Hcmp, Ipsum

Received: 12 April 2018 | Revised: 26 May 2018 | Accepted: 3 July 2018

DOI: 10.1111/ppc.12315

OR I G I NA L AR T I C L E

Implementation of a mental health consumer academic position: Benefits and challenges

Brenda Happell RN, RPN, BA (Hons), Dip Ed, B Ed, M Ed, PhD1 | Julia Bocking B Phil (Hons)2 | Brett Scholz BHSci (Hons), PhD3 | Chris Platania‐Phung BA (Hons), PhD4

1School of Nursing and Midwifery, University

of Newcastle, Newcastle, New South Wales,

Australia

2Consumer Academic Synergy, Nursing and

Midwifery Research Centre, University of

Canberra, Faculty of Health, and ACT Health,

Building 6, Level 3, Canberra Hospital,

Australia

3Research Fellow, ANU Medical School,

College of Health and Medicine, The

Australian National University, Canberra,

Australia

4Conjoint Lecturer, School of Nursing and

Midwifery, University of Newcastle,

Newcastle, New South Wales, Australia

Correspondence

Professor Brenda Happell RN, RPN, BA

(Hons), Dip Ed, B Ed, M Ed, PhD, School of

Nursing and Midwifery, University of

Newcastle, Newcastle, New South Wales,

2308 Australia.

Email: [email protected]

Abstract

Purpose: Academic positions for consumers of mental health services remain rare despite

positive evaluation. This paper considers the benefits and challenges of a consumer

academician position, from perspectives of stakeholders involved in the implementation.

Design and Methods: Qualitative, exploratory involving in‐depth interviews with

academicians. Thematic analysis identified the main benefits and challenges.

Findings: Benefits identified included lived experience perspective and facilitates

interaction and reflection; demonstrating recovery and promoting person centered care.

Challenges identified included process, too close to home, and too little too late.

Practice Implications: Enhanced understanding of consumer academician positions

could increase effectiveness and maximize educational opportunity.

K E YWORD S

consumer academician, consumer participation, education of health professionals, mental health,

mental health nursing

1 | INTRODUCTION

Mental health consumer involvement in the education of health

professionals has gradually emerged as a strategy in the research

literature over recent years. This development has occurred most

frequently within the nursing profession,1–6 with recent activity in

occupational therapy7,8 and social work.9–11

Educational outcomes from consumer academicians are

generally reported as positive, indicating such exposure improves

students’ skills and reduces stigmatized attitudes. Consumer

involvement in health professional education has demonstrated

benefits, such as students developing a greater understanding of

the unique experience of being diagnosed with a mental illness

and mental health service use, a more holistic understanding of

people's needs throughout the health care system, and increased

self‐awareness. These improvements have translated into notable

and person‐centered changes by students to their approach to

practice.10–13

It is unfortunate that this positive evidence has not resulted in

consumer‐led teaching being identified as a necessary component for

quality health professional education, or being further explored as a

strategy to strengthen curricula. Successive national surveys of

nursing programs, conducted approximately 8 years apart,3,14

demonstrated an increase in universities engaging consumers in

nursing education some capacity. It was also demonstrated that most

universities continue to involve consumers in a limited capacity,

primarily in an ad hoc teaching role and usually contained the telling

of narratives, with minimal impact on the curriculum more broadly.3

This approach limits the capacity for transformative change to

curricula, restricts the value and contribution of consumer knowl-

edge gained from lived experience, and curtails the potential impact

on student outcomes.5,11–13

Academic positions for mental health consumers have been

identified as an important initiative to facilitate their transfor-

mative potential within mental health nursing programs6,13,15,16

by expanding beyond ad hoc and often teaching focused

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input.17,18 Consumer academicians (known in Australia as con-

sumer academics) are people who have been diagnosed with a

mental illness and have utilized mental health services either

voluntarily or involuntarily in the past. Unfortunately, despite

the strong emphasis on consumer participation in Australian

mental health policy,19,20 consumer academician positions remain

rare.3

The strongest developments within consumer academia were

influenced by leadership from the nursing profession,2 and nurses

are identified as potentially strong allies to positively influence

consumer participatory roles.21,22 The potential of nurses as

major influencers is further supported by a limited literature base

suggesting mental health nurse academicians hold positive views

toward consumer involvement in nurse education.2,23 However,

the experiences of most nurse academicians participating in this

research involved consumers as guest lecturers or working in

defined and time‐limited roles. The extent to which these

attitudes may translate into ongoing support for consumer

academician positions cannot be determined from this work

alone and requires further investigation.

