Knowledge, confidence and attitudes towards mental health of nurses working in NHS Direct and the effects of training


Fiona Payne, Immediate Access Project, Department of General Practice, Guy's, King's and St Thomas' School of Medicine, The Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. E-mail:


Background.  NHS Direct, the United Kingdom's 24-hour nurse-led telephone advice service, was announced in December 1997. By November 2000 the service was available throughout England and Wales. Initial research had shown that people with mental health problems used the service and that, prior to its going live, this was one area about which nurses felt least confident.

Aims.  The aim of the study was to measure confidence in dealing with mental health calls, knowledge of mental health issues, and attitudes to mental health before and after training.

Methods.  A postal questionnaire was sent to all nurse advisers working in 17 NHS Direct sites in England before and after mental health training had been received. The questionnaire was designed to measure confidence, knowledge and attitudes. This was done through scenarios of real calls to NHS Direct, questions from the World Health Organization guide to Mental Health in Primary Care and the Depression Attitude Questionnaire.

Results.  Confidence increased in nurses who received mental health training. Although there was no statistically significant increase in knowledge scores after training, those who had received training increased by on average one point. After training, attitudes towards depression had shifted in that nurses now felt more positive towards their role in treating depressed patients.

Conclusions.  Training in mental health can lead to increases in confidence and a change in attitudes and would be beneficial for all nurses working in NHS Direct and in other primary care fields. It would also be beneficial to repeat the study with a larger number of nurses and after a longer period of time to assess the long-term effects of training.