Summary of Evaluations

MEDICAL STUDENT MENTAL HEALTH ANTI - STIGMA TRAINING
PLUS Perth & Kinross, has delivered mental health anti - stigma training annually to third year medical student since being invited to do so in 2005 by Dr Richard Day, Honorary Psychiatrist at Ninewells Medical School, Dundee.
This brief report summarizes the feedback gathered from the students alongside the experiences of the PLUS volunteers who delivered the training in November 2012.
The aims of the training were to enhance the students understanding of peoplewith mental illness and subsequently improve attitudes and practice towards a more person centred approach. During the training the students were given the opportunity to listen to the ‘patient’s story’ and see things from the individuals point of view before entering into questions and discussion.The I hour training sessions were delivered to 160 students split into groups of 20.An evaluation consisting of the following four questions was completed by all the students at the end of each session;
What did you find useful? What do you think was missing? What surprised you? What have you learned which will change the way you practice?
The report illustrates the very positives outcomes in changing wrong information (or myths) in the student population about mental illness and improving their practice towards this often ill understood group of people. It also shows the positive effects on the wellbeing of the volunteers who delivered the training.
The same model of training delivered to dental students in March 2012 had similar successful outcomes.

Medical Students Evaluations

What did you find useful?

Listening to patients’ stories, experiences opposed to text book cases and statistics. Students have not seen or spoken to any psychiatric patients or been exposed to psychiatric illnesses before – good to hear of it. Some students believe that it has been useful in that it will aid them in advising patients in the future on how their illness can affect their lives.
Personal views and perspectives of illness of those who have gone through it instead of an external viewi.e. doctors.Also, personal feelings and experiences.
How patients understood the illness.
Real life experiences giving better insight towards psychiatry.
Bringing the theory of what was taught into reality.
Learning how medication affects daily life and theside effects of medication. Ultimately, that medication isn’t all that is needed.
To understand what people go through.
Different stories of the same illness, different aspects of disease i.e. symptoms & courses. And how people cope with their illness and differences between them.
The use of arts therapy.
How Bi-polar disorder (BPD) has directly affected their lives and how they cope.
How BPD affects women.
To learn of the importance of positivity in recovery.
Effects on family and friends.
The valuable insight gained.
Being educated about charities, volunteering services, and local services.
Experiences of services and system.
Seeing how ‘care’ has changed over the last 30 years (and how it can still get better.)
How stigma affects recovery/treatment.
Having chance to ask questions.
Good to hear the success stories.

What do you think was missing?

Limited time- More time for the personal accounts and questions.
Medical history of patients perhaps but appreciate the difficulty of this.
More detail: info on medical symptoms and treatment.More factual information.Nothing on the medical (management/ treatment etc.); lack of clinical opinion, but was nice for a change.
More group interaction.
More specific information on the work that the groups do and the roles within them, as well as the groups’ aims are and plan for future development.Also more information on PLUS – what campaigns they do and services offered
Wider ranges of mental illness and more detailed information on mental illnesses described i.e. progression/symptom development.
Family history and how it can be affect the illness.
More on mental health in the community, hospital care and treatment i.e. psychological therapies.
More structured.
To have a discussion without the patients present so we could have asked more questions about their symptoms & psychiatric illness.
How to access the services discussed.

Have you learned anything that surprised you?

How illness can affect/influence lives, also the different courses an illness may take. Additionally, how anyone can be affected.

Some were specifically surprised of how Bipolar Disorder can present its self. Also that some people like the ‘high’ in BPD and that some wouldn’t change having their illness.

Electro Convulsive Therapy is sometimes used for BPD.
Hearing about the experiences of ECT –was helpful.
The importance of support – family, friends etc.
How helpful a Community Psychiatric Nurse can be?
The recovery team is vital, as well as support networks and local services. Also having a constant throughout recovery, instead of just medication. Finding people an aim, e.g. a job, volunteer and/or relationships.
The patients views of why they are ill.
Length of hospitalisation and the fact people did not have a voice. Thought it was only in the past people were kept in hospitals so long (20+ years).
That patients are so aware of what is going on and have quite strong views on treatment and relationships.
Some patients do not respond to treatment – good to learn of alternatives, for when traditional treatments fail.
That people could open up and share so much. Specifically, how open the volunteers were about their problems.
How debilitating stigma can be. Also how internal stigma experienced can affect recovery.
Experiences of patients – perseverance and how they handle stigma.
How peoples’ lives have changed so dramatically since recovery.
Realising that when people are manic they might not realise and believe it is the people around them that are acting strangely.
That some people actually enjoy their periods of mania and would rather be medicated so they are more up than down. Others missed the mania.
The change between mania and depression and the length without treatment. Also that there were ‘bad phases’ of mania.
How art can help.
How people with mental illness can get involved and contribute.
People may appear normal but actually aren’t.
How people cope and move on.
That mood can change in minutes.
That no-one can realise their living with an illness.
Doctor took patient of Lithium without going slowly.
Use of Clozapine and its side effects.
Patient’s experiences of treatment are sometimes negative and are against it.
Medication can be detrimental to recovery.
How people can learn their mood is changing but still cannot do anything about it.
That they were still locking people up in the 1980’s. Also the difference in treatment from then and now and how it has affected those of today.
The level of isolation a person can live with for so long without someone in medicine, GP or social work trying to help then and encouraging social inclusion.
Those who are sectioned lose control completely.
That one of the volunteers had a child – I did not realise that you could recover to that extent from serious mental illness.
Understanding a patients view – not something we (students) hear.
Mental illness is not always as bad as it is made out to be..
How difficult it was to progress out with detention.
How difficult boredom can be for people.
The importance of having a range of services available.

