The changing relationship between mental health nurses and psychiatrists in the United Kingdom


  • Neil R. Brimblecombe BSc MSc PhD RMN

    1. Lead Nurse, Mental Health, Hertfordshire Partnership NHS Trust, Mental Health Services, St Albans; and Visiting Senior Fellow, University of Hertfordshire, Hatfield, Hertfordshire, UK
    Search for more papers by this author

Neil Brimblecombe,
Hertfordshire Partnership NHS Trust,
99 Waverley Road,
St Albans,
Hertfordshire AL3 5TL,


Aim.  This paper illustrates key developments in the changing relationship between the two professions over the last 200 years.

Background.  To understand the current relationship between mental health nurses and psychiatrists within the UK, it is necessary to understand the historical development of that relationship.

Methods.  Information was sought from a range of primary documentary sources, including contemporary journals, asylum documents and official governmental and health service reports. Secondary sources, such as histories of medicine, nursing and individual asylums provided further supportive information.

Findings.  Psychiatry emerged as a profession at the end of the 18th century and found a power base within county asylums from the middle of the 19th century. Medical superintendents, the doctors in charge of asylums, had strict control over the activities of attendants, the justification for which was the need to protect patients from cruelty and neglect. Superintendents’ desire for their own enhanced professional status led to formalized training for attendants at the end of the 19th Century, in which training materials again reinforced the importance of obedience by nurses (as attendants had become known). During the 1920s, trade unions struggled for improved pay and conditions, whilst professionalizing mental health nursing was a secondary priority. Reorganization following creation of the National Health Service in 1948 lessened superintendents’ authority, and ultimately the management of mental health nursing shifted from them. The move towards community care allowed mental health nurses to develop greater independence, which was supported by changes in nurse education.

Conclusions.  Psychiatrists in the UK remain highly influential, despite the move from their traditional power base in hospitals. Changes in mental health care, such as new nurse prescribing powers and the loss of psychiatrists’ control over admission of patients to hospital, will continue to change the relationship between mental health nursing and psychiatry.