ERIC EJ1146632: Informing Scotland's Mental Health Strategy from the Classroom Context

2014·0.12 MB·English

by  ERIC

Informing Scotland’s mental health
strategy from the classroom context
Dannette Marie, Brittany M. Christian, Joanne Lumsden &
Lynden K. Miles
Although conventional psychology is often characterised as the science of the individual mind, it is also
important to introduce students to the potential interdisciplinary and multi-dimensional nature of psychology.
In this paper we outline the design, development, and delivery of an innovative course that employed an
ecological framework to engage students in mental health issues and policy via the teaching of a course on the
basic elements of qualitative inquiry. Students received two lectures on qualitative methodology and methods
and then participated in a set of practical-based activities that involved examining mental health themes and
undertaking semi-structured interviews. The information gleaned from the students’ interviews was collated
and formed the basis of a formal submission to Scotland’s National Mental Health Strategy 2011–2015.
In this way the present approach encouraged students to consider the multiple levels of analysis that can be
employed when researching mental health issues, fostered active citizenship through their participation in a
democratic process, and drew a clear connection between psychological research and mental health policy.
Keywords: Global mental health; mental health policy; ecological framework; active citizenship; qualitative
inquiry.
W
ITH AN ESTIMATED 450 million call for submissions on the development of
people worldwide believed to the Mental Health Strategy in Scotland
have experienced a psychological 2011–2015, as an opportunistic vehicle to
problem, mental health is increasingly being design and develop a learning experience
recognised as a global issue (Mental Health whereby students would approach the topic
Foundation, 2007; Patel & Prince, 2010). of mental health by considering multiple
Along with the international challenges levels of analysis. Additionally, students
germane to the mental health field such as would be introduced to the potential inter-
an absence of cures and the unequal distri- disciplinary nature of psychology along with
bution of treatments (i.e. ‘the treatment basic elements of qualitative research design.
gap’), there are also specific challenges of With these objectives in mind, we designed a
particular significance to individual nations course that allowed students to gain knowl-
(Collins et al., 2011). According to recent edge of global and local mental health
statistics, the UK has one of the highest rates issues. By producing a student contribution
of self-harm in Europe1 and, when to a national submission on the direction of
comparing the four home nations, Scotland mental health service delivery in Scotland,
has the highest suicidal rate in the UK2. we also actively promoted tertiary student
In this article we report details of an participation in democratic processes. In the
innovative short course developed to intro- remainder of this paper we outline the main
duce mental health issues to advanced aims that influenced the course design, the
undergraduate psychology students using an ecological framework from within which the
ecological framework (Bronfenbrenner, course was structured, the course content,
1994). We utilised the Scottish Government’s and feedback. We then discuss the
1 400 per 100,000 population (Mental Health Foundation, 2007).
2 20 per 100,000 population (Mental Health Foundation, 2007).
PPssyycchhoollooggyy TTeeaacchhiinngg RReevviieeww VVooll.. 2200 NNoo. 22,, WWiinntteerr 22001144 113377
© The British Psychological Society
ADuanthnoertte Marie, Brittany M. Christian, Joanne Lumsden & Lynden K. Miles
challenges and constraints involved in the examined (i.e. mental illness) was contextu-
course’s development and provide sugges- alised using a multi-level framework (see
tions as to how the features of this course Table 1).
could be adapted to other contexts.
