Tasks and activities of community mental health nurses: integrative review and thematic analysis / Aufgaben und Tätigkeiten der ambulanten psychiatrischen Pflege: Integratives Review und thematische Analyse

The community setting represents a key environment for the provision of mental health care, as it encompasses the everyday lives and social contexts of people with mental health needs. It offers a unique opportunity to provide personalized, comprehensive and rights-based care and support that contributes to independent living and community inclusion (World Health Organization (WHO), 2021). A broad range of services — including assertive community treatment, home treatment teams, community mental health centers, and outreach services — play a vital role in supporting individuals with mental health conditions in the community (Thornicroft et al., 2016). Nurses play a key role in community mental health services, delivering targeted, individualized care that addresses both medical and psychosocial needs (Heslop et al., 2016; International Council of Nurses, 2022). Their work is inherently interprofessional, often involving collaborations with general practitioners, psychiatrists, social workers, psychologists, and informal support networks such as families and community groups (International Council of Nurses, 2024). They are therefore not only essential providers of care, but also key actors in coordinating and integrating support across fragmented systems.

In response to challenges we are facing in the mental health sector, such as increasing service demand, more complex client needs, shortages of qualified professionals, and a societal shift toward care that is provided in the community and closer to people's lives (Patel et al., 2023; Scheydt, 2025), the roles of mental health nurses in community settings have diversified significantly and diverged from those in the inpatient setting (Hurley et al., 2022).

Scheydt and Hegedüs (2024) identified two main role profiles in community mental health nursing practice that describe distinct functions in the outpatient care of people with mental illness across the lifespan. These are the community mental health nurses (CMHNs) in primary health care settings, and CMHNs in specialized community mental health services. Furthermore, the emergence of advanced practice roles within mental health nursing has led to changes in the provision of community mental health care and nursing (Scheydt & Hegedüs, 2021). Advanced practice nurses (APNs), as defined by the International Council of Nurses, are highly trained professionals with a master's degree and advanced competencies in decision-making, clinical judgment, and care coordination (International Council of Nurses, 2020). APNs work across both primary and specialized settings, and are well-positioned to address complex needs, supervise teams, foster interprofessional collaboration and lead service development initiatives (International Council of Nurses, 2022; Scheydt & Hegedüs, 2024). Together, these diverse roles reflect the expanding contribution of psychiatric nurses to accessible, high-quality community mental health care.

While advancements have been made in understanding the roles of CMHNs, gaps remain in the literature, especially regarding their tasks and activities. Considering the challenges we are facing in the mental health sector, a clearer understanding of what CMHNs currently do and which patient populations they care for is essential. This need is further underscored by the interprofessional nature of community mental health care, where nurses collaborate with a diverse range of professionals including physicians, psychologists, social workers, and peer support workers.

Such insights can inform workforce planning, educational strategies, and service design, as well as help align nursing practice with current and future system needs. Against this background, this integrative review aims to identify and synthesize the internationally reported tasks and activities of psychiatric mental health nurses working in community settings, and to analyze which of these can be attributed specifically to advanced practice roles.

We identified an extensive body of international literature on the tasks and activities of CMHNs through a systematic literature search. Our findings demonstrate that CMHNs engage in a broad range of tasks spanning from direct nursing care to case management; health promotion; and contributions to education, leadership, and research. Core activities include building therapeutic relationships, conducting mental and physical health assessments, providing individualized psychosocial care, managing medication, and coordinating services within healthcare systems.

The findings align with those of Hurley et al. (2022), who describe mental health nursing as highly technical and multifaceted. Reported roles in mental health nursing include safety promotion; aggression reduction; suicide prevention; psychotherapy; and complex clinical reasoning, including diagnostic formulation, prescribing, and physical health maintenance. However, health promotion and prevention were only marginally represented — both in our review and in prior research (Scheydt & Hegedüs, 2024). Gasperini et al. (2023) similarly found that even population-based nursing models, such as Family and Community Health Nursing, are dominated by direct care for individuals, while preventive work and population-health approaches remain underdeveloped.

