The Memoir of a Ghost: The Invisible Plight of Mental Health Nurse Education in the United Kingdom Following the Nursing and Midwifery Council's Move Towards Genericism

The aim of this paper is to identify barriers to quality mental health nurse education in the United Kingdom and show these through the sharing of personal experiences of working as a mental health nurse academic. Since the Nursing and Midwifery Council introduced their ‘future nurse’ education standards in 2018, mental health content for mental health nurses has been argued to have been marginalised. The sense of a diluted mental health nurse education was supported by an open letter, signed by over 100 mental health nurses, with representation across 33 universities. Nonetheless, the approach taken by the NMC has been defended. Meanwhile, mental health nurse academics all over the United Kingdom are having varying experiences, some of incredible discomfort and invalidation. The movement ‘mental health deserves better’ arose through many of these mental health nurses feeling they had no representation or channel to voice their concerns. This is a personal position paper which outlines barriers to autonomy for mental health nurse academics, and shares personal opinion on experiences which have impacted the ability to deliver a depth of knowledge, skill and critical thinking to students, impacting the quality of new mental health nurse graduates. The issue is discussed using contemporary literature to support lines of argument, which are augmented by personal experiences of working in nurse education. There are complex interconnected issues within nurse education which can hinder the autonomy of mental health nursing to decide its own future. This paper recounts a personal journey. Often we cannot understand the failings of a system until we try to navigate it from the

I write about my experience of a previous university, from the comfort of a new one, as while I have tried to be honest before, I have always held back.The following is my perspective, taking place through the worrying predicament of a vulnerable profession sliding slowly from existence, into a void of generic nursing.The profession of mental health nursing is in real and present danger.

| 'Future' Nurse Is One With Less Field Specific Knowledge
In 2018 the Nursing and Midwifery Council's (NMC) 'future nurse standards' came into force in the United Kingdom, detailing their vision for the 'nurse of the 21 st century' (NMC 2018) and all universities needed to revalidate their nursing curricula.Revalidation processes vary on the interpersonal politics and workplace culture at each university, though this time round, were shaped at all universities by the future nurse standards which saw the move to a single set of standards for all fields of nursing (mental health, adult, children and young people and learning disabilities).The United Kingdom is one of few places in the world which maintains these distinct fields of nursing in pre-registration education, and where students apply for a mental health nursing course, and then register specifically, as a 'registered nurse (mental health)'.
During revalidation at my former employer, I attended two world café style events, where nurse academics across the three fields of adult, children and young people's, and mental health nursing (learning disability nursing, under even more threat, had long since disappeared from university course prospectus) had the opportunity for group discussion, whilst outlining ideas for a new curriculum on paper.Following these two sessions, which remained the only invitations I ever received to offer my perspective, there was silence.This was the token 'collaboration', and the extent of my involvement.I am not sure what people in middle and senior management did with the ideas I scribbled down, but they may as well have thrown them in the bin on their way out of the room.Months later the 'minions', those of us registered nurses and academics outside middle and senior management who were doing most of the teaching, were told, 'this is your course'.
What I saw presented was not my mental health nursing course, nor could it be described as a mental health nursing course at all.The course comprised 2 years of shared learning across the three distinct fields of nursing, with a final year of field specific learning, which was squashed into three 6 week modules.The first module which was dedicated to establishing relationships and working relationally, the mainstay of quality mental health nursing, was delivered to students midway through their third and final year.Too little, and too late, especially for a profession which can facilitate the removal of a person's human rights under legislation such as the mental health act and has enormous power over service users.I thought this inadequate and was suspicious that 'future nurse' had pushed mental health nursing towards history, leading to less mental health content for mental health nursing students.
On paper, we still had the degree award of 'BSc Nursing (mental health)' and similarly NMC registration would say 'registered nurse (mental health)', yet this may at best be described as false advertising.At worst, one might call it fraud, defined as an act of deceiving or misrepresenting something (Merriam-Webster 2024a).Much of the 'mental health' had disappeared from the 'mental health' course, with the shared learning favouring adult nursing, and mental health content missing, marginalised or tokenistic.Bewildered, I have gradually learned of the following situation: a sieve of circumstances through which mental health content can disappear.Someone in the United Kingdom will complete a direct entry mental health nursing degree and attain the title of 'registered nurse (mental health)', yet their education will depend on the interpretation of generic nurse standards, how they are contextualised, varying quality of quality assurance for courses, and university politics.

