Between Autonomy and Duty. Mental Health Nurses' Experiences of Early Intervention in a Rights-Prioritised Reform Context: A Qualitative Descriptive Study.

Mental health reform represents a sustained effort to improve the accessibility, quality and human rights orientation of mental health systems through changes to policy, legislation and service delivery. The scale and pace of growth in the lived and living experience workforce (LLEW) is unprecedented within mental health services, with a marked increase in roles representing a significant shift in the contemporary mental health landscape. In Australia, the state of Victoria is currently undergoing the most significant mental health reform in its history. This study aimed to explore mental health nurses' perceptions of the impacts of mental health reform on (1) their delivery of care in relation to consumer and carer safety and wellbeing and (2) their experiences of working alongside lived experience workers within reformed service contexts. This study employed a qualitative descriptive design, with secondary analysis of existing qualitative data (Szabo and Strang 1997), which were thematically analysed using Braun and Clarke and reported in accordance with CORE-Q guidelines. Semi-structured interviews were conducted with mental health nurses working in Victoria (N = 14), Australia, with three themes generated through reflexive thematic analysis: (1) Mind the gap: Reform impacts to safety and risk; (2) When care comes too late: reform impacts to care and treatment; and (3) Between sympathy and resistance: ambivalent attitudes towards LLEW roles. Persistent integration challenges related to LLEW influenced nurses' perceptions of usefulness. Nurses also described that an increased legislative emphasis on consumer choice, relative to clinical decision-making, contributed to uncertainty and hesitancy in intervention, which nurses perceived as negatively affecting care outcomes in some situations.