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Career Spotlight: Dennis Singson, a Mental Health Specialist (RGN/RMN/Nurse Prescriber)

Mental Health Nursing is now becoming one of the in-demand nursing specialisms in the UK. Why is it becoming popular and relevant in the current times?

Meet Dennis Singson, an NHS Windrush 70 awardee, an Advanced Nurse Practitioner, a Mental Health Specialist, and a Filipino nurse champion.

Tell us briefly about your Nursing journey. I arrived in the UK Year 1999 with a group of 17 other nurses from our home country. I first started working as a STROKE Adaptation Nurse, then when the opportunity arose after 4 months for a Senior Nurse (Charge Nurse) post, I applied and started working as a Mental Health nurse. As you probably know, even if we finished BScN and/or Masters in the Philippines, our registration with the NMC (or UKCC during that time) only equates to an entry level RGN. That is why a few years later, after I decided to specialise in mental health, my manager kindly agreed to give me a secondment and allowed me to study full-time for a year to enable me to gain my registration as an RMN. Several years down the line, I also decided to study to become an Independent Nurse Prescriber which I finished in 2011. Now, I am working as an Advanced Nurses Practitioner/Mental Health Specialist in a local GP surgery in East Sussex.

I am relatively new to my current role. I started working in primary care end of March shortly before the lockdown was imposed. Obviously, patients first port of call whenever they feel physically and mentally unwell is their GP surgeries.

My role is also a recent innovation as most of the time, the nurses you would encounter in GP surgeries are RGNs. Since I maintained all my qualifications, I am able to cater to all health needs of all my patients.

Since I am the only RMN in the surgery (with a list of 25,000+ patients), majority of my patients have mental health difficulties ranging from anxiety to depression and psychotic illnesses. This also means that I can get away with doing injections, dressings and extracting blood as most of those are done by practice nurses.

What’s your typical day like? I work four 11-hour days and I am always off on weekends (which my children love). I typically start at 8am. My 1st patient appointment would be at 815AM and my last patient is usually around 430pm. Because of how things are currently (with the proverbial Covid19 restrictions), 99% of my patient consultations are done via telephone and video calls. I “see” an average of 20 patients per day.

Why did you choose this area of nursing?

Before deciding to move to England 20 years ago, I have worked in different fields of nursing. I have worked in the academe in different universities and colleges in the Philippines. I was also doing board exam (Nurse Licensure Exams) reviews and have trained hundreds of competent, compassionate, dedicated and hardworking nurses that I am mightily proud of. I have also worked in KSA during the Gulf War as part of the Philippines' medical mission and under the auspices of the United Nations. I have also previously worked in a Burns Unit, Plastic Surgery, Stroke Unit etc. Mental Health and Psychiatry has always fascinated me. Even as a student, I have always loved reading theories introduced to us by Freud, Erikson, Sullivan etc. I thought medical - surgical nursing is easy as all interventions are specific and “de-kahon” (Tagalog term which means “within a box” or sticking to rules strictly from textbooks or manuals.) whereas, I feel mental health difficulties are more complex. "One size definitely does not fit all".

Pagiisipin ka talaga (Translation: “Really makes you think.”) in terms of treatment, approach and management. One example of this is regarding antidepressants. We all know they all work, but you can't just keep on prescribing the same one to all depressed patients that you encounter in your clinic because different antidepressants work in different ways and your choice should be determined by people's way of living, co-morbid problems etc.

Secretly (not anymore after this), I think I am just really nosy. My mum also used to tell me that people tend to gravitate towards me and open up to me. And professionally being a mental health nurse means I have a “license to ask” more in-depth, sensitive and straight-to-the-point questions. And yes, people actually answer them. Most of the time, I don't even have to ask! Parang Chiska lang (Chismosang Kapitbahay).

What does it mean to be a Mental Health Nurse? I think all of us nurses are in so many ways, whether licensed or not, are also mental health nurses anyway. But most of the time, if you work on the floors (ward or hospital in general), your other tasks (dispensing meds, doing dressings, giving IVs, and other technical tasks) go in the way of being able to provide a more well-rounded and holistic care. And I am very lucky I don't have to think of those tasks and I can just focus on providing the emotional and psychological care my patients need - That's why I love my job. Also, selfishly, I don't have to wear a uniform, so japorms palagi (Translation: “I always feel dapper and dressed up”.)