| Generic Nursing Standards
The NMC's 'future nurse' education standards are identical for all nurses for all fields, with no standards specific to mental health nursing.The document is organised across seven platforms (being an accountable professional/promoting health and preventing ill health/assessing needs and planning care/ providing and evaluating care/leading and managing nursing care and working in teams/improving safety and quality of care/coordinating care), followed by two annexes (communication and relationship management skills/nursing procedures) and reflect what the NMC 'expect a newly registered nurse to know and be capable of doing safely and proficiently at the start of their career' (NMC 2018, 6).These standards are generic in their application to all nurses from all fields, and if courses meet these generic standards, a student can register as a nurse in any distinct field at the university's discretion.Whilst the NMC favour the term 'holistic', the very definition of generic relates to a whole group or class and has no distinctive quality or application (Merriam-Webster 2024b).Collier-Sewell and Monteux (2024, 5) argue that 'in a fundamental way, the purpose of nurse education arrives at universities as a fait accompli-"settled" before questions can be asked'.Thus, questions have been asked on the other side of the implementation of standards, with concerns publicly raised by both the mental health (Connell et al. 2022;Warrender et al. 2024) and children and young people's fields (Edge et al. 2024;Tatterton et al. 2024).
The NMC neither assert specific essential requirements nor offers a positive (nor any) vision for MH nursing.There is no philosophical statement for what it means to be a MH nurse.Key considerations such as 'mental health act', 'human rights', 'least restrictive approaches', 'power dynamics' and 'psychological trauma' do not appear in their standards.No specific mental health condition or diagnosis is mentioned, nor is the controversy regarding psychiatric diagnosis mentioned.This doesn't mean that these things are not covered in MH nurse education, but under the NMC's standards, there is absolutely no requirement for them to be.One may argue these are covered through broad catch-all standards, such as the mental health act falling under '1.2 understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks' (NMC 2018, 8).However, this is open to interpretation, does not specify depth and is arguably too vague when it comes to legislation which can remove human rights and result in iatrogenic harm.Broad and unguided terms have been argued to produce problematic scientific discourse, leading to misunderstandings in communication and conflict (Smoktunowicz et al. 2020).
The standards can appear both incredibly specific and worryingly vague, with so many proficiencies required, yet vague language often used, for example, the word 'appropriate' is used 59 times.I agree with Bifarin et al. (2024, 6), 'that the Future Nurse Standards do not provide specific guidance on mental health nursing only seems to confirm that the specialism is somehow secondary or dispensable'.There should be at least some specific articulation of what it means to be a mental health nurse from the regulator, yet there is none.Whilst there are good arguments that the prescription of standards and competencies may actually run counter to the goal of producing autonomous and critical thinking nurses (Collier-Sewell et al. 2023;Collier-Sewell and Monteux 2024), where there are standards, there should be promotion and protection for fields of nursing.Through this absence, one may wonder if there is a genuine desire to keep fields of nursing, or rather to slowly and quietly join other countries in an explicitly generic nurse training.
Already in UK mental health settings, there are reports of MH nurses being substituted for nurses from other fields, a potentially unlawful substitution with MH nurses having unique legislative powers (Royal College of Nursing 2023).This may be a steppingstone towards the Australian position for mental health nursing, where Lakeman (2023) describes an identity not underpinned by its own philosophy or specialist training, but a situation where 'mental health nurses include any nurse who identifies as working in a mental health setting'.In fact, the NMC itself acknowledges that international nurses do not need a specific mental health nursing qualification to register as a 'registered nurse (mental health)' in the United Kingdom, provided they undertake the NMC's test of competence (NMC 2024a), mapped onto its standards, which as discussed cover all fields of practice.Whilst the future nurse standards may see a creeping genericism through the front door, international recruitment practice ensures it also arrives through the back door.