Course structure: A multi-level
Course design and development ecological framework
considerations The course was structured around six
To engage and capture students’ interests in distinct but interdependent levels of analysis
mental health we identified four subject- (see Table 1). At the international level, the
related aims around which the course was issue of global mental health (involving
structured. These four aims were as follows: mental, neurological, and substance-use
1. To improve students’ understanding of (MNS) disorders) was introduced to
global and local mental health issues; students through the requirement that they
2. To introduce students to the inter- read a selected paper (i.e. Collins et al.,
disciplinary potential of psychology by 2011) on the topic from the leading scien-
highlighting the contribution of other tific journal Nature. The instructors inten-
disciplines to inform on global and tionally selected this paper as it provided
mental health issues (e.g. psychiatric up-to-date information on global mental
epidemiology); health, included supplementary materials
3. To introduce students to the applied and and links on the topic, and invited students
professional nature of psychology by to consider mental health from an interdis-
making explicit, potential links between ciplinary perspective.
qualitative research skills and government- At the national level, a web-link was made
level policy development; and available to the key document Mental Health
4. To promote student participation in Strategy for Scotland 2011–2015: A Consultation
democratic processes by encouraging (2011) (henceforth Mental Health Strategy)
student receptivity to the attribute ‘active around which this course was designed and
citizenship’. developed. A second and related considera-
We aimed to enhance students’ awareness of tion at the national level involved the
these issues via their engagement in, and instructors’ awareness of subject bench-
contribution to, a national submission on marks for psychology. In the UK, subject
the direction of mental health service benchmarks are used for a variety of
delivery in Scotland. This latter focus was purposes, but mainly they are an important
particularly prudent given that the onset of external source of reference for higher
mental health problems often emerges education institutions when new pro-
during adolescence and young adulthood grammes are being developed (Quality
(Kessler et al., 2007), yet it is this cohort that Assurance Agency (QAA), 2010). They
is least likely to be civically engaged in demo- support programme (and in this context –
cratic processes when compared to other age course) design, delivery, and review. For
groups (Henn & Foard, 2012; Jones, 2013). psychology, these benchmarks are closely
Together, these subject-related aims were linked to the British Psychological Society’s
used to structure a course that enabled (BPS) requirements for programme accredi-
students to develop insight and under- tation and the graduate basis for registration
standing of both global and local mental (BPS, 2013). As an underlying objective of
health issues while gaining practical experi- this course was to introduce students to basic
ence using qualitative methodology. Impor- elements of qualitative research, we ensured
tantly, and consistent with an ecological that the course met the requirements of
perspective of human behaviour (Bronfen- both QAA and BPS.
brenner, 1994), the real world phenomenon
138 Psychology Teaching Review Vol. 20 No. 2, Winter 2014
Informing Scotland’s mental health strategy from the classroom conTtietxlet
As aforementioned, active citizenship was ment. Finally, specific attention was directed
an attribute that we were interested in to the group/individual level when
enhancing through student engagement of designing this course as it was duly recog-
this learning experience. This attribute was nised that the issue of mental health may be
selected from an institutional framework a sensitive topic for some individuals espe-
promoted by the University of Aberdeen, cially when completion of this course
which outlines a set of qualities that students required active participation with peers to
can develop in preparation for employment, discuss the topic.
further study, and citizenship. Active citizen-
ship involves an awareness and appreciation Course content and delivery
of ethical and moral issues including social One-hundred-and-four students (aged 19 to
and cultural diversity; an understanding of 42 years, 79 females) from the School of
social and civic responsibilities including the Psychology, University of Aberdeen, took part
rights of individuals and groups; appreciation in the practical exercises after attending two
of the concepts of enterprise and leadership lectures on the nature of qualitative method-
in all aspects of life; and finally, a readiness for ology and methods in Psychology (delivered
citizenship in a civilised and inclusive society. by the first author). These lectures intro-
These elements can be explicitly linked to the duced students to the broad philosophy
global mental health issues and challenges underpinning qualitative methodology and
described by Collins and colleagues (2011). the diversity of methods available to
For example, one of the main challenges researchers. In addition, the innate subjec-
outlined in their paper involves raising aware- tivity of qualitative inquiry and the role it
ness of the global burden of mental, neuro- plays in understanding human experience
logical, and substance-use disorders, whilst was emphasised. The practicals formed a
another involves the transforming of health minor component (i.e. a two-week course) of
systems and policy responses (Collins et al., a 12-week junior honours (i.e. year three of a
2011, p.29). four-year undergraduate degree in
At the discipline level, we were princi- Psychology) methodology course where the
pally interested in introducing students to main emphasis was on teaching quantitative
the interdisciplinary nature of psychological statistics. There were five practical groups
inquiry. In addition, students were exposed each of which comprised approximately 20 to
to the opportunities a qualitative approach 25 students. The cohort was very interna-
affords the researcher both in terms of tional with students from 29 nations repre-
broadening the scope of investigation as well sented. Approximately one-third (N=34) of
as the potential to inform policy develop- the class reported being Scottish.
