Lived experience in teaching mental health nursing: Issues of fear and power

Australian mental health policy clearly articulates recovery focus as the underpinning of mental health services. Barriers to achieving a recovery focus are identified in the literature, with negative attitudes of health professionals receiving particular attention. The involvement of people with lived experience of significant mental health challenges and mental health service use is essential to enhancing more positive attitudes. Lived‐experience involvement in the education of nurses is evident; however, it is generally limited and implemented on an ad hoc basis. Overall, there is a paucity of literature on this topic. A qualitative exploratory study was undertaken to elicit the views and perceptions of nurse academics and lived‐experience educators about the inclusion of lived experience in mental health nursing education. One major theme to emerge from the research was issues of fear and power, which included three subthemes: facing fear, demystifying mental illness, and issues of power. Lived‐experience involvement has an important role to play in the education of nurses in addressing fear and demystifying the experience of mental illness. The power that lived‐experience educators exercised in their roles varied considerably, and for many, was limited. Therefore, the effectiveness of lived‐experience involvement requires a more equitable distribution of power.     

Implications of evidence‐based practice for mental health nursing

The introduction of evidence‐based practice (EBP) and the hierarchical approach to evidence it engenders within research and evaluation has aroused controversy in the mental health professions. The aim of this paper is to present a critique of EBP with a specific relationship to mental health nursing. It will be argued that in its current form, EBP presents a potential impediment to the facilitation of consumer participation in mental health services and to the recovery model. The need for the consumer voice and the importance of the lived experience of mental illness are not readily reconciled with a strong scientific paradigm that promotes detachment and objectivity. The importance of evidence in contemporary mental health care will also be acknowledged and discussed in light of the current climate of increased consumer knowledge, fiscal constraint, and extensive social criticism of mental health‐care services. The current approach to EBP requires reconstruction to support the consumer‐focused nature of mental health nursing, and to facilitate the implementation of a recovery model for mental health care.     

Interprofessional education in mental health: An opportunity to reduce mental illness stigma

Mental illness stigma is a common problem in healthcare students and professionals in addition to the general public. Stigma is associated with numerous negative outcomes and hence there is an urgent need to address it. This article explores the potential for interprofessional education (IPE) to emerge as a strategy to reduce mental illness stigma amongst healthcare students and professionals. Most anti-stigma strategies use a combination of knowledge and contact (with a person with lived experience) to change attitudes towards mental illness. Not surprisingly interprofessional educators are well acquainted with theory and learning approaches for attitude change as they are already used in IPE to address learners’ attitudes and perceptions of themselves, other professions, and/or teamwork. This article, through an analysis of IPE pedagogy and learning methods, identifies opportunities to address mental illness stigma with application of the conditions that facilitate stigma reduction. The goal of this article is to raise awareness of the issue of mental illness stigma amongst healthcare students and professionals and to highlight interprofessional education as an untapped opportunity for change.     

Promoting consumer participation through the implementation of a consumer academic position

Consumer participation in mental health care is increasingly becoming an expectation. A review of the literature suggests that the negative attitudes of mental health professionals towards people diagnosed with mental illness constitutes a significant barrier to the realization of this goal. The education of health professionals has been identified as a major strategy for reducing the negatively of such attitudes, and to promoting a more participatory relationship between consumer and provider. This paper describes the process of the development and implementation of an academic role for a consumer of mental health services in teaching psychiatric nursing students. A personal case study by the consumer academic is provided to illustrate the process of this collaborative venture. This paper contributes to the development of framework to guide the implementation of similar positions.     

Promoting the Value of Mental Health Nursing: The Contribution of a Consumer Academic

Mental illness is known to occur frequently in the general population and is more common within the general health care system. High-quality health care requires nurses to have the skills, knowledge and attitudes to provide care for people experiencing mental illness or mental distress. Research suggests health professionals, including nurses, tend to share similar negative attitudes to mental illness as the general population, and consequently, mental health nursing is not a popular career path. These two factors signify a need to influence more positive attitudes toward mental illness and mental health nursing among nursing students. A qualitative exploratory research study was undertaken to examine the experiences, opinions and attitudes of an academic and research team to the introduction of a consumer academic within an undergraduate mental health nursing subject. In-depth interviews were conducted with teaching and research team members. The importance of mental health skills emerged as a major theme and included sub-themes: mental health across the health care system; contribution of consumer academic to nursing skills; addressing fear and stigma, and inspiring passion in mental health nursing. Findings suggest academic input from people with lived experience of recovery from mental illness can influence the development of mental health nursing skills and enhance the popularity of mental health nursing as a career.     

