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“Empathy Machines”: using theatre and film in the training of compassionate and reflective health professionals

Pete Carruthers - PhD Student at University of Central Lancashire (UCLan) and Writer, Actor, Director and Producer at Tree Fish Productions

Mental Health Early Career Researcher Development Fellowship with the Equitable Place-Based Health and Care (EPHC) theme

Background: Relevant to this research are the well documented inequalities experienced by people with serious mental illness (SMI). The UK Health Security Agency’s 2018 article: ‘Health Matters: Reducing health inequalities in mental illness’ states that people living with SMI are particularly vulnerable to experiencing many forms of inequalities, largely driven by complex and interrelated factors, including:
• wider social and environmental determinants of poor health, including poverty, unemployment, homelessness and incarceration,
• stigma, discrimination, social isolation and exclusion,
• increased behaviours that pose a risk to health such as smoking and poor diet,
• lack of support to access health and preventative care,
• and diagnostic overshadowing.

‘Severe mental illness (SMI), such as psychosis and bipolar disorder, affects close to an estimated 551,000 people in England. These individuals have a life expectancy of up to 20 years shorter than the general population and evidence suggests that the mortality gap is continuing to widen.’ (Makurah, 2018). My research project explores the use of film and theatre within the training of compassionate and reflective health professionals and impacting public sensibilities concerning mental health and the mental health system.

Research aims and objectives:
• Deepening understanding of the effectiveness of film and theatre as a pedagogical tool within the training of health professionals.
• Deepening understanding of how and why student health professionals respond differently to film and theatre compared to the more traditional pedagogical approach.
• Producing a best practice model for the use of film and theatre as a pedagogical tool for future training.
• Exploring public appreciation of key issues regarding societal and service level mental health concerns.

Methods: For this PhD by Portfolio research project, I am focusing on the use of my own film and theatre work since 2013 within the training of health professionals and in wider public awareness. The three projects included are:
1. (Historical) Three short films that focus on military veteran mental health.
2. (Historical) The development and production of a full length play (“The Possibility of Colour”) focusing on mental health, voice hearing, neurodiversity and more.
3. (Live) The co-development, testing and rollout of a new theatre and film based simulated practice learning experience for student nurses.

Existing quantitative and qualitative data from historical projects was captured by post-screening / post-performance audience questionnaires, which were completed by student nurses, health lecturers, health professionals, experts by experience and the wider public. New data will be collected via further questionnaires, as well as up to 20 semi-structured interviews with student nurses, lecturers, health professionals and experts by experience who have watched my films/theatre work in a training capacity and/or taken part in the co-development, testing and rollout of the new theatre and film based simulated practice learning experience for student nurses.

Patient and public involvement: The artistic content of the film and theatre work has been co-developed with regular input from experts by experience at every stage of development to ensure the work is accurate, sensitive and empowering. Experts by experience will also be recruited as research participants, and will be central to the development and testing of the new simulated practice learning experience. All my work has been shared with public audiences at every stage of development and data collected via audience questionnaires will be included in the research.

Findings: Early findings, in the form of analysis of data captured via post-show audience feedback forms, are already being shared with key stakeholders including health education leads at NHS England and nursing course leaders at several higher education institutions (HEIs). The main element of the PhD synopsis will be in the form of a new theatrical play, which will be performed to the same key stakeholders as well as student health professionals, lecturers and people who have contributed to the project as lived experience experts. I will also be working with relevant stakeholders to ensure that this new play (as well as The Possibility of Colour) is seen by policy makers, arts professionals and the wider general public.

Potential impact: Already supported by NHS England and several HEIs, the proposed new theatre and film based training package aims to provide one full week of simulated practice learning experience for student nurses from September 2024. This will most likely focus on the training of mental health and learning disabilities nursing students at first, but could eventually be used within the training of adult and children and young people nurses too. Schools of nursing are already finding it increasingly difficult to provide enough practice learning experience for the 30,000 student nurses (including over 5000 mental health nurses) trained in the UK each year, and this is set to become even more difficult from 2024 when the new NHS Long Term Workforce Plan comes into effect, which aims to train over 50,000 nurses each year by 2031. This innovative approach to nurse training could be used by schools of nursing all over the country to help meet this increasing demand. The film and theatre work can also be used as continuing professional development training for qualified clinicians. There is also interest in using this work within the training of other health professionals, including medicine, clinical psychology, social work, paramedics and more.

The Possibility of Colour YouTube video – Pete Carruthers
Empathy Machines – PACT Poster

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