ERIC EJ891113: Mental Health Issues and Higher Education Psychology Teaching

2010·0.06 MB·English

by  ERIC

Mental health issues and higher
education psychology teaching
Naomi Craig
This paper focuses on widening participation and accessibility in relation to mental health issues and
undergraduate psychology students. Sections 1 and 2 set the context and outline the scope and aims of this
paper. Section 3 presents evidence of the student experience from the Improving Provisions for Disabled
Psychology Students (IPDPS) project. Students in this project all had some form of disability as defined by
the DDA (2005). Section 4 provides examples of ways in which learning and teaching about mental health
can be designed from an inclusive and accessible perspective. These examples are drawn from work done by
the Mental Health in Higher Education (mhhe) project in conjunction with the Psychology Network.
Finally, Section 5 notes that research into other minority groups studying psychology reflects very similar
findings to those reported about mental health and psychology teaching and learning, and also highlights
the need for further research into these areas.
Section 1. Context and language be considered a disability (Beresford, 2000).
W
IDENING PARTICIPATION is This paper does not attempt to enter that
defined by the Higher Education debate. Rather, it simply uses the data gained
Funding Council for England to focus on mental health as a widening
(HEFCE) as ‘policy initiatives to target the participation issue in relation to psychology
individual groups that higher education learning and teaching.
institutions (HEIs) have identified as under- Language around disability has also
represented and to ensure their success’ evolved over the past decade or so. The
(Lewis, 2002). Identified under-represented terminology of the social model of disability
groups include disabled, international and (Oliver, 1981) is now widely accepted, in
mature students, as well as Black and which people have ‘impairments’ such as
Minority Ethnic communities and sexual deafness, dyslexia, etc., and ‘disability’ is the
minority groups. outcome of the interaction between a person
In addition to the introduction of with an impairment and the environmental
widening participation policies, disability and attitudinal barriers they may face (Davis,
legislation has changed dramatically over the 1996). The social model is thereby an
past 10 years, with the introduction in 1995 explicit attempt to move away from the
of the Disability Discrimination Act (DDA) medical model of disability, in which
(updated in 2005). The law now protects disability is a ‘problem’ that belongs to the
people with a long-term health condition disabled person.
against discrimination and unfair treatment Within this paper the term ‘disabled
in almost every aspect of college and univer- student’ is still sometimes used, because the
sity life. This includes students, staff and Improving Provisions for Disabled
others who use the services and facilities of Psychology Students (IPDPS) project (see
the institution. Section 2 below) used this term. However,
The data in this paper have been the preferred term is now ‘students with
collected from students with declared disabilities’, and is used within this paper
disabilities which included students with wherever possible. Similarly, the preferred
mental health issues. There is debate around term is now ‘mental health issues’ as
whether or not mental health issues should opposed to ‘mental health difficulties’,
16 Psychology Teaching Review Vol. 16 No. 1
© The British Psychological Society 2010
Mental health issues and higher education psychology teaching
to reflect a move towards the recognition Section 2. The aims and structure of
that some atypical mental health experi- this paper
ences can be positive as well as negative. Accessible and inclusive teaching and
Throughout this paper the term ‘mental learning, therefore, have relevance to
health issues’ is, therefore, used as an alter- disabled and non-disabled students. This
native to ‘mental health impairments’ and paper focuses on accessibility issues relating
‘mental health difficulties’. Finally, within to mental health issues and psychology
higher education more generally, two new learning and teaching and, in particular, on
and interchangeable terms are now used the teaching of mental health issues to under-
extensively when referring to learning and graduate psychology students – with a special
teaching policies designed to support focus on ways to reduce the barriers encoun-
widening participation: accessibility and tered by students with mental health issues by
inclusion. making material and teaching more relevant
Accessibility in higher education institu- to them, and consequently giving all students
tions is not just about physical access: it is greater understanding of the social obstacles
also about an institution’s public informa- faced by those with mental health issues.
