Sharing Power: developing a mental health curriculum

Elisa Yule, Alexandra Logan & Julie Hughes, School of Allied Health, Faculty of Health Sciences, Australian Catholic University

This is the 10th year of the Bachelor of Occupational Therapy course at the Australian Catholic University. With this new degree came the opportunity to develop a mental health curriculum centred on recovery principles and recoveryoriented practice. The curriculum was co-produced and delivered with mental health consumers, and the purpose was to produce occupational therapy graduates who would espouse these values and have strong commitment to genuine partnerships with mental health consumers.

In our experience at ACU, students often find it difficult to grasp the concept of recovery and to apply it to their practices as occupational therapists. Students come with an understanding of medical recovery as the absence of symptoms, yet in mental health, recovery is understood as “being able to create and live a meaningful and contributing life in a community of choice with or without the presence of mental health issues” (Australian Health Ministers Advisory Council, 2012, p.11).

Students often have preconceived and stigmatised ideas about consumers as incapable of making decisions about their own treatment. However, recovery-oriented practice focuses on working with consumers to take back control of their lives, promoting independence from relationships with mental health professionals and services (Slade, 2009). It also recognises consumers as experts based on their lived experience and knowledge of themselves, and prioritises partnering with consumers to achieve their goals. Often this contradicts the students’ conception of the health professional as expert within the therapeutic relationship.

We have employed a co-production approach to the design, delivery and evaluation of the ACU mental health curriculum as a key strategy to foster students’ understanding of recovery and capabilities for recovery-oriented practice (Arblaster, et al., 2018). The involvement of consumers in student education can take many forms. These sit within a spectrum of participation, ranging from non-participation and “tokenistic” telling of the story of lived experience through to meaningful participation at the level of co-production (Arnstein, 2019; Martin & Mahboub, nd).

Co-production sees consumers and academics working in authentic partnership where there is “equal sharing of expertise and experience, workload, design and implementation, [with] shared decision making” (Martin & Mahboub, nd, p.3). This sharing of the power to create the curriculum ensures that students directly hear and engage with the expertise and experience of consumers at every point in the curriculum. This interaction offers the crucial catalyst for transforming students’ understandings and beliefs about mental illness, their hopes for the recovery of consumers, and their future practice in mental health settings.

Roper, Gray and Cadogan (2018) identified three core principles underpinning coproduction partnerships with consumers: consumers are partners from the outset; power differentials are acknowledged, explored and addressed; and consumer leadership and capacity is developed. We would like to share some of the strategies we have used in applying these principles and some lessons learned from implementing a co-production approach in the two consecutive dedicated mental health units that span the second and third years of the course.

• Becoming familiar with recognised spectrums of consumer participation (see for example Arnstein, 2019; Martin & Mahboub, nd; Tew, Foster, Gell, 2004) allowed us to assess the level of consumer participation in our mental health curriculum and develop a strategy for increasing consumer participation that went beyond storytelling; • A crucial step was ensuring discipline leadership and organisational decision makers understood and supported co-production and were committed to consumer participation. Without this support it would not have been possible to secure the workload and funding necessary for implementing this approach or the necessary approvals for changes to the curriculum. Consumers are partners from the outset

• Fostering connections with local consumer groups and organisations enabled us to identify consumer advocates interested in educational roles. This led to long-term collaborative partnerships built on trust between academic staff and leading mental health consumer advocates, which has been essential to successful co-production

• All partners had a shared purpose of embedding recovery principles in the design, delivery and evaluation of the curriculum. We were not, however, able to do everything at once. We started small by co-producing teaching materials on recovery oriented practice, traumainformed care, peer and family work and recovery oriented communication.

Following this we co-produced an assessment task that focused on the articulation of collaborative recovery planning. As these initiatives were new to the curriculum, we implemented research to evaluate the efficacy of the initiatives. This assisted us in providing the evidence needed for sustainable consumer participation in the course, and a successful funding grant enabled us to embark on a project to co-produce the entire mental health curriculum. Power differentials are acknowledged, explored, and addressed

• An equal number of consumers and academic staff were involved in all curriculum stages. Power differentials were discussed in the initial meetings of the project to co-produce the entire curriculum. These meetings were also used to ensure all partners had a shared understanding about the purpose and scope of the project, and of co-production, and had collectively decided on processes that would support the team to work collaboratively; • Key areas where academic staff have traditionally exercised power in the design of the curriculum were a

focus to shift decision-making in the direction of consumers. For example, consumer interests and ideas in developing content, and teaching and learning activities, to be included in the curriculum were prioritised; • Wherever possible we looked for opportunities to model collaboration and genuine partnership with consumers in a way that is visible to students, for example, through co-delivering lectures and tutorials and co-marking of an oral presentation assessment. We have seen firsthand how this can be a transformational experience for students in understanding how traditional power imbalances between consumers and practitioners can be challenged.

• Building consumer capacity has been a goal of the co-production process. A key avenue for doing so is through briefing and debriefing around encounters with students to ensure consumers feel appropriately trained, resourced and

supported. Several consumers involved in the process reported how it helped them in their professional and personal growth and have gone on to become more involved in consumer projects and roles at ACU and externally; • Co-production has also created a space for building the capacity of academic staff. The benefits have extended far beyond the intended purpose, shaping not only the curriculum but also who we are as educators.

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