The aim of this study was to evaluate a pilot placement in a mental health unit for undergraduate paramedic students. The results showed that student responses to this placement experience were overwhelmingly positive. Participants reported that this experience and exposure to mental health patients allowed them to develop communication and clinical skills as well as deepen their knowledge and understanding of mental illness. Furthermore, the results suggested that previous negative stigma and attitudes toward mental health patients were challenging. Additionally, participants stated that the nursing staff were professional, welcoming, had individualised teaching styles and provided sufficient feedback, which in turn encouraged learning and assisted in clinical and professional development.
This study showed that the placement experience presented in this study has the capacity to improve student confidence, knowledge and understanding of mental health. This has a major impact on student learning. The study was conceived with the anticipation of its results presenting some evidence to inform and support the integration of mental health placement experiences into the Bachelor of Paramedicine degree at Charles Sturt University.
The findings of this study support the integration of mental health placement into the paramedic curriculum. Therefore, based on the evidence provided by this pilot, the faculty at Charles Sturt University pursued the integration of mental health care WPL experiences into the cohort as valuable experiences that can meaningfully contribute to increased mental health literacy and skills for paramedic students.
Charles Sturt undergraduate paramedic students now participate in mental health WPL experiences for a minimum of two weeks during their degree, with the option to spend up to four weeks in these settings. These placements occur in either the second or third year of the program and occur in environments such as community outreach teams working alongside mental health nurses, within inpatient facilities and intake centers.
These placements provide students with learning opportunities in psychosocial health care, patient-centered and shared care health models, enhanced communication skills, non-invasive approaches to healthcare and referral services and complete health education. Together, these learning opportunities challenge any preconceived bias or stigmas the students may have held toward this patient population prior to engaging in these placements.
This research provides evidence that mental health placements for paramedics hold meaningful educational value. By incorporating this placement experience into the paramedic curriculum, paramedic students may be provided with a higher standard of education. This could assist students in providing safer and thus more effective care when entering the workforce. The potential result of this is that mental health patient outcomes improve. An additional potential benefit of this type of educational intervention could be the enhanced capacity of students to recognise and manage their own personal mental health and wellbeing. By being exposed to and developing greater knowledge surrounding mental health issues, students will hopefully gain stronger insight into their own mental health. This approach will in turn better prepare them to more adequately address personal mental health issues safely and effectively. As the prevalence of mental health issues within the paramedic profession is high, this approach could prove to be extremely beneficial to future paramedics3.
A further benefit of this research is the possibility of minimising the risk to paramedics. If paramedic students can participate in educational interventions that provide a higher level of knowledge surrounding the management of mental health patients (improving their mental health literacy), they will have the ability to adopt a more effective and safer approach to mental health when entering the workforce. Interventions such as these could improve risk mitigation and de-escalation skills through enhanced learning and exposure to mental health patients, although further research is needed to confirm this phenomenon.
A further benefit mental health placements could have, although not focused on in this study, is the impact these types of placements could have on improving some of the negative stigmas surrounding mental health, particularly those held by paramedic students. While this study does not discuss this topic, there is a body of literature demonstrating how medical students undertaking mental health placements experience reduced levels of stigma concerning mental health upon completion of mental health placements26. It is speculated here that this benefit would also most likely translate similarly to the paramedic profession.
Dearman, Joiner, Gordon and Vince (2018) explored the interactions between mental health patients and medical students, intending to establish whether these interactions were positive or negative from the patient’s perspective26. This systematic review included all studies that reported on patients with a mental illness who interacted with medical students, had a primary diagnosis of mental illness and involved students who did not have any prior training. Two different databases were searched, resulting in 11,103 potential articles, which were narrowed down to eight articles that were examined in the study. These articles included 1088 patients from five different countries. This research revealed that patients experienced significant value, comfort and enjoyment when interacting with students on placement. Mental health patients disagreed with the notion of being talked down to and stated that they would be willing to interact with medical students in the future. Participants stated that they felt more involved in their care and reported enhanced self-esteem and a facilitator of learning. This evidence suggests that there are also benefits associated with mental health placements from the patient’s perspective. The patient’s perspective is one area that has not yet been explored with regards to paramedic mental health placements. This presents a very exciting opportunity for more research.
Table 5 shows how the results of this study align with those of previously published work. This table shows that while the results of our study can be directly compared to those of other studies, in some cases, this direct comparison was not possible. This is because our study measured different data from those of other studies.
Table 5 shows the study itself with its reference number, the study’s major findings and the findings of this study. The text that is in bold is to help the reader directly compare both. This table shows that our findings directly align with 9 /11 of the studies listed. Our results did not align with one study and the patient’s perspective was not measured. The studies that did not align with our results are shown in italics.
Table 5
The direct comparison of findings from previous studies to that of this study.
