Written by David Vago
BSc (Hons) Adults Nursing (Mental Health) (2024)
University of Brighton
‘When an opportunity presents itself, the answer is always yes.’ Those are the words of Professor Debra Humphris, our Vice Chancellor at the University of Brighton.
Fast forwards four months later, and after many discussions, and emails with my professors and the Gibraltar Health Authority, I find myself writing this reflective account of my international placement in Gibraltar designed to learn about the practices set in place for individuals who have mental health conditions in Gibraltar.
As a first-year Mental Health student, my own resilience was key to this being a successful placement. Having strong resilience, and the ability to find solutions to the challenges that others and I would face, was always a feature of discussion, and gave me the opportunity to challenge my own skills and abilities similar to what a qualified nurse would do on a daily basis.
The idea of doing a bespoke placement overseas started because of two reasons. Firstly, my family is from Saint Helena, which is one of 14 British Overseas Territories, and has led me to have an interest in the British Overseas Territories. Secondly, I enjoy studying and learning about healthcare and supporting individuals to get better, which is why I am doing my Adults Mental Health Nursing degree here at the University of Brighton. Combining the two reasons gives me the opportunity and aim to help to support and improve the health practice in all the British Overseas Territories, which will support the British Citizens that live there.
Now, to make this happen, I did extensive research looking at the different territories and what mental health provisions were currently being provided to the population. I came up with a list: Gibraltar, Falkland Islands, and Sovereign Base Areas of Akrotiri and Dhekelia in Cyprus. I selected Gibraltar due to the following reasons: the number of services available to their population was greater than the other two territories, and their population size of 34,000.
With this information, I presented the pilot placement in mental health services in the British Overseas Territories to Kathleen Galvin, Professor of Nursing Practice and Maggie Stewart, Senior Lecturer at the School of Health and Social Services.
With positive endorsement, it was time to contact Gibraltar. It was hard at first to find the right person, and I kept coming up with dead ends, but finally, I managed through the University of Gibraltar to get in touch with Niall Wright, the charge nurse for the community mental health team in Gibraltar. From our first contact, he was very supportive of my idea for a bespoke placement in Gibraltar with the mental health services provided by the Gibraltar Health Authority (GHA). His enthusiasm was one of the key drivers in maintaining my resilience to see this pilot project through whenever I faced barriers or problems in organising the placement.
After a few calls, we agreed on the structure of the placement. The placement would focus on an atypical journey of a patient that needed support going through the mental health services, starting with the community mental health team (CMHT), progressing to Liaison service in Accident and Emergency at St Bernard’s Hospital to then arriving at the Ocean Mental Health Facility.
With this I arrived in Gibraltar on the 4th of July 2022 and started the placement with the CMHT on the Tuesday. I was given an overall introduction of the CMHT and then set about working with the team on identifying patients who needed support and learning about the Gibraltarian way of nursing.
On Wednesday, it was Clozapine and Depo-Provera injections clinic. We began the day with a review of the Clozapine records with the Charge Nurse, and then found myself working within the clinical room being given instructions by Alan, the Enrolled Nurse, on learning basic clinical skills such as measurement of blood pressures, blood sugar levels, and measurement of individual weight and height to calculate Body Mass Index (BMI).
Then Alan showed me the technique for doing venepuncture and I was supervised to do three Depo-Provera injections on three different patients. Alan was a great teacher, and his best advice for giving a Depo-Provera injection is, and I quote: “be confident and administer it with confidence until all the liquid has come out, and retract it using a Z-track technique!” It was a great second day, and I was able to learn so much while having a practical hands-on approach.
I spent the next two days with the Liaison Team in St Bernard’s Hospital Accident and Emergency. There I had the opportunity to learn about and see first-hand the Liaison Team’s process when a patient in a mental health crisis presents themselves at Accident and Emergency. It was an eye-opening experience as I was able to see how any individual with a mental health crisis is triaged. Effective triaging for individuals in mental health crises can ultimately save lives and lead to better clinical interventions from nurses.
