond Blue and then I left, and then I went back. And part of that, the work there was working on their anxiety campaign and being able to be that clinical voice about what is good in this space and really trying to navigate the space between what sells social media clicks and website visits and advertising and find a way to make that clinical and catchy and reach people and understand what do we need to do to inspire behavior change on a systemic level so that people will understand and recognize signs of anxiety and be able to then seek support. And another thing that I was really proud of working at Beyond Blue was being able to develop a clinical governance framework for Beyond Blue. So being able to understand how what we do, even if it is non-clinical in nature, can actually have clinical implications, right? And being able to take a step back and see that anything that you do in the mental health space might have an impact in someone or on someone. And both positive and negative. And being able to look at it from that kind of lens and then have that influence that really can drive change and drive organizational culture change. Because I think for a long time, there was that understanding that we weren't a clinical organization, and so why do we need clinical governance? And just trying to build that change in the organization as well. Yeah, I did teach for a little while at Deakin, and I actually really loved teaching. I loved nursing students. I thought that was great. It was a really good experience. And I often think of mental health nursing as trying to inspire and motivate people. And so that's why I really loved that. But part of the reason that didn't last so long was because it was just a little bit for me, the teaching was such a small part of it. And everything else felt like it was actually being at uni again. So I really liked that it was I loved the teaching, but nursing, the semesters are so short because of the placements, and it just didn't fit with where I wanted to go. And now I'm working as a deputy director of nursing and in charge of some of the workforce and education development, which I love because it meets everything that I have done so far, and it kind of brings everything together. And I can bring some of the public health skills. I can bring some of the behavior change and the inspiration and the education and kind of wrap it all together and think about how we develop mental health nurses and how we can develop mental health nurses to be the best that they can be, which is a real inspiration for me, I think, because, like I said, I think we often sell ourselves short or we don't understand what our true value is. I think every time I've ever interviewed a mental health nurse and you ask them about their skills or what they bring to the job, and they tend to first go for that medication administration or the risk assessment or the MSA. And you're like, "Yeah, yeah, okay, they're tasks that you do, but the real skills, the core skills is that therapeutic engagement, that building rapport, that behavior change, that empathy and understanding where someone's coming from, that being able to connect with someone. That's the stuff that makes a good mental health nurse." And everything else, yeah, is important.

Cheri Huggins: I was just going to say, Chris, so why do you think that is? Why do you think that nurses, mental health nurses, aren't great at selling themselves in terms of the interpersonal skills that they have? Which, let's be honest, is the foundation of what we do, really.

Chris Schilt: Because I think that we get so focused on the day-to-day, on the tasks that we have to do, rather than the ways that we do the tasks. And perhaps that's also the same for acute care and general nurses too, because we get so focused on, "Okay, we've got this day. We need to do XYZ. We need to discharge this person by that time." And we forget to stop and think, "Actually, the way that we're doing the tasks is the stuff that's the stuff that's making a difference." I think, yeah, perhaps that's it. I'm not really sure if there is much more to it. And maybe it's just that we don't focus enough on learning those skills. And what we focus on when we're teaching at university and we're teaching our student nurses is those tasks and not those things that we end up picking up on the job, that communication style, that way that we view someone that we're buddied with or we're observing. If we've got a preceptor and we observe the way that they communicate with someone and you're like, "Oh, yeah, that was really cool. I liked the way that they spoke about that," or, "That really had an impact on the person." So I'm going to take a bit of that. And I think that's the stuff we learn on the job more than what we teach at university. And maybe that's why as well.

Cheri Huggins: Yeah, that sounds right to me. I would kind of agree with that because my background is also mental health nursing. So that really resonates with me. I'm just wondering, what have been the biggest challenges that you've experienced working as a mental health nurse? Oh, and by the way, I should also say that I should also acknowledge your wide and varied career that you've had. It really sounds as if it's been very rewarding and diverse. But yeah, so what have the biggest challenges been for you?