Year | Author | Findings of studies in the literature | The Findings of this study |
2014 | Bharathy and Foo8 | Following involvement in a social interaction program with psychiatric patients, it was emphasised that students had reduced stigma towards mental illness and reduced apprehension in communicating with mental health patients. | As a result of participating in the mental health placement, it was highlighted that paramedic students noted that previously held stigmas were challenged. Furthermore, students demonstrated a deeper understanding of mental illness and therefore, improvement in communication skills with mental health patients. |
2014 | Yidong, Huixi, Xiaoduo, Zhanchou, Lehua, Hailong, Zhimin and Xiaofeng11 | Following the comparison of questionnaire results prior to and following a psychiatry placement experience, medical students stated that they experienced deepened understanding and knowledge of mental illness, as well as enhanced attitudes towards mental health patients. | Paramedic students who participated in the mental health placement displayed a more thorough knowledge and understanding of mental illness, as well as improvements in their approach to mental health patients. With this in mind, this study did not examine student knowledge, understanding and attitudes prior to participation in the mental health placement. |
2017 | Chiles, Stefanovics and Rosenheck7 | This study found that there was no evidence that a mental health placement experience improved attitudes towards mental health. | The results of this study showed that the students found the experience overwhelmingly positive. |
2017 | Delbridge, Zubatsky and Fowler13 | After exposure to mental health patients through a training program, it was illustrated that medical students were able to develop their critical thinking abilities which in turn improved their clinical skills and understanding of mental illness. | Paramedic students had exposure to a variety of different mental health patients throughout the placement, allowing them to develop and refine their communication, clinical assessment and skill set relating to mental health patients. |
2017 | Martinez, Fargason and Meador-Woodruff Murzl, Durns, Mowrey, Tubbs and Boeve12 | Following exposure to psychiatric patients as part of a placement experience staffed by medical students, participants reported that they were more enthusiastic and willing to volunteer for this experience. Similarly, it was reflected that a psychiatric placement experience encouraged students to feel comfortable and confident around these patients. | Paramedic students reported enhanced confidence, comfort levels and resilience after participation in the mental health placement, as well as notable improvements in knowledge, communication and clinical skills relating to mental health patients. |
2018 | Mian, Chachar, Saeed and Naseem14 | Through the integration of a variety of teaching methods for the mental health curriculum, medical students reported an enhanced engagement and ability to implement clinical skills. | Following participation in the mental health placement, it was highlighted that paramedic students reported improvements in communication, knowledge and clinical skills. |
2018 | Russell, Clarke, Loo, Bharathy, Vasudevan, Byrne and Smith9 | Through participation in a consultation psychiatry service, medical students reported a significant change in attitudes towards mental health, an increase in knowledge and an improvement in previously held stigma and attitudes surrounding mental illness. | It was evident that through participation in the mental health placement, paramedic students experienced enhanced knowledge and understanding of mental health, leading to improvements in attitude and stigma relating to mental illness. |
2018 | Petkari, Masedo Gutiérrez, Xavier and Moreno Küstner10 | Students from medicine, nursing and occupational therapy backgrounds revealed an increased understanding and a reduced incidence of previously held negative stigma following participation in a mental health placement. | It was demonstrated that paramedic students reported less incidence of negative stigma and enhanced understanding of mental illness as a result of the placement experience. |
2018 | Dearman, Joiner, Gordon and Vince26 | From a mental health patient’s perspective, it was demonstrated that there was significant value, comfort, enjoyment and willingness to interact with medical students. | Through engagement in the mental health placement, it was evident that it was a beneficial and positive experience for paramedic students. With this in mind, no data was collected based on the patient’s perspective of this experience. |
2019 | Attoe, Lavelle, Sherwali, Rimes and Jabur15 | Following participation in mental health simulations, medical students stated that they noted improvements in resilience, confidence, communication and clinical skills, as well as an enhanced ability to work efficiently alongside other health professionals. | Through engagement in the mental health placement, it was illustrated that paramedic students experienced improvements in understanding and awareness of mental illness, confidence in communicating with mental health patients and enhanced their ability to work effectively with nursing staff. |
2019 | Marwood and Hearn16 | Following participation in a Mental Health Literacy survey, it was demonstrated that medical students scored higher for those who had prior experiences with mental health patient. | Although the mental health placement didn’t specifically examine mental health literacy of paramedic students, it was clear that this experience promoted students’ learning and extended their knowledge of mental health. |
The main limitation of this study is the small sample size of participating students. Due to this being a pilot placement initiative and the extensive liaison time required to establish the clinical placement, only a limited number of student places were made available in the first offering. The placement experience that was evaluated for the purposes of this study was only available at one inpatient mental health unit in Port Macquarie, NSW, Australia.
The survey instrument used in this study has been found to be an effective tool for assessing nursing students but was not specifically designed for paramedic placement evaluations. A further limitation of this tool was that it contains only a limited range of questions, which restricts the amount of data available for analysis. A further limitation of this tool is the lack of reliability and validity available for this instrument.
The development of a survey instrument that is specific to both paramedic students and a mental health placement would be extremely beneficial for evaluating the success of future placements. One since this study was conducted has been developed27. Further studies could be done using this new tool to determine if those results align with that fond here. Additional studies could also be conducted to assess paramedic students’ knowledge before and after participation in a mental health placement. This mental health placement could, in theory, sit alongside a mental health subject in the curriculum of the undergraduate paramedic degree.
To continuously improve the placement experience, the placement itself could also be reorganised to include an induction and supply students with further information and set clear learning objectives. This initial pilot placement was arranged within a limited timeframe, which resulted in students feeling that they were not provided with sufficient information or adequate orientation.
An additional research gap that was identified by this study was the paucity of research surrounding the assessment of stigmas held by paramedic students toward and surrounding mental health. Although mental health placements have been shown to reduce and improve stigma toward and associated with mental health held by medical students, the questions included and analysed in this research study did not involve specific questions regarding stigma.