Table 1: Designing the learning experience: An ecological framework.
International l Global mental health challenges (Collins et al., 2011)
National l Consultation on the Mental Health Strategy for Scotland 2011–2015
l Quality Assurance Agency (2010): Psychology subject benchmarks:
knowledge domains
Institutional l University of Aberdeen Graduate Attributes with a focus on the
‘Active Citizenship’ element (see: http://www.abdn.ac.uk/graduateattributes)
Discipline l Psychology
Sub-discipline l Methodology and methods
Group/Individual l Mental health
Psychology Teaching Review Vol. 20 No. 2, Winter 2014 139
ADuanthnoertte Marie, Brittany M. Christian, Joanne Lumsden & Lynden K. Miles
Following discussion with the chair- related to each of the themes. For example,
person of the School of Psychology’s ethics Theme 2 was ‘Eliminating stigma of mental
committee, it was decided that obtaining illness and ill-health and discrimination’and the
ethical approval from students participating corresponding question targeting this
in the practicals wasn’t necessary as the tasks specific theme was What further action can we
constituted a learning activity that was a take to continue to reduce stigma of mental illness
component of the regular curriculum. The and ill-health to reduce discrimination? These
students who took part in these activities questions were selected by the first author
were informed of this, and it was made clear based on her expertise in the area of mental
that their responses would be anonymised. health. The central questions are repro-
Moreover, on completion of the qualitative duced in Table 2. The main criterion used in
section of the course, a guided discussion selecting the most appropriate themes and
was undertaken that focused on any poten- questions was their potential relevancy to a
tial theoretical, methodological, and ethical Level 3 cohort studying psychology. As
issues related to student participation in described in the previous section, the class
these practicals. was split into five groups; therefore, each
The course comprised four practical group was allocated two central questions.
sessions run over a two-week period. Minor changes to the wording of some of the
Students were informed that mental health central questions was undertaken in order to
had been described by the Scottish Govern- improve the relevance of the question to the
ment as a significant national priority and students participating in this exercise.
were introduced to the Mental Health Each group was allocated two of the 10
Strategy consultation document. Students questions. Within each group, half of the
were also informed that the Scottish Minister students were given the group’s first question
for Public Health Michael Matheson had whereas the other half were given the second
encouraged members of the public to take question. As such, each individual was allo-
part in a consultation process to shape and cated a single question and could later be
improve the mental health and well-being of paired with an individual who had been allo-
people in Scotland over the following four cated a different question in order to
years. Four learning objectives were outlined conduct unique interviews. Resources were
and the main outcome of the learning expe- provided to all students and these comprised:
rience described. The learning objectives a handout detailing the aims of the practical
included: (1) exploring mental health sessions and task requirements; a web-link to
themes; (2) developing a semi-structured the consultation document; the article by
interview schedule; (3) developing interview Collins et al. (2011) on global mental health;
skills; and (4) transcribing an interview and Scottish Government publications pertaining
reflecting on the nature of qualitative to mental health policy, mental health initia-
inquiry. The main outcome was that the tives, and best practice guidelines; mental
work undertaken by students would be health promotion and service provider publi-
submitted to the consultation process as a cations; and a transcription method
group submission. We now outline each of (Jefferson, 2004). All of the practicals were
the practical sessions in more detail. undertaken in a laboratory setting with every
The Mental Health Strategy document student having access to a computer and
contained 19 broad themes and under each internet connection.
