The role for service users in higher education – why it matters

Authors: Eleanor Jack, Bournemouth University, UK, PhD Student/University Practice Learning Adviser

I remember my enthusiasm in seeking to share the captured students' views of mental health (MH) undergraduate nursing experiences of service user (SU – role title as requested by the SU team involved) input throughout a theoretical unit for the programme[i].

Having witnessed first-hand the professional and personal impact that SU input had on the students was testimony to the collaborative design and delivery between academic and SUs, the confidence as a relatively new academic to ‘let go of the reins’ and see where the SUs wanted to lead the sessions for, and with, the students.

Hearing students in the session expressing thankfulness to the SUs for the sharing of illness and wellness narratives, being unafraid to ask open and direct questions – not just of the SUs and their experiences of the services and illness but also of the academics involved as to how theory and practice often differ casting doubt on the current evidence base for current holistic approaches to care and recovery. Indeed, after witnessing the sessions I felt the term ‘Impact Testimony’ could describe how the students became animated in sessions and openly questioned all that they had experienced in practice and had understood from theory units given the expertly told narratives by the SUs. Students openly debated current national and local policies supporting mental health and social care, highlighting where inadequacies and changes should be considered plus the negative impact stigma and self-stigma can have on individuals.

It was quite the revelation! – which has stayed with me over the years.

Two focus groups sought to capture in more detail the (38) students’ views and experiences and ascertain the underpinning factors that may have contributed to the impact that sessions had on the students. Repeated themes ‘emerged’ (yes, I hate that term too, thank you Braun and Clarke!)[ii] from the data e.g. pertaining to the importance of carrying hope for SUs and their recovery, the importance of addressing care priorities with the SUs, the importance of the small things that matter and human connections like bringing requested tea/coffee/meals, supporting cigarette/fresh-air breaks, ensuring privacy and offering respect at all times with effective communication, actually facilitating SUs to be heard and not just listened to by all stakeholders involved in their care.

The students expressed that their attitudes and preconceptions had been challenged – it was indeed possible to achieve wellness and recovery from mental illness. The students articulated that hearing narratives with all the raw emotions and human sensory experiences expressed helped their understanding and also served to imprint on their memory for professional practice in a way that traditional teaching and learning from academics and practitioners did not. The students appreciated that their/other professionals’ involvement with an SU in the health and social care setting was a short episode in the SUs timeline of their life, they have a life beyond this, but also that what happens during this ‘episode’ can have a negative and traumatic impact lasting a lifetime.

The students stated that SU involvement in their teaching reinforced the human ‘sameness’ of mental health and wellbeing, it is part of us all – indeed they said it become less ‘them and us’ with the new acknowledgement of the power imbalances often present in mental health and social care with SUs. Alongside this, the students were grateful for the time, skill and emotional labour invested by the SUs, above that of academics – as SUs were not assessing them directly, although did have input into assessments.

Furthermore, reflecting on power imbalances, students noted that the sessions from the SUs carried the power to impact on their personal and professional practice, learning from SUs was a unique experience for them in the traditional academic setting. A key facet that the students expressed was that SUs were often very appreciative of the health and social care individuals that supported their recovery, importantly to articulate the qualities that these individuals had and the actions that they took – there was critical balance in the spoken narratives, cited as reinforcing the students’ initial rationale for undertaking the programme, to make a difference to peoples’ lives.

So where does that leave me, an academic, now a few years on?

I have a couple of thoughts. Professor Brenda Happell[iii] and Peter Beresford OBE[iv] are way ahead of me here. They have provided the evidence base to support not just adequate reimbursement of SUs for involvement in healthcare curricula but argue for substantive academic research and teaching posts in universities to avoid the frequent tokenism/policy box ticking, plus, more recently, highlighted the need to facilitate aspiring health and social care professionals to engage critically with the less than positive experiences of SUs within the international healthcare systems to actively produce change.

Students are the healthcare workforce of our future, let us help them to make the necessary changes for us all by ensuring the SU experience and voice is embedded into healthcare programmes.
 

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References

[i] Jack, E. (2020) Service user involvement in an undergraduate nursing programme, Journal of Mental Health Training, 15, 3. pp.125-140. https://doi.org/10.1108/JMHTEP-12-2018-0073

[ii] Braun, V. and Clarke, V. (2021) One size fits all? What counts as quality practice in (reflexive) analysis? Qualitative Research in Psychology, 18, 3. pp. 328-352. DOI: 10.1080/14780887.2020.1769238

[iii] Happell, B., Waks, S., Horgan, A., Greaney, S., Bocking, J., Manning, F., Goodwin, J., Scholz, B., Jan van der Vaart, K., Allon, J. and Hals, E., (2019). Expert by experience involvement in mental health nursing education: Nursing students’ perspectives on potential improvements. Issues in Mental Health Nursing, 40, 2. pp.1026-1033. https://doi.org/10.1080/01612840.2019.1631417

[iv] Beresford, P. (2020) PPI Or User Involvement: Taking stock from a service user perspective in the twenty first century, Research Involvement and Engagement, 6, 36. https://doi.org/10.1186/s40900-020-00211-8

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