All Party Parliamentary Group on Mental Health

ALL-PARTY PARLIAMENTARY GROUP ON MENTAL HEALTH MEETING ON THE ASTEC PROJECT

Tuesday 22^nd  January

CHAIR:

Lynne Jones MP (Co-Chair of the APPGMH)

SPEAKERS:

Jo Loughran – Rethink

Aliya Kassam – Institute of Psychiatry, Kings College London

Robert Westhead – Shift

The Chair, Lynne Jones MP, welcomed the Members of the All-Party Group on Mental Health and the stakeholders present to the meeting.

She reminded the group that the Annual Review had been sent around to all Members and hoped that it had been well received.

Ms Jo Loughran, Astec Project

Ms Loughran said that she runs the Mental Health Promotion Department at Rethink and has been working with Rethink since 2003. She said that her presentation would talk through the anti-stigma training and evaluation collaboration (ASTEC) project and what has happened.

She started by discussing why it was important to tackle stigma and discrimination and gave the following statistics:

• 70% of people affected by mental illness have experienced discrimination at some time because of it
• Fewer than four in ten employers would consider employing someone with mental health problems
• People with severe mental illness die, on average, 10 years younger that the general population dude to physical health problems
• 2/3 of all British press and television coverage on mental health includes an association with violence.

She described that the ASTEC project built on an existing Awareness in Action initiative and the work has developed through three different phases.

In the first phase, from 2000 until 2003, those working on the project visited schools and the police deliver mental health awareness workshops that dealt with stigma, particularly in relation to sectioning. (for the police).  

The work then moved on to the second phase called EMOTivatIONS, which took place between 2002 and 2005. This looked specifically at delivering self-sustaining mental health promotion strategies in schools, taking a whole school approach; involving staff, pupils and parents.

Through a small survey of service users, voluntary sector organisations and user forums in West Kent, they were able to select three target groups who service users and carers thought could benefit from anti-stigma and anti-discrimination workshops.  This survey showed that it was medical students who were a key target group

So, in 2005, the project moved to its third phase and focused on medical students. The overriding issue was that medical students want to get it right, but do not always have the tools. This is why is important for ASTEC to work alongside students.

She described the social impacts that lead to stigma and discrimination, such as difficulty in getting into or back into the jobs market for example.   Lots of these social impacts, and stigma and discrimination, are useful for medical students to understand because there’s a very good chance that this might impact on help seeking behaviour, medication compliance, or the likelihood of other associated physical health problems.

She said that they have done this by working with key audiences; audiences that have the ability to positively influence the lives of people living with mental illness by their working or personal practices.

They found that the key ingredient in changing attitudes about the social impact of living with a diagnosis of mental illness was the meaningful engagement, at every level of service users and carers. This meant involving service users right from the start, discussing key messages and acting out role-play scenarios.

The objective of the ASTEC Project was to positively impact knowledge and influence change in the welfare, well-being and social inclusion of people affected by mental health problems.

They conducted focus groups with service users and carers, medical students, trainee psychiatrists and key stakeholders at the medical school. Then they began the delicate negotiation of accessing 3 hours of training time from a very busy curriculum. Once this was done, they worked with service users and carers to develop the materials and then piloted the lecture three times in academic year 05/06 to year 3 medical students adapting it each time to take account of feedback.  In total it reached 260 year 3 medical students. 

The key facts and figures and a personal story from a service user and carer were then presented to a large group of medical students

Ms Loughran said that they know that they can make small changes with the kind of work that they have been doing up to now, but they also know that a stronger change can be experienced if there’s a concerted multi agency, multi level social marketing campaign. 

Robert Westhead

Mr Westhead said that he had been involved with the work since 2000 and specifically with the ASTEC project for about a year.

The magic about it is the interaction between medical students and users and carers through tricky role play situations. But the best bit, he said, was actually talking directly to the students; as this exchange will often break the ice.

It may be that medical students may not have actually had direct experience of meeting someone with mental health problems before they have worked in medicine and this project gives an opportunity for the students to experience the human element and meet people with mental health problems first of all as people, rather than first meeting them as patients.

