Moving beyond policy rhetoric: building a moral community for early psychosis intervention

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. Margaret Mead It has been my privilege to work in partnership with hundreds of patients experiencing emergent psychosis, in Hamilton, Ontario during the course of my lengthy nursing career. Indeed, the knowledge I have gleaned from both the courageous individuals who have experienced serious mental illness and their resilient families has been monumental. When I first began my career, I was utterly naïve and most certainly held the misguided assumption that to be a mental health nurse required an adherence to a strict set of nursing principles and that the nurse-patient relationship was approached from an objective and 'safe' distance. Reflecting on this now, many years later I understand that the therapeutic relationship between nurses and those they serve is foundational to the delivery of safe and ethical mental health care. Although increasingly clinical practice guidelines and evidence-based interventions serve to inform nursing practice, in my mind it is the embodied experience of relationship that is the real instrument of healing and transformation. Recognizing that early intervention provides an unprecedented opportunity to begin anew with young patients who have no prior experiences with the mental health care system, the purpose of this paper is to serve as a vehicle for discussion and potentially inspire a group of thoughtful, committed nurses to change the world of mental health services by creating a respectful moral community. I propose that relational ethics form the values and ideals of a fully humane early psychosis intervention community in Ontario. Using the foundational tenets of the nurse-patient relationship illustrated through the use of a clinical narrative, I will suggest ways that nurses can proactively take up the early intervention challenge and contribute to an overall culture of optimism and hope. Intervening early is simply not enough. We must first commit to developing comprehensive recovery-oriented treatments in a coordinated and thoughtful way.