I spent the weekend exploring Gibraltar, visiting St Michael’s Cave, and other locations. I even made friends with the local monkeys known appropriately as ‘Rock Apes’ due to them living solely on the rock that Gibraltar is home to.
The Monday of the second week began with a bright and early start. As I was staying in Europa Point, where you can see both the Atlantic Ocean and the Mediterranean Sea on a good day, I walked the 10 minutes each morning to Ocean Views Mental Health Facility. Arriving for 8am, I was signed in and then made my way up to Horizon Ward where I met with the Charge Nurse, Kate. We had a handover where I was able to learn about the patients currently in the ward and meet the team supporting them. The team was a mixture of Spanish, Gibraltarian, and British staff, and all were very knowledgeable about the patients, understanding their care by approaching them with the Gibraltarian way of nursing.
Over the next two days, I spent time with different charge nurses on the ward, who gave me the opportunity to spend time with the patients, and work with them and the Clinical Psychologist in reviews and discharge meetings. It was interesting to see all the different types of mental health conditions that are supported, and the acute ward works on stabilizing patients for discharging after being sectioned. The process can be slow, but the staff on the ward do an excellent job in working towards achievement goals with patients.
On Wednesday, I was asked to come back down to CMHT to support the Depo-Provera injections clinic again. At this point, I was able to put all the learning I had done in training into practice, with minimal supervision from Alan. Throughout the day, I had an opportunity to support an individual who is a regular with the CMHT by giving him the opportunity to discuss how he was feeling, and then report this to Alan and what my potential recommendations would be. These were agreed upon and presented to the individual who was happy with them.
On my last two days I was back at Ocean Views Mental Health Facility in Dawn ward. Dawn ward is a recovery ward used to support individuals who have addictions such as alcoholism or drug usage that have led to overdoses and then hospitalisation for treatment.
On the Thursday, I spent a lot of time with Jamie, Enrolled Nurse, where we visited the community as part of the Outreach team from the Rehabilitation ward to support the recovery of individuals who had been discharged from the service, but who were still in need to general support.
Friday came, it was my last day on placement, working with Kate, the Charge Nurse. I was given the task of supporting the work experience students from the local secondary school with understanding some of the tasks a nurse would do. It was a great session and made me reflect on the fact that maybe one day after qualifying and gaining experience, I may be able to train student nurses.
So, as I near the end of this reflection, there are a couple of topics I would like to reflect on from my two-week placement with the Mental Health service in Gibraltar. Firstly, the Gibraltarian way of nursing: it’s unique, it’s person-centred and it gives a reflection on the cultural approaches that Gibraltar currently has. Gibraltar is a mixture of both British and Spanish cultures, and sometimes inputs from each culture are needed to suit the situation. This is what makes the Gibraltarian way of nursing interesting, as you have both these cultures impacting the nursing interventions for patients. Furthermore, there is a sense of nursing in Gibraltar having an identity crisis, some nursing practices are very modern and some are out-dated simply due to the limitations of the nursing services that can be provided.
As far as how mental health services are currently positioned to support the population of Gibraltar, I feel that Gibraltar is at a crossroads and going through what I see as a rebirth of its services. The change is underway with a new management team who are actively looking towards working in a way that progressively brings mental health nursing in Gibraltar into the 21st century.
Finally, the funding for this was always going to be an essential part of whether the pilot project failed or was a success. So, at this point, I would like to say thank you to Marnie Middlemiss, Director of Philanthropy at University of Brighton and The Turing Scheme for providing me with the funding to do this placement in Gibraltar.
One final reflection from myself would be the following. Gibraltar was a very eye-opening experience, and I enjoyed every minute of it. I was given the opportunity to be able to experience placement there, and hopefully, in the future, this reflection will be part of a bigger series of reflections regarding mental health and nursing practice impacts on the populations of the British Overseas Territories. Furthermore, it will give the opportunity for me to hopefully use this reflection as a good foundation to develop links to other British Overseas Territories for further placements to experience how mental health is conducted there. Let’s hope opportunity knocks again because I am ready and enthusiastic for the next one!