MEDEV

School of Medical Sciences Education Development

Introduction

Mental Health in Higher Education (mhhe), a collaborative project of the Learning and Teaching Support Network, set out to increase networking and the sharing of good practice between the disciplines involved in learning and teaching about mental health in higher education. Outputs have included three national workshops; scoping reports on the teaching of mental health in difference disciplines; two forthcoming practice guides (on user involvement and the use of self in learning and teaching about mental health); and a set of case studies of learning and teaching. A web site has been established www.mhhe.ltsn.ac.uk which is linked to a jiscmail discussion group: ltsn mental health in higher education.

"There is more that unites than separates us" (nurse academic)

It was clear from responses to an initial mhhe questionnaire that educators across the disciplines are grappling with similar challenges:

• How to determine what all students, on generic programmes, need to understand about mental health problems and wellbeing
• The constraints of increasing student numbers, and insufficient time to devote to learning and teaching about mental health.
• How best to ensure that students are helped to learn about the range of perspectives which exist, whilst developing a sense of their own professional identity and the particular contribution they can make
• How to combat stigma and ensure that mental health is perceived as an attractive option at the point of specialisation.
• How to involve service users and carers in education and training in constructive ways of benefit to all concerned.
• How to address the needs of students with mental health problems and their implications for support structures and curriculum development.

"There is much to be gained from talking to each other" (medical educator)

The project has provided a range of opportunities for exchange between educators from different disciplines. The chance to meet face to face, at workshops and events, has had an important role to play.

The project has disseminated information about other initiatives in mental health teaching, such as the development of a module on psychosis, drawing on the results of the BPS report Recent Advances in Understanding Mental Illness and Psychotic Experiences; as well as guidance being developed nationally, such as the recent work by the joint NIMHE/Sainsbury Centre Workforce Unit on developing Essential Shared Capabilities for Mental Health. For further information about both see below.

"Increased knowledge about how things work in different disciplines can only help understanding" (medical educator)

Becher's work on Academic Tribes and Territories (2001), draws attention to the differences that exist between disciplines in higher education. We know, too, that the area of mental health is characterized by a diverse range of understandings and perspectives.

Unsurprisingly, given this context, there have also been differences of opinion and challenges over the year.

At a practical level, it took time to become familiar with the differences between the subject communities. Whilst the majority of medical and psychology educators remain clinically active, many of those involved in social work or occupational therapy do not (as evidenced in the recent report on the Clinical Activity of Mental Health Lecturers, available on the mhhe website). Different cultures about CPD credits and charging, for example, surround the organisation of events in different disciplines. Educators, in common with students and practitioners, may also have preconceptions about their peers from other disciplines, sometimes based on outdated notions about how mental health is taught.

Brian Lunn, in the above mentioned case study notes how "nursing students had anticipated a cold... clinical approach from psychiatrists and were surprised to see a broad approach which differed from the medical model they had been taught on". Educators, given the opportunity to find out about recent changes in education in fields other than their own, can similarly be surprised and develop their understanding.

"It's may be important that as psychiatric educators, we start to speak to each other, before beginning to speak to everyone else as well!" (medical educator)

Feedback from the workshops, via the website and in other ways, underlines the gains to be made from increasing networking between disciplines. A key message has also been the desire for educators to talk within each. Far-reaching change to the curriculum within a subject area can place significant demands on educators' time and energy, reducing that available for inter-disciplinary initiatives and exchange. The mhhe project has both engaged with, and linked educators to single discipline organizations, including the Association of University Teachers in Psychiatry.

In the face of a raft of recent policy and practice developments in mental health, it is timely to consider how the learning of students and practitioners can be enhanced. The experience of the mhhe project has shown that inter-disciplinary exchange can bolster and disseminate effective practice and support change.

Given limitations as to what can be achieved in a one year project, identification of ongoing funding was a key priority in the latter stages of this work.

The mhhe project has been welcomed by many external regional and national bodies (e.g. the National Institute for Mental Health in England, Workforce Development Confederations, Sainsbury Centre for Mental Health etc) providing, for the first time, a means for policy makers and others to dialogue with mental health educators in other than an ad hoc way. The context for this is of course the increasing imperative for MH services to be integrated and provided collaboratively in practice across health and social care.

We enter the next phase of the project's work with three year funding from the Department of Health to develop a more systematic network of mental health educators in England. Further development work in Wales, Scotland and Northern Ireland is anticipated to ensure that the UK focus of this work is maintained. A regular e-bulletin will be produced and a series of regional networking events is planned. Links with developments around e-learning initiatives in mental health are anticipated. We are keen to increase the involvement of medical educators in this next phase. Please contact the Senior Project Development Officer if you would like to be added to the project's mailing list or to suggest priority areas for future work.

Workshop one: Paying more than lip service

The importance of user and carer involvement in mental health education is acknowledged across all disciplines (for interesting examples from undergraduate medical education, see the recent article by Livingston & Cooper in Advances in Psychiatric Treatment).

This event, attended by 60 participants, provided an opportunity for the cross-fertilisation of ideas.

The use of service users trained as role players in medical training was, for example, of particular interest to educators from other disciplines (an idea being worked through in a current ltsn-01 funded mini-project - see below).

A good practice guide on this topic, co-sponsored by NIMHE, will be published in the autumn.

Workshop Two: Nobody knows as much as everybody

Edinburgh for the second mhhe workshop in November 2003.

The focus of this event was to share perspectives on how we learn and teach about mental health.

It was co-sponsored by the National Resource Centre for Ethnic Minority Health, part of NHS Scotland.

Examples were given of how students can be helped to develop a broad and holistic understanding of mental health problems and wellbeing.

Workshop Three: Starting small and thinking big

Interprofessional education about mental health, took place in Bristol in January 2004, attended by 85 people.

Findings were presented from the TRIPLE project, a parallel collaborative project on interprofessional education in which ltsn-01 has been an active partner.

A key note presentation by Bill Fulford introduced the concept of "values-based practice" which has important implications for the training of medical students and those from other disciplines (see www.scmh.org.uk for details of a forthcoming event in this area).

Brian Lunn's case study, on the mhhe website www.mhhe.ltsn.ac.uk/casestudies/casestudy2.asp is an interesting example of an interprofessional initiative involving medical and nursing students at pre-registration level.

Useful links

1. The Association of University Teachers of Psychiatry. http://www.rcpsych.ac.uk
2. Psychosis revisited - a module on psychosis http://www.salomonscentre.org.uk/caspd/consultancy/psychosis.htm
3. Essential Shared Capabilities for Mental Health. An update on this work available in Workforce 3, downloadable from the workforce stream section of the NIMHE website: http://www.nimhe.org.uk
4. Developing mental health user input into medical student learning: an ltsn-01 funded mini project. http://www.medev.ac.uk/resources/funded_projects/show_project?reference_number=394