'I Can't See Myself Seeking Help': The Influence of Clinical Placements on Nursing Students' Stigmatising Beliefs and Intentions to Seek Help for Their Own Mental Health Issues: A Prospective Cohort Study.

Mental health conditions such as anxiety, depression and psychosis represent a global health challenge. Stigma surrounding mental health continues to hinder help-seeking behaviours for people with mental illness and as this study demonstrates, nursing students as well. However, if student nurses are reluctant to seek help for mental health issues, how can others be expected to do so? This reluctance poses challenges in mental health nursing, impacting both care provision and nursing education. The present study seeks to explore the influence of traditional versus non-traditional mental health clinical placements on second-year nursing students' stigmatising beliefs and intentions to seek help for mental health issues. Employing a prospective cohort design using the TREND checklist, the study sampled second-year nursing students assigned to either traditional hospital-based or non-traditional recovery-focused mental health clinical placements. Using validated scales, stigmatising beliefs and help-seeking intentions were measured before and after the placements. Statistical analyses were conducted to assess changes in these variables over time and across placement settings. A significant impact of placement setting on help-seeking intentions was observed, with students in non-traditional placements showing an increased willingness to seek help. Additionally, non-traditional placements were found to significantly reduce stigmatising beliefs in all measured domains, suggesting that these settings may provide a more conducive environment for fostering positive attitudes towards mental health. Recovery-focused placements appear to offer experiences that can diminish stigma and encourage more positive perceptions and intentions related to mental health support.

"This should be a compulsory placement for all nursing students": An evaluation of pre-registration nursing students' perceptions of learning on a mental health clinical placement.

AIM: To conduct a longitudinal exploration of pre-registration nursing students' perceptions of their learning on an immersive mental health clinical placement grounded in learning from people with a lived experience of mental illness (otherwise known as consumers). BACKGROUND: Enriching mental health clinical learning environments are crucial for positive mental health nursing outcomes. Though non-traditional clinical placement (i.e. non-hospital-based) models effectively increase student learning in a range of domains, little is known about the specific features of contemporary non-traditional placement settings that may be supporting student learning over time. DESIGN: A survey design in the form of a standardised evaluation tool with additional qualitative response questions was used to examine nursing students' perceptions of learning whilst on a non-traditional clinical placement over a 5-year period. Non-traditional placement settings are alternative placement options to traditional inpatient/community mental health settings. The TREND Statement Checklist was adhered to. METHODS: Second- and third-year students studying a Bachelor of Nursing (N = 753) from eight Australian Universities completed a Student Placement Feedback Survey between 2019 and 2023. Data were collected via an evaluation survey including 7-items (rated on a 5-point agreement scale) and three free-response questions. Quantitative and qualitative responses were analysed over all observations and compared between the five years of student evaluations. RESULTS: Across five years, the immersive mental health placement was consistently rated by students as a highly valuable learning experience. Utilizing a Multivariate Analysis-of-variance (MANOVA) for the quantitative component revealed that student 'learning from lived experience' remained uniformly high and steady throughout 2020-2023. This was despite disrupted learning that ceased face-to-face tuition caused by the COVID-19 pandemic. An increase in 'student enthusiasm for nursing' was identified after the return to face-to-face learning. Qualitative analysis identified a greater need for preparedness prior to attending the placement and wellbeing support amongst students. CONCLUSIONS: Over the five years, pre-registration nursing students report clinical skill improvement and enhanced knowledge following the immersive mental health placement alongside an increased desire for further skill development. Learning from people's lived experience of mental illness and specialised facilitators was valuable for student learning outcomes. Increased support is needed for student mental health vulnerabilities and wellbeing ahead of clinical placements. Further research is recommended on the aspects of non-traditional clinical placements that may be protective for student learning.

Non-traditional mental health clinical placements: An effective means for reducing self-stigma in pre-registration nursing students.

