“The impact of mental health disabilities on field education in a University setting: contemporary issues and future directions”

Nikki Kenney
Learning Connection
University of South Australia

Outline
Facts
Field Education
Legislative context
Implications of student registration
‘Medically unfit to practice’
Case study
 
Concerns & dilemmas
Approaches to practice
Limitations of approaches
In conclusion
Questions?
References

Facts
One in five Australians over 18 will experience a mental illness at some stage in their lives (National Mental Health Strategy, 2000)
Age of onset is often simultaneous with entry into tertiary education
Number of students with a mental health disability will at least be as great as the national average (ADCET, 2006)

Field Education
University of South Australia offers a high proportion of vocational degrees that include a significant field education component
It is an essential requirement
Successful completion is necessary for professional registration
It is renowned for causing significant stress to students perse
It presents specific challenges to students and universities alike (Andre & Manson, 2004)

Legislative context
Internal and external legal constraints:
 - Policies for Students with Disabilities
- Disability Discrimination Act 1992
- Disability Standards for Education 2005
- Professional Registration Acts

Implications of Student Registration
Will be applicable to all health science degrees, plus psychology
Some new and continuing students in 2007 will be required to register with their professional Boards before commencing their studies for the year
Universities will be obligated to notify Boards if they have reason to suspect a student is unfit to practice

‘Medically unfit to practice’
Described as giving thought to whether a practitioner (student or otherwise) is able to provide treatment without jeopardizing a patient’s health or safety (Minter Ellison Lawyers, 2005)
It includes those students who pose a risk to self or to others
Examples include highly communicable illnesses, violent behavioural tendencies and physical or mental impairments 
 
Case study 
27 year old final year Nursing student
Successfully passed all the theoretical components of his program, but has not been able to pass any of the clinical placements
First indication of something being wrong was when his peers alleged inappropriate communication and behaviour in class
Shortly after he was then removed from placement for inappropriate communication and behaviour with colleagues and patients

He self diagnosed himself with an obsessive compulsive disorder 
Another placement was organized by the school, which was also terminated after he was reported to be behaving erratically and unusually
Became evident that he had not met with a psychiatrist and was not being treated for his condition
He was informed that before he would be able to attend placement again, he would need to provide a letter from a suitably qualified specialist in support of his fitness to practice

Concerns and dilemmas
Psychiatric conditions can take several years before they are correctly diagnosed or treated, providing professional help is sought (Kitchener & Jorm, 2002)
Students who do not disclose or do not fully disclose
Accommodating students who may never be considered as ‘medically fit to practice’ by the University due to the nature of their disability
Students who have managed to graduate not being able to register with their professional Boards
Students’ right to confidentiality 
Students may not have ability or insight to understand the impact of their disability or realize the effects of their illness (Centrelink, 2001)
Duty of care
Difficulties of finding a suitable placement  
Structure of degrees
Equity and fairness

Approaches to practice
Consistent themes are flexibility and creativity
Recommendation that course objectives are reviewed and changed depending on the student’s disability (Cooley & Salvaggio, 2002) 
Academics to take a position of ambiguity (Birnie & Grant, 2001) and develop a plan for the student within the context of the situation
Case management approach with on-going intensive assistance

Limitations of approaches
Little room for creativity and flexibility within the scope of mental health disabilities
Do not address fitness to practice and professional registration requirement
Do not take into account external regulations imposed on universities (BAF, Commonwealth of Australia, 2005)

In conclusion…
Rethinking Field Education
Extensive marketing campaign for all promotional materials
Offer similar programs, without the field education component
i.e. research
administration
management

Questions?

References
Andre, K. and Manson, S. (2004). “Students with disabilities undertaking clinical education experience”.  Collegian, 11 (4), 26-30. 

Attorney General’s Department (2005a). Disability Standards for Education.  Commonwealth of Australia, Barton, ACT. http://www.ag.gov.au/agd/WWW/agdHome.nsf/AllDocs/1821B1CD1293253DCA2570610014D867?OpenDocument

Birnie, J. and Grant, A.  (2001). Providing Learning Support for Students with Mental Health Difficulties Undertaking Fieldwork and Related Activities.  Geography Discipline Network, University of Gloucestershire, Gloucestershire, UK. 

Centrelink (2001).  Investing in Ability: A Guide to Understanding, Evaluating and reducing the Impact of Injury, Illness and Disability in the Workplace.  Commonwealth of Australia, Tuggeranong, ACT. 

Commonwealth of Australia (2005a). Our Universities: Backing Australia’s Future. Commonwealth of Australia, Barton, ACT.  http://www.backingaustraliasfuture.gov.au/reforms.htm

Commonwealth of Australia (2005b). Disability Discrimination Act 1992.  Commonwealth of Australia, Barton, ACT.  http://scaleplus.law.gov.au/html/pasteact/0/311/top.htm

Cooley, B. and Salvaggio, R.  (2002). “Ditching the ‘dis’ in disability: Supervising students who have a disability”. Australian Social Work, 55 (1),50-59. 

Kitchener, B. and Jorm, A. (2002).  Mental Health First Aid Manual.  Centre for Mental Health Research, The Australian National University, Canberra,  ACT. 

Minter Ellison Lawyers (2005). New legislation incorporating student registration requirement.  Adelaide, SA.  

National Mental Health Strategy. (2000, March).  Mental Illness – The Facts.   Mental Health Branch of the Department of Health and Aged Care, Canberra. 

The Australian Disability Clearing House on Education and Training (2006).  Creating Accessible Teaching and Support:  For Students with Mental Health Conditions.   University of Tasmania, Tasmania.