| Are These Generic Standards Contextualised According to Specific Field Education?
The NMC do state that their proficiencies 'apply to all registered nurses, but the level of expertise and knowledge required will vary depending on the chosen field(s) of practice' (NMC 2018, 27, 31).Yet, they offer no guidance for universities as to how this contextualisation should occur, nor to the depth it should occur.Just how much do mental health nurses need to know about catheterisation, blood transfusions and manual evacuation?Just how much does an adult nurse need to know about cognitive behavioural therapy or motivational interviewing?The way these standards can be interpreted and translated offers enormous scope for difference, and with no guidance, universities interpret this in any way they wish.Thus there are ongoing examples of students and academics feeling mental health content is marginalised and inadequate to prepare graduates to work with people who are acutely mentally unwell (Church 2024;Mitchell 2024).The only measure of contextualisation, is for a university to say content has been contextualised.Mental health nurse education has thus become a choice for universities.Do they want to have a good field specific offering, or don't they?Do those who are making the decisions around course structure and content, even know what they don't know about mental health nursing?Moreover, there is no requirement for a specific weighting of field specific over shared learning in any course, nor a requirement that mental health content needs to be developed with or taught by a mental health nurse.Cognitive behavioural therapy for example, most relevant to mental health nurses, has been taught in some instances by adult nursing lecturers with no expertise in the subject.Mental health nurses too are sometimes teaching physical health skills they are unfamiliar with, and this may not be a good thing for students of other fields.This is not the fault of the nurses doing the teaching, as generally people do as they are told by their superiors.To a university manager looking to keep things efficient, simple and economic, 'a nurse is a nurse', and as long as some teaching is going on and boxes can be ticked, the conveyer belt in the nurse factory can continue to churn out graduates.Questions of quality don't need to come into it.I suggest this not only impacts mental health students but students from other fields who have a varying quality of education depending on who they have teaching them.

| 'Appropriate' Practice Assessment?
There is no set requirement for the number of placement hours students need to complete in mental health settings to become a mental health nurse.Whilst the NMC's standards for student supervision and assessment state that '6.3 nursing students are assigned to practice and academic assessors who are NMC registered nurses with appropriate equivalent experience for the student's field of practice' (NMC 2023a, 9), they don't specify what the vague 'appropriate' means.Furthermore, as part of student nurse education in the United Kingdom, many are sent to placements outside their field, with adult nurses supervised by mental health nurses, and mental health nurses supervised by adult nurses.It isn't clear how this is justified, and if I were to speculate, in a new era where the future nurse standards have all nurses working to achieve the same standards, and with all students from all fields using a single practice assessment document, there is simply no need for supervisors and assessors with distinct field experience.Assessors may now always be deemed 'appropriate', and it feels as if a university can use this vague term to suit its own ends, whether that be belief in the generic model of training or a brutally pragmatic limitation of placement availability.'Appropriate' is whatever a university deems appropriate, or convenient.

| The Need to Quality Assure the Quality Assurance
Completing the sieve, the quality assurance process for undergraduate education only requires a registered nurse, from any field, to review curricula.Thus, a mental health nursing course can be approved by someone who is not a mental health nurse.This may be one of the largest holes in the sieve.When people don't know what to look for, how are they expected to understand when it is inadequate or missing?As a mental health nurse, I wouldn't be confident in quality assuring the education for students studying adult, children and young people and learning disabilities nursing.I respect nurses in those fields, as having the necessary expertise to understand their fields.Conversations through the 'mental health deserves better' group have identified experiences where quality assurance has sometimes involved little to no scrutiny of mental health content.The quality assurance processes are in dire need of some quality assurance.