of these themes there were a number of
different questions, on which the Scottish Practical content
Government solicited input. Ten of the 19 Students were instructed on the require-
themes were selected for these practical ments for each of the four practicals. Prac-
sessions, as was a central question directly tical one required each student to
140 Psychology Teaching Review Vol. 20 No. 2, Winter 2014
Informing Scotland’s mental health strategy from the classroom conTtietxlet
Table 2: 10 central questions from the Mental Health Strategy consultation document.
1. Are there other actions we should be taking nationally to reduce self-harm and suicide?
2. What further action can we take to continue to reduce the stigma of mental illness and
ill-health to reduce discrimination?
3. What other actions should we be taking to support promotion of mental well-being for
individuals and within communities?
4. What approaches do we need to encourage people to seek help when they need to?
5. What do we need to do to identify mental illness and disorder as early as possible and
ensure quick access to treatment?
6. How can we build up a national picture of what works to deliver better mental health
outcomes?
7. How could person-centred care better meet the needs of young people or individuals with
diverse needs?
8. What should the national priorities for mental health services targeting young people be?
9. How can we ensure that there is adequate provision of psychological therapies targeting
young people?
10. How do we guarantee that care and treatment targeting young people is delivered
in line with legislative requirements?
independently research their specific tical. The interview schedule had to contain
question by using the online resources the central question along with the student’s
provided or any additional resources three to four additional questions. Precau-
including search engines of their choice. tions were taken to ensure that students did
Instructors informed students that the focus not include any personal questions that
of their review was to be on young people or might lead an interviewee to self-disclose
their own cohort. Students were instructed issues of a private nature including having a
to formally document their search strategy mental illness. Students were, therefore,
and summarise any findings from their explicitly instructed to avoid questions of a
review. During practical two, students were personal nature and provided with examples
provided with detailed information about of what these might be. Additionally,
interview techniques and how to develop an students’ interview schedules were reviewed
interview schedule using a five-step process by the practical instructors prior to conduct-
refined from the broader exposition on the ing interviews.
task outlined by Hugh-Jones (2010). After Practical three involved each student
this instruction, students were given the interviewing a peer (in the same group, but
remainder of the practical session to develop focusing on a different question) and also
a semi-structured interview schedule based being interviewed. Students were informed
on the findings of their literature search that before the interview commenced they
from practical one. More specifically, were to record their interviewee’s details
students were required to develop three to using a code that would protect the identity
four open-ended questions related to the of each of the students and asked to make
central question associated with their theme detailed notes as a record of the interview.
that they could use to conduct a 15- to The final practical involved students
20-minute interview during the third prac- accessing the web-link to the Jefferson
Psychology Teaching Review Vol. 20 No. 2, Winter 2014 141
ADuanthnoertte Marie, Brittany M. Christian, Joanne Lumsden & Lynden K. Miles
(2004) transcription method and writing up Theme 1: Are there other actions we should
their notes from the interview they had be taking nationally to reduce self-harm and
conducted. After students had completed suicide rates?
their transcriptions and corrected any errors Programmes that are available to everyone should
they were instructed to upload their word be made more public, especially throughout schools
document file to their group’s secure Black- and colleges as these are the age groups that are
board online folder. As a group, students most at risk, and the group likely to have the least
were then debriefed using a guided discus- knowledge on programmes set up to help.
sion format. They were asked to consider the Charities possibly going around secondary
link between psychological science and schools and giving talks or workshops on the topic
mental health policy development, the value may be a good idea, or possibly drop-in sessions for
of qualitative inquiry to contribute to global students to talk about their feelings on the subject
and local consultation processes, and the would also be useful.
relevancy of the Scottish Government Female, 20, Belgium
reading the views of students about the
mental health themes. They were also asked Theme 4: What other actions should we be
to consider whether there were any ethical taking to support promotion of mental
issues involved in the practicals and to well-being for individuals and within commu-
provide constructive comments about the nities?
classes. Start young – teach kids about how to look after
themselves. Schools could also have after-school
Mental Health Strategy submission and clubs to get kids away from the streets, up to no
student feedback good.
