Enhancing learning and teaching about mental health in higher education

This article is part of the following series: Experiments with pedagogy

An interview with Jill Anderson about the Mental Health in Higher Education project

mhhe can be found at www.mhhehub.ning.com and, on twitter, @mhhehub.

The UK-based project Mental Health in Higher Education (mhhe) sets out to increase networking and sharing innovative approaches to learning and teaching about mental health and distress across the disciplines in higher education. An important feature of this project is that it advocates for the involvement of service users and carers in mental health education, teaching and training. I had the great opportunity to interview the coordinator of mhhe, Jill Anderson (department of Educational Research at Lancaster University) about the project and new pedagogical approaches that it has engendered.

HK: What motivated the development, in the UK, of the Mental Health in Higher Education (mhhe) project?

JA: That’s an interesting question. It means thinking back a decade or so. . . . Creation of the project predated my appointment as development worker. There were, I think, two drivers.

First, there was an awareness that if people experiencing mental health difficulties are to receive the services they need, delivered in ways that work for them, then professionals need to work together across the disciplines in health and social care.  That kind of collaboration doesn’t come easy. It has to be learned, through interprofessional education initiatives aimed at beginning practitioners. And – here’s the rationale for the project – if those, in turn, are to be effective then there is a need for educators in a higher education context to learn together too.

Yet, prior to establishment of the mhhe project, those teaching mental health in social work, nursing, psychology, medicine and allied health programmes tended to occupy distinct disciplinary ‘boxes’. Where teaching was concerned, they read and published in different journals and attended uni-disciplinary events. Even where, at an institutional level, educators were co-located – within a faculty of health and social care for example – connections could be few and far between (Anderson & Burgess, 2007). In the early days of the mhhe project we travelled the length and breadth of the country to introduce people to their colleague on the neighbouring corridor!

Second, there was a growing recognition that effective mental health support is contingent on the meaningful involvement of service users and carers (or patients)[1] in the planning and delivery of services. That too has implications for the initial and continuing education of health and social care professionals. Service users and carers need to be actively involved in universities, as in services. Ten years ago such developments were quite new, with few opportunities for dialogue across the disciplines.

HK: What form did the project take, in its early days?

JA: Mental Health in Higher Education was set up as a partnership between four subject centres of the Learning and Teaching Support Network (subsequently incorporated in to the UK Higher Education Academy). It had its origins at a particularly well-resourced and vibrant time for educational development in the UK. In its first year, mhhe held three UK-wide mental health teaching events; produced a set of teaching ‘case studies’ and a good practice guide, Learning from Experience, on involving service users and carers in mental health education and training; established a website and database of educators and produced a regular e-bulletin.

HK: What was the initial aim of the project and how has it developed over time?

JA: mhhe was set up as a central point of contact for all those involved in learning and teaching about mental health and for those with an interest in what is taught and learned; such as policy makers, survivors and service users, carers, students and practitioners. It aimed to enhance learning and teaching about mental health through creating opportunities for all involved to network, to share ideas, approaches and dilemmas.  Outputs have included over fifty events, a growing network of educators based in UK higher education institutions and a range of publications. mhhe played a role in the development of a number of national educational initiatives, such as the Ten Essential Shared Capabilities for Mental Health and the College of Social Work Curriculum Guide on Mental Health and Distress. It was financially supported until the closure of the HEA subject centres in 2011, and continues – though at a reduced level – through a small contribution from Making Space (a third sector organisation) and the voluntary efforts of enthusiasts.

HK: A central component of the project is to enhance service user and carer involvement in teaching. What does this imply? And what has mhhe done to support this?

JA: It implies that those who are on the receiving end of services are involved not only in their planning and delivery but, importantly, in the education of current and future practitioners. Across the UK higher education sector, service users and carers are involved in programme planning and development, in the delivery of teaching, in the recruitment and selection of students and in the assessment of their work. Such activity is mandated by regulators and professional bodies, for example through the Health and Care Professions Council’s Standard on Involvement. Some universities employ one or more staff specifically to facilitate such activity, whilst in others it is conceived of as one aspect of an academic role. Still others contract with third sector organisations, or develop joint appointments with them.

Service user and carer involvement in education has been core to mhhe’s work. We have acted as a central point of contact for those seeking to involve people with experience of being on the receiving end of services in their teaching; through developing resource and reading lists, collating and disseminating information and resources. Service user and carer involvement has been a central focus of a number of our events and publications. mhhe has, for the past ten years, facilitated the Developers of User and Carer Involvement in Education (DUCIE) network. DUCIE aims to support those people specifically employed by UK higher education institutions to develop service user and carer involvement in education for health and social care (see McKeown et al 2011 for an account of DUCIE’s work). For three years mhhe coordinated an award scheme for such workers, the Ian Light Award for Work in Pairs.

