The role of a mental health consumer in the education of postgraduate psychiatric nursing students: the students' evaluation

Lived experience narratives in health professional education: educators' perspectives of a co-designed, online mental health education resource

INTRODUCTION

Meaningful involvement of people with lived experience is an invaluable approach to education that facilitates the development of knowledge, skills and attitudes for collaborative, compassionate and person-centred healthcare practice. The purpose of this evaluation was to gain health professional educators' perspectives of an online learning resource that presents the lived experiences of people who have been consumers of the Australian mental health system.

METHODS

A cross sectional study design was used to survey educators who had registered to use the online education resource. Data were collected using an online survey and follow-up interviews. Two lived experience researchers were involved in the research. Quantitative survey data were analysed descriptively, and qualitative data were analysed thematically.

FINDINGS

The Listening to Voices online education resource is being used in a range of settings. Educators perceived the content facilitated achievement of learning outcomes related to understanding the experiences of people with mental health issues. The free, online, and flexible design of the resource promoted access and helped overcome barriers to including lived experience experts in education. The powerful impact of the resource and importance of creating safe learning environments when using the resource were highlighted. Suggestions for future developments were provided.

CONCLUSION

Involving people with lived experience in education of healthcare students and professionals can assist in developing skills for collaborative, compassionate, and person-centred care. Implementation of co-design principles and the use of creative pedagogical approaches can contribute to the development of impactful educational resources that foreground lived experience. Making these resources flexible and freely available online improves their utility.

Co-designing psychosis simulated patient scenarios with mental health stakeholders for pharmacy curricula

BACKGROUND

Pharmacists need knowledge and confidence to support people living with mental illness. Evidence-based educational materials for pharmacy students to provide psychosis care is limited.

AIM

To co-design, content validate and pilot-test, with mental health stakeholders, simulated patient scenarios to educate and assess students in providing psychosis care.

METHOD

Mental health consumers were invited to co-design three simulated patient scenarios (first-episode psychosis, carer of someone living with schizophrenia, non-adherence to antipsychotics), guided by published and psychometrically-tested materials. A panel of mental health stakeholders participated in two rounds of content validation (RAND/UCLA appropriateness model). Round 1 involved individual survey completion to calculate item content validity index (I-CVI) for relevance/clarity, content validity ratio for essentiality and overall scale content validity index (S-CVI/Ave and S-CVI/UA) scores for each scenario. Scores analyses and feedback comments informed revisions. Round 2 involved a panel meeting to discuss revisions and finalise content. The scenarios were then pilot-tested with pharmacy students.

RESULTS

Two consumers participated in co-design, nine stakeholders in content validation. All items showed excellent content validity for relevance/clarity. Eleven items were revised for essentiality, discussed, then re-rated at the panel meeting for consensus. The scenarios were pilot-tested with pharmacy students (n = 15) and reported to be realistic and relevant to future practice, contributing to students' confidence in supporting people experiencing mental health symptoms or crises.

CONCLUSION

Partnering with mental health stakeholders has enabled co-design of authentic, content valid educational materials for pharmacy students to provide psychosis care, in preparation for future provision of mental health support.

"Making It Happen": Supporting the Implementation of Positions for Experts by Experience in Mental Health Education

Significant changes to mental health policy have positioned consumers of mental health services as active participants in all aspects of service design and delivery, leading to the development and expansion of consumer workforce roles (Experts by Experience [EBE]). Negative attitudes of health professions pose a major limitation to the success of these positions. EBE involvement in mental health education has shown favourable outcomes, particularly enhancing more positive attitudes. Unfortunately, these positions remain limited in number and scope and have largely been supported by individual clinical academic champions (allies). This article presents findings from a qualitative study, involving individual interviews that explored the experiences and perceptions of allies who supported the implementation of academic positions for EBE. Data were analysed thematically. "Making it happen" was the overarching theme identified. It comprised the sub-themes: strategic or opportunistic?; developing an argument; using evidence; showing what EBE bring; getting buy-in and utilising existing relationships. The articulation of these processes provides a useful guide to other allies interested in supporting the implementation of these positions. The implementation of further positions will ultimately improve the attitudes of other health professionals towards Expert by Experience roles.

The impact of face-to-face mental health consumer-led teaching on occupational therapy student empathy levels: Two group comparison design

INTRODUCTION

Australian and New Zealand accreditation standards for occupational therapy courses mandate consumer involvement in the design, delivery, and evaluation of courses. Consumer involvement in medical, dental, and nursing education has been evidenced as a factor for increasing student empathy. To date, there has been no known research on the impact of mental health consumer involvement on occupational therapy students' empathy. The aim of this study was to investigate if occupational therapy students who receive teaching from a mental health consumer demonstrate higher levels of empathy compared with students who receive teaching delivered by occupational therapy academics.

METHODS

Pre-post, quasi experimental, two group comparison design was used to measure second-year student empathy pre and post a consumer-led teaching tutorial. Students (N = 217) were randomised into two groups across three university campuses: 'teaching as usual group' (control) or 'consumer-led' group (experimental group). The Jefferson Scale of Empathy was used to measure student empathy.