WHAT IS KNOWN ON THE SUBJECT: Pre-registration nursing students report high rates of stigma, leading to low help-seeking attitudes when seeking help for mental health issues. Traditional mental health clinical placements can improve stigma related to attitudes and social distance for pre-registration nursing students. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: There are nil recorded clinical placement interventions that have decreased self-stigma for pre-registration nursing students, with this study highlighting a clinical placement model that is effective in significantly decreasing self-stigma. IMPLICATIONS FOR PRACTICE: The knowledge around the mental health struggles experienced by pre-registration nursing students, and the effect of a non-traditional mental health placement in decreasing self-stigmatizing attitudes in this population, is important for the future of retaining mental health nurses. There is an opportunity to use the clinical placement model presented, and design interventions for nursing students that aims to promote help-seeking behaviours. ABSTRACT: INTRODUCTION: Traditional mental health clinical placements can improve pre-registration nurse stigma toward mental illness, particularly in measures of attitudes and social distance. However, they have not yet been shown to improve self-stigma, which affects mental health disclosure and help-seeking behaviour. AIM: The present study investigates nursing students' stigma following a non-traditional mental health placement immersed alongside people living with mental illness. METHODS: Three stigma subtypes were measured using the Opening Minds Scale for Healthcare Providers: Attitudes, Social Distance, and Disclosure/Help-seeking. RESULTS: Pre-registration nurses (N = 848) completed the instrument pre- and post-placement. A multivariate analysis of variance (MANOVA) identified a large effect of placement on stigma (p < .001, η p 2 $$ {\eta}_p^2 $$ = .101). Post hoc pairwise comparisons revealed all three types of stigma decreased after the non-traditional placement (Attitudes: p < .001, η p 2 $$ {\eta}_p^2 $$ = 0.09, Social Distance: p < .001, η p 2 $$ {\eta}_p^2 $$ = 0.07, Disclosure/Help-seeking: p < .001, η p 2 $$ {\eta}_p^2 $$ = 0.04). DISCUSSION: These findings emphasize that attending a non-traditional mental health clinical placement can effectively reduce multiple types of nursing student stigma. LIMITATIONS: Further research in this area could focus on which attributes of the clinical placement setting foster positive help-seeking. IMPLICATIONS: These results are noteworthy for stigma surrounding disclosure/help-seeking, as traditional (i.e. hospital-based) mental-health clinical placements have been found ineffective in reducing nursing student stigma in this domain. RECOMMENDATIONS: Further research into the effectiveness of non-traditional clinical placements in reducing nursing students' stigma regarding mental health disclosure and help-seeking, is required.

Contributing to 'a sense of purpose' - Evaluating consumer recovery progress after attending a therapeutic-recreation intervention programme: A quantitative analysis.

INTRODUCTION: The recommended objective for mental health plans and policies is the adoption of recovery approaches to mental healthcare. Mental health recovery is no longer defined by symptom resolution but as a journey towards a meaningful life from the consumer's own perspective. Recovery approaches focus on consumers' strengths, feelings of well-being and the achievement of personal goals. Designing recovery-oriented interventions is crucial for supporting people in their personal recovery journey. AIM: This study sought to evaluate how attending a recovery-oriented intervention impacts the recovery of attending people living with serious mental illness. METHODS: A quasi-experimental approach was utilised to examine changes in self-reported recovery progress in a purposive sample of consumers living with enduring mental illness (N = 105). Recovery progress was evaluated via the Recovery Assessment Scale - Domains and Stages (RAS-DS). Data were collected at entry and exit to a therapeutic recreation programme grounded in principles of recovery-oriented care and social contact theory. Pre-post scores were analysed via a repeated-measures multivariate analysis of variance (RM-MANOVA) per the four RAS-DS recovery domains. RESULTS: After attending the therapeutic recreation programme, consumer recovery scores significantly increased in the functional, personal, and social recovery RAS-DS domains as measured by 'Doing Things I Value', 'Looking Forward', and 'Connecting and Belonging' (respectively). No changes were observed to consumers' clinical recovery progress, as assessed via the recovery domain 'Mastering my Illness'. CONCLUSION: The results of this study demonstrate that therapeutic recreation camps can provide a recovery-based approach to mental healthcare, with positive effects on the three areas of: a purposeful life; connection and belonging; and optimism and hope. Recovery Camp has been previously identified by the Productivity Commission as having potential person-centred recovery benefits for mental health consumers. The results of this study now establish these benefits as evidence based and can be used to guide mental health practice and policy for the implementation of therapeutic recreation camps for mental health recovery.

Connection and recovery in the COVID-19 age: An analysis of changes in goal-setting throughout the pandemic by consumers living with enduring mental illness.