This paper considers the impact of implementing a position of

this type on all members of the teaching and research team and

provides in detail the identified benefits and challenges of this

initiative.

The aim of this paper is to present findings from the

perspective of nursing academicians, who are currently pivotal in

maximizing the input of consumer academicians. This information

will provide an enhanced understanding of the implementation

process and identify areas for improvement. It may also offer

direction to teaching academicians and researchers with an

interest in introducing a consumer academician position within

their university.

2 | METHODS

2.1 | Design

The research was undertaken using a qualitative exploratory

approach.24 Qualitative exploratory methods are frequently used to

explore areas where little or no research has been undertaken and

more information is required to develop a knowledge base as a

means to enhance understanding and contribute to further develop-

ment. This approach provides opportunities for key stakeholders to

directly influence knowledge created through their perspectives,

experiences, and insights.

2.2 | Setting

This research was undertaken in an Australian University

providing an undergraduate Bachelor of Nursing program. The

program includes a compulsory mental health nursing subject for

students completing their last semester of the program. One

hundred and ninety‐two students were enrolled in the subject. A

consumer academician was introduced to teach students a

consumer perspective of nonclinical (e.g., stigma) and clinical

aspects (e.g., medication), based on their lived experience of

mental distress and mental health service use. The consumer

academician led three of the eight lectures for the semester. Each

2‐hour tutorial was effectively delivered in two segments of

1 hour. A nurse academician delivered 1 hour and the consumer

academician delivered the second hour.

2.3 | Participants

The research was approved and supported by the Head of School

and coordinator for mental health nursing. Participation was

open to all members of the research and teaching teams, and all

five agreed to participate. Participants included the consumer

academician, the two nurse academicians responsible for teach-

ing and coordinating the mental health nursing component, and

the two mental health researchers coordinating and overseeing

the research.

2.4 | Procedure

Interviews were conducted with the five participants at the

conclusion of the teaching period. Given the dual roles between

researchers and participants, an independent researcher

was employed to recruit participants and conduct the

interviews.

Interviews were organized with each participant at a mutually

convenient time and location. Interviews were conducted individually

and in person. An interview guide provided some structure for the

interviews and ensure specifically identified issues were addressed

(the interview guide is presented in Table 1). At the same time, a

conversational approach was adopted to enable participants to

inform the process with their own experiences, perspectives, and

opinions, and to raise matters not anticipated by the researchers. All

interviews were audio recorded and transcribed by an independent,

external company. The verbatim transcripts provided an accurate

and complete record of interviews.

TABLE 1 Interview guide

1. Please describe your views and opinions about mental health service user involvement in teaching nursing students

2. What do you see as the positives (if any) for students of being taught by a mental health service user? Please explain.

3. What do you see as the negatives (if any) for students of being taught by a mental health service user? Please explain.

4. In what ways (if any) do you feel students’ nursing practice will be influenced by this experience?

5. Having been involved in this teaching are there ways it could be improved? Please elaborate

6. Do you feel service user involvement should be integral to teaching mental health? Please elaborate

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2.5 | Ethics

The research was approved by the University of Canberra in

Human Research. Participants were informed about the study

verbally initially and given the opportunity to ask questions or

seek additional information. They were provided with a Plain

Language Statement and consent form, to be signed before the

interview commenced. Because there were only five participants

in this project, no information such as pseudonyms or participant

codes has been provided to protect the identity of individuals as

much as possible.

2.6 | Data analysis

Data analysis was based on the five‐step framework of Braun and

Clark.25 Initially, transcripts were read several times to establish

familiarity with the content and its underlying meaning. Specific

content areas were identified, and a code was assigned to each area.

To ensure only relevant information was included, each code was

separately studied with respect to the research aims. Codes of similar

or related content were clustered together into provisional themes. A

conceptual map was developed comprising the provisional themes.