Lived‐experience participation in nurse education: Reducing stigma and enhancing popularity

Mental health nursing consistently emerges as less popular than other specialties, and both service users and mental health practitioners are affected by negative attitudes. Education is fundamental to attracting students to the field of mental health nursing. The aim of this study was to determine the impact of undergraduate mental health curricula on student attitudes to people with mental illness, and career interest in mental health nursing. A traditional mental health course was compared to a course delivered by a person with lived experience of mental illness (and mental health service use) for its impact on student attitudes and career intentions in mental health nursing (cohort 1: n = 70, cohort 2: n = 131, respectively). In both cohorts, attitudes were measured via self‐report, before and after the course, and changes were investigated through within‐subjects t‐tests. The lived experience‐led course demonstrated statistically‐significant positive changes in intentions to pursue mental health nursing and a decrease in negative stereotypes, which were not observed in the traditional course. The valuable contribution of mental health nursing emerged in the traditional, but not lived‐experience‐led, programmes. These findings support the value of an academic with lived experience of mental health challenges in promoting attraction to mental health nursing as a career option.     

‘It is meant to be heart rather than head’; International perspectives of teaching from lived experience in mental health nursing programs

Consumer participation is a clear expectation of contemporary mental health policy. Most activity has concentrated in direct service delivery, and academic roles for mental health consumers have been slow to establish. An international project was undertaken to implement and evaluate meaningful consumer involvement in mental health nursing education. A learning module was co‐produced between ‘Experts by Experience’ (drawing on experience of mental distress and service use) and Mental Health Nurse Academics. This qualitative exploratory study aimed to capture how Experts by Experience perceive their contribution. Interviews were undertaken with Experts by Experience who delivered the learning module. Data were analysed thematically and subsequently interpreted with Critical Social Theory. Two main themes emerged from the findings: ‘there wasn't a barrier’ described how personal narratives enhanced relationships between Experts by Experience and students; and ‘made the human being visible’, described their experiences of allowing students to see the person behind a diagnosis. These findings suggest Experts by Experience teaching is valuable and potentially a tool in redressing stigma. Addressing poor public perceptions could attract higher numbers of quality practitioners to mental health and meet identified workforce shortages. The findings presented here strengthen the evidence base for Expert by Experience roles in mental health professional education. These findings can be considered in international curricula reviews and aid progress towards a more socio‐political, humanistic focus in mental health nursing, congruent with rights‐based reform agendas.     

‘There's more to a person than what's in front of you’: Nursing students’ experiences of consumer taught mental health education

Holistic and person‐centred nursing care is commonly regarded as fundamental to nursing practice. These approaches are complementary to recovery which is rapidly becoming the preferred mode of practice within mental health. The willingness and ability of nurses to adopt recovery‐oriented practice is essential to services realizing recovery goals. Involving consumers (referred herein as Experts by Experience) in mental health nursing education has demonstrated positive impact on the skills and attitudes of nursing students. A qualitative exploratory research project was undertaken to examine the perspectives of undergraduate nursing students to Expert by Experience‐led teaching as part of a co‐produced learning module developed through an international study. Focus groups were held with students at each site. Data were analysed thematically. Understanding the person behind the diagnosis was a major theme, including subthemes: person‐centred care/seeing the whole person; getting to know the person, understanding, listening; and challenging the medical model, embracing recovery. Participants described recognizing consumers as far more than their psychiatric diagnoses, and the importance of person‐centred care and recovery‐oriented practice. Understanding the individuality of consumers, their needs and goals, is crucial in mental health and all areas of nursing practice. These findings suggest that recovery, taught by Experts by Experience, is effective and impactful on students’ approach to practice. Further research addressing the impact of Experts by Experience is crucial to enhance our understanding of ways to facilitate the development of recovery‐oriented practice in mental health and holistic and person‐centred practice in all areas of health care.     

Undergraduate nursing students’ stigma and recovery attitudes during mental health clinical placement: A pre/post‐test survey study

Undergraduate nursing students have been reported to hold negative and stigmatizing attitudes towards mental health consumers and to be under‐prepared for mental health clinical placement. This study aimed to investigate undergraduate nurses’ stigma and recovery attitudes to mental illness, and describe their understandings of personal recovery on entry and exit to traditional mental health clinical placement. A pre/post‐test survey was administered to N = 249 nursing students in Australia. Demographic data, attitudes towards mental health nursing and clinical placement, the Opening Minds Scale for Healthcare Providers (OMS‐HC), Recovery Attitudes Questionnaire (RAQ‐7), and an open‐ended question on understandings of personal recovery from mental illness were collected on entry (T1) and exit (T2) to placement. At T1, students reported moderate stigma and positive attitudes towards recovery (OMS‐HC mean = 34.6; RAQ‐7 mean = 4.0). At T2, there was a reduction in stigma (social distance P = 0.02, d = 0.26) and improvement in recovery attitudes (P < 0.01, d = 0.40). Attitudes towards mental health nursing and placement also improved (P < 0.01). Having a family member with mental illness predicted improvements in stigma and recovery attitudes. On entry to placement, most students described accurate understandings of personal recovery, which were maintained during placement. The findings indicate that mental health clinical placements are effective in improving students’ mental health stigma and recovery attitudes and provide a prime opportunity to attract students into the field. Co‐produced or consumer‐led education provided by peer workers during clinical placements may improve students’ stigmatizing attitudes and stimulate their interest to work in the field.     