Chris Schilt: It's been a lot of challenges, I think, over the time. I think there's probably, in my personal life, some of the challenges have been trying to I had a family member who needed to access mental health services. And then from a personal level, being aware of what they needed and how they needed it, but not being able to navigate the system that they were in because of the way that the system was. So I think for me, that was a really big challenge and just almost feeling powerless to help someone when I knew what they needed, but they didn't know. And the service needed to appreciate the rights of her and the place that she was at, which I understood as well. I think over time, it has felt like things have changed in some ways for the better and some ways for the worse. And one of the challenges I think that I had found was that real change in focus. I think when I first started in community, it was really about the person and building support networks and really helping and putting the person first. And then changes came in where teams were redesigned, and it felt like we were spending less time with the person and more time focusing on those tasks and the medication administration. And it felt like there was less time to do things holistically. I feel like we've probably gone back a little bit more into the holistic space, but maybe not as much as it used to be, in my opinion. But I think that that's I think everybody might have different views on that. I think the other challenge that I've seen over time is that the change in the mental health system perhaps has been quite it has been quite quick, but it also has been slow. And so getting people on board with this new culture about empowering and about really celebrating and working with the consumer has been a journey. And I think that there is still or perhaps not so much anymore, but there was still an old-school workforce that had come from the institutions. And they bring a wealth of experience, but some also have some of those that culture and that view of those days. And we have learned so much and we've grown so much since then. And I think bringing those people on that journey has been a challenge. And I think in some ways, it's probably been a bit of a detriment to the mental health nursing workforce. Not all people, just some of those people that really were almost kind of stuck in doing things the way that they were done just because they were done that way. And I think we need to be adaptable and we need to be flexible and we need to understand that things are changing and that they're changing for the better and that this job is about the consumer and it's about making sure that the consumer has what they need for their own lives to create meaning and to create impact for them. And I think that used to be very different. We used to be very paternalistic in the institution days. It used to be, "We know what's best for you," and not really understanding that the person knows what's best for them. Of course, they do. And that's been a real culture shift. And I think that's the hard part of that is bringing those people along on that journey. I think one of the other things that I don't know if it's been a challenge is in my personal life and my therapeutic foster care. I've got two kids in my care and they have experienced significant trauma. And for me, one of the challenges is that now that I can see almost that link between childhood trauma and mental health, the development of mental health conditions, it's understanding how important that early intervention space is and how difficult it is to navigate the system to be able to get that early intervention. I think it has been something that I absolutely love, but it also has been something that has been really challenging because you see the way that trauma evolves over time and you see the way that maladaptive coping strategies evolve and you see the way that you know where this goes. As an adult, I'm constantly thinking, "Okay, what's going to happen for this child in the next 5 or 10 years? And are they going to get the support that they need? Or what can I do now to stop that from progressing to that level?" Because it can have devastating impacts for the child and kids in the care system are much more likely to develop mental health conditions. They're much more likely to be incarcerated. They're much more likely to be homeless as adults. And so understanding that early intervention, the impact of early intervention, and how to do all of that and feeling like often the system's not really set up. And that's the out-of-home care system, but also the mental health system. And really understanding that these things can be there is an opportunity here to intervene and to build capacity and really reduce the risk of the impact of mental health from an early age, but there's probably not the level of support that's needed.

Cheri Huggins: So would you have had, do you think, all those insights if you hadn't trained as a mental health nurse? Just to link the two because we're talking about career and mental health nursing. We're also talking about how that can influence not only our professional career, but our personal lives as well. And it sounds as if you have all these insights and it sounds like there's a lot of frustration within that, but you might not have been thinking along those lines without your mental health nursing qualifications.