Given their community orientation, CMHNs are well-positioned to take on greater responsibility in prevention and public mental health (Phoenix et al., 2016). Their embeddedness enables early interventions and low-threshold access. Moreover, the present findings support the WHO's call for personalized, inclusive, comprehensive and rights-based care (World Health Organization (WHO), 2021). Activities that promote independent living and community participation contribute directly to fulfilling the goals of the UN Convention on the Rights of Persons with Disabilities, which can provide guidance on how CMHNs' practice can support more rights-based, community-integrated services.

Activities attributable specifically to CMH-APNs were difficult to distinguish from those of CMHNs. The role of CMH-APNs remains emergent and is mostly reflected in studies from countries with established APN frameworks, such as the United States, the United Kingdom, and Australia. This highlights the need to differentiate tasks more clearly to support implementation in other health care systems. In our review, APNs and registered nurses were found to perform many overlapping activities. The few APN-specific tasks appeared mainly in research, leadership, and service development — although even these domains were less prominent than expected, at least with APNs in inpatient psychiatric care (Scheydt & Hegedüs, 2021). One explanation may be that CMH-APNs are more likely to work in nurse practitioner roles, with a continued focus on direct clinical care (International Council of Nurses, 2020).

Although distinctions in direct care and interprofessional collaboration are minimal, differences emerged in target populations. CMH-APNs more often worked with individuals with severe mental illness, specific diagnoses, or complex psychosocial risks (e.g. homelessness), while CMHNs tended to serve broader or more general patient groups. According to the ICN (2024), APNs in psychiatric nursing require advanced competencies and in-depth knowledge to support people with complex mental health conditions, and they typically perform tasks with greater clinical autonomy, expanded responsibilities, and a broader scope of practice. APNs can therefore be expected to focus on populations with high levels of complexity or risk of service underutilization. Clarifying the unique value of APNs in community settings will be essential for advancing role development and policy recognition — particularly in countries where these roles are not yet fully established. Beyond clarifying current roles, there is also a need to consider how both CMHNs and CMH-APNs must adapt to meet future demands in mental health care.

CMHN roles must evolve in response to migration, demographic shifts, comorbidities, migration, global workforce shortages, and other issues of rising complexity (Patel et al., 2023). Our review shows that CMHNs are already engaged in many relevant areas, including physical and mental health assessment, care coordination, case management, and low-threshold services. As highlighted by Giacco et al. (2017) and Priebe et al. (2019), future-oriented models of mental health care need to be more socially and contextually embedded, but also more technologically integrated, trauma-informed, and inclusive of new population needs. The reviewed literature found few of these future-facing aspects in the current tasks and activities attributed to CMHNs. For example, the use of digital tools and e-mental health — key for improving access, reducing wait times, and supporting self-management — remains underrepresented (Ehrt-Schafer et al., 2023). Given their embeddedness in communities and close client relationships, CMHNs are well-positioned to take on guiding roles in the use and mediation of such technologies (Hegedüs et al., 2025), but this will also require targeted upskilling and role development (National Academies of Sciences, 2021). Developing CMHN roles that incorporate public mental health and digital competencies could help address existing service gaps, while preparing for emerging societal needs.

This integrative review provides a comprehensive synthesis of the tasks and activities performed by CMHNs across international settings. It highlights their wide-ranging contributions, including direct care; care coordination and case management; health promotion; consulting and education; leadership and management; research; and practice development. However, our findings also reveal notable gaps. Although advanced practice roles are widely acknowledged, there remains a lack of clarity regarding how these roles are defined and enacted in community settings. The distinction between specialized and advanced responsibilities is often blurred — particularly in countries without formal APN frameworks — and this poses a challenge to the recognition and implementation of advanced nursing competencies.

Key areas that are essential for the future of mental health care — such as health promotion, digital interventions, and population-based approaches — have also been underrepresented in current CMHN practice. These gaps must be addressed if community-based services are to effectively meet increasing complexity and evolving population needs. A dedicated review of public mental health nursing could help clarify the profession's role in these emerging fields.

To equip the nursing workforce for future demands, clear role delineation, strategic investment in APN development, and expanded training in preventive and digital competencies are urgently needed. Practice models that promote autonomy, continuity of care, and rights-based approaches should be further developed and empirically supported. Clarifying and strengthening the roles of CMHNs and APNs will be essential for advancing mental health systems toward more integrated, equitable, and person-centred care, in line with the WHO's global mental health strategy.