Co-design and evaluation of a multidisciplinary teaching resource on mental health recovery involving people with lived experience.

BACKGROUND: Students from a range of health disciplines need to learn from people with lived experience of mental distress and recovery to develop recovery capabilities for mental health practice. AIMS: The aims of this study are to describe the co-design of a teaching resource, to explore the experience of people with lived experience during the resource development, and to evaluate the outcome of the resource on student recovery capabilities. METHOD: Using a sequential mixed method, a project group consisting of six people with lived experience and 10 academics from five health disciplines was convened to co-develop teaching resources. People with lived experience met independently without researchers on several occasions to decide on the key topics and met with the research team monthly. The teaching resource was used in mental health subjects for two health professional programmes, and the Capabilities for Recovery-Oriented Practice Questionnaire (CROP-Q) was used before and after to measure any change in student recovery capabilities. Scores were compared using the Wilcoxon signed rank test. The people with lived experience were also interviewed about their experience of being involved in constructing the teaching resources. Interviews were audiotaped, transcribed, and analysed thematically. RESULTS: The finished resource consisted of 28 short videos and suggested teaching plans. Occupational therapy and nursing student scores on the CROP-Q prior to using the educational resource (n = 33) were 68 (median) and post scores (n = 28) were 74 (median), indicating a statistically significant improvement in recovery capability (P = 0.04). Lived experience interview themes were (i) the importance of lived experience in education; (ii) personal benefits of participating; (iii) co-design experience; and (iv) creating the resource. CONCLUSION: Co-design of teaching resources with people with lived experience was pivotal to the success and quality of the final product, and people with lived experience described personal benefits of participating in resource development. More evidence to demonstrate the use of the CROP-Q in teaching and practice is needed.

Predicting Housing Related Delayed Discharge from Mental Health Inpatient Units: A Case Control Study.

The aims of this study were to identify factors that a) predict whether people experience housing related discharge delay (HRDD) from a mental health inpatient unit; and b) predict the length of HRDD for people affected. By identifying the groups most affected by HRDD, clinicians and policy makers can prioritise and address barriers to timely discharge at both an individual and systemic level. A case control study using a detailed medical record review was conducted in one Australian mental health service. Demographic, clinical, contextual and systemic variables were collected for patients with HRDD in one calendar year (n = 55) and a random comparison sample (n = 55). Logistical and multiple regression analyses were conducted to identify variables that predict HRDD and length of HRDD. A model that correctly predicted 92% of HRDD and 78% of non-HRDD cases using five variables was developed. These variables were: diagnosis of schizophrenia or other psychotic disorder, physical comorbidity, having a history of violence or aggressive behaviour, being employed and being involved as a defendant in the justice system. The first three variables increased the likelihood of HRDD, while the second two reduced the likelihood of HRDD. For people who experienced HRDD, the only variable that predicted length of delay was staff reported difficulty finding appropriate support services. This model can be used to rapidly identify patients who might be at risk of HRDD and commence coordinated actions to secure appropriate housing and supports to facilitate timely discharge, thereby addressing a current practice gap. These findings highlight the intersection between health, housing and disability services in the lives of people with serious mental illness, and the need for a whole of government approach to investment and integration to address systemic barriers to suitable housing and supports.

'I'm institutionalised there's not much I can do': Lived experience of housing related delayed discharge.

