Marcia Porter

Green and flowering plants, colorful keepsakes from students and framed art on the desks and walls create atmospheres conducive to conversation in the offices of Drs. Joy Maddigan and Nicole Snow. It's just the kind of place that encourages you to sit, catch your breath for a few minutes and cradle a cup of tea in your hands.

Creating a calm environment―including pouring up steaming hot beverages―is one of the ways the two School of Nursing faculty members hope to get people talking about mental illness and the need to reduce its stigma, as well as to build awareness. They'd also like to encourage more conversation around nurses taking on a more dynamic role in the care and recovery of patients with mental illnesses.

Drs. Maddigan and Snow share a keen interest in mental health that dates back to their days as bachelor of nursing (BN) students in the SON; for Dr. Maddigan that goes back to the 1970s, for Dr. Snow it was two decades later in the 1990s.

"When I teach mental health I try to do my best to instill a very questioning, inquisitive mind in my students," said Dr. Snow, who received her PhD from the University of Alberta this past fall. "I want them to ask, for example, 'How do I tolerate the way people with mental illnesses are portrayed?'"

"I felt like I had come home," said Dr. Maddigan, who was introduced to mental health nursing in the final year of her BN program. "Mental health tends to draw people who have a natural bent for social justice and equality. I went to work in mental health early in my career."

Psychosocial interventions

Following her master's in nursing graduation, Dr. Maddigan spent several years working in community mental health in Nova Scotia, and then teaching at the University of New Brunswick before returning to Newfoundland and Labrador to take on various positions within Department of Health and Community Services.

For her PhD research she studied recovery outcomes for Eastern Health's Early Psychosis Recovery Program. It's a three-year, community-based program that offers interdisciplinary care for individuals who've experienced their first psychotic episodes and need specialized treatment to promote early and comprehensive recovery.

One of Dr. Maddigan's key findings related to the rate and timing of recovery following a first psychosis. Most recovery gains were made in the first eight to 10 months of treatments, after which there was a plateau in improvement.

"We need to ask what nurses can do after the initial improvement to more effectively help clients achieve a fuller, more stable recovery." she said. "Patients are not 100 per cent well, and their quality of life is severely impacted by the experience of psychosis. What psychosocial interventions should nurses be implementing in year two and three to enhance a patient's recovery and return to life?"

"When I teach mental health I try to do my best to instill a very questioning, inquisitive mind in my students," said Dr. Snow, who received her PhD from the University of Alberta this past fall. "I want them to ask, for example, 'How do I tolerate the way people with mental illnesses are portrayed?'"

More questions

Those kinds of questions led Dr. Snow to study the use of Community Treatment Orders (CTOs) in the province. CTOs are ordered if a person with severe persistent mental illness is refusing treatment, considered a danger to others and has had a number of involuntary admissions to hospital.

"I'm interested in mental health ethics, and how we can make things better," said Dr. Snow, who began her PhD program while teaching full-time at the Centre for Nursing Studies.

"I wanted to find out why CTOs were not being used to the extent that they were in other place; even when you looked at things per capita it was really low. I wanted to find out why."

Though CTOs were introduced for therapeutic purposes, Dr. Snow's investigation found the orders were being used as a more punitive way of dealing with patients, further contributing to the stigma around mental illness.

Many countries are dealing with issues similar to ones that Drs. Snow and Maddigan have written about in their research, and the two have been asked to present at provincial, national and international conferences.

"I think we need to put a lot of dedicated time into pushing the mental health agenda forward in terms of research, ethics and understanding," said Dr. Snow. "I know we can do better."