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Digital Subscriptions > Mental Health Nursing > OctNov 2018 > Severe and enduringmental illness

Severe and enduringmental illness

Eric Davis describes the developments in care for service users over the course of the NHS

At the inception of the NHS on 5 July 1948 the provision of mental health care for people with severe and enduring mental illness (SMI), or psychosis (schizophrenia and bipolar disorder) was concentrated in institutional settings such as hospitals and psychiatric asylums.

Medical practitioners and use of the medical model of psychiatric care held sway. Necessarily, this concentrated on a biological view of SMI and was preoccupied with psychopathology and deficit. This was important, because psychiatric taxonomy implicitly and explicitly shape professional expectation, attribution and input (Bentall, 1990 and 2003; Haddock and Slade, 1996; Velleman Davis et al, 2007).

The zeitgeist then in terms of treatment for SMI was somewhat akin to systemic ‘learned helplessness’ (Seligman, 1975) who later wrote about happiness. A purely medical view of illness such as schizophrenia has received cogent criticism from Bentall (1990 and 2003).

A more sophisticated and balanced conceptualisation of SMI was provided by Nuechterlein and Dawson (1984). This model attempts to capture the complex and multifactorial nature of SMI, particularly schizophrenia. It reflects the important role that psychological, social and environmental factors as well as biogenetic factors play in the expression of SMI. Importantly, this then opens up the possibility of useful wider professional intervention from mental health nurses and other disciplines.

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About Mental Health Nursing

This special edition of Mental Health Nursing has been produced to celebrate 70 years of the NHS. It includes features examining how mental health nursing has changed and developed over the decades.