Finally, themes were reviewed for relevance and accuracy. Tran-

scripts were then read once more to ensure no important data had

been omitted from analysis.

3 | FINDINGS

The main themes, delineated as benefits or challenges, are presented

in Table 2.

3.1 | Benefits

Participants discussed the advantages of inclusion of lived experience

perspectives, and the facilitation of interaction and reflection. This

content is presented below.

3.1.1 | Lived experience perspective

All participants saw some advantage in the consumer or lived

experience teaching as an integral part of the curriculum. The use

of story was particularly noted as a technique which encouraged

students to consider their practice from the perspective of those

most closely impacted by services.

Watching the consumer academic … sit in front of the

class and talk about her own personal story with mental

illness, was a very powerful moment … lots of people are

touched by issues of mental ill health, if not within

themselves, by a family member or a friend, and I think

when you start to be able to empathize and think, oh gosh,

okay, the mental health system has treated some people

pretty poorly, what if that was me or what if that was my

mum … it does refine the way that you think about it.

The consumer perspective was broadly viewed as unique and

irreplaceable, and as creating a unique learning experience. It

provided an opportunity for students to more closely understand

the lived experience of mental health service use in a way that could

only be delivered by a person who had firsthand experiences:

I think it's invaluable, I think it should be part of any

quality program … their learning has been directed by

somebody who has that experience and I think that makes

them think differently. It's very easy to read things in a

text book; we should be empathetic … to actually have

somebody say this is what it was like for me when I was

secluded … this is the kind of nursing care found really

useful … it alters attitudes.

3.1.2 | Facilitates interaction and reflection

The presence of a consumer academician provided the opportunity

for more dynamic classroom interaction. This enabled the educa-

tional experience to go beyond merely telling story to enable the

students to ask questions—or even challenge the consumer—to

further enhance their learning:

There is the opportunity for them [students] to ask

questions … They do have the ability to then balance it out

with what they thought and perceived … a student might

go … ‘did that really happen?’ The consumer … can then

engage with the group … I can see how you might feel that

way. But this was my reality and this is how it came across

to me, rather than – no, this is my story. There it is, take it.

This enhanced students’ capacity to be reflective and engage in

critical thinking regarding established mental health nursing practice:

One student referred to a situation described by the

consumer academic: “I could actually see why the nurses

would have thought what they were doing was the right

thing to do and the best thing to do but it actually wasn't,

it was terrible and then the consequences for [the

consumer academic] were shocking,” and that's incredibly

insightful. So even though they might have felt uncomfor-

table hearing about these situations … They are able to go,

TABLE 2 Themes

Benefits Challenges

Lived experience perspective Process

Facilitates interaction and reflection Too close to home

Demonstrating recovery and promoting

person centered care

Too little too late

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‘well I can see how that could easily happen but now I

know how to avoid it.’

The role of the consumer academician extended beyond story-

telling, with exercises specifically developed to encourage students

to reflect on their personal views and values which can impact on

their nursing role:

…the exercises I did really promoted critical thinking and

there was not a whole lot of critical thinking in the course

… this was being presented with something quite

complicated and having to work it through the critical

thinking exercises … they made the students examine their

own values and bias, which is very important for people

who want to go into mental health nursing … values of the

individual nurse really drive and influence clinical

decision‐making.

The consumer's academic value was noted as a very important

additional skill:

… she was able to share, but also place it in an academic

context. She supplied the students with some readings, so

that was really good. she had some great exercises … Also,

her lecture … was excellent … it was about commu-

nication.

3.1.3 | Demonstrating recovery and promoting person‐centered care

The presence of a lived experience academician provided a firsthand

demonstration that recovery happens and encourages students to

see mental distress as a temporary state, rather than a feature of

their personal identity:

… people who may seem extremely strange are people and

that's a …time when they may be unwell …a snapshot in

their life. [The consumer academic has] had those

snapshots in her life but that's not her life. Her life is …

all these other things that she's really good at and that

she's achieved.

