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With the reconfiguration of health services in both the primary and secondary sectors, the role of community mental health nurses (CMHNs) has become a highly contested one within mental health care. There would be great variability in the skills that CMHNs possess, the contexts in which they work and the nature of the work they do. This study sought to explore aspects of the work of those nurses who provide services at the interface between policy and practice. Two groups of CMHNs were compared, one working in an urban setting (Trust A) and the other in a rural (Trust B), focusing particularly on caseloads and client mix, the values held by CMHNs, the models of care they utilize and what they consider would improve care in the future. A specially designed 39-item questionnaire was employed, with a mix of open and closed questions, and statements to which participants were asked to respond on a three-point Likert scale. The findings raised interesting issues around collaborative working, whether CMHNs are happy to take on clients previously on their caseload, bureaucratization, autonomy, role definition within a culture of working with primary care, lack of specific models utilized by CMHNs, and the demand for greater training and educational support. The implications of the study are discussed with the aim of assisting mental health nurses determine their future roles.

There is little scholarship to compare the work of mental health nurses in different countries, although this is perhaps understandable given that mental health nursing as a discrete discipline exists only in a few countries worldwide. The small-scale study reported here sought to compare the perceptions of UK and American Clinical Nurse Specialists of various aspects of their work, including latest professional developments, current therapies and interventions, and the major problems confronting nurses today. Prior to the main study being undertaken, a short questionnaire was piloted in both countries. The main questionnaire was distributed to 34 American nurses and completed by 25 (75.5% response rate), and to 28 UK nurses and completed by 24 (86% response rate). Descriptive statistics and content analyses were used to analyse the data which suggested that where UK nurses were concerned with the range and availability of services for clients and their families, American nurses were primarily preoccupied with the quality of those services. The American sample placed greater emphasis on the provision of care that enabled clients to take responsibility for themselves than did their UK counterparts. While acknowledging the limitations of the study, the results would appear to suggest that American nurses tend to favour humanistic care, have a belief in the efficacy of chemotherapy and aim to get people functioning independently. They fear the threat to their relationship with clients that managed care might entail. Concurrently, UK nurses appear to be preoccupied with finding appropriate services for their clients and they appear to believe that the changing nature of their work is designed to accommodate structural changes in the health service, rather than to meet the needs of clients. The implications of these findings are discussed.

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