What have you learned that will change the way you practice?

Learn how to be empathic and compassionate and focus on the person behind the illness, not just as a set of symptoms and this will have an effect on recovery and treatment. Respect the patient regardless of their illness.

To be open-minded and not to generalise - look behind the illness and symptoms. Remember the patient not the illness and to treat the person not the illness.

That mental illness can affect anyone.

Recovery is difficult and requires a lot of support and there are many aspects to recovery not just a doctor.

The person has insight into their illness.

To find something that the person can connect to.

Supply relevant information to patients as it will help them recover.

To be mindful of the different impacts of a disease on lives and the different support at home – the students do not have much patient contact.

To remember that disease comes in a spectrum, and won’t affect everyone in obvious ways.

Give credence to non-medical treatment. Talking and supporting are as important as medication. Drugs aren’t everything. Don’t jump straight to medication.

Less of a stigma with mental health and to give more consideration.

Listen to their stories and what they want (treatment), and what their needs are, also to relate to the individuals experience. Also, to be thoughtful and to know how patients feel in hospital.

That people with Bipolar Disorder can live fulfilling lives.

Be more aware of the wide ranging implications of BPD.

Everyone acts differently. Everyone needs different approaches. Don’t jump to stereotypes.

Understanding signs and symptoms.

Remember the normal life a patient has lived before they were ill.

Listen for more warning signs that someone may need more help than they have or a different type i.e. counselling.

Encourage patients to talk willingly and to talk about condition. And be mindful that some patients are aware of their condition.

Refer patients to help services – voluntary, social and more community based services.

Being there and giving your own time can really make a difference

Patient history helps to understand the progression of a disorder and how we can manage it.

More time counselling people on importance of medication and how to recognise relapse.

Make sure patients understand the side effects of treatment and manage them with these in mind – make sure they feel able to comply.

To explore relationships in a patient’s life as well as the individual.

Try to remember how much it affects every aspect of one’s life.

A lot of time is needed to find out what is best for the patient.

Include family in treatment.

Promote awareness

Let patients take time to recover.

Try to be aware of the side effects of drugs.

Listen.

Importance of time – not always easy in the modern NHS but maybe something to think about when organisationally, when arranging appts/rotas etc.

Try to give as much choice and control to the patient as possible.

Ensure the person is fully engaged in the treatment.

Make sure patients voice are heard and arrange for an advocate where appropriate – helps break out of hospitalisation cycle.

The importance of patient centred care.

Look more into lifestyle changes first.

To be very careful of your decisions as a doctor.

The benefits of therapies such as, drawing and arts.

Think twice about taking someone off of anti-psychotics just because they are doing well.

Risks vs. benefits of prescribing drugs.

Good rapport is essential.

Work with CPN’s closely.

Encourage voluntary work.

PLUS Volunteer Experience of Delivering Training

“I feel that giving a personal perspective of my mental illness to the medical students at NinewellsHospital helps to dissolve stigma & reveal the person behind the illness. Educating our future doctors is paramount for the mental health and wellbeing of the next generation. I think it is important to deliver training at the right time in your recovery journey. Personally I was feeling well, confident and relating my experiences caused no feelings of anxiousness or trauma, on the other hand I felt I was making a valuable contribution”.

Jackie

“Delivering this training to the medical students gave me a great sense of wellbeing as a service user. Before, my story was just brushed under the carpet. It was good to get it off your chest without any worry about being put under lock and key again. Words can be heard as long as they are not aggressive – make love not war – and you should sail through the journey you are going to take in life. Life Skills – Use Them.

Kenny

“I feel telling our story in our own way getsthings over to the students in a more meaningful fashion and they can geta more accuratepicture ofhow things have affected our lives. It’s much more useful than bombarding us with their often very prescriptive questions. At the end of the day you feel much more satisfied that you have got over the things that matter most to you and will help your recovery best”.

Annette

“I took part on two of the four days training. On this occasion I gave a diagnosis. The last time I talked the students seemed to want a diagnosis, perhaps to look up in their books. I much preferred talking to the groups with older students and on one of the talk days I noticed things like odd socks so felt more able. In some of the groups it was very noticeable that they were listening and understanding what we were saying. I think I was able and ready to give the talks but on occasions I prefer to forget, so I need to do a mental inventory of how I’m feeling beforehand.

It sounds strange that I enjoyed talking to the students when I don’t like going over the past but I did like the teaching part where you’re reminding people that there is a lot more to you than a diagnosis. I don’t think I could cope with talking about me on a regular basis but I do like talking and discussing mental wellbeing”.

Marilyne

SUSAN SCOTT 21ST December 2012

PLUS Perth & Kinross Development Manager