title: District nurses' involvement and attitudes to mental health problems: a three-area cross-sectional study.
abstract: OBJECTIVE
  The main aims of this study were to obtain information on the extent of staff contact and input with mental health problems and to determine their experience, training and attitudes to such problems.
  
  
  BACKGROUND
  Historical changes and policy shifts have resulted in primary care providers playing an increasing role in the care of mental health problems. Such problems are common within community settings and a major cause of suffering and disability. District nurses in particular are likely to encounter a high level of psychological co-morbidity in their patients. Information is lacking on their involvement, attitudes and specific training for this area of their work.
  
  
  METHODS
  A cross-sectional study was conducted of the staff of district nursing services in three areas, Jersey (Channel Islands), Lewisham and Hertfordshire, using a postal questionnaire.
  
  
  RESULTS
  Questionnaires were sent to 331 staff; 66% responded. Community and district nurses estimated a 16% prevalence of mental health problems among their patients, most commonly dementia, depression and anxiety disorders. Staff noted participation in a wide range of psychological care activities, but identified a lack of training for this aspect of their role (three-quarter of nurses had received no such training during the past five years). They reported a willingness to develop their understanding and skills by means of educational programmes. Attitude measures revealed generally optimistic views concerning depression treatment, a rejection of deterministic attitudes about this condition and confidence in the role of district nursing staff in managing such problems.
  
  
  CONCLUSIONS
  The need for primary care mental health training is widely noted and based upon consistent evidence of the limited detection and treatment of these problems. This study has employed quantitative methods to clarify the extent and nature of district nursing staff involvement in this area of practice and indicates that training needs are acknowledged by community nurses from geographically distinct settings.
  
  
  CONCLUSIONS
  Staff are interested in developing knowledge and skills pertinent to the psychological problems of their patients and their views reveal a consensus that the most important areas for learning are recognition of mental disorders, anxiety management, crisis intervention and pharmacological treatments for depression.
authors.affiliation: MRC Clinical Research Fellow, Specialist Practitioner, Health Services Research Department, Institute of Psychiatry, London, UK. m.haddad@iop.kcl.ac.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Haddad
authors.forename: Susan
authors.initials: S
authors.lastname: Plummer
authors.forename: Ann
authors.initials: A
authors.lastname: Taverner
authors.forename: Richard
authors.initials: R
authors.lastname: Gray
authors.forename: Soo
authors.initials: S
authors.lastname: Lee
authors.forename: Fiona
authors.initials: F
authors.lastname: Payne
authors.forename: Denise
authors.initials: D
authors.lastname: Knight
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002603:Channel Islands / Q000453:epidemiology; D002983:Clinical Competence / Q000592:standards; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004509:Education, Nursing, Continuing; D004739:England / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D007318:Inservice Training; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000451:nursing*; D008875:Middle Aged; D024802:Nurse's Role; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D011287:Prejudice; D015995:Prevalence; D011320:Primary Health Care / Q000458:organization & administration; D011637:Public Health Nursing / Q000193:education / Q000458:organization & administration*; D020377:Self Efficacy; D011795:Surveys and Questionnaires