RESULTS

N = 138 matched scales were returned. Little difference in empathy scales was detected between groups. The 'consumer-led' group increased for the empathy scale by 3.4(95% CI: 0.7,6.1, p = 0.014) but was not statistically significant compared to 1.3(95% CI: -1.0,3.5, p = 0.267) for the control group. Both groups scored highly on empathy.

CONCLUSION

This study found that occupational therapy students had pre-existing high levels of empathy. The challenge for future research is to identify appropriate ways to measure the impact of mental health consumer involvement on occupational therapy curriculum and students.

"I don't think we've quite got there yet": The experience of allyship for mental health consumer researchers

WHAT IS KNOWN OF THE SUBJECT

Consumer participation in mental health services is an expectation articulated through mental health policy. Consumers as researchers could contribute significantly to mental health services. Barriers to participation are significant and limit consumer involvement.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Enhanced understandings of collaborative relationships between consumer and nonconsumer researchers. Researchers from the health disciplines find value in consumer involvement in mental health research. These researchers can support and facilitate consumer research by being allies to consumer researchers.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Understanding the role of allies is necessary to strengthen their capacity to support consumer researchers. Involving consumers in mental health research is likely to lead to improved practice.

ABSTRACT

Introduction Australia and New Zealand mental health policy requires consumer participation in all aspects of mental health services. Systemic participation informs and improves the quality of mental health services. Collaboration with consumer researchers should be similarly required. Enhanced understandings of collaborations are needed. Aim To enhance understanding of the perspectives and experiences of nonconsumer researchers in working collaboratively with consumers as researchers. Method This qualitative exploratory study involved interviews with nonconsumer mental health researchers who have worked collaboratively with consumers in research. Interviews were conducted with participants from Australia and New Zealand. Results "Allyship" emerged as a major theme. This describes nonconsumer researchers playing an actively supportive role to facilitate opportunities for the development and growth of consumer research roles and activities. Seven subthemes were identified: establishing and supporting roles, corralling resources, guiding navigation of university systems, advocacy at multiple levels, aspiring to coproduction and consumer-led research, extending connections and partnerships, and desire to do better. Discussion Allyship may have an important role to play in the broader consumer research agenda and requires further consideration. Implications for practice Embedding meaningful consumer participation within mental health services requires active consumer involvement in research. Allies can play an important facilitative role.

Doing what we can, but knowing our place: Being an ally to promote consumer leadership in mental health

Consumer participation in all aspects of mental health services is clearly articulated as an expectation of contemporary mental health policy. Consumer leadership has been demonstrated to be beneficial to mental health services. Barriers to implementation have limited the realization of this goal. In this discursive paper, we argue that non-consumers who support consumer partnerships and leadership (known as 'allies') have an important role to play in facilitating and supporting consumers in leadership roles. Allies currently have more potential to influence resource allocation, and might be viewed more credibly by their peers than consumer leaders themselves. We call for allies to ensure their role is one of support and facilitation (doing what they can), rather than directing the content or speaking on behalf of the consumer movement (knowing their place). In the present study, we address the importance of allies for the consumer movement. It proposes some 'rules of engagement' to ensure that allies do not intentionally or otherwise encroach on consumer knowledge and expertise, so that they maintain the important position of supporting consumers and facilitating the valuing and use of consumer knowledge, expertise, and ultimately, leadership.

Attitudes of mental health professionals towards service user involvement

Patient-centred care and user involvement in healthcare services are much emphasised globally. This study was the first step in a multicentre research project in Finland to improve service users' and carers' opportunities to be more involved in mental health services. The aim of the study was to assess attitudes of professionals towards service user involvement. The data were collected via an online questionnaire from 1069 mental health professionals in four hospital districts. Altogether, 351 professionals responded. Data were analysed using appropriate statistical methods. According to the results, attitudes of healthcare professionals were more positive towards service users' involvement in their own treatment than in other levels of services. There were also differences in gender, age groups, working places and experiences in the attitudes of professionals concerning service users' involvement in their own treatment. These should be taken into account in the future when planning education for mental health professionals. In spite of governmental guidance on service user involvement and the growing body of knowledge of the benefits associated with it, change in attitudes towards user involvement is slow. Special attention should be paid to the attitudes of professionals working in inpatient care and of those with less working experience.

Exploring the Scope of Consumer Participation in Mental Health Nursing Education: Perspectives From Nurses and Consumers

PURPOSE

Exploration of the views and experiences of nurse academics and consumer academics and educators regarding the scope of consumer participation in mental health nursing education.

DESIGN AND METHODS

A qualitative, exploratory inquiry into the description and views of mental health nurse academics and consumer educators about these roles

FINDINGS

A significant variation in roles from guest speaker to substantive academic positions was evident, with most involvement brief and specifically teaching focused. Consumer participation in education was generally valued but noted to be limited in breadth and scope. Some concern was raised about the relevance of consumer academic roles, with a clear conceptualization of the consumer academic role necessary to facilitate their contribution to the education of health professionals.

