‘Mental Health in the qualifying professions; the politics of acceptance and support. A close study of Mental Health students’ experiences of practice placements and the negotiation of reasonable adjustments.’
Introduction:
The idea for this project came about from the researcher’s own practice in the area of disability support within a Higher Education institution. The practicalities of negotiating reasonable adjustments in line with current legislation often prove challenging. Disabled people, including those with mental health issues, still face both physical and attitudinal barriers in education. Students who choose to study a professional degree such as Social Work, Nursing or Speech and Language Therapy, to name a few, are faced with the additional barriers that are still present within the work environment as fifty per cent of their learning is done on practice placements. The disclosure of mental health issues amongst first year students to their University has increased since 2005/06 from 0.12% - 0.19% but still remains at 6.2% of all disability disclosure in 2009/10 (HESA) these figures are well shy of the ‘1 in 4’ statistic quoted by many mental health organisations (The Mental Health Foundation, 2011) which indicates that 25% of the population have a mental health issue at some time. It points to the fact that the stigma around mental health prevails, particularly in the professional programmes listed above, where the tension between support and fitness to practice policy collides. This study aims to build a picture of the support that is available in the educational setting and how well that transfers into the work environment by considering the policies that HEIs deploy and how these are understood in practice. It will then seek to engage with students’ own experiences of working towards a degree in their chosen area and the barriers they may, or may not encounter, on their training programme. It will also seek to give some thought to the teaching and learning practices on these particular programmes as they deal with training professionals, some of who will go onto work with people in the wider population with mental health issues. There has been a drive in the last ten years to encourage service user involvement in the classroom (Basset et al, 2006; Tew et al, 2004) and this study will look at whether this is a model that not only prepares professionals for their chosen careers but brings inclusivity into the classroom and the wider work environment through practice placements.
In 2010 the Equality Act replaced the existing legislative protection for Disabled people that was previously covered by the Disability Discrimination Act 1995 and in relation to Higher Education the Special Educational Needs and Disability Act (SENDA) amended in 2005. The Equality Act identifies ‘protected characteristics’ of which disability, including mental health, is one. Protected characteristics are covered by the Act in regard to direct and indirect discrimination, the Act also insists that reasonable adjustments are made in policies, practices and procedures to ensure that disabled people have equal access to Employment, Education and Goods and Services. In relation to Higher Education it is illegal to prevent a disabled person from applying to a degree programme, however there is provision within the Act to reject a disabled person if it is felt that they would not meet the learning outcomes or do not comply with the regulations of fitness to practice. It also makes clear that academic standards should not be lowered in order to meet a student’s individual requirements.
Legislation and subsequent policy initiatives, such as Widening Participation in Higher Education and employment support such as Access to Work signal a move towards interpreting disability within the realms of the Social Model, rather than relying on the Medical Model (Oliver, 1990; Barnes, 2000). The Social Model of disability can be broadly described as the conceptualisation of disability through the barriers that society places in disabled peoples’ way, through its structures and environments. The Medical Model of disability constructs individuals through their respective impairments and locates any issues within them and not wider society. The increased numbers of disabled students accessing Higher education are partly attributable to this shift, as disabled people are more likely to see themselves as able to access a University. Widening Participation projects have made some moves in this area too and from 1993-2005 £23million has been used for widening access agendas which has include some specific moves to encourage disabled people into Higher Education and support them while they are there. The Disabled Students’ Allowance has also provided funding for equipment and human support for disabled people entering Higher Education. However widening access incentives have run concurrently with strict health requirements and fitness to practice policy particularly on professional programmes. The Nursing and Midwifery Council published a literature review in March 2009 which highlighted the issues with referring to a nurse’s good health and good character specifically in relation to disabled students and although the report suggested it be reviewed the practice still stands. There is research that suggests that there is still a sense in professional practice that disabled people are ‘cared for’ and seen as the patient rather than the practitioner (Sin, 2008). It has also been identified that there is a higher prevalence of mental health conditions amongst students from working-class, less educated families – the very students Widening Participation aims to include, but there is little to address their additional needs (Riddell et al, 2005)). In regard to fitness to practice institutions interpretations seem to vary quite considerably and some struggle to keep a consistency (Sin, 2008). In 2005 the Disability Rights Commission (as was) commissioned an investigation into the fitness standards in nursing, teaching and social work, this identified the very real and present stigma of disclosing and living with mental health conditions within the professions. It also highlighted the impact of high profile cases such as Beverley Allitt and Harold Shipman on the attitudes towards mental health and people with recognised conditions (Stanley et al, 2007). Mental Health is undoubtedly seen as an individual problem to be overcome and one that at best will possibly get you health checked and at worse label you as dangerous.