INTRODUCTION: Delayed discharge from inpatient mental health units is the continued hospitalisation of consumers after being assessed as ready to be discharged. This is common in adult inpatient mental health services and is usually due to a lack of appropriate housing for discharge. Research indicates a range of possible negative impacts, but no studies have explored consumers' perspectives on this issue. This study explores consumers' perspectives of the experience of housing related delayed discharge (HRDD). METHOD: Using a grounded theory approach, in-depth interviews were conducted with 10 consumers. All consumers were experiencing HRDD from inpatient mental health units in one Sydney local health district. The data were analysed using constant comparative analysis. FINDINGS: A lack of choice and control was the central theme that characterised participants' experiences. The combined experience of being delayed in hospital and being homeless led to a lack of choice and control over the basics in life, how consumers spent their time and with whom, and their futures. This lack of autonomy was shaped by the features of the hospital and participants' personal circumstance. The hospital features included rules and routines, physical and social environments, resources, and support from staff. Personal circumstances included individual situations, social networks, and support from community organisations. Participants described a variety of impacts, including reduced mental and physical well-being, and anticipated difficulty transitioning back into the community. CONCLUSION: This study is the first of its kind and provides consumer perspectives on the impacts of HRDD on their well-being and recovery. The inability to participate in meaningful and necessary occupations is an occupational injustice and implies the need for occupational therapists to advocate for both the prevention of HRDD through government investment in affordable and readily available housing and the mitigation of its effects through modified hospital environments and practices.

Mental health consumer involvement in occupational therapy education in Australia and Aotearoa New Zealand.

INTRODUCTION: Recovery-oriented practice policies and occupational therapy education accreditation standards require that consumers are engaged in the design, delivery and evaluation of curricula. This consumer involvement (sometimes referred to as service-user involvement or patient involvement in other contexts) should go beyond consumers simply 'telling their stories' to more meaningful collaboration in curricula. This study was designed to map the current patterns of consumer involvement in occupational therapy programs across Australia and Aotearoa New Zealand. METHOD: A survey was distributed to all occupational therapy programs across Australia and Aotearoa New Zealand. The survey included questions related to: (a) perceived enablers and barriers to consumer involvement in education; (b) organisational structures and support; (c) ways in which consumer are involved in the design, delivery and evaluation of curricula; (d) access to remuneration for consumers; (e) overall ratings of the level of consumer involvement in curricula; and (f) academic confidence in working with consumers. RESULTS: Usable responses were received for 23 programs from 19 universities (83% response rate). Every program reported some consumer involvement in the curriculum. Consumer participation tended to be mainly focussed on curriculum delivery with less frequent involvement in curriculum design or evaluation. The most common barrier to consumer involvement in curricula was 'funding/remuneration for consumers' and the most common enabler of consumer involvement was 'positive attitudes of teaching staff'. CONCLUSION: In comparison to previous reports, consumer involvement in occupational therapy curricula has increased over the past decade. However, ongoing effort is required to support true collaboration in all aspects of curriculum design, delivery and evaluation. While this will require attention and effort from academic teams, changes at a university level to establish systems to engage and effectively remunerate consumers for their involvement (especially in design and evaluation elements) are also required.

Learning from consumers: An eDelphi study of Australian mental health consumers' priorities for recovery-oriented curricula.

BACKGROUND/AIM: Mental health reform in Australia emphasises recovery, partnership working and prioritises consumers' needs over professionals'. Occupational therapy students must develop capabilities for working in this way. Learning from consumers' lived experience of mental illness and recovery is considered critical to developing such capabilities and aligns with occupational therapy programme accreditation for consumer involvement in designing, delivering and evaluating curricula. No definitive capability standards exist to inform curricula and little is known about Australian mental health consumers' preferred modes of involvement in health professional education. This study sought to identify consumers' priorities for curricula, and ways in which they would like to participate in entry-level student education. METHODS: An eDelphi study utilising the Policy Delphi approach was employed. Consensus by 70% of participants was set as the standard for item inclusion. The first round asked open questions about participants' priorities for recovery-oriented curricula, their experiences with mental health workers and asked participants to identify their preferred methods of participating in education. Items generated were rated in subsequent rounds until consensus was reached in round three. RESULTS: Twenty-eight participants completed round one, 18 completed round two and 14 completed round three. Five core values and 171 curriculum priorities, forming 12 capability domains, reached consensus. Each capability domain comprised knowledge and understanding; skills and abilities; and behaviours and actions. Ten ways of participating in mental health curricula in entry-level occupational therapy programmes were identified, with an emphasis on active participation in design, delivery and review of curricula. CONCLUSION: These findings highlight important capabilities from consumers' perspectives, suggesting key content for curricula. Active roles in designing, delivering and evaluating curricula were preferred, providing some guidance for educators seeking to involve consumers. Further research is required to refine these priorities, and to evaluate acceptability, feasibility and efficacy of varying modes of consumer involvement.