PRACTICE IMPLICATIONS

Mental health consumer involvement in the education of nurses has been shown to impact positively on the attitudes of health professionals to people with mental illness. Advocacy for increased, meaningful input from consumers into nursing education is therefore necessary to improve practice.

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.

Mental health lived experience academics in tertiary education: the views of nurse academics

BACKGROUND

Australian national mental health strategy emphasises inclusion of people diagnosed with mental illness in all areas of mental health care, policy development and education of health professionals. However, the way this inclusion has translated to Australian universities is relatively unexplored.

OBJECTIVES

Explore views of nurse academics regarding service user involvement in nursing education programmes.

DESIGN

Qualitative exploratory.

SETTINGS

Australian universities offering educational programmes in nursing at postgraduate and undergraduate levels.

PARTICIPANTS

Thirty four participants from 27 Australian universities participated.

METHODS

Data were collected using semi-structured telephone interviews with academics involved in teaching and/or coordinating undergraduate and/or postgraduate mental health nursing contents. Data were analysed using content analysis based on four cognitive processes: comprehending, synthesising, theorising and re-contextualising data.

RESULTS

Four major themes emerged: good idea? long way to go; conceptualising the service user academic role; strengths of lived experience led student learning; and barriers to implementation.

CONCLUSIONS

Findings indicated strong support for including mental health service users in teaching nursing students. However, at most universities service user engagement was often an informal arrangement, lacking clear guidelines and limited by financial barriers and the positioning of mental health nursing within curricula.

Attitudes of nursing students on consumer participation: the effectiveness of the Mental Health Consumer Participation Questionnaire

PURPOSE

The aims of this article were to evaluate the Mental Health Consumer Participation Questionnaire, and measure nursing students' attitudes to consumer participation.

DESIGN AND METHODS

Undergraduate nursing students (n = 116) completed the Mental Health Consumer Participation Questionnaire at the start of a course on recovery for mental health nursing practice.

FINDINGS

The current findings confirm an endorsement of consumer participation in individual care processes, but less agreement with participation in organizational-level processes, such as management of mental health services and education of providers. This article also confirms that the questionnaire can effectively measure attitudes to consumer participation.

PRACTICE IMPLICATIONS

The participation of consumers is critical for achieving person-centered services mental health services. It is important that nursing education influence positive attitudes.

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.

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.

The views of heads of schools of nursing about mental health nursing content in undergraduate programs

Criticisms about the mental health nursing content of Bachelor of Nursing programs have been common since the introduction of comprehensive nursing education in Australia. Most criticism has come from the mental health nursing sector and the views of key stakeholders have not been systematically reported. Heads of Schools of Nursing have considerable influence over the content of nursing programs, and their perspectives must be part of ongoing discussions about the educational preparation of nurses. This article reports the findings of a qualitative exploratory study, involving in-depth interviews with Heads of Schools of Nursing from Queensland, Australia. Thematic data analysis revealed two main themes: Realising the Goal? and Influencing Factors. Overall, participants did not believe current programs were preparing graduates for beginning level practice in mental health settings. In particular, participants believed that the quality of mental health content was influenced by the overcrowded curriculum, the availability of quality clinical placements, the strength of the mental health team, and the degree of consumer focus. The findings suggest the current model of nursing education in Australia does not provide an adequate foundation for mental health nursing practice and alternative approaches should be pursued as a matter of urgency.

Nine key principles to guide youth mental health: development of service models in New South Wales

AIMS

Historically, the Australian health system has failed to meet the needs of young people with mental health problems and mental illness. In 2006, New South Wales (NSW) Health allocated considerable funds to the reform agenda of mental health services in NSW to address this inadequacy. Children and Young People's Mental Health (CYPMH), a service that provides mental health care for young people aged 12-24 years, with moderate to severe mental health problems, was chosen to establish a prototype Youth Mental Health (YMH) Service Model for NSW. This paper describes nine key principles developed by CYPMH to guide the development of YMH Service Models in NSW.

METHODS

A literature review, numerous stakeholder consultations and consideration of clinical best practice were utilized to inform the development of the key principles.

RESULTS

Subsequent to their development, the nine key principles were formally endorsed by the Mental Health Program Council to ensure consistency and monitor the progress of YMH services across NSW. As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service.

CONCLUSIONS

The nine key principles provide mental health services a framework for how to reorient services to accommodate YMH and provide a high-quality model of care. [Corrections added on 29 November 2013, after first online publication: The last two sentences of the Results section have been replaced with "As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service."].