Chris Schilt: Absolutely. Absolutely. And that's it. I wouldn't have been able to do this without being a mental health nurse. And I think it's funny when I reflect on this with the foster care, the agencies, and they talk to me about the placements and behaviors and issues with children, but some situations might end placements, but how is it maintained and been able to keep it going? And they ask why. And I think, "Oh, hang on. Because mental health nursing is this, right? It's being able to separate a person from their behavior or what's happened to them or their coping strategies and being able to take that person out of that situation and understand that that's not who they are. And that's the key. And I keep saying, "Oh, you just need more mental health nurses to do this. You just need more mental health nurses because we get it. We understand and we are able to understand how we can kind of separate a person from if they are experiencing behavior or they're experiencing strategies that they used to cope because of the trauma. But we can see that and we know that and it makes things a lot easier. It makes us a lot easier to kind of empathize and reset and think, "Okay, well, what do they really need in this moment?" And not, "Why are they doing this?" or, "Why are they acting like this?" And I think that's the important thing. And I think that's why I say to the agency all the time, "Just get more mental health nurses. We know this. We've got this."

Cheri Huggins: Hey, you're an excellent advocate for mental health nurses, clearly. So, what advice would you give someone considering a career in mental health nursing? Or even if they're thinking about advancing within their profession, so they may already be a nurse, but they're looking for a different path, something more challenging.

Chris Schilt: I think we often restrict ourselves to the view of the world in which we are. And I think, for example, when I say about having worked at not-for-profits or in the health space, I wouldn't have been able to do that if I wasn't a mental health nurse. And I think we forget what our value is and really the sky is the limit. Once you know that the mental health nurses have this whole lot of value in the way that we communicate, in the way that we understand people, in the way that we are able to read people or know how to sit with people in some of their darkest moments. And once you kind of know that that's your worth, I think then you begin to realize or think about how we can expand our horizon and be good at different places we can go. My current role, there's often the thought that you move through the hospital land or you go to the community and that's the world that we are or you become an educator. But there is really lots and lots of different options out there. And I think we should be open to any options and any situation that we're interested in and not feel like we should be held back because we have a lot of value and we have a lot of worth that we, I think, are not so great at articulating.

Cheri Huggins: I absolutely agree with you. And that sounds really encouraging to hear that, that we shouldn't be rigid in our outlook regarding our career. We can be flexible. And mental health nursing, it's really quite rewarding. And you've kind of talked about all the benefits, not only for yourself, but the people you're working with, the greater community. Has mental health nursing changed the way you relate to people? Has it increased your resilience, your well-being, or your life? Has it made your life more fulfilling in general, do you think, Chris?

Chris Schilt: Yeah, absolutely. I think there's a few things in that. I think one of the things is that it's made me grow incredibly as a person. I think building my own insight and understanding myself and ways in which I can develop, but also ways in which I need to show myself some self-compassion. But we often say to our consumers, but we forget to take on board ourselves. So I think that's one of the ways that it has helped me in understanding that it's okay to be working on yourself all the time and that there is okay to be impacted by things that happen and to just be able to sometimes sit in that moment and be okay with that. It's taught me the power of connection, I think, as well. I think we know that connection is so good for mental health, but we also forget that when life gets busy and when things are happening and it can be so easy to forget to pick up the phone and to reach out to someone. But that's so important. One of the biggest drivers of mental health outcomes is the connection, right? The connection that someone has with other people, but the connection that they have with their mental health nurse is probably the single most driver of outcomes regardless of what therapy is used. And so it's about remembering that that connection is really important for my own well-being. I think also being able to reflect back on my own experience as a child and my parents and being able to understand why the things had happened that they had and not being able to kind of see that until I was an adult and really being able to reflect on that, but also the complexity of the human experience, right? I think as a child, things happen and then you kind of build that level of understanding of the world. And some of that's in shame and some of that's in the way that you cope and you respond. When you can see the other side of it as an adult and you can see why things had happened the way that they had and you understand that people are very complex and mental health is so complex, and then it kind of takes some of that armor away. That makes sense. It just makes you able to see why things were the way that they were and how coping strategies really frame the way that people respond and the way that my parents responded in certain ways and the way that they had done certain things and then understanding that that might be also something that I have to work on. And the human condition, but also mental health is so, so complex and it's so different from one person to the next. And just being able to understand that, I think, has really helped me to maybe be less hard on myself, to be less hard on my parents, to be less hard on the people that I manage now. And I also want to say that one of the other things that I think that I've learned is that mental health nurses make great leaders because everything that makes us build connection with people, that the trauma-informed approaches to transparency, connect with people, the transparency, the trust, the collaboration, the empowerment, all of those trauma-informed principles that we work with every day are what makes a great leader. And I think that has also really shaped what I do and how my career has kind of progressed because I just changed the target of the skills that I have and really are able to kind of use those in leadership. And I think we have gone on a little bit of a tangent, but I think we need to really understand that and understand the value of that as well.

