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CAMH Stories Centre for Addiction
and Mental Health

Fighting stigma in mental health and addiction nursing

Nurses working in mental health and addiction must often fight stigma experienced by their clients. Sometimes that stigma spills over into their own profession.

“Certainly, popular culture reinforces some stereotypes,” says Cheryl Rolin-Gilman, an Advanced Practice Nurse at the Ambulatory Care and Structure Treatment Program, Women’s Service at CAMH. “We see a character like Nurse Ratched in the movie One Flew Over the Cuckoo’s Nest. She has kind of a starched look to her, with her uniform and authoritarian attitude. She stands behind a window in the Nursing station and just gives out pills.”

Besides cultural stereotypes, mental health and addiction nursing may not, on the surface, seem as sexy or sophisticated as working in a cardiology or intensive care unit (ICU), for example, Cheryl says.

Challenging stereotypes

In her current role, Cheryl has a chance to challenge those stereotypes, interacting with many undergrads who work at CAMH on three-month nursing placements. “Our specialty in nursing really starts with the relationship with the client and seeing the huge potential to help that person. When I speak with students, I talk about many different skills that mental health nurses can apply. These include assessment, group facilitation, helping clients develop safety plans, providing education about living with an illness and treatments such as cognitive behavioural therapy, and skills training.”

Cheryl Rolin-Gilman
Cheryl Rolin-Gilman, Advanced Practice Nurse

Trauma is a big factor in the lives of clients she sees in the Women’s Service. So is self-harm such as cutting, substance use and eating disorders. “Nurses can play a central role to validate the experience of clients. In the case of self-harm, that includes helping clients understand how their behaviours make sense based on the trauma in their lives.” Dialectical Behaviour Therapy (DBT) is an example of a strategy that helps clients with this. It includes a mindfulness component that helps clients be aware of their behaviours and thoughts without judging or blaming themselves. This opens the door to making other choices for a more fulfilling life.”

A rich and rewarding career

In her current role, Cheryl takes on a diverse portfolio of work that includes some direct care, group therapy, providing education and clinical supervision for inter-professional teams, and consulting on client trauma histories. Her work also involves special projects, including the evolution of pain prevention and management best practices. The pain prevention and management work is part of CAMH’s certificationas a Best Practice Spotlight Organization (BPSO).

One student who worked with Cheryl is Jamal Virani, now in his fourth year at McMaster University. When he approached his last nursing placement at the CAMH Women’s Inpatient Unit, some people, including fellow students, approached him to make sure he hadn’t made a mistake. “They asked me if I had chosen to do my mental health placement ‘on purpose’ or if it was assigned to me by the school,” he recalls.

A nursing student pushes back on stigma

Jamal felt he had to push back – to tell them he wanted to work in mental health, and that he felt it was a privilege to work at CAMH.

While society is becoming more open on mental health issues, “there are still some nurses who think of psychiatric nursing as a field that doesn’t require as many skills -- in comparison to Med-Surg, for example,” he says. “Having had my previous placement on a medical floor, and now being here, I wish I could tell them that they couldn’t be more wrong.”

Jamal was intrigued by mental health nursing for personal -- and societal -- reasons. “I’ve seen how dangerous untreated mental illness or addiction can be. Once it affects someone, it can bring down an entire family or community.”

Jamal Virani
Jamal Virani

Identifying solutions

“I want to be part of the solution,” he adds. That includes raising awareness so that people can address mental illness earlier before its impacts are magnified.

How to combat stigma within the profession? Jamal believes in more communication between nurses in different disciplines. He would also like to see greater opportunities to learn about mental health nursing in school. “We do take a clinical psychology course in our first year. It would be amazing if there was an option for a broader course on mental health nursing. “

The right path

Yasmine Giuliano, a nursing student at Lakehead University, had completed a mental health placement in her third year. “The most common reaction was that I might be losing skills in a mental health setting. “There’s a misconception about what psychiatric nurses do. Nurses on a medical unit have more hands-on skills, while nurses in a mental health program have to utilize more communications skills. Both are equally important to help a patient’s well-being.” She knew the mental health placement was “the right path” for her.

In fourth year, Yasmine applied for and completed a placement at CAMH in the General Psychiatry Unit (GPU). Her placement was a great learning experience, with lots of help from the whole team on the unit. “It’s a big family in which all members help and support each other.”

Yasmine Giuliano
Yasmine Giuliano

Pop-culture offside on mental heath

Pop-culture stereotypes of mental health nursing – such as Nurse Ratched in One Flew Over the Cuckoo’s Nest -- are explored in an article published by the Canadian Federation of Mental Health Nurses. Writer Ned Morgan cites Keri De Carlo, a mental health nurse and nurse educator at St. George Hospital and Community Health Service in Sydney, Australia, who examined these popular portrayals. “In an ethnographic analysis that explored how mental health nursing was depicted in 19 American films from 1942 to 2005, De Carlo concluded that mental health nursing was considered abnormal, secret and dangerous work. The study, published in a 2007 issue of the International Journal of Mental Health Nursing, found that films depicted the role of mental health nurses overall as one of ‘custodial companionship’ and ‘doctors’ handmaidens.’”

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