'We have got the tools': Qualitative evaluation of a mental health Wellness Recovery Action Planning (WRAP) education programme in Ireland

In recent years, there has been a consistent drive to incorporate Recovery principles into the Irish mental health services. A group of Irish mental health service providers came together and delivered a 5-day Wellness Recovery Action Planning (WRAP) facilitator's programme. The programme was developed and delivered by key stakeholders including people with self-experience of mental health problem. This paper presents the qualitative findings from an evaluation of these facilitator's programmes. Three focus groups were held with 22 people, the majority of who described themselves as mental health professionals and/or people with self-experience of mental health problems. Data were analysed using a thematic approach and yielded four themes. Although the participants were positive about the programme and felt that their knowledge of Recovery and WRAP had improved, they felt that they still lacked confidence in terms of the presentation skills required for facilitating Recovery and WRAP programmes. The findings suggest that mental health service providers who wish to develop service users and clinicians as WRAP facilitators need to put more emphasis on the provision of facilitation and presentation skills in the programmes they develop.

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.

Sur la contribution des personnes utilisatrices de services de santé mentale en tant que partenaires d’enseignement en psychiatrie

Le Collège royal des médecins et chirurgiens du Canada prévoit qu’au terme de leur formation, les résidents en psychiatrie pourront agir efficacement en tant que promoteurs de la santé. Ce commentaire présente une analyse d’entrevues réalisées dans le cadre d’un perfectionnement professionnel auprès d’experts mondialement reconnus du rétablissement en santé mentale. À la lumière de la Charte d’Ottawa pour la promotion de la santé, il en ressort que des personnes utilisatrices de services de santé mentale peuvent être de précieux partenaires d’enseignement à la fois en matière de promotion de la santé et de rétablissement. Le recours à des patients partenaires d’enseignement en psychiatrie peut également représenter une stratégie de lutte à la stigmatisation et aux préjugés en favorisant davantage de réciprocité entre les professionnels et les personnes traitées.

Keeping the flame alight: understanding and enhancing interest in mental health nursing as a career

Mental health nursing is not regarded favourably by most Bachelor of Nursing (BN) students as a desirable career option. However, little is known about what attracts those students who do become interested. The primary aim of the current study was to explore BN students' reasons for choosing to undertake the major in mental health nursing and the degree to which completing the subject: "Recovery for mental health nursing practice", confirmed that interest or otherwise. A secondary aim was to examine their perceptions about the attitudes of others to their expressed interest in mental health nursing. A qualitative exploratory study was undertaken with undergraduate nursing students (BN) (n = 12) enrolled in a major stream in mental health nursing. In-depth individual interviews were conducted primarily by telephone. Data were analysed using Colaizzi's steps to explicate the main themes. Two main themes emerged: Swimming against the tide - that's not real nursing, captures participants' experience of the negative attitudes of others to their interest in mental health nursing; and, creating and confirming an interest in mental health nursing, where participants discuss how their interest emerged and how it had been enhanced after completing the subject: Recovery for Mental Health Nursing Practice. Mental health nursing continues to be a stigmatised and undervalued profession both within nursing and the general public. Despite this, participants of this research were attracted to the specialty, and their interest was generally strengthened after completing the Recovery subject. Further research is required to examine the impact of being taught by an academic with lived experience on interest in mental health nursing as a career.

'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.

Service user involvement in nurse education: perceptions of mental health nursing students

Increasingly providers of mental health nurse education are required to demonstrate user involvement in all aspects of these programmes including student selection, programme design and student assessment. There has been limited analysis of how nursing students perceive user involvement in nurse education programmes. The aim of this study has been to explore mental health nursing student's perceptions of involving users in all aspects of pre-registration mental health nursing programme. Researchers completed a number of focus group interviews with 12 ex-mental health nursing students who had been recruited by purposeful sampling. Each focus group interview was recorded and analysed using a series of data reduction, data display and verification methods. The study confirms many of the findings reported in earlier user participation in education studies. Three main themes related to user involvement have been identified: the protection of users, enhanced student learning and the added value benefits associated with user involvement.

Reflecting on holistic nursing: the contribution of an academic with lived experience of mental health service use

The educational preparation of registered nurses is presumed to reflect a holistic approach with emphasis on the bio-psycho-social model of care. The broader literature suggests this goal is not always realised. The aim of this study is to present the views, experiences, and perceptions of undergraduate nursing students who were taught by an academic with a lived experience of mental health service use. In particular, we wanted to look at the expected impact of this approach to learning on their nursing practice. A qualitative, exploratory approach was used, involving in-depth individual interviews with 12 undergraduate nursing students completing the course, "recovery for mental health nursing practice," as part of a major in mental health nursing in a university in Queensland, Australia. Students were asked to reflect upon and discuss their experiences of being taught by a person with lived experience of mental health service use. Data were analysed following Colaizzi's steps to identify the main themes. The three main themes were (1) recovery--bringing holistic nursing to life; (2) influencing practice; and (3) gaining self-awareness through course assessment: challenge and opportunity. These themes suggest an appreciation for holistic nursing and an increased capacity for reflective understanding. The responses from participants suggest the Recovery course had a significant impact on their attitudes to nursing and that their nursing practice would be positively enhanced as a consequence.

