‘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.     

‘Meet Me Where I Am’: Mental health service users’ perspectives on the desirable qualities of a mental health nurse

Nurses play a central role in the delivery of quality mental health services. Desired qualities of a mental health nurse, in particular therapeutic relationships, have been described in the literature, primarily reflecting the nursing paradigm. Service users’ perspectives must be more fully understood to reflect contemporary mental health policy and to recognize their position at the centre of mental health service delivery and to directly influence and contribute their perspectives and experiences to mental health nursing education. A qualitative exploratory research project was undertaken to inform and enhance understanding of what service users see as the desired qualities of a mental health nurse. The project was co‐produced by service users as experts by experience, and mental health nurse academics to ensure the service user perspective was privileged. This international project conducted in Europe and Australia included a series of focus groups with service users (n = 50). Data were analysed thematically. Being with me was a major theme identified and reflected the sub‐themes: respect towards service users as persons; empathy, compassion and effective communication; understanding service users; knowledge of services; and fostering hope and believing that recovery is possible. These qualities specifically reflecting the service user perspective must be central to mental health nursing curricula to facilitate the development of holistic care and recovery‐oriented practice. These findings were utilized to directly inform development of a co‐produced mental health nursing learning module, to maximize genuine service user involvement, and to fully realize the benefits of service user led education for undergraduate nursing students.     

‘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.     

‘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.     

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.     

‘Outside the Original Remit’: Co‐production in UK mental health research,lessons from the field

The aim of this discursive paper was to explore the development of co‐production and service user involvement in UK university‐based mental health research and to offer practical recommendations for practitioners co‐producing research with service users and survivors, informed by an overview of the key literature on co‐production in mental health and from a critical reflection on applied research through the medium of a case study. The paper is co‐written by a mental health nurse academic and a service user/survivor researcher academic. The authors argue that the implications of co‐production for mental health research remain underexplored, but that both the practitioner and service user/survivor researcher experience and perspective of co‐production in research can provide practical reflections to inform developing research practice. The theories and values of emancipatory research can provide a framework from which both practitioners and service users can work together on a research project, in a way that requires reflection on process and power dynamics. The authors conclude that whilst co‐produced investigations can offer unique opportunities for advancing emancipatory and applied research in mental health, practitioner researchers need to be more radical in their consideration of power in the research process.     

‘Things you can't learn from books’: Teaching recovery from a lived experience perspective

Mental health policy in Australia is committed to the development of recovery‐focused services and facilitating consumer participation in all aspects of mental health service delivery. Negative attitudes of mental health professionals have been identified as a major barrier to achieving these goals. Although the education of health professionals has been identified as a major strategy, there is limited evidence to suggest that consumers are actively involved in this education process. The aim of this qualitative study was to evaluate students’ views and opinions at having been taught ‘recovery in mental health nursing’ by a person with a lived experience of significant mental health challenges. In‐depth interviews were held with 12 students. Two main themes were identified: (i) ‘looking through fresh eyes’ – what it means to have a mental illness; and (ii) ‘it's all about the teaching’. The experience was perceived positively; students referred to the impact made on their attitudes and self‐awareness, and their ability to appreciate the impact of mental illness on the individual person. Being taught by a person with lived experience was considered integral to the process. This innovative approach could enhance consumer participation and recovery‐focused 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.     

The Mental health Master Class: An innovative approach to improving student learning in mental health nursing

The Master Class was developed as an additional educational innovation designed to promote learning about mental health and illness and mental health nursing as a career option to 2nd‐year undergraduate nursing students. A number of students had approached the mental health nursing academics expressing two polar views on mental health. They either expressed extreme interest in mental health nursing or significant distress and concern related to studying the core 2nd‐year subject. It was considered that the Master Class could potentially provide students with additional support. It was thought the Master Class may either consolidate their interest in mental health or relieve their stress. This article presents the findings of a pre‐ and postevaluation which was employed to explore the effectiveness of the 5‐day intensive mental health Master Class programme on student's mental health learning and their understanding of the role of a mental health nurse. The findings highlighted that prior to participating in the Master Class, there was a significant sense of uncertainty associated with perceived levels of competence required within the profession of mental health nursing. This was coupled with students expressing they wanted to disengage with the profession even before they had commenced any theory or clinical experience. The post‐Master Class findings illustrated a significant improvement in students desire to consider mental health nursing,     