| The Epistemic Injustice of Mental Health Nurse Academics?
Worryingly, the perspective of many MH nurse academics has not been valued.Consultation and representation of MH nursing mean little when people are in the room, yet not listened to, as I have heard was the experience of many mental health nurses during the development of the NMC's future nurse standards.I have to wonder, where MH nurse academics bemoan the state of their courses, what do those who disagree think, especially where they are from another field of nursing?Do they think their resident MH nurse academics don't understand their own subject?Do they believe so strongly in the NMC and their authority that any alternative view is impossible?I hesitate to use the term gaslighting, where one person causes another to question their sanity or perception of reality (Cambridge Dictionary 2024), yet this is how I feel at times.Coleman (2019), using social identity theory, argues that mental health nursing is a low-status group compared to general or adult nursing and has had limited success in enhancing its status.One may wonder if this is in relation to the stigma around mental illness within the nursing profession, which has been argued to apply to people with mental health problems, as well as a 'stigma by association' towards those in mental health nursing who work with them (Ross and Goldner 2009).
I understand MH nursing as a complex undertaking, where there is enormous power over service users and it is very easy to do it badly, where relationships may be harder to establish and maintain due to this balance of power, and where both the experiences which led to MH problems and the potential solutions which may help are entirely subjective.Therefore I strongly believe that the majority of a mental health nurse education should be focused on understanding self and others, and how we work effectively in relationships.Moreover, those who argue that shared learning has enough mental health content often do so on the basis that it has been mentioned.I don't deny mental health may be mentioned, but being mentioned is not a mark of quality, it is simply having a box ticked.Might I be cheeky with an example, briefly use the words 'rocket science', and be able to confidently state, that in this paper I address rocket science?Similarly, I've heard students describe case studies with arrays of physical health conditions, with 'and they've got anxiety' tacked onto the end.This counts as mental health content, and the idea that shared learning always meets the needs of all students in naïve at best.Thus, when I see weak and shrivelled mental health content for my students, when I see them in the coffee queue and they plead with me at the end of their 2nd year 'when will we get taught about mental health?',I find it hard to stomach the idea that I just don't get it, and I should trust in the NMC and the direction of the university.We know that some MH nurse academics have simply left nurse education as a result of the generic creep, either taking retirement or moving back into clinical practice where they can be guaranteed a focus on mental health.We can't evidence these people, and you can't hear them, because they're gone.I read, teach, write, research, present and network within the mental health field, people cite my work and ask for my thoughts (not writing this to boast, but generally these are measures of success in academia), but my opinion was worth nothing at my former institution.Worthy of note, I have never strayed from advocating for the direction of my own field, which I have invested time in coming to understand, and I have never attempted to belittle nurses from other fields, respecting them to tell me about their distinct specialism, its unique challenges, and what its students need.Yet, my concerns about my own field were patronised and dismissed, and it is then hard to find a meaningful response.Can I turn this into a fruitless pantomime 'oh yes it is' verses 'oh no it's not'?Has this now become a form of epistemic injustice, where we are wronged and belittled in our capacity as knowers (Fricker 2007), with the capacity of mental health nurse academics to know about mental health called into question?I have asked myself humble questions.Perhaps I don't know my own field or specialism?Though I suspect me knowing a little about mental health, even if they agree, would hold no weight.It doesn't matter if I know 'mental health', because they know 'nursing'.Where Barker (1990) once argued that developments in mental health nursing depended on the beneficence of psychiatry, it seems that this also depends on the beneficence of dominant and orthodox paradigms of 'nursing'.