Service user involvement in pre-registration mental health nurse education classroom settings: a review of the literature

Service user involvement in pre-registration nurse education is now a requirement, yet little is known about how students engage with users in the classroom, how such initiatives are being evaluated, how service users are prepared themselves to teach students, or the potential influence on clinical practice. The aim of this literature review was to bring together published articles on service user involvement in classroom settings in pre-registration mental health nurse education programmes, including their evaluations. A comprehensive review of the literature was carried out via computer search engines and the Internet, as well as a hand search of pertinent journals and references. This produced eight papers that fitted the inclusion criteria, comprising four empirical studies and four review articles, which were then reviewed using a seven-item checklist. The articles revealed a range of teaching and learning strategies had been employed, ranging from exposure to users' personal stories, to students being required to demonstrate awareness of user perspectives in case study presentations, with others involving eLearning and assessment skills initiatives. This review concludes that further longitudinal research is needed to establish the influence of user involvement in the classroom over time.

Using a socioecological framework to understand the career choices of single- and double-degree nursing students and double-degree graduates

Untested changes in nursing education in Australia, such as the introduction of double degrees in nursing, necessitate a new research approach to study nursing career pathways. A review of the literature on past and present career choice theories demonstrates these are inadequate to gain an understanding of contemporary nursing students' career choices. With the present worldwide shortage of nurses, an understanding of career choice becomes a critical component of recruitment and retention strategies. The purpose of this paper is to demonstrate how an ecological system approach based on Bronfenbrenner's theory of human development can be used to understand and examine the influences affecting nursing students' and graduates' career development and career choices. Bronfenbrenner's socioecological model was adapted to propose a new Nursing Career Development Framework as a way of conceptualizing the career development of nursing students undertaking traditional bachelor of nursing and nontraditional double-degree nursing programs. This Framework is then applied to a study of undergraduate nurses' career decision making, using a sequential explanatory mixed method study. The paper demonstrates the relevance of this approach for addressing challenges associated with nursing recruitment, education, and career choice.

Partnerships for better mental health worldwide: WPA recommendations on best practices in working with service users and family carers

WPA President M. Maj established the Task Force on Best Practice in Working with Service Users and Carers in 2008, chaired by H. Herrman. The Task Force had the remit to create recommendations for the international mental health community on how to develop successful partnership working. The work began with a review of literature on service user and carer involvement and partnership. This set out a range of considerations for good practice, including choice of appropriate terminology, clarifying the partnership process and identifying and reducing barriers to partnership working. Based on the literature review and on the shared knowledge in the Task Force, a set of ten recommendations for good practice was developed. These recommendations were the basis for a worldwide consultation of stakeholders with expertise as service users, families and carers, and the WPA Board and Council. The results showed a strong consensus across the international mental health community on the ten recommendations, with the strongest agreement coming from service users and carers. This general consensus gives a basis for Task Force plans to seek support for activities to promote shared work worldwide to identify best practice examples and create a resource to assist others to begin successful collaboration.

Mental health nursing education in preregistration nursing curricula: a national report

The Australian Mental Health Nurse Education Taskforce conducted a national examination of mental health content of preregistration nursing curricula in order to develop a framework for including mental health in future curricula. This paper presents the qualitative findings from national consultations about the framework. Content analysis of data was undertaken, and the findings show four key themes. First, the mental health content of curricula should be increased; second, overall mental health nursing leadership should be strengthened; third, mental health consumer participation should be increased in all aspects of curricula; and finally, a repository should be established for mental health teaching resources.

Involvement of inpatient mental health clients in the practical training and assessment of mental health nursing students: Can it benefit clients and students?

Even though the central position of the client has been recognized in psychiatric nursing education, the client is seldom formally involved in the feedback provided to students during practical training. This research paper focuses on three questions: (1) What conditions support the gathering of meaningful client feedback to enhance the student's learning process and client's wellbeing? (2) Does the use of the practical model for client feedback lead to positive experiences, and if so, under what conditions? (3) To what extent is a client's feedback on the student's work performance, consistent with feedback from the mentor (nurse from the ward), the teacher and the student? Based on a literature review, participatory observation and contacts with experts, a practical model was developed to elicit client feedback. Using this model in two psychiatric inpatient services, clients were actively and formally involved in providing feedback to four, final year psychiatric nursing students. Clients, nurses, teachers and students were interviewed and data were analysed using a qualitative explorative research approach. Analyses revealed that client feedback becomes meaningful in a safe environment created by the psychiatric nurse. Client feedback generates a learning effect for the student and supports the student's recognition of the value and vulnerability of the psychiatric client.

The impact of mental health nursing education on undergraduate nursing students' attitudes to consumer participation

Consumer participation in all aspects of mental health service delivery, including the education of mental health professionals, is now a policy expectation in Australia. Whether education programs introducing nurses to mental health nursing lead to more favourable attitudes towards consumer participation is yet to be examined in pre-registration nursing programs in Australia. The current evaluation examined changes in scores for the Consumer Participation Survey for undergraduate nursing students (n = 68) in an Australian University. Data were analysed, using repeated measures t-test, to compare the pre- and post-test scores. There was a significant improvement in views on consumers participating as staff members. There were no statistically significant changes in attitudes towards consumer capacity and consumer involvement in care processes. Consumer participation in mental health care is now clearly articulated in Australian Government policy. For this to be successfully implemented a more comprehensive understanding of the ability of education to influence attitudes is required.

