Funder by the Department of Human Services Auspiced by Our Community

A CONSUMER'S GUIDE TO STUDENT CLINICIANS

All of us who use public mental health services come across students. Student social workers, doctors, psychotherapists, psychologists, psychiatric nurses and occupational therapists all have to learn their trade by practicing their craft.

What is important for us is how these beginner clinicians relate to us, learn from us, address us, listen to us, talk with (and not at) us, and learn to work with other clinical groups in teams of equally skilful and mutually respected people, not competitive individuals from different clinical camps.


Education in universities

Many of us have had the opportunity to work with student clinicians in university settings.

There's a lot to be learnt by observing which faculties invite us to be part of teaching programs and which do not, as well as how our participation is perceived and understood.

There are courses in social work and occupational therapy around Australia where consumers are involved in joint running of the mental health component of the course. By this, we mean consumers help to plan the course, make sure consumer perspective texts are on the compulsory reading list, co-teach, and bring in other consumers in an empowered way to use their stories as teaching methods.

The problem with both of these disciplines, however, is the competition for student time. The allotment for the mental health component can sometimes be miserable.

In nursing, an interesting model comes from the University of Melbourne, which has a consumer academic in situ in its Department of Nursing. Although this puts a strain on the incumbent (everyone wants a piece of her!) this is a fantastic model as the consumer academic is heavily involved with all students. She is also involved in the research program, and has introduced many other consumers (who are paid sound academic salaries) to advise her program, and as research colleagues and sessional staff.

These are the sorts of measures that move consumer educators from tokenistic to real. They make a significant difference to students and we are often told when we are in hospital by staff members that this component of the course was very important.

On the other side of the equation, the introduction of consumer educators into the education of psychologists and medical students is piecemeal and often unsatisfactory. And the general feeling amongst consumer educators is that clinical psychology is a hard nut to crack. We have unfortunately had very limited success in influencing the training of post graduate clinical or counselling psychologists.

It's at the peril of ongoing practice that consumer educators continue to be underutilised. What we would like to see is consumer educators in all disciplines right through every course. If we are going to be the fodder for the education of clinicians then we must also be a fundamentally important part of the education system that creates these clinicians.


The right to decline

We may encounter students on placement in a range of settings, including public psychiatric units, public hospital emergency departments, private hospitals, on crisis, assessment and treatment (CAT) teams, as well as in places like Centrelink and child protection and services for older people, children and youth.

It is important to know that we do not have to allow students to examine us, ask us questions nor see our records if we do not want them to. It is our choice.

The problem with this is that the authority and discourse of medicine has a lot more power than a lone patient. In most instances we say 'yes' to student involvement when we may mean 'no'. Many of us find ourselves agreeing to students being involved in almost everything when, really, we would rather they were not.


Registrars and medical officers

It's worth noting that all medical officers and registrars are students; they are no different, in principle, than any other students we come across in an acute unit or a community mental health service.

It's easy for us to forget this because these students have a disproportionate amount of power in relation to their career stage. The reasons for this are twofold:

  1. Registrars are qualified doctors so their student status is often viewed a bit differently (especially when they forget to tell patients they are not qualified psychiatrists!); and
  2. Medical practitioners, fully trained or not, tend to command a lot of status in the field of health and in society as a whole.

Social work, psychiatric nursing & occupational therapist students

These students also carry out placements in the field but they are organised differently.

Usually a student is placed with a clinician for a period of time. As a patient/client you will be introduced to the student and a request will be made offering you the opportunity to do things with the student, both with and without the clinical supervisor.

Many of us are less fearful of these types of clinicians and feel more able to refuse if we don't want students to be involved.

Nonetheless all clinicians have power over us and sometimes we need to remind ourselves that it's our choice whether we wish to do something or not.


Consumer experiences with students

People's experiences with students vary enormously. Because we are human just like anyone else we have very different experiences that leave us enthused or make us angry.

One consumer writer describes how the student nurses (not psychiatric student nurses but ordinary student nurses) saved her from trying to kill herself in a public psychiatric hospital. She describes their beautiful innocent conversations, how they didn't hold in their bodies the judgement and superiority seen in other clinicians, and how this enabled her to speak about a terrible thing she had told no none about before.

Of course, clinicians might argue that students just have more time. This may be so but there is a clear message that listening is as important as, or even more important than, observation or constant scrutiny.

Most consumers would like to help students to become more confident (and competent) and many of us do offer a helping hand. This is sometimes appreciated and sometime not.

This applies even when we are in hospital because the students are the closest people to us in terms of institutional power (or lack thereof).

It's often easier to talk and share with students than other clinicians, and to be authoritative about the things we know more about than they do because of our lived experience. Be careful, though, because students remain part of 'The Team' and all things of import that we say will be reported back.

Not all students are patient, interested observers. Many consumers report experiences with students who seem to have bypassed the questioning, reflective, tentative stage in favour of impressing the visiting academics who will grade them and following the score card of the clinician to whom they are apprenticed.


Complaints

If we are on the end of hurtful, damaging or disrespectful practice by either a student or their supervisor, we can complain.

At a basic level, you might just say, "I don't want that student any more" and the service is obliged to remove them from your team. This applies to everyone, even those of us who are being held under the Mental Health Act. We do at least have some rights, even if we have to be careful about how we use them.

If you have any trouble, ask to see the unit manager or head nurse.


Stories, voyeurism and being 'unheard'

Some consumers love students coming around. This is especially so in public hospital settings where everybody is bored. A nice natter with a student can be something to look forward to.

Many people with 'mental illness' are invisible in our society. People are lonely, treated disrespectfully, never have opportunities to share their lives with others and are eager to find someone who will listen. People want to share their stories and many students are genuinely interested and often reciprocate in ways that change the dynamic and make the experience one that the consumer looks forward to repeating.

There is an innocence in this; however, that can be manipulated by 'the system'. A minority of students engage in ways that have more to do with voyeurism than with our health.

Our story, in its whole, is special to us. It is who we are. It's the most important thing in our lives. But students in all disciplines are being taught to filter our stories in particular ways depending on the discipline. As we tell a whole magic narrative, students are getting better and better at not listening to it in many settings. They are being taught that they have to key in to specific information that they need, to block out the wholeness. And rarely are we told that that's what's being done.

Students will often be sent out from the university with various assignments they have to complete while on their placement - some of us truly feel sorry for those who are trying, often in vain, to get volunteers to help them complete some task or other. This is, for some of us, one area where we can easily step up, mainly so they can finish the thing. They will be very grateful for our involvement and in the majority of cases.

Helping student clinicians in their workplace practicum remains one of those realities that will continue to influence our experience of care. Some of us will find it interesting, challenging, enjoyable and a good thing to make long days go faster, whilst others will avoid it and condemn it as work for which they are not paid. Either position is acceptable and neither should attract consequences that make life even harder for anyone involved.