The consumer academician introduced the students to recov-

ery concepts and through providing her own personal experience

was able to humanize the experience. This approach encouraged

students to be more aware and critical of existing clinical practices

and their actual recovery orientation, by recognizing their human

impact:

… my teaching was around person‐ centered nursing

practice and recovery. Recovery is quite a different

approach to the medical model. So where the medical

model seeks to identify deficits and remedy those with

medication, recovery seeks to identify strengths and

maximise those …Recovery is very different from other

ways that they learn to treat illness. For example, I shared

a personal story of being 17 and under clinical observa-

tions, where you are checked every 15 minutes by a nurse

…so I'm in this white room with just a trap door on the

door, and someone looking through every 15 minutes for a

couple of weeks. That's clinically correct, that is a nursing

policy that is in every hospital. But hearing my perception

of that as a 17‐year‐old, I think made them more willing

to critique some of these practices. I think without hearing

the personal experience …they would have not engaged in

that critique.

This type of teaching approach was seen as invaluable as

enhancing communication with people experiencing any mental

distress, whether specifically in the mental health area or not, and

therefore facilitated enhanced communication:

I think students will feel a lot more comfortable to build

rapport with mental health service users. … A very good

example … was where we were talking about connecting

with a service user and developing clinical rapport. And a

student said that when they went on their clinical

placement, they were told by the supervising nurse … to

never ever share anything personal about themselves …

even your favourite food or whether you have a pet. And I

really challenged that … when they went on their second

placement, one of them talked to a young man, who had a

particular football scarf on, about her football team … She

found it was a really effective way of engaging, but it

didn't put her at risk, by providing any personal

information. So, she was quite excited and shared with

the students, how effective that was.

3.2 | Challenges

Participants raised some of their perceived challenges of the

program, including difficulties with the process of a new course

cotaught by consumer academicians, concerns about managing

potential existing relationships between consumer academicians

and other colleagues or students, and the lack of broader

implementation of consumer perspectives in other subjects and

settings.

3.2.1 | Process

Some participants described the implementation of the consumer

academician position as poorly planned, leaving the teaching team

not understanding the rationale or knowing what to expect in the

weekly tutorials:

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None of those sorts of things were presented to us, until

the moment that the consumer stepped up and wrote

three or four objectives on the whiteboard. This is what

we'll be doing today. Put your pens and pencils down and

here we go. I think students found that interesting … it left

us looking as the academics running the program, what

are we doing? You're not organised.

One participant referred to a member of the teaching team

and one of the researchers being absent for part of the

project team:

it would have been good to be tighter as a group, as a

research group.

Being more organized would also have provided a more

coordinated approach to the teaching:

what we need to do is this … and we will do this … and

together, we'll come up with this. What are you bringing to

it? Let's merge, make sure everything's both complemen-

tary and relevant and go from there … Or is this the

equivalent of two different tutorials?

The view was expressed that students found the different

approaches from the consumer academician and nurse academicians

as disjointed:

The feedback we got through [the online learning

platform from some of the students was that it was

disjointed. They didn't know what was happening. And

mostly, out of the negative stuff, was it just looked

disorganised.

Another participant challenged this thinking, suggesting the

students were more than capable of dealing with different

approaches and teaching techniques:

we can assume that students won't be sophisticated

enough to understand these kinds of issues or that we

need to spoon feed them, but at the end of the day they're

adults, they understand quite complex things, they're very

smart, they got into university and they're doing these

subjects.

The following statement from one participant suggested the

teaching team may not have been fully invested in the project and

may have felt obliged to be involved:

The impression I got was that we needed to participate

and be collegial, or it was just going to be – we're going to

be the uncool kids.

Another participant found the separation between the teaching

academicians and researchers disruptive and believed the process

would have been smoother had they all been part of the team:

It's just they're the researchers, we're the academics and

trying to put the – merge the two together was difficult.

The need for ongoing review for this type of teaching and the

need to adapt to change were highlighted:

if it was to come in within a curriculum, it would need

review every semester, to make sure that the parties that

were teaching were still good with it. That the feedback,

everybody was growing and changing their delivery of the

teaching from the feedback. …You just need other

consumers to come in. You need that refreshment. You

need to keep stirring the punch, otherwise all the fruit

sinks to the bottom.

3.2.2 | Too close to home

Concern was raised by some participants that the consumer

academician was known to some of the students.