A psychometric analysis of the Mental Health Consumer Participation Questionnaire

If consumer participation is to be translated from rhetoric into reality, the attitudes of health professionals need to be addressed. Educational strategies can play an important role, but measures of attitudes are needed to determine the effectiveness of these strategies. This paper seeks to establish the Mental Health Consumer Participation Questionnaire (MHCPQ) on psychometric grounds, and explore attitude levels. Overall, the 150 nursing students who participated saw consumer participation in a favourable light, although this varied with the nature and extent of involvement. Psychometric properties, attitude structure, and attitude differences are reported. The MHCPQ displays good face validity and can be further developed and used in mental health-care settings.

Institutionalized nursing staff: planning and developing a specialized educational framework that enhances psychiatric nurses' roles and promotes de-institutionalization

For centuries psychiatric services were provided by mental health hospitals, which were operating upon bureaucratic principles: strict hierarchies, slow processes and segmentation of duties. Research has shown that psychiatric nursing, as exercised in these traditional settings, has dealt with several problems in relation to: the amount and quality of time spent with patients, the type of duties performed, the lack of autonomy etc. The closure of many psychiatric institutions and their substitution with community-based settings, signified that health professionals should perform a variety of new duties, exhibit new skills and develop new perceptions about their work and the patients. In order for such alterations to occur, education can play a vital role in the re-conceptualization of psychiatric nursing and in the practical preparation of students for their future work. The present paper focuses on the contradiction between nursing as practised in Greek mental health hospitals and the current trends and demands placed upon nurses, to exhibit a new 'face'. The purposes of this paper are: first, to review the research on psychiatric nurses' behaviours in mental health hospitals. Second, to present the outcomes of bureaucracy on employees and finally, to propose an educational scheme that could reinforce the shift from institutionalized work to de-institutionalized.

Service user involvement in undergraduate mental health nursing in New Zealand

This paper describes a service user role in the mental health component of an undergraduate nursing programme in New Zealand. The paper provides a background to mental health nursing education in New Zealand and discusses the implications of recent reforms in the mental health sector. The undergraduate nursing programme at the University of Auckland has a strong commitment to service user involvement. The programme aims to educate nurses to be responsive and skillful in meeting the mental health needs of service users in all areas of the health sector and to present mental health nursing as an attractive option for nurses upon graduation. We outline the mental health component of the programme, with an emphasis on the development of the service user role. In the second half of the paper, we present a summary of responses to a student satisfaction questionnaire. The responses indicate that the service user role is an important element of the programme and is well received by a substantial proportion of students. We consider the implications for nursing education and for recruitment into mental health nursing. Finally, we discuss some issues related to service user involvement in the development of new models of mental health service delivery.

Bachelor of Nursing students career choices: a three-year longitudinal study

This paper presents the findings of a survey which explored the career preferences of Australian Bachelor of Nursing students for certain clinical specialities. A convenience sample was recruited, with data collected three times between 2005 and 2007. With first-year students, acute care nursing of the adult and child and midwifery were the most popular career choices, whereas considerably less were interested in mental health or aged care nursing, and nearly two-fifths were undecided. By third-year, there was a shift in career preferences, with acute care of the adult and mental health being the most popular choices. In contrast, midwifery and aged care were the least preferred careers. The study provides some evidence students commence their course with a predominantly lay-informed image of nursing, but this may be tempered by favourable curricular influences towards the mental health field. However, the curriculum discourages students from pursuing a career in aged care and midwifery.

Mental health content of comprehensive pre-registration nursing curricula in Australia

In 2008 the final report of the Mental Health Nurse Education Taskforce was released. This paper presents the findings of the report’s survey into the mental health content of generic pre-registration nursing curricula in Australia. A questionnaire was sent to all nursing schools providing pre-registration curricula. Results indicate curricula contained a wide range of mental health theory and clinical hours. While the majority of universities incorporated most of the 20 key topics recommended by the Mental Health Nurse Education Taskforce in their courses, few addressed issues such as Indigenous mental health. There was considerable competition for placements between universities, and concern about the quality of some placements. Nurse academics with formal qualifications in mental health and specialist clinical mental health nurses were mainly involved in teaching theory. Specialist mental health clinicians and clinical educators were the key groups engaged in students’ clinical education, and preceptorship was the most common form of clinical supervision. Consumers and carers had limited involvement in the development or provision of mental health content of pre-registration curricula. Greater attention is needed to increasing the mental health content in pre-registration curricula. Furthermore, initiatives should be developed to increase access to clinical placements and reduce competition for places between universities.