As a disability practitioner responsible for delivering support for disabled students within the placement environment the researcher has encountered some of the gaps within provision that the research aims to identify. Anecdotally, between staff and students, there is much evidence to suggest that disabled students experience a variety of approaches in relation to negotiating reasonable adjustments. Some of these experiences identify areas of good practice but they are not disseminated widely within programmes, universities or nationally. It has been identified in some studies that universities have developed considerable inclusive practices for their academic environments but these have not transferred to the placement setting. (Tee 2009; Riddell et al. 2005)
Wray et al (2005) conducted research to address issues of how ‘on campus’ support transferred to the workplace where students on Social Work programmes had to complete placements. They found that placements could provide a useful testing ground for disabled people to ‘try out’ the work environment, it could be used a transitional ‘testing ground’ giving a disabled person the opportunity to experience some of the challenges and begin to develop strategies within the workplace setting. However, they also identified that this transitional stage had its own challenges due to the variety and scope of placements.
Stanley et al (2007) found that placement agencies were less flexible and accommodating than the HEIs in relation to their responses to disabled people. The report goes onto make the observation that interviews with students who had completed both statutory and voluntary sector placements found that the students placed within the voluntary sector enjoyed far greater flexibility. The voluntary sector, with potentially less rigid codes and policies allows the freedom of flexibility which disabled people will benefit from. It also suggests that the individuals in the voluntary sector play a key part, thus indicating the role of the mentor can be critical but varied.
The attitudes and prejudice of managers and the culture that they promote within their departments has been identified as a key factor in the success of securing the required adjustments for disabled people (Stanley et al, 2007; Baron et al, 1996). The relationship that a disabled person has with their mentor and the mentor’s awareness of an organisation’s responsibility also has been identified as having a large impact on the experiences of a disabled person on the placement element of a professional programme (Tee et al, 2009 ;White, 2007; Morris and Turnbull, 2006). The relationship and perception of mentors and managers has also been linked to whether or not a disabled person feels comfortable with disclosing their disability within a placement setting (Griffiths et al, 2009).
The literature does not address the issue of placements existing in an educational context but an employment setting. There are conflicting elements within a training ground and an academic environment, this often leads to HEIs being accused of setting disabled professionals up to fail as support provision will vary and the disconnect within policy covering employment and education manifests itself in the experience of disabled students. This tension will be investigated by the case studies as will the priorities of staff in defining and delivering reasonable adjustments for students with mental health conditions.
Mental Health is an area that institutions are slowly beginning to grapple with (Riddell et al, 2005) There has been accompanying advice and guidance to support them in this, notably HEFCE funded projects aimed at institutions to map student mental health, look at staff awareness raising and sharing good practice. Universities UK published a guide in 2002 to reduce the number of student suicides (Riddell et al, 2005)
Proposed Study
This will be a two stage investigation into a study of the practices and procedures of Higher Education Institutions in regard to making reasonable adjustments for students with mental health conditions on practice placements. This first stage will be to determine what practices and systems are in place within universities for identifying what the requirements are and the procedures for making reasonable adjustments. The data that is collected in this first stage will inform the wider context of disabled people’s inclusion on professional programmes. It will give a clear picture of the staff who have responsibility for determining and making adjustments within this setting. It will identify the shared areas that universities feel they have robust practices in and also the areas of weakness. This first stage will also address the work that is done on the programmes in relation to their teaching and learning. Most professional programmes have an element of study that involves discussing the policy and procedures for working with disabled people and those with mental health conditions in their respective areas. The first stage will look at how universities have introduced concepts of anti-oppressive practice to the classroom and whether approaches could be seen to be inclusive of all. Questions will also be asked about the role of service users within teaching and learning as advanced by the Mental Health Higher Education Academy workforce unit’s various projects.
