Nursing theories and nursing models have a low profile within psychiatric and mental health nursing in the United Kingdom. This paper describes the philosophical and theoretical background of the Tidal Model, which emerged from a 5-year study of the 'need for psychiatric nursing'. The Tidal Model extends and develops some of the traditional assumptions concerning the centrality of interpersonal relations within nursing practice. The model also integrates discrete processes for re-empowering the person who is disempowered by mental distress or psychiatric services or both. The paper reports briefly on the ongoing evaluation of the model in practice.

Psychiatric/mental health (P/MH) nursing has rightly been described as a 'broad church', and one that contains many contested matters and areas of differing opinion. One such contested matter is that of the appropriate care for the person who is at risk of suicide. Recent, albeit limited, debate of this issue has taken place, and the literature, such as it is, indicates two principal (though linked) positions. These can be summarized as the 'engagement and hope inspiration' position and the 'observations' position. Given the P/MH nurse's unique position in providing 24-hour, day-to-day care to suicidal clients and the growing problem of suicide within people who suffer from mental health problems, it is both necessary and perhaps timely to consider this debate in more detail. Accordingly, this paper considers the debate regarding care for suicidal mental health care clients. First, the paper briefly describes the historical policy context of care for the suicidal client. Next, it focuses on 'observations' and concludes that there is a range of well-established, empirically based problems or drawbacks to this approach. Following this, it focuses on 'engagement, inspiring hope' and points out the key processes of engagement: forming a relationship, a human-human connection, conveying acceptance and tolerance, and hearing and understanding. The value and importance of these most fundamental of interpersonal processes is described and alluded to throughout the limited research into care of the suicidal client. The paper then describes the range of criticisms that have been levelled at the engagement-inspiring hope approach and considers these criticisms in more detail. As a result of this detailed examination, the paper then reiterates the need to replace 'observations' with 'engagement-hope inspiration' as the principal approach to caring for suicidal mental health clients.

The development, over the last decade, of the Tidal Model of Mental Health Recovery and Reclamation is described, and a summary of the application of the various Tidal processes of care is provided. Studies of evaluations of the Tidal Model within acute care settings are summarised and the potential contribution that the model makes to the development of person-centred care, within acute settings, is discussed.

Although the concept of 'mental health nursing' has grown in popularity over the past 35 years, it remains a myth. People believe that they know what it is and value it highly, but cannot describe or define it other than in vague terms. This paper briefly charts the rise of 'mental health nursing', emphasizing its political implications, and in particular, the drive towards an embrace of a person-centred, recovery-focused approach to care. If nurses are to realize such ambitions, they must resolve their historical association with psychiatric nursing. The concept of the 'mental health nurse' might signal the emergence of a new vision for human services, but might also signal the need for 'mental health nurses' to negotiate a formal separation from the traditional 'psychiatric' family.

Nursing theories and nursing models have a low profile within psychiatric and mental health nursing within the United Kingdom. This paper considers some of the historical, policy and rhetorical issues that may have framed nursing's relative dependency on the medical paradigm, and briefly considers some of the ethical challenges, which proposed 'extensions' of the nurse's role might have for a 'caring' discipline.The paper describes the philosophical background of the Tidal Model, which emerged from a series of studies of the 'need for psychiatric nursing'. The Tidal Model extends and develops some of the traditional assumptions concerning the centrality of interpersonal relations within nursing practice, emphasizing in particular the importance of perceived meanings within the lived-experience of the person-in-care and the role of the narrative in the development of person-centred care plans. The model also integrates discrete processes for re-empowering the person who is in mental distress, and provides a practical template for the exploration of the spiritual dimensions of the person's lived-experience, if appropriate.

The theory of Veiled Sexualities may facilitate acknowledgement of the presence of sexuality in all nurse-client encounters, and promote a discourse on the sexual rights of people experiencing mental distress among mental health nurses and all involved in the delivery of mental health services.

The assessment and management of 'risk' has become a focal aspect of contemporary mental health practice. Given their proximal relationship with service users, nurses most often represent the 'front line' of risk management, typically expressed in hospital settings through the bureaucratic process of 'observation'. Much of the available 'evidence' is highly critical of this practice and service user researchers, in particular, have repeatedly called for alternatives. This paper reviews the historical and inter-professional dimensions of the practice of observation, contrasting this with mental health nursing's search over the past two decades, at least within the UK, for professional autonomy. Contemporary mental health nursing is trapped in an anachronistic relationship with psychiatric medicine. If nursing is to prosper, nurses must address the complex issues underlying this inter-professional relationship. The authors describe the development of 'bridging'--a radical alternative to observation practice, which represents a means of managing 'risk' and a way that nurses might develop their interpersonal relationships with people deemed to be at risk, thereby asserting the power of 'caring'.

Contemporary and established literature indicates that people with mental health problems are at a higher risk of suicide than the general population. Because suicide is a multifaceted, complex phenomenon, risk assessment within the mental health care system requires a pluralistic, multidimensional and multiprofessional response. While assessment tools may provide useful guidance, especially guarding against complacency and over confidence, the fundamental basis of risk assessment must involve a thorough examination of the personal, interpersonal and social circumstances of each individual. Such thorough and rigorous assessments, the authors of this paper would add, require a degree of 'clinical judgement'. As a rule, inexperienced members of mental health care staff should not be charged with the responsibility of conducting suicide risk assessments without sound mentorship. However, with the right support and assessment tool, the novice practitioner might develop the kind of clinical judgement necessary for this critical task. Accordingly, this paper traces the development of the Nurses' Global Assessment of Suicide Risk (NGASR). It illustrates the practice development context out of which the need for the tool arose; it outlines the key evidence that underpins the construction of the tool and it is described. It is important to point out that as yet, no wide scale, quantitative validation of the tool has been conducted. Therefore, at this point, the tool should be treated with a degree of appropriate caution. Nevertheless, the preliminary attempts that have been made to 'validate' or 'rate' the tool in practice are included. While acknowledging that any risk assessment tool represents only one aspect of the necessarily broader assessment of risk, the NGASR appears to provide a useful template for the nursing assessment of suicide risk, especially for the novice.