Attitudes of postgraduate nursing students towards consumer participation in mental health services and the role of the consumer academic

Consumer participation in health care is increasingly becoming an expectation of health services. While important progress has been made in the mental health area, the attitudes of mental health professionals towards consumers poses a severe limitation. Greater consumer involvement in the education of mental health professionals has been presented as a strategy to encourage the development of a greater acceptance of consumer involvement by health professionals. A consumer academic position has been introduced into the Centre for Psychiatric Nursing Research and Practice. An important aspect of this role concerns the education of postgraduate psychiatric/mental health nursing students, in order to provide a consumer perspective and encourage greater consumer participation. In order to determine the impact of this project a questionnaire was developed by the authors to measure attitudes to consumer participation and the role of the consumer academic. This paper presents the first stage of this study. The questionnaire was administered to students (n = 25) on the first day of the course. The findings suggest that most students favour a high level of consumer participation but that this is limited to specific areas of treatment planning and delivery. Furthermore, the students' demonstrate some level of ambivalence regarding the value and necessity of the consumer academic role.     

‘Walking the tightrope’: The role of peer support workers in facilitating consumers’ participation in decision‐making

In adult mental health services, the participation of consumers is essential. The aim of this study was to explore the challenges faced by peer support workers when involving mental health consumers in decision‐making about their care and the strategies they employed to overcome these challenges so as to improve mental health consumers’ participation in decision‐making and recovery. Semi‐structured individual interviews were conducted with six peer support workers currently employed in psychiatric hospitals and/or community mental health systems. Thematic analysis identified challenges related to role definition, power imbalance, doctor‐centric medical approaches to care, and lack of resources. Strategies to overcome these challenges that were reported, included the following: facilitating meaningful involvement for service users, appropriate use of the lived experience, building relationships and communication, promoting rights and advocacy, and promoting professionalism of peer support workers (PSWs). Nursing staff need ongoing support and education to understand and value the varied roles of PSWs and thereby empower PSWs to engage in enhancing consumer decision‐making. The roles of the PSWs should be viewed as complementary, and greater appreciation and understanding of roles would better support recovery‐oriented care.     

Changing attitudes: the role of a consumer academic in the education of postgraduate psychiatric nursing students

Consumer participation in health care is increasingly becoming an expectation within mental health services. Consumer involvement in the education of mental health professionals, including nurses is considered crucial to achieving this aim. This article describes the impact of a mental health consumer academic on the attitudes of postgraduate psychiatric nursing students towards consumer participation. A questionnaire was administered to students before (n = 25) and following (n = 19) exposure to the teaching of the consumer academic. Comparison of results suggests that support for consumer participation increases after exposure to the consumer academic reinforcing the value of mental health consumers in psychiatric nursing education.     

‘Anyone can have a mental illness’: A qualitative inquiry of pre‐registration nursing students’ experiences of traditional mental health clinical placements

Nurses play a crucial role in mental healthcare provision. Like many countries, Australian nursing students are educated in comprehensive pre‐registration programmes which include mental health clinical placements. Placements play a vital role in students’ education, providing the opportunity to engage with consumers and develop mental health nursing knowledge and skills. There is limited knowledge of student perspectives on traditional placements in contemporary recovery‐oriented mental health services. This interpretive qualitative inquiry aimed to explore nursing students’ experience of traditional mental health clinical placement and how it influenced their practice and their understandings of recovery from mental illness. Data were collected from focus groups with n = 31 nursing students in a large metropolitan public mental health service. Thematic analysis resulted in three themes of experience: humanizing people with mental illness; learning about recovery; and shifting perspectives on mental health nursing. Through a positive placement experience where they felt supported and included by staff, students came to see consumers as people rather than diagnoses, developed greater understanding of mental health nursing work and were more likely to consider mental health nursing as a career choice. Peer‐support workers were an important influence on students’ understandings of recovery and have a key role to play in educating students on placement. Students need to be prepared and supported by university and clinical staff to deal with vicarious trauma that may occur on placement. Mental health placements play a crucial role in attracting students into the field, and it is imperative they remain part of comprehensive pre‐registration education.     