Sharing power in criminal justice: The potential of co‐production for offenders experiencing mental health and addictions in New Zealand

Co‐production has begun to make inroads into research, policy, and practice in mental health and addictions. Little is known, however, about the role co‐production has or could have in shaping how the criminal justice system responds to mental health and addictions. Given that a large majority of prisoners in Aotearoa New Zealand have been diagnosed with either a mental health or substance use disorder within their lifetime, it is imperative alternative approaches are considered if we are to reduce the high imprisonment rates and contribute positively to health, safety, and well‐being of all New Zealanders. In this study, we explore how co‐production has been conceptualized and used in criminal justice systems internationally, and offer an experiential account of our first steps into co‐production both in service delivery and research. We conclude by proposing a way forward to expand partnerships between those who have experience‐based expertise and researchers within the criminal justice context, offering a small‐ and large‐scale project as potential examples of what co‐production may look like in this space.     

Undergraduate nursing students attitude to mental health nursing: a cluster analysis approach

Aims. The use of cluster analysis to determine if specific groups of students could be identified based on their attitudes towards mental health nursing following the completion of a clinical experience in a mental health setting. Background. Research suggests that nursing students generally have a negative image of mental health nursing. This can be improved following clinical exposure in mental health settings, however, specific aspects of clinical experience that might facilitate attitudinal change have been under‐researched. Design. Survey. Methods. A survey was administered to students (n = 703) immediately after completion of their clinical experience. Cluster analysis was used to identify natural groupings within the study cohort. Results. Three distinct clusters were identified. Cluster 1 demonstrated more positive attitudes, greater confidence and viewed mental health more positively than students in the other two Clusters. They were more likely to be male, have spent at least 30 minutes per shift with a preceptor and have completed shifts of eight hours rather than seven hours. Conclusions. Attitudes to mental health nursing may be influenced by specific demographic characteristics of students and by specific aspects of their clinical experience. Relevance to clinical practice. The nursing workforce is an essential element of quality mental health service delivery. Knowledge about factors influencing more positive attitudes is important for structuring clinical experience and designing effective recruitment strategies to attract more students into this field of practice.     

Risky business: Lived experience mental health practice,nurses as potential allies

Mental health policy includes a clear expectation that consumers will participate in all aspects of the design and delivery of mental health services. This edict has led to employment roles for people with lived experience of significant mental health challenges and service use. Despite the proliferation of these roles, research into factors impacting their success or otherwise is limited. This paper presents findings from a grounded theory study investigating the experiences of Lived Experience Practitioners in the context of their employment. In‐depth interviews were conducted with 13 Lived Experience Practitioners. Risk was identified as a core category, and included sub‐categories: vulnerability, ‘out and proud’, fear to disclose, and self‐care. Essentially participants described the unique vulnerabilities of their mental health challenges being known, and while there were many positives about disclosing there was also apprehension about personal information being so publically known. Self‐care techniques were important mediators against these identified risks. The success of lived experience roles requires support and nurses can play an important role, given the size of the nursing workforce in mental health, the close relationships nurses enjoy with consumers and the contribution they have made to the development of lived experience roles within academia.     

Mental health placements in a general health setting: no substitute for the real thing!

Aim. To determine effectiveness of clinical placements in non‐mental health facilities in producing improvement in attitudes toward people with a mental illness and toward mental health nursing in nursing students. Background. Clinical placements in mental health settings have favourably impacted students’ attitudes and confidence in mental health settings. Placement shortages have created discussion about using non‐mental health settings to gain this experience, as mental illness is common in all health settings. To date, no research findings support or refute the efficacy of non‐mental health settings in influencing confidence and attitudes. Design. A within‐subject design was used. Participants provided self‐report data soon after the beginning and at the conclusion of the mental health component. Methods. A questionnaire was administered to a cohort of undergraduate nursing students (n = 66) to measure attitudes, preparedness for practice and interest in mental health nursing as a career, using a pre‐ and post‐test design. Results. Only 25% of participants completed clinical experience in a mental health facility. Minor improvement in attitudes, confidence and appreciating the nursing role in mental health were identified, but the impact on attitudes was considerably less favourable than when clinical experience was undertaken in a mental health facility. Conclusion. Participants who completed clinical experience in a non‐mental health facility did not demonstrate more favourable views about mental health nursing. Relevance to clinical practice. Clinical placements in mental health are essential preparation for undergraduate students to maximise improvement in attitudes to the care of people diagnosed with a mental illness and to mental health nursing.     