This work is so important because medical professionals are such a key group, as they can, with appropriate knowledge, intervene early to prevent people with mental health problems dieing 10 years earlier on average.

He said that it had taken him sixteen years to get the appropriate treatment but hopefully this project will help to change this in the future.

Ms Aliya Kassam

Ms Kassan gave an outline of the work that was carried out and the key findings.

She described that when working with medical students, the project started with a 20 minute presentation of mental health facts and figures behind discrimination and stigma.  Next there were personal testimonies from service users, which developed into an interactive question and answer session. This, she said, was the most important part for the medical students.

In order to take the direct experience a step further they then developed role plays for the students to act out and gain real experiences. This was an incredibly useful process, as it allowed the students to make mistake then get feedback from the service users about why they may enforce stigma and discrimination.

Ms Kassan discussed the effect that the project has on the attitudes of medical students. Her assessment was that the project has achieved its aim of changing discriminatory and stigmatic attitudes. The key point was that the medical students got a good grasp of the idea that recovery is possible.

In general, students saw that it enabled them to feel more open minded. This was especially the case when it came to attitudes around the physical health of those with mental health problems.

Looking at the project from the perspective of the service users, she said that the evidence had shown that they found it rewarding and were encouraged that the project could have such a positive effect on the students involved.

Discussion from the floor:

Anna Pinney from Banardos mentioned a meeting that she had attended on social inclusion, which had shown that teenagers are a very useful group to work with regarding the stigma and discrimination surrounding mental health. She said that often some teenage groups can cause real distress for people with mental health problems.

Lord Alderdice highlighted the fact that there is some stigma even within the medical profession about psychiatry.

He then asked the ASTEC team what they meant by mental health problems in their work. He said he was worried that putting all problems together could add to stigma.

Aliya Kassam responded to this point by saying that limitations of the project meant that all mental health problems were put together, and kept generic. She said that perhaps this would be something they could look at changing.

Jo Loughran said that the project was trying to open dialogue by removing the fact that some things are less stigmatised. She said it was important to bring people closer to mental health problems by describing, through personal stories, what they can feel like. She gave the example of saying: “have you ever gone to sleep and thought you heard voices – that is what it is like”.

Dr Ian Hall from the Royal College of Psychiatrists congratulated the work of the ASTEC project, which he said had struck a chord with him. He highlighted the importance of ‘ordinary relationships’ with service users and said that often the root to some stigma and discrimination can be in the services themselves, so it is important to take a wider perspective and look at how improving mental health services can play a role.

A member of the audience wondered how the DVD was funded, if it was independent of the Moving People project, and whether it could be embedded in psychiatric training?

Jo Loughran replied and said that the funding is independent of the Moving People project and that the idea of the DVD was to make it financially sustainable. At the moment it is sent to all current year 4s, but they wondered about the idea of booster sessions.

She also said that embedding the project in the curriculum is very important so that it can become the norm. For this, they need to work with the medical schools.

Aliya Kassam said that a DVD for Continuing Professional Development has been produced and will be ready by March.

Jonathan Naess from Stands to Reason suggested that it was important to look at service users and also see how they view themselves. He added that anything which helps with mental health literacy is extremely important.

Dr JS Bamrah from the BMA said that he though the work of the project was great and he was keen for them to take it to his medical school in Manchester. He said that stigma and discrimination was a generic NHS problem, and something which had to be dealt with across the NHS, particularly on issues such as NHS staff not referring those with mental health problems at the appropriate time. He finished by saying that he looked forward to seeing the results of the project.

Baroness Murphy added her congratulations to the very worthwhile project. She wondered whether they might also be able to look at journalism students as well, as they are another source of the stigma and discrimination.

She then mentioned some work that she had done on medical students and attitudes to older people. In this, the views had changed for the worse from 1^st to 4^th year, so she said that booster sessions were definitely a good idea.

Jo Loughran repeated her previous point that they were keen to look at booster sessions for medical students.

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