Mental health nurses’ attitudes towards consumer involvement in nursing handover pre and post an educational implementation

Involving mental health consumers in nursing handover is a recent introduction to practise in acute mental health units. However, implementation must recognize that mental health care is complex and the approach needs to include recovery‐focused philosophies of practice. Evidence shows that nurses and other health professionals consider poor handover practices may be the source of adverse events; however, the views of mental health nurses about involving consumers in nursing handover have not been previously reported. The aim of this study was to identify nurses’ attitudes towards consumer involvement in handover and to measure the effect of a training programme upon these attitudes. A single‐group pre‐post‐test intervention study was undertaken. The study was conducted on the adult acute mental health inpatient unit of a major metropolitan hospital in Victoria, Australia, 2016–2017. Questionnaires were developed to capture the views of the nurses about proposed changes in the afternoon nursing handover process. A questionnaire was administered before and after the training intervention, an innovative, multi‐media education handover package. We found that training had a significant influence on mental health nurses’ attitudes towards involving consumers in the handover. Therapeutic engagement improved following training and miscommunication reduced when all players are informed and have the opportunity to engage with the information. This study has demonstrated that well‐planned education can influence nurses’ attitudes about involving consumers in the nursing handover processes.     

Changing Nursing Student Attitudes to Consumer Participation in Mental Health Services: A Survey Study of Traditional and Lived Experience-led Education

Mental health policy emphasises the importance of consumer participation in mental health services. To align education with policy and orient future healthcare services to active consumer involvement, the potential of academics with a lived experience of mental illness to impact on student attitudes towards consumer participation needs to be examined. A cohort comparative study was undertaken comparing attitudinal change between undergraduate nursing students undertaking two different mental health courses, one nurse-led (n = 61) and one lived experience-led. Attitudes were measured through the Mental Health Consumer Participation Questionnaire. Within-cohort change was assessed via dependent sample t-tests, and degree of change was observed in each cohort, by comparing effect sizes. For the nurse-led course, attitudes on consumer involvement t (60) = –1.79, p < 0.005 (95% CI: –2.84, –0.74) and consumer as staff t (60) = –4.12, p < 0.005 (95% CI: –3.34, –1.16), positively changed with effect size r of 0.40 and 0.47, respectively. For the lived experience-led course, attitudes on consumer capacity t (109) = –3.63, p < 0.005 (95% CI: –0.48, –1.41) and consumer as staff, t (109) = –5.63, p < 0.005 (95% CI: –0.97, –0.46), positively changed, effect size r of 0.33 and 0.47, respectively. Mental health nursing education has a positive and selective influence on attitudes to consumer participation. Lived experience-led education was more beneficial in changing attitudes to consumer capacity and both types of education had similar positive effects on attitudes to consumers as staff.     

Consumer involvement in the tertiary‐level education of mental health professionals: A systematic review

A systematic review of the published work on consumer involvement in the education of health professionals was undertaken using the PRISMA guidelines. Searches of the CINAHL, MEDLINE, and PsychINFO electronic databases returned 487 records, and 20 met the inclusion criteria. Further papers were obtained through scanning the reference lists of those articles included from the initial published work search (n = 9) and contacting researchers in the field (n = 1). Thirty papers (representing 28 studies) were included in this review. Findings from three studies indicate that consumer involvement in the education of mental health professionals is limited and variable across professions. Evaluations of consumer involvement in 16 courses suggest that students gain insight into consumers' perspectives of: (i) what life is like for people with mental illness; (ii) mental illness itself; (iii) the experiences of admission to, and treatment within, mental health services; and (iv) how these services could be improved. Some students and educators, however, raised numerous concerns about consumer involvement in education (e.g. whether consumers were pursuing their own agendas, whether consumers' views were representative). Evaluations of consumer involvement in education are limited in that their main focus is on the perceptions of students. The findings of this review suggest that public policy expectations regarding consumer involvement in mental health services appear to be slowly affecting the education of mental health professionals. Future research needs to focus on determining the effect of consumer involvement in education on the behaviours and attitudes of students in healthcare environments.     

Mental health nurses’ views of recovery within an acute setting

How the principles of a recovery‐oriented mental health service are incorporated in the day‐to‐day nursing practice of mental health nurses in inpatient settings is unclear. In this study, we interviewed 21 mental health nurses working in acute inpatient mental health units about a range of recovery‐focused topics. Three overlapping themes were identified: (i) the perception of recovery; (ii) congruent humanistic approaches; and (iii) practical realities. Only four interviewees had some formal training about recovery. Most respondents recognize that positive attitudes, person‐centred care, hope, education about mental illness, medication and side‐effects, and the acknowledgement of individual recovery pathways are necessary to prevent readmission, and are central to a better life for people who live with a mental illness. This research supports the view that ideas and practices associated with the recovery movement have been adopted to some degree by nurses working at the acute end of the services continuum. However, most saw the recovery orientation as rhetoric rather than as an appropriately resourced, coordinated, and integrated program. These nurses, however, speak of much more detailed aspects of working with patients and being required to prepare them for the exigencies of living in the community post‐discharge.