Seeking and defining the ‘special’ in specialist mental health nursing: A theoretical construct

In the context of an enduring debate about the distinct identity of mental health nursing, this qualitative study explored the nature, scope and consequences of mental health nursing practice. Data for interpretation were generated through interviews with 36 mental health nurses, five of their clients and one health care colleague, each of whom were asked to speak in as much detail as possible about what they believe is special about mental health nursing and what had influenced them to arrive at this understanding. Using a constructivist grounded theory approach, the study generated a substantive theory of recovery‐focused mental health nursing expressed as ‘Being in the here and now, side by side, co‐constructing care’. The study revealed that the distinct nature and identity of mental health nursing provides the foundation that primes and drives practice scope and consequences. Conceptual interpretations of the data emphasized the mental health nursing perspective of care as an acquired lens founded in nursing as a profession and enhanced by the relational interplay between the nurse and the client that facilitates the nurse to adopt recovery‐focused practices. This theoretical construct holds the potential to be the mediating connection between client and mental health nurse. By situating mental health nursing and its central role in practice as something co‐constructed, findings from this study can be expanded beyond the Australian context, particularly in terms of mental health nursing's distinct professional identity and practice.     

Co‐responding police–mental health programmes: Service user experiences and outcomes in a large urban centre

As police officers are often the first responders to mental health crises, a number of approaches have emerged to support skilled police crisis responses. One such approach is the police–mental health co‐responding team model, whereby mental health nurses and police officers jointly respond to mental health crises in the community. In the present mixed‐method study, we evaluated outcomes of co‐responding team interactions at a large Canadian urban centre by analysing administrative data for 2743 such interactions, and where comparison data were available, compared them to 16 226 police‐only team responses. To understand service user experiences, we recruited 15 service users for in‐depth qualitative interviews, and completed inductive thematic analysis. Co‐responding team interactions had low rates of injury and arrest, and compared to police‐only teams, co‐responding teams had higher overall rates of escorts to hospital, but lower rates of involuntary escorts. Co‐responding teams also spent less time on hospital handovers than police‐only teams. Service users valued responders with mental health knowledge and verbal de‐escalation skills, as well as a compassionate, empowering, and non‐criminalizing approach. Current findings suggest that co‐responding teams could be a useful component of existing crisis‐response systems.     

An ethnic interpretation of mental distress from the perspective of Tongan men and community leaders

Tongan people living in New Zealand have a high prevalence of mental illness and low uptake of mental health services. Rates of mental illnesses also differ between those born in Tonga and those born in New Zealand. However, little is known about the personalized and culturally shaped meaning and experience of mental distress in this population. Therefore, this research explored the meaning of mental distress for Tongan men and community leaders living in Auckland, New Zealand. The Tongan cultural framework, talanoa (talking, to tell), enabled a culturally congruent and collective approach to examining mental health‐related ideologies and ensuing distress. Two talanoa groups were held (one with men and one with community leaders), with a total of 18 participants. The primary research questions focused on tufunga faka‐Tonga (Tongan constructions of mental distress). Four themes emerged: fa’unga (reality), hu‘unga (directionality), ta‘anga (temporality), and tu‘unga (positionality). The analytic lens used to define reality was fa‘unga, because this concept encompasses the creation/preservation of sino (body), me‘a (thing, something), and mo‘oni (truth, real). The findings suggested that it is necessary to incorporate tufunga faka‐Tonga into all aspects of service delivery to improve mental health services for the Tongan population. The Tongan community will benefit from increased awareness of tufunga faka‐paiōsaikosōsiolo (biopsychosocial constructions of mental distress) and tufunga fepaki mo e fetaulaki he vaha‘a ‘o e tufunga faka‐paiōsaikosōsiolo mo e tufunga faka‐Tonga (intersections between biopsychosocial and Tongan constructions of mental distress) to support identification of health risks and health service seeking behaviours.