tion, selection and admission procedures, Mental health is a particularly relevant
learning and teaching, examination and widening participation issue because mental
assessment methods and materials, as well as health issues are typically less visible than
its central facilities, staff development physical impairments. This can mean that it
programmes and quality assurance is easier for students to ‘hide’ their mental
processes, all of which should demonstrate health issues than it is for them to hide a
that they can best meet the needs of an physical impairment. Students can also be
increasingly diverse student population. less willing to disclose information about
Within teaching and learning, ‘accessibil- their mental health to the higher education
ity’ and ‘inclusion’ are both used in the institution. Moreover, mental health issues
context of enabling someone to have full are reported as increasing in both the
access to the whole higher education student and the general population (Craig &
curriculum – not just obtaining materials Zinkiewicz, 2010), and a higher percentage
and information in accessible forms, but of psychology students than those in other
being able to use these in a meaningful way. subjects now declare mental health issues
This covers every aspect of a course, as (Craig & Zinkiewicz, 2010; see Section 3
summarised by Simpson (2008): ‘Can any below).
student with any type of disability (or what- The apparent growth and relative ‘invisi-
ever background or culture) understand bility’ of mental health issues, therefore,
what is taught, understand what coursework makes these issues and the teaching of these
is looking for, and what learning outcomes issues even more important for widening
an examination is seeking evidence of?’ participation: the needs of students with
Consideration of the impact of teaching mental health issues will need to be taken
activities on diverse student groups will into account across the entire psychology
reduce the number of barriers students programme, and students who do not have
encounter, and it is important to recognise mental health issues will need to learn to be
that ‘non-scholarly’ expectations and the open and non-judgemental about mental
ability to live up to these are as much a part health issues and about people who do have
of the ‘teaching activities’ as delivering a such issues, both within and outside a
lecture that fulfils its learning outcomes, University environment.
especially for marginalised and minority The following section presents evidence
groups. about the disabled student experience from
the Improving Provisions for Disabled
Psychology Teaching Review Vol. 16 No. 1 17
Naomi Craig
Psychology Students (IPDPS) project, funded no exception. In fact, some disabled students
by The Higher Education Funding Council may find elements of the psychology
for England and the Department for Educa- curriculum particularly relevant to their life
tion and Learning in Northern Ireland, as experiences – for example, sensation and
part of their 2003–2005 Improving Provision perception, health psychology, neuropsy-
for Disabled Students Strand 2 funding chology, clinical psychology, cognitive
scheme (Craig & Zinkiewicz, 2010). This psychology, social psychology and develop-
project collected evidence from surveys and mental psychology all cover material related
interviews with past and present disabled to the impairments and medical conditions
psychology students (N=113), disabled experienced by students with a range of
psychology staff (N=8), and institutional disabilities. Moreover, the Improving Provi-
disability staff (N=42). sion for Disabled Psychology Students
Section 4 provides examples of ways in (IPDPS) report provides evidence that some
which to design teaching about mental health students choose to study psychology
from an inclusive and accessible perspective. precisely because they have a physical
These examples are drawn from the work of disability, learning difficulty or mental
the Mental Health in Higher Education health issue and are eager to learn more
project (mhhe). The mhhe project aims to about it (Craig & Zinkiewicz, 2010).
enhance learning and teaching about mental The relevance of the psychology
health through increasing networking and curriculum to personal circumstance has
the sharing of approaches across the varying consequences for disabled students.
disciplines in UK higher education In some cases students report being more
(www.mhhe.heacademy.ac.uk). It is a partner- motivated to study the subject, or to gain a
ship between five subject centres of the greater insight into what is studied.