The consumer coming from [name of area] … there were

some students that knew [her] … That was a bit close. I did

have a student … one night after a tute … really distressed

about the whole thing. But that was one student.

One participant had previously worked in the mental health

service where the consumer academician had been an outpatient.

The prior clinical relationship created tension, and it was not clear

how to negotiate this in context:

I had no idea what the foundation was for our relationship

and that made it very awkward as well. …

3.2.3 | Too little, too late

Difficulties balancing the consumer content with the broader

curriculum were also noted. The teaching academicians felt the

inclusion of the consumer academician created difficulties in covering

the required content and preparing students for examination:

the time that we had to deliver our content, but then we

had to split the – every tutorial down to allow time for the

consumer academic to deliver her material

Furthermore, devoting course time to the consumer academician

was seen to leave the teaching team with the less interesting content

in order to ensure students achieve course requirements:

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here's today's boring dry content that you're going to need

to know to pass the exam at the end of the year.

Apparently, this was also an issue of concern for students, who

understandably (most) being in their final semester, were concerned

about completing the requirements for registration as a nurse:

The students wrote in their feedback … they felt that they

weren't getting through the curriculum requirements,

because they had – or the unit requirements, because

they have a set exam.

It was interesting to note that while insufficient time was noted

as problematic, when unexpectedly the consumer academician was

not available, the teaching team found it difficult to fill the time:

There was one time where [consumer academician] was

unable to attend the tutes …. we were notified quite late,

so that left us as a teaching staff, looking for how to fill

seven extra hours of tutorial material.

One participant suggested introducing the consumer academician

component earlier in the curriculum. In addition to increasing student

exposure, it could potentially reduce the impact on individual

students:

… a lesson that they're learning in the last year of their

degree, and I …feel like this probably could come earlier,

and probably should potentially come earlier [with]

consumer perspectives…really embedded throughout the

curriculum.

4 | DISCUSSION

The findings of the current study elaborate on the importance and

value of coproduction of mental health teaching programs. The

advantages of such programs include the ability for students to

better understand, to interact with, and reflect on the perspectives of

lived experience of mental health service, in addition to their own

preexisting value systems. Such coproduction has been identified in

the broader literature as the next critical step to meaningfully

improve clinical practice and reflection.10–13

Realizing these advantages requires certain challenges to be

overcome. The challenges identified in this research include ensuring

that the process of coproduction is meaningfully planned, ensuring

potential existing relationships with consumer academicians are

clarified, and that consumer perspectives become deeply embedded

into curricula. If these challenges are not effectively addressed,

consumer involvement in education is likely to be tokenistic and to

fail to achieve its potential.2,26

Policy requires that consumers are involved at all levels of the

mental health sector,20 and indeed the findings of this study

demonstrate several advantages of the consumer involvement in

curriculum planning and teaching. The landmark Mental Health

Nurse Education Taskforce Report27 has consumer participation

as an underlying principle for mental health nursing content in

undergraduate curricula. Furthermore, current accreditation pro-

cesses for nursing education already require approaches to

curriculum delivery which are collaborative with consumers.28

Some findings of the current study suggest that there is still

resistance toward truly collaborative approaches, particularly

where decision‐making is shared. For instance, one teaching staff

member suggested that if a cotaught subject was to become a

permanent part of the curriculum, “it would need review every

semester, to make sure that the parties that were teaching were

still good with it.” It is not usual practice to review curricula in this

way. Negative attitudes of health professionals to working

collaboratively with consumers are well referenced in the

literature and presents a significant challenge,21,29–31 and there

is no reason to assume nurse educators may not hold similar views.

Truly collaborative approaches can be fostered and galvanized if

accreditation guidelines more clearly require more consumer

involvement in teaching, at least as a starting point.

An interesting finding from this study was the heavy emphasis on

examination results (and passing the course) as one of students’

primary motivations, and hence a strong imperative for teaching

academicians. In the current research, some participants expressed

their views that the consumer perspective component reduced the

time available to address assessment requirements. Some research

critiques this approach. Such a strong focus on examination has been

identified as limiting the creative development of students’ practical

skills.32 Creative thinking is particularly important in mental health

settings and in fostering and promoting consumer participation in

general. This important finding suggests that formal summative or

formative assessment of the consumer component is essential to

meaningfully embedding consumer participation in nursing curricula.