| The Emperor Is Naked
Despite not being heard within the building, when I shared my concerns and reached out via email to colleagues from Mental Health Nurse Academics UK in January 2022, I had an overwhelming response overnight, and this led to the development of campaign group 'mental health deserves better', and an open letter to the NMC signed by over 100 mental health nurses including academics across 33 universities (Mental Health Deserves Better 2023).(A note for schools of nursing in universities; if an employee feels so disenfranchised and voiceless that they go and start a national movement, you may want to review how collaborative your decision-making processes are, and improve your means of engagement with staff across all fields of nursing.)This reminds me of Hans Christian Anderson's (1923) tale of the emperor's new clothes.In this tale, an emperor is tricked by two swindlers who convince him they can make beautiful garments.They in reality do nothing, but say the garments are only visible to those who are worthy to see them, and not wanting to be considered unworthy, the emperor and his subjects all pretend to see what is not there.The entire town goes along with this pretence, until a young boy exclaims the truth, that the emperor is in fact naked.Once uttered, everyone else begins to say the same thing.The future nurse standards are beautiful garments, where the mental health content is invisible, yet question them, and you may be suspect as not understanding nursing.However once questioned out loud, for many the pretence falls, and others have the confidence to say honestly what they see (or don't see).
The NMC's standards are argued to try to be 'all things, to all people, all at once' (Bifarin et al. 2024, 2), and I agree this is what seems to be attempted, and it is hard to argue with the sentiment.I simply feel this is not possible, and you attempt to do everything, but instead do nothing to any depth, or very well.A course which is often 3 years long is not a Tardis from Doctor Who, which is described as 'dimensionally transcendental, meaning it's bigger on the inside than the outside' (The Doctor Who Site 2024).A course is a time-limited vehicle where the more content you have, the less depth you achieve.You might achieve the illusion of holism, but never realistically get there.We might very reasonably argue that in terms of preparing graduates for the jobs they will do, less is more.
However, with the NMC already accused of a culture of defensiveness (Webber 2024), and a recent damning report on its culture seeing staff describe the organisation as having 'toxic positivity' and being managed like a 'media company' (NMC 2024b, 35), it is perhaps not surprising to see a defensive approach taken by the NMC from the outside.The reply from the NMC can be summarised as a patronising 'keep calm, it's holistic' (Holt and Dixon 2022), arguing that the standards do adequately cover mental health, because they cover everything.The NMC and Chief Nursing Officers official response also replied defensively with the non-committal 'we feel it is too soon to reach any definitive conclusions on the impact of these standards' (Nursing and Midwifery Council 2023b, 2).The emperor continues to parade around, showing off his beautiful garments.