HK: This is really interesting. Could you give some examples of service user and carer education projects in university teaching? What kinds of new pedagogical approaches are currently being developed in this field? It would be great if you could mention some examples.

JA: I guess, at one level, service user and carer (or patient) involvement is in itself a new pedagogical approach, which chimes with other approaches that aim to bring lived experience in to the classroom.  In some quarters it has been seen as a prioritising of ‘experience’ over more formal knowledge and expertise. Yet what service users and carers bring in to classrooms is not only their personal narratives but alternative forms of knowledge which can be argued to be at least as valid as those which have been traditionally given prominence.

In terms of examples, at the ‘Where’s the Patient Voice in Health Professional Education?’ conference in Vancouver last November there were presentations from more than 17 countries. People from the UK were well represented there. There is so much going on now that it is hard to pick out just a few examples.

Service users and carers are involved in the following ways, and in many more:

• Contributing to programme planning and development. At Liverpool Hope University, for example, the social work programme was developed with the active involvement of a third sector organisation (Person Shaped Support) and people using that service are involved in ongoing development of the programme.
• Direct teaching. Service users and carers are involved across a range of disciplines, and at pre- and post-qualifying levels, in sharing their own experiences in a classroom context. They do this in large and small groups and on-to-one, as one off inputs and through regular sessions. Some designated teaching posts have been created, such as the appointment of a Senior Teaching Fellow (Patient Perspective) in the School of Medicine at the University of Leeds.
• Module development and facilitation. There are now examples (on the social work programmes at the University of Central Lancashire and the University of Cumbria for example) of modules which are entirely service user designed and led; with every aspect of the teaching and assessment in the hands of people with experience of using services.
• Co-learning. Service users and carers are involved in some universities in learning alongside students, both through online forums (see this City University project) and face-to-face. This includes the Mend the Gap initiative, and also – for students outside the field of health and social care – the innovative Storying Sheffield
• Student recruitment and selection. It is now common for people with experience of being on the receiving end of services to be involved in open days for prospective students of health and social care and, as co-interviewers, in student interviews (See this Open University Guide).
• Service users and carers are involved, in a variety of ways, in the assessment of student work; both written work and practice skills. On social work programmes they frequently have a role in assessing students’ readiness for practice, prior to their first placement. See here for a reading list on involvement in assessment.
• Resource development. Service users and carers have been involved, in a number of universities, in the production of learning resources. At the Centre of Excellence in Interdisciplinary Mental Health for example, they developed a range of video resources including those on the impact of psychiatric medication and the experience of inpatient care. Excellent learning resources are also being produced outside academic institutions which draw on lived experience of using services – see, for example Animated Minds and the resources produced by the Patient Voices and HealthTalk.
• Conference organisation. Service users and carers have been involved in the organisation of a range of events, from one-off seminars, through larger conferences – including the biannual Authenticity to Action conferences on service user and carer involvement in higher education, coordinated by the Comensus project at the University of Central Lancashire. This is part of a wider movement towards more inclusive conferences – see Patients Included.
• Writing and publication. There are a growing number of articles written by service users and carers who input to university teaching. This development has been supported by the increasing number of journals hosting special issues on involvement – see for example this forthcoming issue of Social Work Education. In 2011, the Comensus project collaboratively edited a book – Service user and Carer Involvement in Education for Health and Social Care. Another interesting development is the ‘What Your Patient is Thinking’ series in the British Medical Journal, which sets learning objectives for doctors.
• Student mentoring and support. Although less formalised, there are a range of examples of service user and carer involvement in providing support and mentoring for students; acting as role models too, for those who may themselves be experiencing difficulties.
• The development and support of involvement initiatives. Many of those who are taking forward this work, at institutional, regional, national (and even international) levels bring their own experience of using services. Developers of User and Carer Involvement in Education and the Lived Experience Network are examples of support networks which draw together such expertise.

To get an overview of what is happening across a broader range of institutions, you might like to visit this set of links to university involvement pages, covering medicine, psychology, nursing, social work and allied health professions. Involvement is extending beyond the education of clinical staff. At the University of the West of England, Viv Rolfe and colleagues have been involving patients in the education of health science students.

There are a number of online resources, which provide further insight in to involvement initiatives. For example, Social Work Education Participation (SWEP) has produced a set of videos, showcasing the work going on within four university social work departments, and there are a range of learning resources, such as the University of Nottingham’s online tool: Involving Service Users in Your Teaching.

HK: How do you think these new teaching techniques impact on students’ learning, skills and personal growth?

