‘Learning from stories of mental distress in occupational therapy professional education’

This thesis aims to explore how personal experience of mental distress can be used to help occupational therapy students to understand the experiences of individuals with mental health issues. The research project underlying the thesis helps us to see what permits and prevents such learning and discusses how learning was negotiated between service users, students and tutors in professional mental health education.

The setting of the research is an occupational therapy course in a new (post 1992) university, where service users are invited to contribute their personal experience of mental distress in learning contexts with students and tutors, some of whom have also had experiences of mental distress.

The methodology used involved the application of a post-structural theoretical perspective to the various stories which emerged from the research process. In the analysis, we can see how some of these stories work to expose how practices of power can (re)inscribe dominant discourses and positions in professional education.
Methods used were semi-structured individual and group interviews as ‘conversations’ with three service users, three students and three tutors (including the researcher) who all had, at some time in their lives, experiences of mental distress.

Findings show that occupational therapy students can learn about living with mental health issues by exchanging stories based on personal experiences of mental distress. Service users’ stories of ‘acceptance’, ‘possibility’ and ‘transformation’ based on previously hidden ‘personal’ knowledges of mental distress were consistent with the concerns and interests of the political service user movement. As stories were recognised as ‘legitimate’ in learning contexts they began to shift dominant understandings of mental health.

Further, in visibly participating as ‘educators’ and as legitimate ‘knowers’, service users began to challenge whose authority it is to speak about mental distress and permit different narrative positions for students and tutors.

However, ‘technologies of power’ and ‘technologies of self’ of powerful mental illness, professional and educational discourses which represent the consumerist concerns and interests of a marketised system of occupational therapy professional mental health education continue to divide, disqualify, exclude and isolate personal knowledges and knowers of mental distress.

This research concludes that although service users as ‘educators’ working with occupational therapy students and tutors can create new stories and narrative possibilities in mental health learning contexts, learning requires a critical historical approach to storytelling to expose how powerful discourses maintain some knowledges and ways of being as desirable and normal.

Further, as we were positioned in complex and contradictory ways as service user, student and tutor we engaged in narrative work which is often ‘hidden’ and unaccounted for in learning settings. Importantly, the work of tutors in creating conditions for learning from personal experience of mental distress is unrecognised by the institution in which they work.

The impact of service users’ stories, then, will be limited without a shift in social and institutional processes towards new alliances and contexts for professional mental health education which supports learning at the margins of personal/political and personal/professional boundaries.