Students’ mental health literacy practices in the management of chronic mental health conditions: ESRC Postdoctoral Fellowship

By Dr Emily Peach

Over the next academic year, I’ll be completing an ESRC-funded postdoctoral fellowship in the Literacy Research Centre with the aim of increasing the impact from my PhD thesis. I worked with students with mental health conditions to understand their use of literacy to navigate mental health support systems and manage their mental health. The students used literacy to get recognition of their mental health, access and participate in support, and to care for their own mental health. Their practices were shaped by the context of their university and the NHS. Emotions and identity also played an important role in the students’ practices. For practitioners working with students, the research showed how important it is to talk about, write, present, and use texts in ways that make students feel respected, capable and listened to. Communicating this key finding, and others, is one of the primary aims of this year’s fellowship. I’ll be writing academic and non-academic reports of the findings, doing some follow-up research, and running workshops for different groups of stakeholders. I will also be doing some further training and developing new professional and academic networks. In this blog post, I’ll be giving more of an overview of my thesis work and share more of my plans for the next academic year.

My thesis, supervised by Uta Papen and examined by Karin Tusting and Zoe Nikolaidou, explored the use of mental health literacy practices by students with mental health conditions here at Lancaster University, inspired by work on health literacy as a social practice by Uta and colleagues (e.g., Papen and Walters, 2008; Papen, 2009) and gaps in the previous literature on mental health literacy. Mental health literacy, as a concept, is a development of health literacy, originally developed as a concept in the 1990s (Jorm et al., 1997). This original understanding used literacy in the metaphorical sense, focusing on the sort of knowledge and attitudes people ought to have about mental health, rather than the actual literacy practices involved in mental health management, support, or treatment. Newer conceptualisations of mental health literacy (e.g., Jorm, 2012; Kutcher et al., 2016) have continued to focus on measurement and assessment of knowledge and attitudes with minimal attention on the actual role of literacy. In my thesis, I took a social practice approach to mental health literacy, where the focus is on what people do with literacy in terms of their mental health in real situations. This approach views mental health literacy as the situated literacy practices used by individuals in the domain of mental health or to engage with their mental health on any level. Taking this approach allowed me to collect detailed, contextualised accounts of students’ experiences and practices in using literacy to navigate mental health support systems and manage their mental health.

I collected these accounts from students through several video-calling interviews over the course of an academic year. I decided to have video calls with the participants rather than meet them face to face for several reasons, a methodological decision discussed further in a recent paper (Peach, 2021). The ethics of working with students with mental health conditions were complicated and using video-calling technology helped me manage potential vulnerabilities for both the participants and me. The participants seemed to welcome contributing their wide range of experiences in this way. There were eleven student participants involved in the project with both undergraduate and postgraduate students, as well as both home (UK) and international students. All the students self-identified as having experiences of poor mental health or a mental health condition whilst at university. During the research, they were all actively engaging with their courses, and many were very academically successful.

There were four key findings about the students’ experiences with mental health literacy practices:

1. Students engaged with mental health literacy practices in different ways to achieve different purposes, including to get institutional recognition of their mental health experiences and conditions, to access support and treatment, to participate in that support or treatment and to care for their own mental health.
2. Mental health literacy practices played a role in how the students engaged in being a student, including their academic writing. These experiences demonstrated how complex the relationship is for students between their mental health, their use of literacy, and assessment.
3. The institutional contexts of higher education and the healthcare system have an important impact on students’ practices. In these contexts, students were often positioned as powerless in making decisions but were nevertheless expected to be active and responsible in managing their mental health and getting access to support.
4. Mental health literacy practices were emotional, involved identity work, mediated many of the activities involved in managing and seeking support for a mental health condition, and were sites of literacy mediation.

The findings in my thesis have implications for practice for different groups of stakeholders. I want to focus on three groups here:

1. For counselling practitioners, particularly those who work with students, how texts used as part of counselling are spoken about and used is important. Students shared how the use of clip art and the term ‘homework’ for therapy worksheets reminded them of primary school, making them feel they were being treated like children rather than adults. In another example, some students felt uncomfortable with the way mental health measurement questionnaires were presented. For some, answering these questionnaires out loud in front of their counsellors, rather than in writing, made them uncomfortable, particularly in their first session when they did not know or trust the practitioner yet. For others, writing their answers was more uncomfortable, as it felt more serious and permanent than speaking. Practitioners could ask individual students if they have a preference for how they fill in this kind of questionnaire.
2. For student support professionals working in higher education institutions, the students shared how greater targeted support for certain groups is needed. For example, international students would benefit from greater support in accessing NHS services, which may be very different than the healthcare services in their home country. Written support plans also play an important role in students’ experiences. The way these plans are written, updated, and shared across the university affect how well supported students feel. The students shared that they wanted to feel involved and listened to in this process.
3. For teachers and support staff in academic departments, it is important that students’ support plans are read and understood by staff members teaching and coordinating their courses. The students shared that it could be particularly distressing if required adjustments for assessments were not known or followed by staff, or if they had to do lots of work to access these adjustments. Extensions on assessment deadlines were one of the adjustments discussed and used by many of the students. Across departments, there were significant differences in how extensions were handled. It is important that departments are transparent and consistent in their processes surrounding extension requests. Students want to be able to ask for extensions easily and discreetly. This helps students who are nervous about asking for the support that they are entitled to feel more confident and comfortable. If students are not clear about how to ask for an extension, or the process does not happen smoothly, this could cause significant stress and anxiety, and have a wider detrimental impact on a student’s mental health and engagement with their course.