For you to be a good mental health nurse, you should be a good communicator. You need know to when to say things and when not to speak and just sit with your patient and listen. You also need to learn the skill of being able to defuse a difficult and touchy situation. Being a damn good listener is a must. I have had to let go of being so self-conscious. I reckon human nature at times dictate that we don't really listen to people we talk to because we are more concerned with what we want to say or how we will respond to them. Sometimes, you just need to let them open up and allow them to process things on their own. We just moderate and navigate the discussion. They are not always coming to you for advice and answers. You need to allow them to figure out the answers themselves, and just lead them to it rather than feeding them the answers to all their queries There are also instances when you do not have to say anything and that can mean so much more to your mental health patients. Most of the time, your presence is more than enough. You should also know how to be a good team player.

You should also be able to quickly switch from being an effective leader and an acquiescent and amenable follower. We are not saints though. It's a massive art. It definitely can be a long process too. But that's also an essential part of being a mental health nurse - calling people's bluff and being straight and honest with them. Do you think you are making a difference as a nurse in this field? How? Definitely. Most especially in this unprecedented and tumultuous times. You can only imagine the amount of calls for help, advice and we receive at work. There are a lot of people who are reliant on their families, friends and social circle to remain well. Some people achieve their self-worth and well-being by being surrounded by other people and the last 6 months or so have been a massive shift and change for them. The world as we know it is gone. It is a different environment we are living at now. We have read and seen on the news about people ending their lives due to this lockdown / quarantine and this doesn't surprise me as we as human beings are naturally social beings - whether we acknowledge it or not. Being a part of a community is a big thing.

We all have a need for a sense of belonging (ask Maslow!). There is a good sense of safety & security knowing we can see friends and family when needed and be surrounded by them - and some of us still can't do any of that at the moment. There is only so much zoom, facetiming and calls we can make. That is not enough. We need human contact. I can boldly say I save at least a life each day I come to work. And that's huge! That is making a difference. Not necessarily to me, but to other people's lives and families.

What are career progression opportunities for a MHN/RMN? Career progression is subjective. If you measure it in terms of monetary value, or stepping up in terms of banding, there are a lot of opportunities. And I think it also depends on how you sell yourself. With my current role, they did not really advertise for my post. I just told the GP partners that they need someone like me. And fortunately, they believed in me, hired me and gave me a very competitive and attractive package. I've had other opportunities that I passed up on because I want to continue my clinical work. It is very important to me.

As a Mental Health Specialist, can you give some practical tips on how people can protect their mental health and why they should do it? What support they can get to ensure their mental well-being?

I have had a massive influx of referrals from all ages since March. And it is not letting up. It can be quite tricky. I always give my patients the options - the same way I would want my doctor or nurse to give me the options on how I can help and manage my own problem and difficulties. And I believe that is the first step in treatment and rehabilitation. People need to have a certain level of control and ownership with regards to their plan of care. We should not also discount the invaluable input family, carers and friends contribute to people's recovery. They are also a very integral part of the puzzle. Thankfully, there were a lot of local and national agencies that were very responsive to the community's needs and introduced a lot of services that proved to be helpful to a lot of people. They came in different forms from practical day-to-day tips/guidance to specialist services and I ensure my patients have access to those information.

Generally, I guess I would encourage everyone to have an open mind about how our world was turned upside down by this pandemic. Rightly or wrongly, our world as we know it 6 months ago has now completely changed and we shouldn't expect for it to go back to how it used to be because it just would not and we just can't. Things have changed. Things are different now. The pandemic has and will mean different things to everyone. And whatever you do or whoever you are will not make you immune to the direct or indirect effects of the pandemic. It is likely to affect us in different ways, in varied intensities and in disparate times. How we respond to it can and will change too. But however and whatever it does to us, seek help. Talk to someone. Do your research. Check resources online.

Do not keep things to yourself and do not ever think you are weak because you are crumbling inside. We are allowed to crumble, most especially if the world around us is crumbling too. We need a good work-life balance and we need to acknowledge this sooner rather than later. Have a break. Take time to appreciate things and people around you. Try and find the positive in everything. There is always one. You just need to look further or sideways- as they may not always be apparent when you look at it directly.

The struggles you may be experiencing now is developing the strength you need for tomorrow.

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