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"Most people really doesn't know mental patients"
Interview with Mike Firn, President of the National Forum of Assertive Outreach

Daniel Cuesta Lozano,1 José Eloy García García,2 Ángel Amaya Refusta3
1Enfermero Especialista en Salud Mental. Unidad de Hospitalización Breve de Psiquiatría del Hospital Universitario Príncipe de Asturias. Alcalá de Henares (Madrid), España. 2Enfermero Especialista en Salud Mental. Equipo de Tratamiento Asertivo Comuntiario de Oviedo. Servicio de Salud del Principado de Asturias. Oviedo (Principado de Asturias), España. 3Estudiante de Enfermería. Facultad de Enfermería y Fisioterapia de la Universidad de Alcalá. Alcalá de Henares (Madrid), España

Mail delivery: C/ Henares 1-Edif. 4-Ptal. 5-1ºA, 28816 Camarma de Esteruelas (Madrid), España

Manuscript received by 18.7.2011
Manuscrito accepted by 21.11.2011

Presencia 2011 jul-dic; 7(14)




How to cite this document

Cuesta Lozano, Daniel; García García, José Eloy; Amaya Refusta, Ángel. "Most people really doesn't know mental patients". Interview with Mike Firn, President of the National Forum of Assertive Outreach. Presencia Journal 2011 jul-dic, 7(14). In </presencia/n14/p0014e.php> Consulted by



    Mike Firn has been a Mental Health Nurse for over 20 years. He has thirteen years experience using the Assertive Outreach Model in England, and has managed and set up services including Assertive Outreach, Home Treatment and Early Intervention in Psychosis. He has worked for the National Institute of Mental Health in England working as Service Improvement Lead in the redesign of community services and workforces across London. Mike is also Chair of the National Forum for Assertive Outreach in England.

He has co-authored, with Prof. Tom Burns, the book Assertive Outreach in Mental Health; a manual for practitioners, published by Oxford University Press in 2002 and numerous journal articles. Mike has provided on site training, facilitation and external review pertaining to Assertive Outreach, Crisis Resolution and Home Treatment & Adult mental health service redesign. In particular he can bring a wide perspective of clinical expertise, operational management experience and service improvement theory and skills to local issues.

PRESENCIA was with Mike Firn at 1st Mental Health Nursing International Conference, in Tarragona, Spain, during the 28th Spanish National Mental Health Nursing Congress, and we could talk with him about the situation of mental health nursing and community programs at the moment.


Question: Good afternoon Mr. Firn and welcome to Tarragona to the 1st Mental Health Nursing International Conference. First of all, we would like to begin asking you about the current situation of mental health nurses in the United Kingdom (UK). Do you think mental health nurses are properly recognized (professionally and economically) in UK?
Answer: In the UK professional training has improved in recent years and besides it has had important institutional support. There has been an increase in mental health budgets and salaries have risen. We can consider that now that are nurses are relatively well paid. The mental health system has a solid structure and is delivered through real multidisciplinary working on a par with, the social worker or the doctor.

Q: What are the main problems for this collective?
A: Twenty years ago there were important difficulties in the profession, but this has changed today. The establishment of the Nursing Degree in the University has improved the level and the quality of the profession.

Q: A recent article which you figure as author, talk about paying to persons with severe mental illness to maintain their adherence to the pharmaceutical treatment. What is your personal opinion?
A: Oh! How do you know about that? It is a purely research question. This article did not have a great impact in changing practice. We know by the Assertive Community Treatment (ACT) that there are persons with severe mental illness who have poor adherence to medication. A small study showed that paying people to accept long acting injectable medication worked when everything else had failed.  The question is to see if a full scale randomized trial would have the same result. We also looked at nurses and doctors attitudes as the whether this is ethical. Most of them thought it was not.

Q: What do you think is more important: the fidelity to American ACT model, or instead, each country or region, develop their particular ACT?
A: Family in Spain is very important, in the UK less so. Many of our patients live alone and our services must respond to these different needs. In the UK and Mediterranean countries there are just a few mentally ill people who have no homes and are living on the street. In the United States (US) we see much more people living in the street or in prison. I do not think there is only one way to do it, because our societies and welfare systems have different levels of support.

Q: What advantages and disadvantage has ACT against the assistance in the community mental health units?
A: In community Case Management you are working alone, and that makes more difficult the job. ACT is the most continues and longitudinal. Even, in ACT case, nurse is more recognized, you have autonomy, more interaction with the patient, you can see the long term relation, not as in the hospital, having a continuity in the care and being able to do things which you could not do in standard care. You can do different groups and you have huge liberty to be creative.

Q: To prolong the permanency at ACT programs means to increase the dependency and/or loss of autonomy of the patient?
A: Yes. Autonomy is important. In ACT you have to ask yourself if it's ethical that caring won't finish and won't go way when the patient in need rejects it. The patient could tell you: "I want you to go, to not to come. I am not sick." All of us have had that experience. To conclude we should consider that patient's autonomy but also the autonomy of others around them if the patient's behavior is impacting upon them. The value of working in a multi-disciplinary team is that you can resolve these questions collectively.

Q: Last year Dr. G. Pacheco Borrella mental health nurse and principal of this journal read your thesis about the social construction of mentally. Why do you think stigma stills present in this kind of pathologies?
A: Most of the people don't see real mental illnesswhen patients are at the hospital, but when they face them at the community they are afraid because of movies, TV series. In the last 10 years movies of mentally (bipolar, schizophrenics, depressive.) had become very popular and they have a strong impact. In the UK they evaluated an anti stigma campaign, and they concluded that stigma rose despite public education several years of public education are undone if a homicide occurs and is publicized widely. People are basically afraid at the perceived loss of control, and that's why they are afraid of people who they believe are not fully in control of themselves. There are many cases of positive public characters who acknowledged that they have a mental disease, but despite of this, press publishes negative news about "the patient released to kill" not positive role models of people living and being successful despite a mental illness.

Q: How do you assess the pharmaceutical industry role in the human heath topic?
A: (Laughs) The pharmaceutical industry is a difficult market to control. Many times side effects are not reported in industry funded studies. But without the industry advances in medications would not occur as research and development costs are high.

Q: What message would you send to the politics about the mental health nurses role in the society?
A: I do not fight for nursing, I do it for the team and for services. I am not that partisan. Nursing in our country is important, and is the biggest collective. I do not think there should be a politic movement just for nurses which excludes other workers and the voice of patients.

Q: What would you say to the mental health nurses beyond the future of the profession?
A: I think is more rewarding to work in the community than in the hospital. The community is different. I started to work in the community very soon, I built a new career for myself which developed into opportunities to participate in research studies and to publish. Combining a professional and academic career as doctors often do will contribute to the professional development of nursing.

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