Communicating the findings of my research and the potential impacts for practice will be one of the four primary objectives of my fellowship for the next year:

1. Publishing: I plan to produce three journal articles and a book proposal based on my thesis. The journal articles will discuss, respectively, the students’ creative literacy practices for self-care, their experiences with texts during counselling, and the conceptual development of mental health literacy. The book proposal will be for a monograph focussed on the contribution of my key findings to current understandings of literacy and the development of the field of Literacy Studies.
2. Training: I’m going to participate in research training to develop my skills further. This will include training on participatory action research, surveys and questionnaires, and focus group design and moderation.
3. Impact: I plan to deliver workshops or presentations for different groups of stakeholders to communicate my findings and the practice impacts, including student support professionals, academics and professional services staff in academic departments, and friends and family of students with mental health conditions. From these workshops, I hope to develop more permanent resources. I also hope to do more non-academic writing about my thesis, including this blog and others.
4. Research: To consolidate and extend my thesis research, I hope to use a survey to collect the views of a larger group of students and then have focus groups around the different themes and findings of the thesis to explore them in more detail.

I’m really excited to spend this year working towards these objectives as part of this fellowship and as a member of the Literacy Research Centre. If you’d like to know more about my thesis or my plans for the year, I’d love to hear from you by email (e.peach1@lancaster.ac.uk).

 References

Jorm, A. F. (2012). Mental health literacy: Empowering the community to take action for better mental health. The American Psychologist, 67(3), 231–243. https://doi.org/10.1037/a0025957

Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., Rodgers, B., & Pollitt, P. (1997). ‘Mental health literacy’: A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. The Medical Journal of Australia, 166(4), 182–186. https://doi.org/10.5694/j.1326-5377.1997.tb140071.x

Kutcher, S., Wei, Y., & Coniglio, C. (2016). Mental health literacy: Past, present, and future. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 61(3), 154–158. https://doi.org/10.1177/0706743715616609

Papen, U., & Walters, S. (2008). Literacy, learning and health. Research report. National Research and Development Centre for adult literacy and numeracy.

Papen, U. (2009). Literacy, learning and health – A social practices view of health literacy. Literacy and Numeracy Studies, 19–34. https://doi.org/10.5130/lns.v0i0.1275

Peach, E. (2021). Using Skype to research literacy practices: Providing opportunities for participants with mental health conditions to share their experiences. Literacy, 55(3), 201–209. https://doi.org/10.1111/lit.12248

READ WRITE EASY: Research, practice and innovation in deaf multiliteracies Volumes 1 and 2 Open Access

https://library.oapen.org/handle/20.500.12657/51600

https://library.oapen.org/handle/20.500.12657/52174

We’re delighted to announce the open access publication of two volumes from the project “Peer to peer deaf multiliteracies: research into a sustainable approach to education of Deaf children and young adults in developing countries”. This ESRC funded project, led by Ulrike Zeshan of University of Central Lancashire (ES/P008623/1) ran from 1 July to 30 December 2020 and involved Julia Gillen and Uta Papen of the Lancaster Literacy Research Centre as co-investigators.

Volume 1:  This book is the first of two volumes on deaf multiliteracies based on research with deaf children and adults in India, Uganda and Ghana. Multiliteracies include not only reading and writing but also skills in sign language, drawing, acting, digitally mediated communication, and other modes. The book covers a variety of themes including the assessment of learners’ progress, pedagogical issues as seen from teachers’ perspectives, and issues related to curricula. Authors discuss, for instance, the use of multimedia portfolios for tracking the learning of deaf primary school children, the training needs of deaf teachers, and a collaborative approach to curriculum development. The book is of interest to both researchers and practitioners. In addition to four research chapters, it features four ‘innovation sketches’. These are reports of innovative practices that have arisen in the context of the research, and they are particularly relevant for practitioners with an interest in methodologies.

This volume includes the chapter “The storymakers mini-project: encouraging children’s multimodal writing” by Julia Gillen and Uta Papen, pp. 257-274.

