'There's more to a person than what's in front of you': Nursing students' experiences of consumer taught mental health education

Holistic and person‐centred nursing care is commonly regarded as fundamental to nursing practice. These approaches are complementary to recovery which is rapidly becoming the preferred mode of practice within mental health. The willingness and ability of nurses to adopt recovery‐oriented practice is essential to services realizing recovery goals. Involving consumers (referred herein as Experts by Experience) in mental health nursing education has demonstrated positive impact on the skills and attitudes of nursing students. A qualitative exploratory research project was undertaken to examine the perspectives of undergraduate nursing students to Expert by Experience‐led teaching as part of a co‐produced learning module developed through an international study. Focus groups were held with students at each site. Data were analysed thematically. Understanding the person behind the diagnosis was a major theme, including subthemes: person‐centred care/seeing the whole person; getting to know the person, understanding, listening; and challenging the medical model, embracing recovery. Participants described recognizing consumers as far more than their psychiatric diagnoses, and the importance of person‐centred care and recovery‐oriented practice. Understanding the individuality of consumers, their needs and goals, is crucial in mental health and all areas of nursing practice. These findings suggest that recovery, taught by Experts by Experience, is effective and impactful on students’ approach to practice. Further research addressing the impact of Experts by Experience is crucial to enhance our understanding of ways to facilitate the development of recovery‐oriented practice in mental health and holistic and person‐centred practice in all areas of health care

Staff awareness of suicide and self-harm risk in healthcare settings: A mixed-methods systematic review

Background: Suicide risk screening in healthcare settings plays a significant role in suicide prevention. Healthcare staff who are poorly informed about self-harm and suicide risk are less likely to identify and subsequently screen at-risk individuals. This mixed-method systematic review aimed to appraise and synthesise evidence from studies that explored and promoted healthcare staff's knowledge and awareness of suicide and self-harm risk in healthcare settings. Methods: Electronic databases (CINAHL, MEDLINE, APA PsycInfo, APA PsycARTICLES, Psychology and behavioural Science Collection, ERIC, and SocINDEX), the Cochrane Library, and various grey literature databases were searched for relevant studies. The level of evidence and methodological quality of the included studies were assessed. Results: Eighteen empirical studies were included. Levels of knowledge about suicide and self-harm risk varied significantly across the reviewed studies. Face-to-face group training and educational programmes, digital or online educational programmes, and an educational poster campaign were amongst the strategies used to promote awareness of suicide and self-harm risk, with the majority marginally succeeding in doing so. Limitations: The reviewed studies were heterogeneous in terms of design, interventions, and outcome measures which made it difficult to make comparisons. The overall level of scientific evidence was classified as being relatively low. The lack of blinding and lack of a control group were amongst the limitations for experimental studies. Conclusions: Long-term, routine face-to-face group training programmes should be established to educate healthcare staff about suicide risk across all professions and in specific patient groups

Suicide and self-harm risk assessment: A systematic review of prospective research

Objective: Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users. Method: Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide. Results: Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths. Conclusions: There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide

Experts by experience in mental health nursing education: What have we learned from the COMMUNE project?

The COMMUNE (co-produced mental health nursing education) was an international project established to embed EBE perspectives in mental health nursing education by developing and delivering a specific mental health nursing module. The underlying intention of this project was to go well beyond ad hoc implementation and tokenistic approaches to EBE involvement. Standards for co-production of Education (Mental Health Nursing) (SCo-PE [MHN]) was developed to provide guidance to the increasing number of academics seeking genuine and meaningful involvement of Experts by Experience in the education of health professionals. These standards were recently published in the Journal of Mental Health and Psychiatric Nursing (Horgan et al., 2020): https://onlinelibrary.wiley.com/doi/abs/10.1111/jpm.12605 and prompted this Editorial to discuss the COMMUNE project more fully, including the lessons learned

Expert by Experience involvement in Mental Health Nursing Education: The co-production of standards between Experts by Experience and Academics in Mental Health Nursing

Introduction: Involving people with lived experience of mental distress in mental health nursing education has gained considerable traction yet broader implementation remains ad-hoc and tokenistic. Effective involvement requires curricula be informed by lived experience of service use. Aim: To develop standards to underpin expert by experience involvement in mental health nursing education based on lived experience of service use. Methods: Phase one used qualitative descriptive methods, involving focus groups with service users (n=50) from six countries to explore perceptions of service user involvement in mental health nursing education. Phase two utilised these findings through consensus building to co-produce standards to support Experts by Experience involvement in mental health nursing education. Results: Three themes emerged in Phase one: enablers and barriers, practical and informational support, and emotional and appraisal support. These themes underpinned development of the standards, which reflect nine processes: induction and orientation, external supervision, supportive teamwork, preparation for teaching and assessing, 'intervision', mutual mentorship, pre and post debriefing, role clarity and equitable payment. Conclusions: These standards form the framework entitled; Standards for Co-production of Education (Mental Health Nursing) (SCo-PE [MHN]). Implications for Practice The standards aim to support implementation of Expert by Experience roles in mental health nursing education

