Abstract

Background: Like situations worldwide, Australia is currently experiencing a time of much needed mental health reform, spurred on by improvements to models of practice and consumer inclusion in policy.This has seen an increased emphasis from inpatient to community mental healthcare, and a move to reduce restrictive interventions, such as seclusion and restraint.While this is a welcomed approach to mental healthcare, this is not without some trepidation-particularly in more complex clinical environments where nurses are vulnerable to experiencing violence.In response to the Royal Commission into Mental Health, an updated Mental Health and Well-being Act was implemented in Victoria in 2022. Aims:The aims of this study were to describe the experiences and perceptions of mental health nurses on reform in Victoria.Design: Qualitative descriptive study.Methods: N = 14 participants were recruited from Victorian public mental health services and interviewed over Zoom.Interviews were deidentified, transcribed and thematically analysed.Results: Nurses described distress regarding their role in managing risk and caring for vulnerable persons under the new Act, particularly with its emphasis on consumer choice to refuse treatment.Additionally, nurses described significant concerns about the removal of restrictive interventions despite there being no reduction in violence and aggression, or in their eyes, an acceptable framework to manage violence, while also maintaining safety for all.Finally, nurses noted concern about early-career nurses and their ability to safely work in this dynamic environment.After analysis of results, three themes were identified: (1) Navigating the new Act: Overcoming challenges faced by mental health nurses.(2) Defusing the storm: Mental health nurses' safety concerns under the new Act.(3) Workforce strain and organisational value: The impact on mental health nurses.Conclusions: As the largest workforce in mental health, nurses must be supported, valued and consulted during times of reform as well as be provided the tools to be able to safely enact reform.The needs and wishes of consumers are undeniably incredibly important, but they must also be balanced with expert clinical decision making and consider the safety needs for all involved.