ASTEC phase 3: May 2005 to September 2007
Rethink has developed ASTEC (Anti-Stigma Training and Evaluation Collaboration), an evidence-based training programme, with the Institute of Psychiatry, King’s College London. It draws on the New Zealand and Scotland models and is founded on the social contact theory – by bringing people with and without mental health problems together, stereotypes break down and relationships based on respect can be developed. The approach also builds on the Mental Health Awareness in Action (MHAA) project study, part of the World Psychiatric Association anti-stigma programme.
Rethink developed and delivered two anti-stigma and discrimination training sessions with year three medical students. Service users and carers were integral to both the development of the sessions; via consultation groups and to the delivery of the training itself; by co-facilitation and personal testimonies.
Why target medical students?Third year medical students were considered an important target group because they have not yet specialised in their chosen stream of medicine and could become any type of medical doctor. It is acknowledged that basic awareness of issues faced by individuals and their families in relation to stigma and discrimination on the grounds of mental illness is important for any medical professional, from general practitioner to surgeon, as individuals with mental illness have the same, if not more heightened, physical health needs as the general population.
Furthermore, medical students in their third year at the school of medicine in which the intervention took place, were considered suitable targets as this academic year offered them their first comprehensive exposure of psychiatry compared to academic years one and two.
What works in anti-discrimination?
There are a number of different models for addressing discrimination developed over the years.
Based on work previously undertaken in this area under the Awareness in Action Programme, of which ASTEC forms a part, Rethink found that social contact; the exposure of the subject groups to people with direct experience of mental ill health thereby normalising and humanising the diagnosis, was the single most effective means of tackling stigma and discrimination. Indeed the recommendations of this previous work went further, stressing that to maximise this effect any intervention should to be designed, developed and delivered with people with direct experience of mental illness.
The main aims and objectives of the work of this particular project were to produce a significant improvement in:
- knowledge about stigma and discrimination on the grounds of mental illness
- attitudes amongst this target audience of medical students towards people with severe mental illness and carers
- behaviour towards people with severe mental illness and carers
by raising awareness, amongst this target group, of the issues faced by service users and carers due to stigma and discrimination, to work with medical students to reinforce positive attitudes and behaviours and to dispel the myths, fears and misconceptions that all too often surround mental illness.
The medical students
At the time of the lecture and role play intervention, the medical students were in week one of their academic year and day three of their two week induction programme to the year three curriculum.
We began from the premise, gained through the consultation process with medical students and from piloting the material, that we needed to make this a positive learning experience and that we had to be realistic about our expectations of what students knew about mental health issues, particularly the stigma and discrimination associated with the same. We were therefore looking to reinforce areas of good practice and to suggest possible tools for working with service users and carers whilst in their training and beyond.
The interventions
Wednesday 20th September 2006 - lecture
From 18th September 2006 medical students were timetabled to attend two weeks of induction into the year three curriculum which included lectures and role play sessions.
220 students were timetabled to receive an ASTEC lecture delivered by Rethink outlining the key facts and figures pertinent to service users and carers experience and included personal experience talks and a question and answer sessions
Friday 22nd September 2006 – training role play
The role play sessions, developed in collaboration with service users and carers, involved the use of role players from “Professional Role Players”, with service users and carers as facilitators or observers. A volunteer medical student from the group of 12-15 students were asked to “play” themselves.
Why role play?
Learning how to deal with new or unusual situations can be daunting. Role play in a teaching setting is a safe way to explore ways of doing things that work or don’t work; an opportunity to practise and perfect skills for the “real world”.
Role of role players in the intervention
The role players each took a particular character, either someone with experience of mental illness or a carer. They were given a detailed brief including the teaching outcomes, and steered the role play fluidly, based on the brief and how the medical student responded to them.
Role of observers in the intervention
Once students, observers and facilitators were in their rooms and a volunteer medical student had agreed to be the interviewer, the first role player entered the room, in character and the role play began. A service user and carer observer were asked to make notes in readiness for feedback when directed by the room facilitator (a carer or service user). Observers were given a feedback guidance list for each scenario.