Higher Education Academy, including the ‘I think that my mental health problems give
Psychology Network (www.psychology. me some insight into clinical psychology; and
heacademy.ac.uk/). Together, mhhe and the my former visual impairment gave me an
Psychology Network have supported work insight into visual processing/perception.’
around new approaches to teaching mental (Student with mental health issues)
health in undergraduate psychology, resulting ‘With hindsight my disability has given me an
in a series of case studies and publications enhanced understanding of prejudice and
(Cromby, Harper & Reavey, 2008; Harper et individual difference which has enhanced my
al., 2007). psychological understanding and made me
critical of mainstream psychology.’ (Student
Section 3. The student experience with a specific learning difficulty)
Participation by students with disabilities in Some students may actually seek to study
higher education has increased from 4.8 per psychology to learn more about their impair-
cent in 1998/99 to 6.5 per cent in 2007/08. ment and in some cases this will help them
In psychology, 2.1 per cent of psychology cope with it better. This may be a factor
students declared a disability in 1998/99, contributing to the slightly greater propor-
and this increased to 8.8 per cent in 2007/08 tion of students with disclosed mental health
(Source: Higher Education Statistics issues amongst psychology undergraduates,
Agency). in comparison to undergraduate students as
Given the range of topics covered in a whole (though other factors may be oper-
psychology courses, and that the focus of ating). In 2007/2008 0.4 per cent of all HE
such courses is human behaviour in all its first-degree students declared a mental
variety, it is unsurprising that students may health issue; in psychology 0.9 per cent
find the content of a psychology course to be declared a mental health issue (Source:
relevant to themselves. Disabled students are HESA).
18 Psychology Teaching Review Vol. 16 No. 1
Mental health issues and higher education psychology teaching
Such experiences and feelings are mistakenly expect that most psychology
acknowledged by some of the disabled academic staff will have clinical experience
psychology students who were surveyed as and that they will, therefore, be sensitive and
part of the IPDPS project: empathic, have highly developed skills in
‘I wanted to find out more about my disability communication and counselling, and gener-
by studying psychology.’ (Disabled ally be more supportive than academics in
psychology student) other disciplines. As one student put it:
‘I thought it would help me deal with and solve ‘I expected that psychology staff would have a
my mental problems … I hoped it [my deeper understanding of issues such as chronic
impairment] would motivate me but feared it pain, frustration and the needs of an
would stop me from studying.’(Student with individual to be included.’ (Student with
mental health issues) multiple sclerosis)
Increased knowledge may come with some Even where students know that most
costs. Learning about one’s impairment can psychology academics are research- rather
be painful for students. As one staff member than clinically-focused, they still may expect
put it: psychology staff to apply the relevant knowl-
‘Psychology attracts more students with mental edge they have to their own practice:
health problems than other disciplines. ‘They are scientists, but don’t appreciate the
Students think this will help but in fact they knowledge they have that explains my
tend to feel worse.’(Psychology academic) behaviour, and how they can help. A lecturer
Some students find the new knowledge can that specialises in reading, and in dyslexia
trigger negative feelings or memories, while and reading, doesn’t apply what she teaches
others find the contrast between what is when she knows she has students that match
taught and their own life experience prob- the case studies that she presents. It’s very
lematic, particularly when teaching staff frustrating.’ (Student with specific
over-simplify a complex reality: learning difficulties)
‘There are some aspects of the course that I find Such beliefs and expectations may lead
irritating: in a module on Personality, for disabled psychology students to have higher
example, the suggestion that cancer (such a expectations of psychology academics than
generalisation) can, in some cases, be those in other teaching disciplines, resulting
attributed to personality traits seems very in students being more disappointed if they
simplistic. (This was the cause of my receive inadequate support from psychology
disability).’ (Student who uses a staff than from other staff. As one student
wheelchair or has mobility problems) put it:
‘Some subjects, like study of repressed memories ‘None of my expectations were met regarding
and social psychology, has made me feel more my disability in this department. [Psychology
depressed and made me focus on my own staff were] not as aware or considerate as
problems and made me feel more hopeless and I would have expected.’ (Student with
helpless.’ (Student with mental health specific learning difficulties)
issues) This possibility is recognised by some institu-
Many psychology students, whether disabled tional disability support staff, with 30 per
or not, perceive (perhaps on the basis of cent of such staff surveyed by the IPDPS
mass media representations) that psychology project stating that they felt disabled
is purely a professional discipline, focusing students entering psychology programmes
on treating people with psychological had higher expectations of psychology staff
impairments of various sorts, rather than than did students of staff in other disciplines.
being both an academic and research disci- Disabled students may also be attracted
pline as well as a profession. Given this to psychology as a career as a result of their
belief, disabled psychology students may experience with health and social services.