Mental health education in occupational therapy professional preparation programs: Alignment between clinician priorities and coverage in university curricula.

BACKGROUND/AIM: Occupational therapy programs must prepare graduates for work in mental health. However, this area of practice is complex and rapidly changing. This study explored the alignment between educational priorities identified by occupational therapists practising in mental health and level of coverage of these topics in occupational therapy programs in Australia and New Zealand. METHODS: Surveys were distributed to heads of all occupational therapy programs across Australia and New Zealand. The survey included educational priorities identified by occupational therapists in mental health from a previous study. Respondents were requested to identify the level of coverage given to each of these priorities within their curriculum. These data were analysed to determine a ranking of educational topics in terms of level of coverage in university programs. RESULTS: Responses were received for 19 programs from 16 universities. Thirty-four topics were given 'High-level coverage' in university programs, and these were compared against the 29 topics classified as 'Essential priorities' by clinicians. Twenty topics were included in both the 'Essential priorities' and 'High-level coverage' categories. Topics considered to be 'Essential priorities' by clinicians which were not given 'High-level coverage' in university programs included the following: mental health fieldwork experiences; risk assessment and management; professional self-care resilience and sensory approaches. CONCLUSION: While there appears to be overall good alignment between mental health curricula and priorities identified by practising occupational therapists, there are some discrepancies. These discrepancies are described and establish a strong foundation for further discussion between clinicians, academics and university administration to support curriculum review and revision.

Mental health consumer participation in education: a structured literature review.

BACKGROUND/AIM: Consumer participation in design, delivery and evaluation of occupational therapy educational programs is a recently introduced requirement for accreditation. It aligns with the principle of recovery, which underpins Australian mental health policy. Graduates' capabilities for recovery-oriented practice are thought to be enhanced through learning from consumers' lived experience. This structured literature review evaluates the current evidence for mental health consumer participation in health professional education to inform occupational therapy educators. METHOD: Searches were completed in five online databases, one journal and published reading lists on the topic. Studies were included if they addressed mental health consumer participation in health professional education programs, were published in peer reviewed journals between 2000 and 2014 and were in English. Articles were critically reviewed, and analysed for key findings related to stages of the educational process and recovery-oriented practice capabilities. RESULTS: An emerging body of evidence for consumer participation in mental health education was identified. Studies are characterised by a lack of quality and a low to medium level of evidence. Findings relate to design, planning, delivery and evaluation of education as well as to most aspects of recovery-oriented practice. Emphases on exploratory research and proximal outcomes, and a reliance on published outcome measurement instruments designed for other purposes are key limitations in this body of evidence. CONCLUSION AND SIGNIFICANCE OF THE STUDY: This study identifies a weak evidence base for the requirement for consumer participation in occupational therapy programs, specifically related to mental health curricula. A research agenda is proposed in response.

Effectiveness of a workplace training programme in improving social, communication and emotional skills for adults with autism and intellectual disability in Hong Kong--a pilot study.

This pilot study explored the effectiveness of workplace training programme that aimed to enhance the work-related behaviours in individuals with autism and intellectual disabilities. Fourteen participants with autism and mild to moderate intellectual disability (mean age = 24.6 years) were recruited. The workplace training programme included practices in work context and group educational sessions. A pre-test-post-test design was used with the Work Personality Profile, the Scale of Independent Behaviour Revised and the Observational Emotional Inventory Revised to evaluate the targeted behaviours. Improvement in social and communication skills specific to the workplace was achieved. For emotional control, participants became less confused and had a better self-concept. However, improvement in other general emotional behaviours, such as impulse control, was limited. The results indicated that a structured workplace training programme aimed at improving social, communication and emotional behaviours can be helpful for people with autism and intellectual disability. Further study with a larger sample size and a control group is recommended. The development of specific programme to cater for the emotional control needs at workplace for people with autism is also suggested.