Goal-setting is a tool that empowers consumer recovery. Though the pandemic has affected consumer goal-setting, the nature and extent of this impact have not been examined in a recovery setting. The aim of this study is to assess whether the recovery goals of individuals with serious mental illness changed in association with the COVID-19 pandemic. In this mixed-methods design, data were collected from a purposeful sample of consumers (nTOTAL = 355) aged 19-67 years (MAGE = 44.56, SD = 13.05) attending Recovery Camp, a 5-day therapeutic-recreation programme for individuals living with severe mental illness (e.g., PTSD, schizophrenia). Consumer-set goals were examined across 5 programmes prior to March 2020 (nPRE = 126) and 11 following (nPOST = 229). Goals were set on day one, with attainment self-scored on day five. Chi-squared goodness-of-fit tests compared goal proportions per domain; tests of independence assessed changes in goals pre- and post-pandemic. Six goal domains were identified: Approach-Based Recovery, Avoidance-based Recovery, Novel Physical Activities, Relationships, Health, and Recreation/Relaxation. Irrespective of the pandemic, goal attainment was consistently high across all programmes (86.56%). Approach-based Recovery goals were predominant pre-pandemic, but were significantly reduced post-pandemic (p = 0.040). Goals related to Relationships and Novel Physical Activities took precedence throughout the pandemic. Post-COVID-19, consumer recovery goals reveal increased desire for connection, novelty-seeking, and positive behavioural change.

Experiences of recovery among adults with a mental illness using visual art methods: A systematic review.

WHAT IS KNOWN ON THE SUBJECT?: Arts-based research is an established and accepted research approach and systematic reviews have been published on this methodology. There are many possible data collection techniques and study designs within arts-based research, which have been implemented but not yet systematically reviewed. Rationales and challenges for arts-based research have covered participants' experiences of being in arts-based studies in health service research. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The main results of this systematic review are that mental health recovery concepts are effectively communicated by visual arts-based research and participation in these studies is progressive and connecting for mental health consumers. This paper adds new knowledge about participants' experiences specifically in visual arts-based studies, where the participants are mental health consumers. The results are significant because they support visual arts-based research in its development and popularity, both as a research approach and as an empowerment intervention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The results of this systematic review can enhance the fields of qualitative research methods and mental health nursing. Recommendations for professional development can be advanced from consumers' ideas and experiences of recovery reported in this review. Nurse scientists and consumer researchers can take into consideration visual arts-based data collection techniques for use as research and empowerment interventions with mental health consumer participants. ABSTRACT: INTRODUCTION: Art creation has been found to be therapeutic to mental health consumers, making the prospect of art creation's conceivable benefits as a mental health research strategy worthy of consideration. AIM: This systematic review aims to explore experiences of recovery among adults with a mental illness using visual art methods. METHOD: Following a comprehensive database search, 14 suitable studies were identified. These involved adult participants with a formal mental health diagnosis, or who self-identify as having a mental illness. The studies employed arts-based methodologies with participant-created, visual art as their data. Articles underwent data extraction and quality appraisal with the JBI-QARI (Qualitative Assessment and Review Instrument). RESULTS: Results were categorised and further aggregated into two synthesised findings according to Joanna Briggs Institute (JBI) guidelines. The synthesised findings are: (1) Creative artmaking enables the use of visual metaphors which can aid expression of feelings, externalisation of identity, and personal learning, and (2) Interpersonal and self-connectedness through inclusion in community, receiving support when needed, and progressing through loss, are beneficial for mental health recovery. DISCUSSION: These findings are comparable to those already existing in the literature, and suggest that visual arts-based research methods are as dependable as other qualitative research methods. Additionally, this systematic review reveals that when conducting research studies, there are benefits for mental health consumer participants when visual arts-based methods are used. IMPLICATIONS FOR PRACTICE: A visual arts-based research intervention can be concluded to have the effect of an empowerment intervention, as well as being a credible research method.

Using an arts-based approach to explore the building of social capital at a therapeutic recreation camp.

Therapeutic recreation is beneficial for people with and without disabilities, promoting an empowered, connected, and joyful life. The present study aimed to analyse canvas art created on a therapeutic recreation programme called Recovery Camp, to discover what they reveal about the shared experiences which have occurred. This study utilized an arts-based research method and thematic analysis to discover what participants have communicated via their artwork from ten camps between 2018 and 2019. This study adheres to the COREQ guidelines for qualitative studies. Reflexive thematic analysis produced subthemes which informed three main themes and an identified core meaning of Social Capital. The three main themes were Togetherness and teamwork, Positivity, and Gratitude for Recovery Camp. Based on these findings, canvas art has revealed that shared experiences during a therapeutic recreation camp were positive and connecting. Social capital was created and bridged at Recovery Camp through teamwork and prosocial attitudes. Gratitude has also been disclosed by participants for their shared positive experience.