Building Canada’s Future Mental Health Nursing Workforce

Nurse leaders in education have a pivotal opportunity to shape the future of mental health nursing in Canada. This is not simply a question of increasing the number of nurses available to work in mental health or substance-use settings. It is a question of what every nurse is prepared to do: build trust, recognize distress, address stigma, respond safely to suicide and substance use, and provide equitable care across the health system. 

Many of the principles now described as “holistic” or person-centred nursing have deep roots in mental health and mental health and psychiatric nursing and in nursing generally. Therapeutic relationships, trauma-informed care, attention to social context, advocacy, communication, and not only respect for but understanding of a person’s lived experience have long been central to mental health nursing practice. Today, these competencies cannot sit within one specialty alone.  

Mental health needs are present in every care environment. A person may disclose suicidal thoughts in a primary care clinic, experience withdrawal during a hospital admission, present with psychosis in an emergency department, or struggle with depression while receiving cancer care, rehabilitation, maternity, or long-term care services. This means that nurses in all roles need the confidence and foundational competence to recognize mental health concerns, initiate compassionate conversations, assess immediate safety, reduce stigma, and connect people with appropriate support.

For nursing leaders, this means mental health education should not be treated as a discrete course completed early in pre-licensure education and rarely revisited. It is not a box to check or a one-off skill to show to receive course credits. It should be integrated throughout curricula, clinical learning, continuing education, leadership development, and competency frameworks. A nurse’s ability to provide mental health-focused care is essential, deeply integrated with their ability to assess pain, respond to physical deterioration, or communicate medication information safely.

Preparing Nurses for Difficult Conversations

The future nursing workforce must be prepared not only to identify mental health concerns, but also to speak openly about issues that health systems have often avoided.

This includes conversations about stigma, racism, poverty, housing insecurity, trauma, substance use, violence, and suicide. These are not peripheral issues. They are often central to a person’s health, their capacity to access care, and their willingness to trust the professionals and institutions intended to support them. This also means that nurses are required to engage in deeply reflexive work to continually surface their unconscious bias and the impact of that in their own care, but also program and systems-level.

Nurses must be able to ask direct, respectful questions about suicidal thoughts without fear that asking will cause harm. They must be able to discuss substance use without judgment or moralizing. They must understand the principles of harm reduction and recognize that people may use substances for complex reasons, including pain, trauma, social exclusion, and unmet health needs and how these impact mental health. They must also be prepared to identify how structural factors (we are bringing this back to the social determinants of health) including colonialism, discrimination, poverty, inadequate housing, and fragmented access to care, shape mental health outcomes.

This does not mean every nurse must become a specialist in psychiatric or mental health nursing. It means every nurse needs a reliable baseline of mental health literacy, relational skill, and cultural humility. Specialty mental health nurses remain essential for advanced assessment, therapeutic interventions, complex care planning, consultation, and leadership. But a strong specialist workforce cannot compensate for a general health system in which people are repeatedly told, implicitly or explicitly, that they have come to the wrong place.

Making Every Door the Right Door

“Every door is the right door” should be more than a policy phrase. It can't mean "every door eventually redirects you to somewhere else after filling in the required forms, 2 follow-up intake appointments, and a very long wait." It must become an organizing principle for nursing education and health-system design.

Nurses are often among the first professionals a person encounters in the health system.  Nurses are also providing and leading care 24/7 in hospitals, in urgent care services, and often leading care in bed-based services. They may be the clinician who receives a disclosure, notices a change in behaviour, recognizes the impact of trauma, or creates the conditions for a patient to accept help. This position carries both privilege and responsibility. It's not just Spider-man that's carrying great power and responsibility. 

For many people who have experienced marginalization, health care has not historically been a trusted system. Indigenous peoples, racialized communities, people who use drugs, people living in poverty, people with disabilities, 2SLGBTQIA+ individuals, and people with lived or living experience of mental illness may have encountered dismissal, coercion, discrimination, or unsafe care. Trust cannot be assumed simply because services are available.

Nurse education must therefore prepare nurses to understand their role in repairing, not reproducing, harm. This involves teaching trauma- and violence-informed practice, cultural safety, anti-racism, harm reduction, recovery-oriented care, and meaningful partnership with people who have lived and living experience. This also involves taking a step back an critically examining the ways that harm is actively perpetuated within the current structures of an established system. It also requires nursing leaders to ensure that these approaches are reflected in practice environments, staffing models, documentation systems, policies, and performance expectations.

Mobility Is Not a Workforce Strategy 

Discussions about improving the mobility of regulated practical nurses (RPNs) across Canada are important. Greater mobility may help address local staffing pressures and reduce unnecessary barriers for nurses seeking to practise in another province or territory. However, mobility alone is not a sustainable answer to Canada’s mental health nursing workforce challenges.

Moving nurses from one jurisdiction to another may temporarily relieve shortages in one region while worsening them in another. It can also create ethical concerns when it relies on nurses leaving their communities, families, cultural supports, and established professional networks. Workforce strategies must account for retention, working conditions, career development, compensation, workload, psychological safety, and access to advanced education, not just the redistribution of a limited supply of nurses.

Canada also needs a clearer and more equitable approach to educational pathways. Registered psychiatric nurses, regulated practical nurses, registered nurses, and nurse practitioners each contribute valuable but distinct expertise to mental health and substance-use care. Yet opportunities for mobility, degree completion, advanced practice, and graduate education remain uneven across professional groups and jurisdictions.

This matters especially because advanced mental health nursing education remains limited. Canada needs more accessible graduate-level programs, clinical placements, faculty expertise, and funded pathways for nurses who want to develop advanced competencies in mental health and substance-use care. Without this investment, health systems risk losing the very specialist knowledge needed to support increasingly complex care needs.

A Leadership Imperative

The future of mental health nursing will be determined not only by regulatory changes or staffing numbers, but by educational choices made now. Nursing leaders can advocate for integrated mental health competencies across all programs, expand opportunities for specialization and graduate education, support practical pathways for workforce mobility, and insist that equity and trust are central measures of quality.

Canada does not need a workforce strategy that simply moves a small number of nurses from one place to another. It needs a long-term vision that strengthens mental health capacity throughout nursing while protecting and advancing specialist expertise.

Every nurse should be prepared to respond when mental health, substance use, trauma, or suicide enters the room. Every patient should encounter a nurse who can listen without judgment and act with skill. And every part of the health system should be equipped to make the first door, not the eventual door hopefully if everyone did the required online learning module, but immediately, the right door.

Love,

Michelle D.