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Between Autonomy and Duty. Mental Health Nurses' Experiences of Early Intervention in a Rights-Prioritised Reform
Louise Alexander1,2,3, Whitney Johnson3, Adam Searby4
1Deakin University, School of Nursing & Midwifery, Burwood, Australia.
International Journal of Mental Health Nursing
|July 22, 2026
Summary
Mental health reform in Victoria impacts patient safety and care delivery. Nurses report challenges integrating the lived and living experience workforce (LLEW) and balancing consumer choice with clinical judgment.
Area of Science:
- Mental Health Services Research
- Healthcare Policy and Reform
- Nursing Practice and Workforce Studies
Background:
- Mental health reform aims to enhance accessibility, quality, and human rights in mental health systems.
- The lived and living experience workforce (LLEW) is rapidly expanding within mental health services.
- Victoria, Australia, is implementing significant mental health reforms impacting service delivery.
Purpose of the Study:
- To explore mental health nurses' perceptions of mental health reform impacts on care delivery, focusing on consumer/carer safety and wellbeing.
- To investigate nurses' experiences working alongside LLEW within reformed mental health service contexts.
Main Methods:
- Qualitative descriptive design utilizing secondary analysis of existing qualitative data.
- Thematic analysis of semi-structured interviews with 14 mental health nurses in Victoria, Australia.
- Reporting adherence to CORE-Q guidelines and employing Braun and Clarke's thematic analysis.
Main Results:
- Three themes emerged: "Mind the gap: Reform impacts to safety and risk," "When care comes too late: reform impacts to care and treatment," and "Between sympathy and resistance: ambivalent attitudes towards LLEW roles."
- Integration challenges with LLEW affected nurses' perceptions of their usefulness.
- Increased legislative focus on consumer choice over clinical decision-making led to nurse uncertainty and perceived negative impacts on care outcomes.
Conclusions:
- Mental health reform presents challenges for nurses regarding patient safety, care provision, and the integration of the LLEW.
- Ambivalent attitudes towards LLEW and the shift towards consumer choice require further attention to optimize reformed mental health services.
- Addressing integration challenges and clarifying the roles within reformed systems is crucial for effective mental health care delivery.
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