Practice Guidelines for Co-Production of Mental Health Nursing Education

COMMUNE (Co-production of Mental Health Nursing Education) is an Erasmus+ Strategic Partnership Project based on the collaboration of experts by experience (EBE) and mental health nursing academics from six European universities and the University of Canberra in Australia. Its purpose was to advance the involvement of those who have experiences of mental health service use (EBE) in mental health nursing education. The project combined experiential and academic knowledge, with the aim of co-producing a module on ‘mental health recovery’ for undergraduate nursing students; a module that was taught to the students by EBE. Principles of co-production where followed as much as possible, involving EBE in all stages of the process, from grant application to dissemination. The project tried to move beyond typical service user involvement and towards co-creation of knowledge, where power differentials are acknowledged and equity issues addressed. Barriers to meeting these goals were experienced and will be discussed in this Guidelines. We hope that these Practice Guidelines will be useful for those who intend to co-produce learning programs or modules in mental health nursing and inspire others to follow similar paths and learn from our experiences, positive or otherwise. These Guidelines provide an overview of our experiences, learnings, limitations and barriers.The Commune team decided on the term ‘Expert by Experience’ (EBE) to describe the members of the team and other collaborators who has lived experience of mental distress. Other more commonly used terms are ‘service user’, ‘consumer’ and ‘people with mental illness.’ As not all experts by experience are mental health care users, and what constitutes an illness is highly debated, the team decided on a term that more correctly describes and value lived experience.Erasmus

I felt some prejudice in the back of my head: Nursing students' perspectives on learning about mental health from "Experts by Experience"

1 Introduction Consumer participation is central to mental health policy. Negative attitudes of health professionals are barriers to realizing policy goals. Evidence suggests consumers (Experts by Experience) can influence positive attitudes in nursing students. Research in this area to date is limited and primarily from Australia and New Zealand. 2 Aim To enhance understanding of nursing students’ perspectives and experiences of being taught mental health by an Expert by Experience. 3 Method A qualitative exploratory approach was used. Focus groups were conducted with nursing students from seven universities in Australia and Europe. Data were analysed thematically. 4 Results Student participants described how exposure to Experts by Experience challenged their views and attitudes and provided a mechanism for reflection, critique and change. The main theme “changing mindset” includes two subthemes: exposing stereotypes and reflection. 5 Discussion This unique international study demonstrates the capacity for Experts by Experience to contribute to positive attitudinal change towards mental illness in nursing students. This changed mindset must occur for policy goals to be realized. 6 Implications for practice Nurses in all areas of practice will work with people labelled with mental illness and experiencing mental distress. Overcoming stereotypes and adopting more positive attitudes is essential to deliver quality mental health care.The authors acknowledge and thank: Erasmus + for the funding which made this innovative project possible

Expert by Experience Involvement in Mental Health Nursing Education: Nursing Students' Perspectives on Potential Improvements

Expert by experience involvement in mental health education for health professional programmes has increased in recent decades. The related literature has articulated the benefits, and changes in attitudes have been measured in some studies. Less attention has been devoted to ways this learning approach could be improved. The aim of this paper is to present the nursing students perspectives on how Expert by Experience input into nursing curricula could be enhanced. Qualitative exploratory research was undertaken, involving focus groups with students who had completed a mental health learning module co-produced by Experts by Experience and nurse academics. Results show two main themes: getting the structure right, and changes to content and approach. Some student responses could directly influence changes to the learning module. In other instances, responses indicate the need to better prepare students of the value of lived experience knowledge in its own right, rather than adjunct to more traditional methods of education. These findings are important in encouraging reflection on how future learning modules co-produced by Experts by Experience and Mental Health Nursing academics can be refined and better articulated.Erasmus+ for the funding which made this innovative project possibl

Healthcare staff's views on responding to suicide and self-harm: Part II.

PURPOSE To report on healthcare staff's views of the barriers to preventing suicide and self-harm. DESIGN AND METHODS Using a qualitative approach, data were collected through "World Café" discussion forums and written submissions, and analyzed using reflexive thematic analysis. FINDINGS Healthcare staff, including psychiatric nurses, perceived that a whole of society approach was needed for suicide and self-harm prevention. Support for those at the front line is needed as well as clear referral pathways and interagency working. PRACTICE IMPLICATIONS Formalized support for staff working in healthcare should be given with a flexible and inclusive approach to service delivery adopted

Healthcare staff's views on responding to suicide and self-harm: Part I.

PURPOSE To explore healthcare staff's knowledge and awareness of, and responses to, suicide and self-harm. DESIGN AND METHODS A qualitative design was adopted, and data were collected using a "World Café" approach (n = 143 participants), in addition to written submissions (n = 10). Data were analyzed using reflexive thematic analysis. FINDINGS There was variation relating to awareness of and responses to suicide and self-harm. Participants highlighted the need for further staff education and training, and a review of standardized assessment tools and referral processes. PRACTICE IMPLICATIONS Tailored training and education resources are required for healthcare staff. Clear protocols for assessing, treating, and referring people deemed at risk of suicide and self-harm are needed