The formal submission document was Female, 21, Scotland
prepared by the instructors. All of the
students’ files were downloaded and cata- I think ‘lunch and learn’ sessions would be best.
logued according to the core themes. Each Offering a free lunch with a guest speaker such as
transcribed interview was proof-read and psychologists and people with experience of mental
where required minor editing was under- health.
taken to improve readability. No changes Male, 21, Scotland
were made that altered the meaning of
responses. Each response was tagged with Theme 9: What approaches do we need to
the sex, age, and country of origin of the encourage people to seek help when they
respondent. The document comprised need to?
eighty-five unique responses (not all of the This may be overcome with advertisements which
students who participated in the practicals show that mental problems are nothing to be
uploaded their files or did so correctly). The ashamed of, that other people suffer with them and
final document along with a cover letter and that it’s ok to seek help. Possibly also the conse-
information on methodology was submitted quences of not receiving help.
to the Scottish Government Health Direc- Male, 21, United Kingdom
torate as a formal submission to their
Consultation on the Mental Health Strategy As part of the debriefing session, students
of Scotland 2011–2015. We provide exam- were also asked for their feedback on the
ples of three of the 10 specific themes that course. Overall, the feedback was largely
students researched along with a sample of positive with students commending the
their responses. organised structure of the course and the
value of being able to actively engage in the
topic of mental health. Students found the
course highly relevant and applicable to
142 Psychology Teaching Review Vol. 20 No. 2, Winter 2014
Informing Scotland’s mental health strategy from the classroom conTtietxlet
their interests in mental health and al., 2003). To this end, the programme
psychology in general. One student did chal- outlined by Bosio and Graffigna (2012)
lenge the relevance of learning basic aimed at training professional qualitative
elements of qualitative research in researchers, shares similar design features
psychology, but this wasn’t particularly and pedagogical principles with the present
surprising as qualitative methods in the framework. That is, a framework charac-
school’s methodology courses are only mini- terised as being flexible, problem-oriented,
mally represented. It is worth noting, highly applicable, and pragmatically oriented
however, that the students did express a with respect to psychological inquiry.
desire for greater exposure to courses such By providing a forum for students to
as the one presented here, which reinforces engage with deeply relevant topics on
the need to more thoroughly integrate these mental health from both an inquisitive (i.e.
skills and techniques into the curriculum. interviewer) and self-reflective (i.e. inter-
Students highlighted the collaborative viewee) perspective, we were able to chal-
nature of the interviewing tasks as being lenge students to think critically about these
particularly relevant, especially for those who issues and how they could be addressed at
were anticipating going on to undertake individual, institutional, national, and inter-
future postgraduate studies. Although a national levels. Additionally, the practical
formal evaluation was beyond the scope of curriculum as designed, developed, and
this exercise, future work should look to delivered provided an opportunity for
implement a more rigorous appraisal to students to express their ideas and concerns
determine the efficacy of this novel about the role of government policy as it
approach. relates to mental health. In doing so, the
course also facilitated and encouraged active
Discussion citizenship thereby giving a voice to a largely
Through developing this innovative course, under-represented, yet highly relevant
we sought to create an interactive learning cohort with respect to mental health issues
environment that provided students with a and public policy. We believe this framework
hands-on approach to examine global and could easily be adapted to other sub-fields of
local mental health issues. In addition, we psychology, which also have the opportunity
fostered active citizenship by producing a to contribute to public policy formulations
student submission to Scotland’s consulta- including, but not limited to, educational,
tion on the direction of mental health forensic, and social psychology. Calls by
delivery. We suggest that the ecological governmental ministries for public submis-
framework we developed in order to achieve sions to critical areas such as education,
the course’s aims focused on the progression criminal justice, social justice as well as
from knowledge acquisition to applied mental health are made routinely and we
inquiry and illustrated how psychology (and believe these calls offer an excellent vehicle
undergraduate students) can actively to develop innovative courses linking
contribute to real-world change (Halonen et research inquiry to political literacy.
