The Unseen Weight: Reflections on Mental Health Nursing, Gender, and the Quiet Strength of Care

Forgive the length of this piece and only slight diversion from psychotherapy, although psychotherapy is curiosity and enquiry so maybe not too far from the tree. This seemed like it needed a little more of my attention as it is close to my heart.  Between 1996 and 2020, I worked as a male mental health nurse in the NHS. It was, without question, one of the greatest privileges

To be remembered

of my life: to be alongside people at their most vulnerable, to witness resilience in the darkest moments, and to work with teams of skilled, compassionate, and often unsung professionals who carry the emotional heartbeat of our healthcare system.  It was also a tiring, exhausting and often soul punching experience that took a lot out of me.  I’m not going to profess that everyone I worked with had only positive values but that a large majority had or at least strived for better.  I’m not going to romanticise the role as it is often done for political gain or to reduce resources and make the blow softened.  I do however want to tip my hat at the profession that gave me so much and prepared me well for my career as a psychotherapist.

Looking back, I find myself reflecting not only on the work we did, but on the hidden dynamics within the role itself—especially the gendered expectations that shape the profession, the way society views those who care for others, and the enduring influence of deeply ingrained cultural patterns.  The way that this impacts on the way nurses are treated and the way they are used in the wider political sphere.

The Feminisation of Care and the Legacy of the Maternal

Mental health nursing, like much of nursing, remains a largely female profession. In the UK, around 11.4% of all registered nurses are male, while 89–90% are female. This is not just a statistic—it is a lens through which the role is seen, valued, and, too often, undervalued. The qualities most associated with good mental health nursing—empathy, containment, emotional resilience, patience, the capacity to "hold" another's distress—have traditionally been linked to the archetype of the mother, the caregiver, the feminine.

Venus

Psychoanalytic thinkers, particularly within the Kleinian tradition, have long explored the powerful dynamics of the mother-child relationship. Melanie Klein described how infants project their fears, rage, and anxieties onto the mother, who is then tasked with containing and transforming this into something tolerable. This process—that Bion later termed “container-contained”—is, in many ways, at the heart of what mental health nurses do every single day.

Nurses become the containers of others' projections: their pain, despair, aggression, fear, and sometimes even their hatred. And yet, as with the maternal role, society often expects this work to be done quietly, without complaint, without adequate reward, and without recognition of the enormous psychological labour it demands.

The Silent Load: Nurses as Emotional Containers

In the NHS, mental health nurses are often the first to arrive and the last to leave when someone is in emotional crisis. They build the relationships, absorb the anxiety of distressed individuals, and hold together the fragile threads of safety in highly charged environments.

And yet, the profession is frequently invisible in the wider discourse on healthcare. We celebrate surgeons, we fundraise for equipment, we innovate with technology—but the relational, emotional labour of care remains in the background.

Carrying the weight

There is an unspoken expectation that this emotional work—so often feminised—is simply part of the job, part of what nurses are “naturally” good at. It echoes the societal expectation of the maternal figure: to care endlessly, to absorb the distress of others, to hold everything together without ever falling apart.

In my 24 years in the NHS, I saw this again and again: brilliant, compassionate nurses—mostly women, but men too—carrying immense emotional burdens without complaint, even as services were stretched, support was limited, and recognition was sparse.

My Own Perspective: A Male Nurse in a Feminised Role

As a male mental health nurse, I occupied an unusual space within this dynamic. Nursing is still widely perceived as a “female” role, and while male nurses are more common in mental health settings, the cultural scripts of caregiving remained in place.

I was often struck by how easily male nurses were praised for their calmness, their de-escalation skills, or their “strong” presence—qualities seen as exceptional or noteworthy when performed by a man but simply expected when embodied by female colleagues.  The male nurses including myself promoted into more active directive roles and managers while the female staff were more likely to not even attempt for these roles.

This, too, is the subtle fingerprint of patriarchy: the way in which care is devalued precisely because it is associated with the feminine, and the way in which we men who step into these roles can be seen as somehow “above” the work, rather than fully immersed in its emotional reality.

I learned so much from the women I worked alongside—nurses whose wisdom, strength, and emotional intelligence shaped not only patient outcomes but team cultures and clinical practice. Their leadership, often informal but essential, held services together when systems faltered.  The containing presence of some female staff who seemed to be able to calm and restore peace without a raised voice or threat of any kind.

The Systemic Blind Spot

This pattern is not accidental. It is the result of centuries of cultural narratives that place care, and by extension those who provide it, at the bottom of social hierarchies. It is no coincidence that professions linked to nurture and care—nursing, social work, early years education—are chronically underpaid, underfunded, and overlooked.

And while we have made strides in recognising the importance of mental health within healthcare, the workforce who deliver that care remains stretched thin, frequently burnt out, and insufficiently supported.

payment for work rendered... The clap

The COVID-19 pandemic brought temporary public attention to the sacrifices of healthcare workers, but as time passes, so too does the visibility of their work. The “mother figure” of the NHS—be it literal mothers or those in maternal roles—continues to bear the weight of collective distress, often without the acknowledgment or structural support that such work demands.  What did society and political parties deem an appropriate reward?  A collective clap.  Though perhaps thoughtful it seems like a half attempted homemade gift with little deep thought involved and an attempt to appease rather than actually acknowledge and reward.

Toward a Culture of Recognition

Perhaps we need to shift the way we value care. Not just in sentiment, but in action:

• Investment: Proper funding for mental health services, including meaningful pay for nurses that reflects the complexity and emotional depth of their work.

• Support: Access to regular, high-quality clinical supervision that acknowledges the emotional toll of the role and offers real containment for the containers.

• Cultural Shift: A reframing of nursing and caring professions away from gendered stereotypes and toward recognition of their essential role in societal wellbeing.

• Appropriate and quality supervision We also need to create space for nurses themselves to speak about their experiences—their fatigue, their fulfilment, their need for care—without stigma or dismissal.

  
  

Holding the Holders

In Winnicott’s work, the “good enough mother” is not a perfect, tireless figure. She is fallible, human, and in need of support herself. The same is true for mental health nurses. To sustain this vital work, we must hold the holders.

holding

To all my former colleagues still working on the front lines: I see you. I honour the quiet strength you bring to your work every day. And I hope that as a society, we can begin to see, value, and sustain the immense contribution you make—not as an afterthought, but as central to the health of us all.

I’d love to hear from others working in mental health or nursing. What has your experience been of these dynamics? How can we, collectively, bring about change? Email me or comment on my facebook page - Archibald Psychotherapy