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:
- 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.
- 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.
- 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.
- 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:
- 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.
- 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.
- 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:
- 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.
- 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.
- 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.
- 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 (firstname.lastname@example.org).
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