Volume 2: This book is the second of two volumes on deaf multiliteracies based on research with deaf children and adults in India, Uganda and Ghana. Multiliteracies include not only reading and writing but also skills in sign language, drawing, acting, digitally mediated communication, and other modes. The book covers a variety of themes including learner engagement, classroom practice, capacity building, and education systems. Authors discuss aspects of learning such as the sequencing of different multiliteracies skills in the classroom, a gamified approach to English grammar, a sign-bilingual online environment, and the influence of visual materials on learners’ participation. Capacity building with young deaf professionals and a comparative discussion of deaf education systems in three countries also feature in the volume. The book is of interest to both researchers and practitioners. In addition to four research chapters, it features four ‘innovation sketches’. These are reports of innovative practices that have arisen in the context of the research, and they are particularly relevant for practitioners with an interest in methodologies.

Black History Month: Voices from the Changing Faces Project

As part of Black History Month at Lancaster University, the University Library has put together an exhibition of some of the items stored in the Changing Faces archive held here at Lancaster. The exhibition focuses especially on accounts written by black adults of their experiences in the second part of last century of living, working and learning in the UK. There are sections of reflections on the homelands that some people had left, how they were received in the UK and their hopes and ambitions as British citizens.

The Changing Faces project contains a wide range of writing by adult learners and is a unique and special resource of firsthand accounts from ordinary people who accessed adult education between 1970-2000. 

Those of us who were involved in putting the archive together are really proud that it can make a contribution to Black History month and hope this will encourage more people to explore the documents and interviews in the archive. We also want to acknowledge the important role and continuing support of the archivist, Liz Fawcett, who put together this exhibition. The exhibition runs to the end of October and is highly recommended for a visit if you are on campus during this time.

You can find out more about the archive and and browse the catalogue at 

http://wp.lancs.ac.uk/literacy-research-centre/changing-faces-archive/

By the Writing For Pleasure Centre: a response to the DfE’s Reading Framework – review and implications for teaching writing

We recommend this thoughtful, well resourced blog post by our friends at the Writing for Pleasure Centre. They begin:

“On the 10th of July 2021, the Department for Education published its non-statutory guidance document entitled ‘The reading framework: Teaching the foundations of literacy’. It purports to provide guidance for schools to meet existing expectations for teaching early reading and writing (p.78).

“The mission of The Writing For Pleasure Centre is to help all young people become passionate and successful writers. As a think tank for exploring what world-class writing is and could be, a crucial part of our work is analysing emerging governmental policy. It is therefore important that we issue a response to what this document has to say.

“Overall conclusion

“If commercial scheme writers and schools pursue the recommendations made in this policy paper in any kind of serious way, we run the very real risk of developing the most reluctant, listless and unmotivated writers for a generation. While some of the recommendations within the policy paper are welcome, it remains grossly incomplete. We therefore urge anyone interested in developing world-class writing teaching to read the cited research within this review before making any changes to their writing teaching or commercial offerings.”

We hope you might read the remainder of this thought-provoking article if you are interested in literacy education in primary schools.

‘Home language’, ‘Main Language’ or no language: questions and answers about British Sign Language in the 2011 British censuses (Mark Sebba and Graham Turner)

This fascinating paper is in press in the journal Lingua here (the link is valid until August 7th).

Abstract:

The 2011 census in the UK was the first to ask questions about the use of languages other than the indigenous Celtic languages, Welsh, Irish and Scottish Gaelic. The resulting broadened inquiry included asking about the use of British Sign Language (BSL), the acknowledged language of the Deaf signing community in Britain. Official and public attitudes surrounding signing – its relationship with spoken/written language; its linguistic ‘validity’; its territoriality or universality; its association with ideologies of disability – are rarely placed on display as they are via the census process. The formulation of questions, their linguistic expression, and the responses elicited may all be seen as indexical of societal positioning.

In the UK, England, Wales, Scotland and Northern Ireland each conduct their own census, so the question about sign language was differently phrased in each jurisdiction, and placed alongside a different set of questions about other languages. Thus in each questionnaire the sign language question was contextualized differently, and was open to comparison by respondents with the questions about other, more prominent languages including English. Unsurprisingly, this led to different responses to questions which were ostensibly asking about the same thing.

In this paper we describe how the census questionnaire in each jurisdiction asked about respondents’ principal language, and how British Sign Language was positioned in each. A significant difference in the wording of the question – about ‘home language’ in Scotland and ‘main language’ elsewhere – led to a far larger proportion of respondents mentioning BSL in Scotland. We conclude that while the ‘home language’ question produces a more realistic picture of the extent of BSL use, neither question is sufficient to reveal the complexity of the repertoire of many bi- and multilinguals. More generally, the wording of questions about principal language may crucially affect the responses of users of minority languages.