Previous research has demonstrated a positive response to course

assessment developed and undertaken by a consumer academician,

which aimed to enhance student self‐awareness and reflection.12 It is

likely also to demonstrate to students that this content is important

and relevant to their immediate examination results as well as to

their future careers.

While the benefits of offering consumer‐led teaching in nursing

education is well documented in the literature, the current research

highlights some important challenges. Several aspects of the findings

suggest tensions between the consumer academician and the other

teaching staff that may have prevented the full realization of the

advantages of the coteaching program. For instance, participants

talked about the difficulty in trying to “merge the two together,” and

of the other teaching staff having the impression that they “needed

to participate and be collegial.” Tensions between the perspectives of

consumers and other health professionals have been identified in

other studies of the consumer workforce.30,33 It is important that the

value of all perspectives is acknowledged within educational settings,

yet stigmatized attitudes inhibiting implementation are addressed.

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From the perspective of the three‐stage model of intergroup

contact situations,34 earlier and personalized contact between

intergroup collaborators can assist with greater trust. An implication

of this for educators who seek to coproduce teaching programs

between consumer academicians and other teaching staff relates to

developing trust. Given that the goal of coproduced teaching was not

to merge perspectives but to teach students the value of diverse

perspectives, working together from a position of appreciating and

trusting consumers’ perspectives (without trying to silence or co‐opt) appears an important next step for other teaching staff. Further,

given one participant's concerns that a previous clinical relationship

with the consumer academician made their teaching relationship

awkward, early discussions about collaborating as educators and

moving past previous relationships could be useful in strengthening

collegiality.

5 | RESEARCH LIMITATIONS

One of the limitations of the current study relates to the very specific

setting in which the research was conducted. The five participants

were involved in the same teaching program, and so advantages and

challenges faced by other teams implementing consumer academi-

cian positions may differ. However, the findings may in fact

underscore the importance of mitigating any challenges of coproduc-

tion in other settings that may be less welcoming to consumer

academicians.

6 | CONCLUSIONS

Recruiting consumers of mental health services in academician

positions for the education of nurses and other health professionals

has been identified as a beneficial strategy, and this is borne out in

the findings of the current study. The challenges to this approach

have received significantly less attention. Before they can be

overcome, challenges must be identified and acknowledged, and an

aim of the research presented in this paper is to highlight the

challenges as well as the advantages to better understand the issues

that may be encountered when introducing academic positions for

consumers of mental health services. The knowledge gained will

prove invaluable in implementing these positions. Consumer acade-

micians are as yet a largely untapped resource, with potential to

contribute to the realization of policy goals pertaining to consumer

participation and recovery‐orientated practice. Both are vital to

progress overdue mental health reform.

ACKNOWLEDGMENTS

The authors acknowledge the funding provided from the Erasmus +

funding for the broader Commune project. We acknowledge the

assistance of Piyada Juntanamalaga in undertaking the interviews.

Our sincere thanks to the participants who generously gave of their

time to describe their experiences and opinions.

ORCID

Brenda Happell http://orcid.org/0000-0002-7293-6583

REFERENCES

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21. Byrne L, Happell B, Reid‐Searl K. Risky business: lived experience mental health practice, nurses as potential allies. Int J Ment Health Nurs. 2016b;25:217–223.

22. Happell B, Scholz B. Doing what we can, but knowing our place: being an ally to promote consumer leadership in mental health. Int J Ment Health Nurs. 2018;27:440–447. https://doi.org/10.1111/inm.12404

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32. Tawie R, Neging M, Khan MYM, (2017). Preliminary study on creativity in higher education: perceptions of engineering instructors. Paper presented at the Engineering Education (ICEED), 2017 IEEE 9th International Conference.

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How to cite this article: Happell B, Bocking J, Scholz B,

Platania‐Phung C. Implementation of a mental health consumer

academic position: Benefits and challenges. Perspect Psychiatr

Care. 2019;55:175–182. https://doi.org/10.1111/ppc.12315

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