JA: I guess that question links us back to the previous one. It begs the question about whether these are in fact ‘new teaching techniques’. A lot of energy has been expended debating approaches to the evaluation of service user and carer, or patient, involvement in teaching, and to how we measure its ‘impact’. As yet, although we have ample evidence that students enjoy the input and say that they learn from it, we have little ‘hard evidence’ of its effect upon their future practice. The same could arguably be said for any aspect of their education, however, if singled out and taken in isolation. It seems to me to be clear, from first principles, that students need – in the course of their education – to engage with and learn from those who will be on the receiving end of their services once qualified. Such people are involved, through research, in developing the knowledge base that informs practice; and, through teaching, in imparting such knowledge and in developing students’ skills. They do so as an integral part of professional education and it is not their input in isolation, but that education as a whole, that can be most fruitfully evaluated.

HK: What are some of the main challenges in the field? How do you think could they be overcome?

JA: One significant challenge is the shifting nature of the health, social care and higher education landscapes; in which infrastructure organisations, and hence pots of funding for involvement, come and (more often) go. There is no national body with responsibility for the strategic development of service user and carer involvement in university teaching and the vision of ‘public engagement’ that currently exists appears lopsided; often limited to thinking about how universities can share their expertise with communities, rather than vice versa. In the absence of an overall vision, support can be piecemeal and poorly planned; resulting in longstanding initiatives going to the wall, with consequent loss of experience and expertise.

Within individual higher education institutions, funding can also be a thorny issue. There is some centrally allocated funding for involvement in social work education, but that is limited and does not exist in other disciplines. Linked to this are ongoing debates around ‘impact’, which seem hard to resolve, and concerns about the dangers of tokenism; initiatives, that is, that seek to ‘tick boxes’ whilst falling short of genuine collaboration. There is so much to learn here from the experience of other institutions, but there are challenges in knowing how to access that expertise.  Those relate partly to the lack of infrastructure referred to above; partly to the reality that higher education institutions exist within a competitive ‘market place’, which can place limits on cooperation. A further challenge is that the split that often exists within universities between teaching and research can be replicated in the field of involvement. That can result in involvement initiatives being understood in terms of service user and carer ‘stories’, rather than an enrichment of the existing knowledge base.

HK: Could you give some tips to lecturers how they could go about involving service users and carers in their teaching in meaningful ways?

JA: Involving service users and carers in education is one very valuable way of prioritizing the importance of knowledge gained from lived experience. It is not the only way of doing so. Both students and educators embody such experience too.

Also, service user and carer involvement in learning and teaching is not an add-on to existing approaches to learning and teaching. It needs to draw on service user and carer led research and implies a fundamental challenge to the accepted knowledge base.

Finally, open sharing, particularly when it comes to teaching, can feel counter-cultural in universities. Form alliances wherever you can: across disciplines, across institutions, with students and between stakeholder groups. Avoid reinvention of the wheel!

Further reading:

Anderson, J. & Burgess, H. (2007) Educators learning together: linking communities of practice, in T. Stickley and T. Basset, Teaching Mental Health. Basingstoke: Palgrave Macmillan.

McKeown, M., Malihi-Shoja, L. & Downe, S., supporting the Comensus Writing Collective (2010), Service User and Carer Involvement in Education for Health and Social Care, Chichester: Wiley-Blackwell.

Notes

[1] There is no agreed terminology here. In what follows, whilst recognising its limitations, the phrase ‘service users and carers’ is used; as a shorthand for a range of terms describing people with experience of using services – or of having support needs which go unmet – in the education of future health and social care practitioners.

 

Jill Anderson (Freelance consultant and doctoral student in educational research) coordinates the Mental Health in Higher Education project. She has a degree in English and is a registered social worker with experience of working in mental health. Jill has taught on pre- and post-qualifying social work programmes at the University of Nottingham, Lancaster University and the University of Cumbria. Currently, she is a doctoral student in the department of Educational Research at Lancaster University, where she has links with Researching Equity, Access and Participation and is an associate member of the Centre for Social Justice and Wellbeing in Education. Jill coordinates the Developers of User and Carer Involvement in Education network and co-facilitates Critical and Creative Approaches to Mental Health Practice, which meets monthly in Lancaster. She is a member of the editorial collective of Asylum: the magazine for democratic psychiatry, and co-author of a recent edited collection: Madness, Distress and the Politics of Disablement.

Dr Hanna Kienzler is a Lecturer (Assistant Professor) in the Department of Social Science, Health and Medicine at King’s College London. She has a long-standing academic interest in the field of global health, in connection with organized violence, ethnic conflict, and complex emergencies, and their health and mental health outcomes. She conducts ethnographic research on the impact of war and trauma on women in Kosovo, on new mental health treatment options for torture survivors in Nepal, and on humanitarian and mental health interventions in the occupied Palestinian territories and Kosovo.