Psychology Teaching Review Vol. 16 No. 1 19
Naomi Craig
Such experiences may give them a desire to teaching and learning activities for students
‘give something back’ to the community, or with mental health issues. The following
to use their insight and knowledge gained by section provides examples of such learning
experience to improve such services. This and teaching that have been collated by the
may be particularly the case in relation to mhhe project.
mental health issues. As students put it:
‘I thought my own life experiences would help Section 4. Inclusive and accessible
me be empathic and understand others’ distress teaching about mental health
so I wanted to pursue the clinical route.’ Traditionally, many undergraduate psycho-
(Student with mental health issues) logy courses presented mental health issues
‘My struggles with a long-term illness, the from a medical perspective, using the Diag-
medical establishment, medication side effects, nostic and Statistical Manual of Mental Disorders
bad management by the course and my (DSM-IV) terminology. The term ‘abnormal
employers have all proved very valuable in psychology’ was frequently used as a course
understanding my clients’ difficulties with title and indeed many textbooks still use this
mental health.’ (Postgraduate student with term in their titles. However, this term is
chronic, fluctuating medical condition) seen as increasingly problematic (Cromby,
In 2002/2003, 5.2 per cent of psychology Harper & Reavey, 2008), particularly for
students who declared a disability declared students with mental health issues as
mental health issues. In 2007/2008, this ‘abnormal psychology’ can be interpreted –
figure was 10.6 per cent (Source: HESA). by their fellow students and by the students
It is important to be aware of the difficul- themselves – to mean that their impairment
ties that can arise for students when learning renders them ‘abnormal’ human beings,
about certain areas of psychology, particu- rather than, say, ‘atypical’ (Conner-Greene,
larly those parts that deal with clinical and 2001; Harper et al., 2007).
mental health issues. Many topics and areas Ensuring that students have a rich under-
within psychology have very personal aspects standing of mental health issues led Paula
or associations that can be distressing for Reavey (date unknown, case study 16, mhhe
students regardless of whether they are website), not only to provide students with
disabled. 'information' about mental health issues; but
‘I found some of the descriptions of to offer them a new way of thinking through
psychopathologies slightly distressing, but I the issues, using critical academic and clin-
think many people who do not have my ical/practical insights. After five years of
disability might share this opinion.’(Student continual research and reading, Reavey has
with mental health issues) changed her module on ‘The Psychology of
‘I feel that within the psychology course there is Mental Health’ dramatically. It still includes
too much of a negative attitude towards mental mainstream psychiatric approaches, but is
illness.’ (Undergraduate psychology run entirely according to a critical and
student with mental health issues) psychosocial agenda, using speakers (clinical
‘With a mental health condition, I had become psychologists and psychiatrists) who do and
tired of hearing conflicting comments about who do not work in accordance with this
human nature and my own condition … The objective. For example, to demonstrate how
knowledge I have gained has helped me grow widely accepted neo-Kraepelinian ideas are
in self-confidence and become more informed in modern psychiatry and to illustrate how
and assertive.’ (Student with mental they impact on a large proportion of clinical
health issues) practice, Reavey now invites a consultant
The comments collected within the IPDPS psychiatrist to deliver a workshop session on
project provide valuable insights that can working in the NHS with patients with
inform the design of accessible and inclusive ‘severe’ mental illnesses, like bi-polar
20 Psychology Teaching Review Vol. 16 No. 1
Mental health issues and higher education psychology teaching
disorder and schizophrenia. The psychiatrist Section 5. Discussion
talks through how he (in this case) uses diag- The mhhe case studies address the specific
noses in order to be able to prescribe rele- issue of delivering teaching that does not
vant medication and courses of treatment. stigmatise students with mental health issues
This also serves to illustrate to students how by moving away from the ‘abnormal’ model.