Promoting genuine consumer participation in mental health education: a consumer academic role

Mental health policy reform in Australia has led to the expectation of increased consumer participation not only in all aspects of service delivery, but also in the education and training of mental health professionals. The aim of this paper is to explore the development and introduction of a role for a consumer of mental health services within an academic institution, including achievements of the role and the principles contributing to successful implementation. The consumer academic position was successfully implemented and has proved a valuable role. The success of the role was considered to be dependent on the following factors: partnership and commitment, support, scope and autonomy. In conclusion, a consumer can play a valuable role within an academic institution. However, success will depend upon a number of important environmental factors that promote the independence of the consumer voice.

Developing and piloting an audit tool for mental health education and training: The National Mental Health Education Continuous Quality Improvement Tool

It is clear from the international literature that education and training can play a crucial role in improving the quality of mental health service delivery. In the UK, post-qualification mental health education and training is not generally allied to the national policy agenda and there is a lack of service user and carer involvement in the design, development and delivery of educational curricula. The Department of Health in England has funded the development of a continuous quality improvement tool to address these important concerns and help commissioners of mental health education and training evaluate key aspects of courses. The design of the tool was informed by the literature and a series of semi-structured interviews and focus groups with key stakeholders. Subsequent drafts were refined through steering group consultation and the instrument was then piloted within a selected region in England. This has resulted in a brief, user-friendly tool that takes into account the views of all stakeholders in mental health education programmes, promotes dialogue and facilitates continuous quality improvement. The tool promotes self-assessment of: partnership arrangements; the relevance of the programme to the policy context; the extent to which service users and carers are involved in the design, delivery and evaluation of programmes; and the assessment of the impact of the programme. Results from the initial implementation project (to be reported separately) suggest that the tool is welcomed and can complement existing quality mechanisms.

Mental health literacy of Australian Bachelor of Nursing students: a longitudinal study

Many students have poor mental health literacy when they finish Bachelor of Nursing courses. This paper presents the findings of a longitudinal study of Australian Bachelor of Nursing students' mental health literacy about the effectiveness of interventions for people with schizophrenia. The 'Attitudes and Beliefs about Mental Health Problems: Professional and Public Views' questionnaire was used with a non-probability sample of nursing students. A time series approach to data collection was used, with data collected on three occasions between 2005 and 2007. Ethics approval was obtained from a university ethics committee. Data were analysed using SPSS Version 15.0. The students' views about the helpfulness of interventions showed a significant and positive improvement as they progressed through the course. There were significant differences over time in their views about the helpfulness of professional and lay interventions, their opinions about the helpfulness of mental health and other medications, and the usefulness of activity and non-pharmacological interventions. Because nursing students need to be mental health literate when they complete their course, mental health nursing content should be incorporated earlier in comprehensive undergraduate curricula and incrementally increased in each year of study.

Bachelor of Nursing students' beliefs about prognosis and outcomes for people with schizophrenia: a longitudinal study

Many nursing students have unfavourable attitudes towards people with mental illness. This study aimed to examine if Australian Bachelor of Nursing students' beliefs about prognosis and long-term outcomes for people with schizophrenia changed through their course. The Attitudes and Beliefs about Mental Health Problems: Professional and Public Views questionnaire, which included a vignette about a person with schizophrenia, was used with a convenience sample of students. An interrupted time series approach to data collection was used, with data collected three times between 2005 and 2007. A university ethics committee approved the study. Data were analysed using SPSS version 15. Overall, the students recognized the person's need for professional help. By third year, students were more pessimistic about prognosis if the person did not receive professional help than in their earlier years of study. By third year, students also rated the long-term outcome to be 'creative or artistic' more favourably than in earlier years. The findings showed no significant differences in perceived overall negative and positive long-term outcomes across the three data collection points. The findings reinforce the need for theoretical and clinical education in mental health to be included and progressively increased in all years of study if attitudes are to be improved.

Consumer participation in mental health in Australia: what progress is being made?

OBJECTIVE

Historically, people living with mental illness have had limited chance to participate in mental health services other than as patients. This has led to serious negative consequences for their health and wellbeing. Recent public policy has aimed at redressing this situation. This paper sets out to investigate the 'state of play' regarding consumer participation in mental health services.

CONCLUSIONS

Consumer participation is not a common topic in the recent literature, despite the significant public policy push to promote it. Although the vision of public policy is for consumers to be at the centre of decision making, the changes are understandably slow in coming. The implications for the practice of psychiatry, and therefore mental health services, of the demands for meaningful participation are profound. They challenge some of the social covenants under which mental health services have historically been delivered. Traditionally, people living with a mental illness have not had their rights respected. In recent times, the College has developed policies that aim to ensure that the rights of people living with a mental disorder are respected. These policies also acknowledge that effective health care requires collaboration with consumers.

Consumer-clinician co-taught training about borderline personality disorder

OBJECTIVE

The aim of this paper is to provide further outcome data on a novel consumer-clinician co-taught borderline personality disorder training program.

METHOD

Participants (n=216) who attended consumer-clinician co-taught borderline personality disorder training had their ratings of the training compared to ratings of participants who attended the previous clinician-only borderline personality disorder training.