Psychology Teaching Review Vol. 20 No. 2, Winter 2014 143
ADuanthnoertte Marie, Brittany M. Christian, Joanne Lumsden & Lynden K. Miles
The Authors Correspondence
Dannette Marie Dr Dannette Marie
School of Psychology, School of Psychology,
University of Aberdeen, Scotland. University of Aberdeen,
Brittany M. Christian William Guild Building,
Booth School of Business, Aberdeen AB24 3UB,
University of Chicago, USA. Scotland.
Joanne Lumsden Email: [email protected]
School of Psychology,
University of Aberdeen, Scotland
Lynden K. Miles
School of Psychology,
University of Aberdeen, Scotland.
References
Bosio, A.C. & Graffigna, G. (2012). ‘Issue-based Jefferson, G. (2004). Glossary of transcript symbols
research’ and ‘process methodology’: Reflections with an introduction. In G. Lerner (Ed.),
on a postgraduate Master’s programme in Conversation analysis: Studies from the first generation
qualitative methods. Psychology Learning and (pp.13–31). Amsterdam: John Benjamins.
Teaching, 11, 52–59. Jones, P.B. (2013). Adult mental health disorders and
British Psychological Society (BPS) (2013). their age at onset. The British Journal of Psychiatry,
Accreditation through partnership handbook. Guidance 202, s5–s10.
for undergraduate and conversion programmes in Kessler, R.C., Amminger, G.P., Aguilar-Gaxiola, S.,
psychology.Leicester: BPS. Alonso, J., Lee, S. & Ustun, T.B. (2007). Age of
Bronfenbrenner, U. (1994). Ecological models of onset of mental disorders: A review of recent
human development. International Encyclopaedia of literature. Current Opinions in Psychiatry, 20,
Education, Vol. 3 (2nd ed., pp.1643–1647). 359–364.
Oxford, England: Elsevier Sciences Ltd. Mental Health Foundation (2007). The fundamental
Collins, P.Y., Patel, V., Joestl, S.S. et al. (2011). Grand facts. The latest facts and figures on mental health.
challenges in global mental health. Nature, 475, UK: Mental Health Foundation.
27–30. Patel, V. & Prince, M. (2010). Global mental health.
Halonen, J.S., Bosack, T., Clay, S., McCarthy, M. (with A new global health field comes of age. JAMA,
Dunn, D.S., Hill IV, G.W., McEntarffer, R., 303, 1976–1977.
Mehrotra, C., Nesmith, R., Weaver, K.A. & The Quality Assurance Agency for Higher Education
Whitlock, K.) (2003). A rubric for learning, (2010). Subject benchmark statement: Psychology
teaching, and assessing scientific enquiry in (3rd ed.). Gloucester: The Quality Assurance
psychology. Teaching of Psychology, 30, 196–208. Agency for Higher Education.
Henn, M. & Foard, N. (2012). Young people, political The Scottish Government (2011). Mental Health
participation, and trust in Britain.Parliamentary Strategy for Scotland 2011–2015: A consultation.
Affairs, 65, 47–67. Edinburgh: The Scottish Government.
Hugh-Jones, S. (2010). The interview in qualitative http://www.scotland.gov.uk/Publications/
research. In M. Forrester (Ed.), Doing qualitative 2011/09/01163037/0
research in psychology(pp.77–97). Los Angeles: Sage.
144 Psychology Teaching Review Vol. 20 No. 2, Winter 2014