psychiatric theories and diagnoses translate A similar development within the wider
into actual practices. education agenda underpins a move to focus
Exam scripts can provide evidence of on inclusive teaching for mental well-being
gaps in students’ depth of understanding. (Burgess, Anderson & Westerby, 2009). This
Dave Harper (date unknown, case study 3, approach recommends that the design of
mhhe website), became aware through his the curriculum should take into account the
students’ scripts that his students were structural demands imposed on students
focusing too much on psychiatric definitions and pay attention to the balance of learning
rather than a broader psychological opportunities provided for students.
approach to mental health. As a result he Mental health is just one aspect of many
changed his teaching to ensure students had on the widening participation agenda.
more opportunities to discuss psychological Research examining other minority groups
approaches to mental health. For example, studying psychology reflects very similar find-
Harper stressed that he did not want ings to those reported about mental health
students to simply regurgitate psychiatric teaching and learning. For example, Hodges
diagnostic definitions but, instead, to be able et al. (2005–2007), identified that minority
to consider the contribution of a psycholog- students reported feelings of marginalisation
ical formulation of these kinds of experi- in the form of discrimination; homophobia
ences. and oppression of identities; there was a
Finally, John Cromby (date unknown, loyalty to psychology as a discipline and high
case study 4, mhhe website) has designed a expectations of what it could offer; and that
course on mental illness to include critical students felt both disillusioned and
perspectives and to contrast these with more cautiously optimistic. Minority groups
orthodox views. To facilitate this activity, the reported a lack of inclusion in the
themes of mind/brain and individual/ curriculum, the teaching and learning envi-
society dualism are fore-grounded from ronment and social milieu; lack of relevance
week 1 of the module, and the module sepa- of the curriculum to their lives; and almost
rated the primary academic content from without exception there was an overall
the input of practitioners and service users – expectation that a liberal and progressive
so that it matters little precisely which environment would pervade a University
external input is received each year. A focus setting. There was also a sense that the
on self-directed learning is also an integral impact and intersection of multiple minority
part of the module. This is partly achieved identity positionings is only cursorily
throughout the semester by setting ‘coffee engaged with by psychology and is thus
break questions’ during the lecture that almost invisible. Hodges et al. (2005–2007),
students must address during their break recommended that psychology as a disci-
and return to the second half of the lecture pline and higher education in general
to discuss as a group. However, self-directed should acknowledge the detrimental exclu-
learning is primarily achieved by the mode sionary impact of ‘institutional homophobia’
of assessment. Students generated their own and ‘institutional racism’ on minority
essay titles: they could write an essay on any students in higher education today, develop
relevant topic they chose, with the constraint policies that will encompass the diversity of
that their essays must involve some form of its student population into its social,
analysis and could not be merely descriptive. teaching and learning practices, and imple-
Psychology Teaching Review Vol. 16 No. 1 21
Naomi Craig
ment strategies that will enable a more inclu- specific examples of improvements to
sive experience for minority students. teaching practice are provided. Many other
Zinkiewicz and Trapp (2004) offer some issues relating to disability and inclusive
recommendations for handling sensitive practice within psychology education are
issues, including: establishing the goals and discussed in the Higher Education
rules of conduct, refraining from relating Academy’s Psychology Network Inclusive
personal frustrations or political views, and Practice within Psychology Higher Education
not alienating minority students. Zinkiewicz (Craig & Zinkiewicz, 2010).
and Trapp (2004) also note that whilst the Finally, this report also illustrates how
correct use of terminology is important this focusing on a particular widening participa-
may not always be applicable in a mental tion group, students with mental health
health setting. It is essential that students are issues, provides insights that can promote
given an opportunity to debate terminology the development of accessible and inclusive
(which is contested) and that they are not practice. We suggest that this may provide a
too quickly judged on the basis of the good model for the development of acces-
language that they use. Ensuring staff have sible and inclusive practice for other
an understanding of the accessibility benefits widening participation groups.
built into everyday technologies is impera-
tive in ensuring an inclusive and accessible Correspondence
learning experience. Naomi Craig
This report has provided evidence of The Higher Education Academy
student perceptions that relate to mental Psychology Network,
health and the study of psychology at under- Psychology Department,
graduate level. Their comments allow us to 1st Floor, Information Centre,
reflect on ways in which teaching and Market Square,
learning activities on undergraduate University of York, YO10 5NH.
