What is a Mental Health Nurse in 2026?

A mental health nurse in 2026 is a specialist in working the fault lines between risk and relationship, safety and autonomy, biomedical power and human narrative. This is a question I first formally contemplated in my 2020 duoethnographic paper, “What is Mental Health Nursing Anyway? Advantages and Issues of Utilizing Duoethnography to Understand Mental Health Nursing.” The role has never been simple, but the mix of rising acuity, digital surveillance, and enduring stigma has made its tensions more visible than ever.

Asking myself the question, again

Most recently, I have come back to this question through the lens of professional history in “A Profession Divided: Critical Reflection on the Evolution of Registered Psychiatric Nursing in Western Canada.” In that 2025 paper, I traced how institutions like Riverview Hospital and the BC School of Psychiatric Nursing shaped a distinct psychiatric nursing designation, and how its eventual closure and subsequent educational reforms left a complex legacy for RPN identity and practice.

Seen from 2026, this is not just a story of division; it is also a story of ongoing transition; roughly half a century of shifting roles, educational reforms, and debates about whether psychiatric/mental health nursing should remain a separate pathway or be absorbed into a broader mental health competency for all nurses. When I ask “what is a mental health nurse?” now, I do so in the light of that contested evolution, not pretending it is behind us but recognizing it as the environment in which I actively practise and think.

Living in the grey zones of care

If all nursing involves risk, mental health nursing lives at risk’s most contested edges, and that is where I work. Safety is never an abstract principle for me; it is negotiated moment by moment, body by body, with policy, history, and my own moral limits pressing in at once.

Back in 2017 Slemon and colleagues contemplated “risk” in mental health care as not a neutral descriptor but a discourse that shapes how people are seen, categorized, and managed, often privileging institutional protection over relational understanding. My earlier research into nurses’ experiences of administering chemical restraint revealed stories that could easily have been my own: “using all the tools in the toolbox,” “taking control,” and then living with moral residue, self-doubt, and a sense of having crossed a line that was difficult to name. Those accounts now sit beside my historical work on psychiatric nursing, with its long association with control, custodial care, and “keeping order” in psychiatric spaces.

But the longer I practise, the more I understand that what I am doing in these moments is not simply risk work: it is care, and, dare I write, love. Sister M. Simone Roach’s caring framework, with its five C’s, compassion, competence, confidence, conscience, and commitment, gives me language for what is actually happening when I decide whether to escalate, hold back, or stay a few minutes longer at the bedside. I am not just applying a policy; I am bringing my conscience, my compassion, and my commitment to this person’s dignity into the room.

Rosemarie Rizzo Parse’s Human becoming theory pushes me further, reminding me that the person in front of me is not a bundle of risk factors but a human being co-creating meaning in that moment. From this perspective, health is not just the absence of crisis; it is how a person lives their values and moves through possibilities in their life. When I enter a room where someone is suicidal, agitated, or deeply mistrustful, I am invited into a shared process of making sense of their situation, not just scoring their risk.

So when I say I work in the “grey zones of risk,” what I really mean is that I work in the grey zones of care. Risk is the language the system uses for my practice; care is the language Roach and Parse give me to understand what is actually at stake. Every act of “risk management” leaves an imprint on their body and mine. My responsibility is not only to prevent catastrophe but to protect the possibility of trust, meaning, and connection going forward.

Practising in the light of a divided profession

My 2025 reflection on the evolution of registered psychiatric nursing argues that the profession’s “division” is not merely a technical matter of different credentials; it is the product of specific institutions, politics, and social conditions. Riverview Hospital and the BC School of Psychiatric Nursing were key sites where psychiatric nursing was defined and differentiated from generalist nursing, even as deinstitutionalization and policy shifts unsettled those identities.

In 2026, I practise in the light of that divided and evolving profession, not pretending those fractures are behind us. I see them when:

• RNs and RPNs are positioned differently in staffing models, leadership roles, and “who is the expert” discussions in mental health settings.

• Old arguments reappear about whether psychiatric/mental health nursing should remain a distinct pathway or become a universal competency for all nurses.

Working in this space, I do not experience division only as deficit. I also see it as a source of critical energy, a persistent reminder that mental health nursing in Canada has always been contested, negotiated, and in motion. My practice is one small contribution to how this story continues to unfold.

Documentation, voice, and power

Alongside this historical and theoretical work, my writing on documentation and the “patient voice” has become central to how I answer the question of what a mental health nurse is. I have argued that nurse-authored records often privilege professional observation, risk language, and problem lists while claiming to speak for the patient, and that mental health nurses stand at a crucial junction where they can either reproduce or disrupt that pattern.

In 2026, when I teach, review, write clinical documentation, I do so as someone shaped by a profession with deep ties to institutions and control. That awareness pushes me to:

• Watch for echoes of older psychiatric scripts like words of "control," "order,” “cooperation,” “behaviour management,” even when they appear in updated language.

• Intentionally foreground patients’ own words, contexts, and strengths, and to advocate for documentation structures that make room for genuine strengths-based, patient perspectives and co-authorship rather than token “narratives.”

For me, documentation has become one of the primary places where nurses can practise mental health nursing as advocacy and repair, rather than unconsciously extending the more harmful aspects of our institutional history.

My contemplation in 2026

​So, what is a mental health nurse in 2026? This is a big question for me, here, in this divided and transitioning profession in a transitioning area of health care. The promises of medical models that we clung to in the 1990s and 2000s have offered nurses opportunities to lead mental health care in 2026. So I will leave you (and me) with this:

• I am a historically situated professional, whose education, identity, and authority are shaped by the contested evolution of psychiatric nursing in Western Canada and by decades of transition in mental health care.

• I am a careful interrogator of concepts and constructs like risk and safety, and how they influence making rapid, morally weighty decisions in spaces haunted by both present-day policy and the institutional past of psychiatric care. These are serious considerations to forge a path forward while we insist that mental health nurses are fundamentally engaging acts of care, not just control.

• I am a narrative curator, knowing that clinical documentation and the design of electronic health records can either echo institutional logics of containment or support more relational, rights-based, and recovery-oriented practice.

• I am a bridge-builder in a divided profession, working with and across RN and RPN roles, honouring specialized mental health expertise while resisting hierarchies that erase or devalue parts of our shared history.

• I am a theory-informed practitioner, drawing on Roach and Parse to remember that my work is about compassion, conscience, and shared meaning, even when the system only wants to talk about risk and metrics.

The question I first named formally in 2020 what is mental health nursing anyway? has become, in 2026, a question about history, power, care, and ongoing transition. I am definitely not the first to ask such questions but 2026 is the year I have the energy to serious find an answer. My best answer now is that a mental health nurse is someone who chooses to work consciously in that bright, uncomfortable space where risk, history, and story intersect, and who insists that, underneath it all, this remains a practice of care.