| Censored, Disciplined and Silenced
In this age of polarised views where people are often afraid to speak their minds, within nurse education a taboo exists around daring to raise this issue, and suggest rather mundanely and modestly that there should be more MH nursing for MH nursing students, or that the NMC or a university may have got it wrong.Not only is this taboo, but often systems and processes can support the silencing of mental health nurse academics.Within universities there are variable, but often messy politics which can impede mental health nursing.My experience was one of a senior leadership team made up of entirely adult nurses, and a course lead role which was filled by an adult nurse, covering 'nursing' as one subject rather than having course leadership for distinct fields.Whilst sometimes MH nurses might be dominated and shouted down, it's more often the case that there is no representation in the room when decisions are made.This is a gentler, yet much more effective systemic means of oppression.
Drawing attention to the issue of diluted MH nurse education, I found myself out of favour and in hot water.Giving up on being heard inside the university, I made noise outside.Nonetheless, any publications where I publicly criticised the direction of MH nurse education were censored from the student-facing newsletter, a zine where the most minor of issues were celebrated and promoted, and any other publication was big news.I have since realised that this zine was not about sharing ideas, debate and academic discourse, but was a propaganda vehicle for the school of nursing, where reputation is life itself, and all things perceived as selling points were paraded for all to see.
When I critiqued the NMC's direction on social media using an April Fools joke and then responded to someone who asked where the best MH nursing course was by saying 'definitely not mine', I was subsequently investigated, disciplined and given a first written warning in a draining ordeal that spanned 6 months.How dare I question the NMC, the gods of UK nursing.How dare I bite the hand that feeds.How dare I stand up for mental health nursing.I had the bizarre experience of being celebrated as a freedom fighter following the 2022 mental health nurse academic keynote lecture (Warrender 2022a), having weeks earlier experienced a disciplinary hearing, where I was treated like an intellectual terrorist, or more patronisingly, like a bad dog.An academic freedom policy stated something akin to there being freedom to 'put forward new ideas and controversial and unpopular opinions, without fear of victimization', with a caveat open to interpretation that it 'expected that individuals will not do anything that would seriously damage the University's reputation or interests'.The clear interests were safeguarding reputation and looking good from the outside, to safeguard the interests of ensuring students continued to apply to the university thus ensuring continued financial income.My interest was different; that the quality of mental health nurse education should be adequate to meet the needs of the population.I learned from being disciplined which took an emotional toll.I became a little more calculated, reserved and measured, used social media much more carefully, and leaned into as much academic freedom as I could justify.I was then delighted when I saw a call for students to participate in research, led by academics from another university, exploring their experiences of courses following the future nurse standards.Despite assurances this would be anonymous with no institution named in the findings, senior and middle management chose to block this study, meaning students were not even offered the opportunity to participate.The same people who will reject claims of any issue in the quality of MH nurse education, suggesting there is no evidence, will actively resist the development of that evidence base through gatekeeping.Not unique to the United Kingdom, this was remarkably similar to the experience of MH nurse academics in Australia, who wrote of their study 'one Head of School declined to pass on the study invite on grounds of the research topic while the Head of School of another large university acted as gatekeeper to the research projects their academic staff could respond to and chose to not pass on the survey request' (Lakeman et al. 2024, 96).
A final systemic issue was the recording of student attrition.A student decided to leave the course, stating it was not as focused on mental health as they had expected.Official recording noted their reasons for leaving as 'poor course choice', indicating they had made the wrong choice.The reality from my perspective was that the student's choice was fine, but they had enrolled at a university which offered a poor course.Anyone choosing mental health nursing and wondering where the mental health nursing is, cannot be questioned in terms of their choices.It is the school of nursing which needs to be questioned regarding its false advertising.Honest advice for prospective students in the United Kingdom should be to shop around.Some courses are better than others, and in a time when many United Kingdom universities are struggling financially, it may be pragmatic to their survival that they give a mental health nursing student what they want; mental health content.
Whilst one may argue that an international journal is not the place to air personal grievances, this is in fact, precisely the point in bucking the trend through this publication.Without me sharing these issues in an academic journal, where do these grievances go?Nowhere.They live and die as whispers in corridors, or if they are lucky end up as elephants in rooms.These issues then continue to prevent mental health nurse education from being what it might be.

| Haunting
As a ghost, what else was I to do but haunt?Having written and contributed to articles publicly expressing my disgust at the impact of the future nurse standards, and using language like the standards being an 'assault' on mental health nursing (Warrender 2022b) and having to hide this 'ludicrous truth' from prospective MH nursing students (Warrender 2022c), I found myself summoned to the Deans office.I was asked if I could express my discontent through the 'approved channels', rather than publicly.There were no approved channels which I had access to (which was one of the reasons 'mental health deserves better' started, and the reason why two and a half years on from its birth in January 2022, it continues to have attendance from MH nurses across the United Kingdom).The Dean and I had a civil but difficult conversation, where I argued that where I had no influence over our curriculum, in expressing my opinion through academic writing, I was using all of the power I had.This was not entirely true, as I also had the power to leave the university, which I eventually did.I now work at another university, further away from my family home but closer to my values, where mental health is the only field of nursing taught.Still held to and meeting weak NMC standards, but at least safe in a stronghold of fieldspecific learning where there is guaranteed contextualisation, and standards interpreted through a focused mental health nursing lens.I hope this isn't the only way for MH nursing to thrive, though experience suggests this model offers protection for the field which many of my peers do not have the luxury of having.If you do not hear more of them out loud, consider some of the forces which may encourage silence.