psychology courses can be designed to be E-mail: [email protected]
both accessible and inclusive and a few Tel: [phone]
22 Psychology Teaching Review Vol. 16 No. 1
Mental health issues and higher education psychology teaching
References
Beresford, P. (2000). What have madness and psychi- Higher Education Statistics Agency (HESA):
atric system survivors got to do with disability and www.hesa.ac.uk/
disability studies? Disability and Society, 15(1), Hodges, I., Jobanputra, S., Pearson, C., Reed, C. &
167–172. Smith, S. (2005–2007). Mapping exclusion in
Burgess, H., Anderson, J. & Westerby, N. (2009). undergraduate psychology: Towards a common archi-
The Higher Education Academy e-bulletin Mental tecture of the minority student experience.Final report
Well-being.Accessed 10 January 2010 from: for the Higher Education Academy Psychology
www.psychology.heacademy.ac.uk/networks/ Network Departmental Enhancement Scheme.
sig/mwb.asp University of Westminster. Accessed 10 January,
Conner-Greene, P. (2001). Family, friends and self: 2010 from the Higher Education Academy
The real-life context of an abnormal psychology website:
class. Teaching of psychology, 28, 210–212. www.psychology.heacademy.ac.uk/docs/pdf/
Craig, N. & Zinkiewicz, L. (2010). Inclusive practice p20090204_Hodges_et_al_final_report.pdf
within psychology higher education. The Higher Improving Provision for Disabled Psychology
Education Academy Psychology Network. Students Project (IPDPS).
Cromby, J. (date unknown). Contrasting critical and www.psychology.heacademy.ac.uk/ipdps/
biomedical perspectives on mental health. Accessed Lewis, B. (2002). Widening participation in higher
10 January 2010 from: the Mental Health Higher education: The HEFCE perspective on policy
Education (mhhe) website: and progress. Higher Education Quarterly, 56(2),
www.mhhe.heacademy.ac.uk/resources/ 204–219.
case-study-4/). Oliver, M., (1981). A new model of the social work
Cromby, J., Harper, D. & Reavey, P. (2008). Mental role in relation to disability. In J. Campling (Ed.),
health teaching to UK psychology undergradu- The handicapped person: A new perspective for social
ates: Report of a survey. Journal of Community & workers?London: RADAR.
Applied Social Psychology, 18(1), 83–90. Reavey, P. (date unknown). Teaching mental health from
Davis, K. (1996). The social model of disability – setting a critical psychology perspective. Accessed 10 January
the terms of a new debate. Published by the 2010 from the Mental Health Higher Education
Derbyshire Coalition of Disabled People (mhhe) website:
(September 1996, revised) www.mhhe.heacademy.ac.uk/resources/
Disability Discrimination Act (DDA) (2005). case-study-16/).
Accessed 10 January 2010 from the Directgov Simpson, A. (2008). The Higher Education Academy
website: e-bulletin Inclusive Teaching Practice. Accessed
www.direct.gov.uk/en/DisabledPeople/Rights 10 January 2010, from the Higher Education
AndObligations/DisabilityRights/DG_400106 Academy website:
Harper, D. (date unknown). Approaches to undergrad- www.psychology.heacademy.ac.uk/networks/
uate psychology teaching: ‘The psychology of delusions’; sig/it.asp
and ‘difference and discrimination in mental health’. Zinkiewicz, L. & Trapp, A. (2004). Widening Participa-
Accessed 10 January 2010 from the Mental tion Report. Accessed 10 January 2010, from the
Health Higher Education (mhhe) website: Psychology Network website:
www.mhhe.heacademy.ac.uk/resources/ www.psychology.heacademy.ac.uk/docs/pdf/
case-study-3/) p20040422_widen_partic.pdf
Harper, D., Cromby, J., Reavey, P., Cooke, A. &
Anderson, J. (2007). Don’t jump ship! New
approaches in teaching mental health to under-
graduates. The Psychologist, 20(5), 302–304.
Psychology Teaching Review Vol. 16 No. 1 23