RESULTS

Mean training ratings of the consumer-clinician co-taught borderline personality disorder trainings were 37 percentile points higher (77th vs 40th percentile) than the ratings of the previous clinician-only borderline personality disorder training, which already had evidence of effectiveness.

CONCLUSION

Data confirm preliminary findings that adding a consumer-presenter to training adds considerable value.

Talking with the experts: evaluation of an online discussion forum involving mental health service users in the education of mental health nursing students

The Chief Nursing Officer's recent review of mental health nursing called for the widespread involvement of mental health service users in the education of mental health nurses. This paper describes an innovative project that involved mental health service users in the education of pre-registration mental health nursing students through an online discussion forum that blended e-learning with enquiry-based learning (EBL). The findings of an evaluation are presented, drawing on quantitative and qualitative methods. Overall, the project was a success with students and service users engaging in online discussions on a range of issues. EBL presentations demonstrated understanding of the service user experience and students reflected on implications for clinical practice. All participants would take part again and recommend the online forum to others. Analysis of activity data revealed different levels and styles of student involvement. Limitations in communication skills appeared to limit student participation, alongside logistical difficulties, whereas the service users eagerly utilised the forum. Potential implications for healthcare education are discussed and recommendations made for developments in user-led e-learning and further research.

Consumer-clinician co-taught borderline personality disorder training: a pilot evaluation

This paper describes a consumer-clinician co-taught borderline personality disorder training programme for clinicians, of whom the largest group were nurses, working in mental health and substance use fields. A pilot evaluation of 73 participants attending the training rated the training as superior to evaluations of an earlier clinician-only-taught training. This study of a novel co-taught training programme found that the consumer input added substantial value. Findings indicate that consumer input into education programmes can make a significant positive contribution to the delivery of mental health services training with likely impacts on mental health service delivery. The potential importance of the findings warrants a comprehensive multicentre study. Confirming the findings would have implications for future borderline personality disorder training programmes.

A socially inclusive approach to user participation in higher education

AIM

This paper is a report of a study to evaluate the development of an innovative Service User Academic post in mental health nursing in relation to student learning and good employment practice in terms of social inclusion.

BACKGROUND

Institutions providing professional mental health education are usually expected to demonstrate user involvement in the design, delivery and evaluation of their educational programmes to ensure that user voices are central to the development of clinical practice. Involvement can take many forms but not everyone values user knowledge as equal to other sources of knowledge. This can lead to users feeling exploited, rather than fully integrated in healthcare professional education processes. Development of the post discussed in this paper was stimulated and informed by an innovative example from Australia.

METHOD

An observational case study of the development and practice of a Service User Academic post was undertaken in 2005. Participants were purposively sampled and included the User Academic, six members of a user and carer reference group, 10 educators and 35 students. Data were collected by group discussions and interviews. Data analysis was based on the framework approach.

FINDINGS

The evaluation revealed tangible benefits for the students and the wider academic community. Most important was the powerful role model the Service User Academic provided for students. The post proved an effective method to promote service user participation and began to integrate service user perspectives within the educational process. However, the attempts to achieve socially inclusive practices were inhibited by organizational factors. The expectations of the role and unintended discriminatory behaviours had an impact on achieving full integration of the role. Furthermore, shortcomings in the support arrangements were revealed.

CONCLUSIONS

The search for an optimum model of involvement may prove elusive, but the need to research and debate different strategies, to avoid tokenism and exploitation, remains.

Psychiatric nurses enhancing consumer and caregiver participation in the state of Victoria: the impact of history and policy

Australian mental health policy now clearly articulates that consumer and carer (informal caregiver) participation in all aspects of service delivery is an expectation. As the largest professional group, nurses clearly play a key role in translating policy into practice. The aim of this article is to briefly overview the history of mental health service development in Victoria, with specific emphasis on the development of psychiatric nursing. Changing perspectives of consumers of mental health services and their informal carers is discussed. Policy development is described in the context of the development of mental health services. It is argued that an appreciation of the history of punishment and confinement is necessary for providing a climate conducive to consumer and carer participation.

Reflection without shame--reflection without blame: towards a more collaborative understanding between mental health consumers and nurses

It is now a clear policy expectation that consumers of mental health services be given the opportunity to be active participants in all aspects of mental health service development and delivery. Psychiatric nurses have an important role to play in ensuring opportunities for genuine participation; however, the literature suggests that this role is not always realized in practice. Negative attitudes of health professionals (including nurses) to consumer has been identified as a significant barrier to the realization of this policy goal, with education and training recognized as an important strategy for developing more positive attitudes. This paper describes the implementation of a mental health consumer academic position, through the personal reflections of a nurse academic and a consumer academic. More specifically, the paper addresses the reactions of some nurses to the work of the consumer academic and the apparent feeling of being attacked as nurses. By recognizing this defensiveness, nurses and other health professionals may more effectively move towards promoting consumer participation in mental health care.