It is intended that once stage one is completed the results will inform the researcher of the focus for the second stage, which involves in-depth case studies. Themes identified from the preliminary data will be used to frame the case studies and to inform the questions that will be asked. The case studies will include some of the stakeholders involved in negotiating a reasonable adjustment for a student with a mental health condition on a practice placement, for example: the student, placement coordinators, mentors, supervisors, senior managers, budget holders, disability coordinators/advisers, student services staff and tutors. Stage Two will begin to address some of the questions about why reasonable adjustments work or not, why there is still a stigma surrounding mental health, and the application of support in the transition between the classroom and the workplace.
Participants
Stage 1:
Disability/Mental Health support staff employed at the seventeen universities which are located within the East and West Midlands will be approached to take part in stage one. The researcher is seeking to ask senior members of support staff, within student service departments to take part in the study with possible input from academic staff where required and appropriate.
Stage 2:
The case studies will include the disabled student and some of the stakeholders involved in negotiating their reasonable adjustments on a practice placement, for example: placement coordinators, mentors, supervisors, senior managers, budget holders, disability coordinators/advisers, student services staff and tutors.
Methods and analysis
Stage one of the research will consist of semi-structured telephone interviews with up to seventeen institutions. The participants will be recruited from targeted emails asking for volunteers for the research. Data from the telephone interviews will be audio-recorded, transcribed and analysed using framework analysis approach, incorporating explanatory analysis for the interpretation, Ritchie et al., (2003). This is an approach developed by the national centre for social research specifically for applied policy studies and has the potential for actionable outcomes.
Stage two of the research will consist of group and individual face-to-face interviews. Participants will be recruited from one institution, which will be identified from the first stage, the recruitment will be through the student initially. Students will be sought from professional programmes with a placement element. The data that is collected from the interviews will be audio-recorded, transcribed and analysed using a similar framework analysis and explanatory interpretation.
Theoretical Framework
The research will be lead by the principles of the Social Model of disability and how this can be used to build a social model of madness and distress (Beresford, 2010). It is the researcher’s intention to identify the barriers that arise from both the interpretation of legislation and policy and societies attitudes. A social model approach will allow for the research to consider all of the elements that disable people with mental health conditions within the educational setting and employment context this will then permit recommendations to be made as to how these barriers might be removed. Barriers in relation to people with mental health conditions are crucial to examine as they can not only prevent a person from accessing something but they can actually exacerbate an issue (Riddell et al. 2005). Inclusivity will be at the heart of this project and it is the researcher’s intent to consider mental health as well as mental ill health to develop practices that are realistic and informed by the experiences of disabled people.
Anticipated Outcomes
1. A bridge of the gap between employment policies and practices and Higher Education agendas within the practice placement environment, through in depth analysis.
2. To identify how the interpretation of policy varies between individuals and institutions and from this to make recommendations that could improve and standardise policy that governs students when they are undertaking professional qualifying programmes.
3. To identify how teaching and learning practices on professional programmes can enhance inclusivity and move towards an agenda where the experience of people with mental health conditions are used positively and proactively.
4. To set the context of being a disabled/mental health student within the parameters of the social model of disability to challenge and contribute to the current debates about the need to consider the experiences of impairment and mental health within such a model of explanation.