| Ensuring There Is a Public Record of Dissent
I believe the NMC's future nurse standards and quality assurance processes are a sieve, through which mental health nursing content can disappear down the sink, leaving a generic slop which benefits nobody, aside from large universities who can cut costs by teaching the same content to as many students as possible.Nonetheless, it might be easy to dismiss all of this as anecdote, to attack my character and dismiss me as a 'rabble rouser' (as has been done in the past), or even suggest that I'm perhaps just too stupid to understand the genius of genericism (always veiled as holism) and the direction of the NMC and some universities.What I can tell you for sure, is that where mental health nursing has become an add-on, or lost depth in relational practice, that this is not my mental health nursing.I simply don't believe in it, and the nurses I meet who have celebrated this direction make me feel as if nursing perhaps isn't for me.I find genericism inadequate, boring, unimaginative, ill-informed and not meeting the needs of mental health nursing students, and therefore not equipping them to provide effective care to people with mental health problems.It may be that I should have studied another profession such as social work or psychology, or maybe, as I currently believe, I am justified in feeling that mental health nursing and its underpinning education can be better than it currently is.I'm almost a little tired of writing about this, and I worry it will lead to little change.If I have moments of hopelessness and disillusionment, I continue to write because, at the very least, I want a public record of dissent.I want people to read this in the future, and know that someone thought mental health was complex and deserved its own respected field of nursing.That genericism was experienced as diluting field identity and watering down education into a flavourless weak sauce.I don't want anyone to be able to say 'everyone thought this was a good idea', because the fact is, some of us see the writing on the wall.Some of our peers in Australia have found that a generic and comprehensive nursing education fails to adequately prepare nurses to meet the needs of service users with mental health problems, and that urgent change is needed (Hurley et al. 2023;Lakeman et al. 2024).Meanwhile, the United Kingdom has the façade of 'future nurse' which claims to be 'holistic and person-centred, assuring a strong foundation that ensures the mental, physical, psychological, social and cultural needs of all the people we care for are met, whilst also ensuring nurses are prepared for their specific field of nursing practice' (NMC 2023b, 1).It claims to do everything, but it doesn't, and mental health is often one of the first casualties of an overly ambitious project which sounds wonderful, but underestimates the complexity of mental health, and overestimates the abilities of human beings who simply cannot do everything, and do it well.

| Opposition
Mental health nursing is being misunderstood, undervalued and diluted, and I do not believe the current direction will lead to improved outcomes for service users.Moreover, the NMC are an unelected government, without an opposition.I oppose not because I enjoy conflict, but because I care deeply.In politics, the presence of an opposition party has been argued as a means of getting a biased government to adjust its policies (Demirkaya 2019).By opposing, alongside my peers in 'mental health deserves better', I want the NMC and universities to do better, and be better.If they can't be, and neither change direction, nor produce evidence that their plan is improving outcomes of both physical health and mental health of people with mental health problems, perhaps more radical action will be required.In the meantime, I will continue to be honest

| Relevance for Clinical Practice
The education which underpins mental health nursing can have a huge influence on clinical practice.At present, new students in mental health nursing in the United Kingdom encounter a lottery of field-specific content, meaning the knowledge and skills of new graduates will be inconsistent, with many lacking a depth of understanding.An awareness of the aforementioned issues impacting nurse education is necessary, and these need to be discussed and addressed to enable positive progress for mental health nursing.
14470349, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/inm.13405by University Of Abertay Dundee, Wiley Online Library on [19/08/2024].See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions)on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 14470349, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/inm.13405by University Of Abertay Dundee, Wiley Online Library on [19/08/2024].See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions)on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 14470349, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/inm.13405by University Of Abertay Dundee, Wiley Online Library on [19/08/2024].See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions)on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License and speak my truth.I would urge others in the mental health nursing profession to do the same.What else are ghosts to do but haunt?