Cheri Huggins: So that takes us back to how invaluable the skills that we can learn in mental health nursing can contribute to many different areas and facets of our life. And leadership is one of those. And I think it's also interesting and very relevant for this service that you talked about self-compassion because quite often nurses will come to the service having no idea about the importance of looking after ourselves and putting ourselves first, which we quite often do not because we're so busy caring for everybody else. So I think that's a really relevant kind of thing to identify, Chris. And also how useful your insights have been in how you've progressed through life and this journey that has been, I guess, inspired in a way by mental health nursing. And you speak so passionately about it. It's just fabulous. And I guess for the final question that I would like to ask you, Chris, is if you could share one message with future mental health nurses or anyone being hesitant about a career in mental health nursing, what would that be?

Chris Schilt: I think if I said this earlier, I think when you know, you know. I think if you know if you're going to be a mental health nurse, if you do your placement, I think you generally know you're a mental health nurse. And I think, like I mentioned, I think I always thought that I had to be I had to do a key care placement because that would consolidate all of my skills. But then I found I did it and I was dreading every second of it. And so I think that you have to do something just because you've done it. Yes, I've used some of those acute care skills over the years, but actually, I don't think I would have lost out if I had just done a straight mental health graduate. And I think the other thing is for me and doing graduate nurse interviews at the moment, for me, it doesn't matter if you haven't if you haven't done well at school or it doesn't matter if you're not great at taking blood or it doesn't matter if you are not all of these kind of these skills that we see that makes a great nurse in mental health. What matters is how you connect with people and your genuineness and your unconditional positive regard and the ability to build a connection with someone. And that's what we look for in grad nurses is that ability to understand the true willingness to be compassionate and to connect with someone and to help someone through what they're going through. And I think we think that we have to know everything or we have to know what to say in particular situations or we have to say the perfect thing. I think at one point when I remember as a grad or a postgrad sitting in someone's living room and they were in tears and that they were really impacted by something that had happened to them. And I thought, "Oh, no." There was this feeling of dread with me and I'm like, "I have to have all the answers." And I don't know what to say. What am I supposed to say? But actually, just being there for that person was more than enough. And I didn't have to know what to say and I didn't have to say the right thing because they just needed someone to hear them and to tell them that their situation was hard and to validate that experience and someone to connect with and to be with them in that moment. That's the value of mental health nursing.

Cheri Huggins: In a nutshell. So really, the therapeutic relationship and who you are as a person and how you view the other is what it's all about, really.

Chris Schilt: Absolutely. Absolutely.

Cheri Huggins: Thank you, Chris. I think we've come to the end now, but I just want to say thank you for joining us today, sharing your experience, your insights, your reflections on your beautiful journey in mental health. 

We hope today's conversation has helped listeners gain a greater insight and understanding of mental health nursing and the crucial role it plays in supporting mental health and well-being across our communities. 

If you've enjoyed this episode, please share it with your colleagues, friends, and networks to help raise awareness of mental health nursing. Thank you, Chris.

Chris Schilt: Thank you.

Cheri Huggins: If you’re a nurse, midwife, or student of these professions who might need support after today's podcast, you can access our service on 03 9415-7551 or by going to our website and completing the contact us page. Thank you for listening.