BACKGROUND

In 1992 Catherine Stein and her colleagues atBowling Green University in Ohio published apaper on a novel approach to psychiatric rehab-ilitation and the undergraduate education of psy-chology students (Stein, Cislo, & Ward, 1992).Their paper described the evaluation of a onesemester (15 week) practicum course thatfocused on social relationships and enhancingsocial networks. The program was based on the

maxim that people with a psychiatric disabilityshould receive community services designed tomaximize their opportunities and personalchoices. The joint project between theDepartment of Psychology at Bowling GreenUniversity and a local mental health centresought to extend community resources for con-sumers and to provide an innovative practicumfor psychology students. The programme wasorganized to facilitate collaboration between thep a rticipants by supporting them to developnetwork relationships and social skills.

The rationale for the project was long standingrecognition that the social networks of consumersa re often impoverished and that communityliving requires competence in interpersonal rela-tionships. The interrelationship between socialcompetence and the ability to sustain supportivenetworks was taken as another justification forthe program. Fourteen consumers and fourteensenior psychology students enrolled in the

Australian and New Zealand Journal of Mental Health Nursing (1999) 8, 100–103

ED U C AT I O N NO T E O A 1 3 9 E N

Collaborative education and social stereotypes

Michael ClintonCentre for Nursing Research and Development, Curtin University of Technology, Perth, WesternAustralia, Australia

ABSTRACT: The purpose of this paper is to present results from a two-year col-laborative education project conducted with people with a serious mental illness andsenior undergraduate students of nursing at the Centre for Mental Health NursingResearch at Queensland University of Technology. The study was funded by theAustralian Commonwealth Government and was completed in June 1998. Theresults suggest that collaborative education is an effective means for breaking downsocial stereotypical thinking about people with a mental illness. A similar findingwith respect to the stigmatization of undergraduates supports this hypothesis.Implications for psychiatric rehabilitation and the undergraduate education ofstudents of nursing are explored.

KEYWORDS: collaborative education, psychiatric rehabilitation, social stereo -types, undergraduate education.

C o rre s p o n d e n c e : P rofessor Michael Clinton, Dire c t o r,Centre for Nursing Research and Development, CurtinUniversity of Technology, GPO Box U1987, Perth, WA6845, Australia.

Michael Clinton, PhD.This paper is an adaption of a paper presented at

Collaboration in Mental Health: Making the Difference, 24thAnnual Conference of the Australian and New ZealandCollege of Mental Health Nurses, Esplanade Hotel,Fremantle, Western Australia, 5–9 October 1998.

Accepted May 1999.

Bowling Green program. Control groups wererecruited for both the consumers (referred to ascommunity students) and the undergraduates. At the end of the programme, the consumersreported a significant increase in personal effec-tiveness and the undergraduates re p o rted adecrease in negative feelings about people witha psychiatric disability. The participants reportedputting more effort into social relationships anddemonstrated significant improvement in socialskills. The participants also reported more transi-tions in their social networks than the controls.

COLLABORATIVE EDUCATION

Collaborative education is consistent with prin-ciples of equal opportunity, antidiscriminationand the mainstreaming of services for peoplewith a mental illness. An important componentis the principle of status equalisation. Researchinto education has found that hetero g e n e o u sclassrooms are characterised by practices basedon social differences among students, includingthose of race, gender, reading ability and athleticability (Rosenhotz, 1985). There f o re, statusequalisation has the potential to change stereo-typical attitudes relevant to participants in class-room interaction. The principle of statusequalisation was extended to aspects of there s e a rch design. For example, a measure ofs t e reotypical perceptions of underg r a d u a t estudents was included in the study. Furthermore,the facilitators of the classroom sessions (theauthor and research assistants) sought to collapsethe status differences between themselves andthe participants, as well as those between the con-sumers and undergraduates.

Status equalisation in the QueenslandUniversity of Technology (QUT) pro g r a minvolved the use of first names in the classro o m ,the joint setting of ground rules by each collabo-rative education group, participation by the facil-itators in all classroom exercises and ‘home work’,and negotiation of assignments, marking criteriaand assessment weightings. Twenty-four peoplewith a serious mental illness and 70 underg r a d u-ate students (38 participants and 32 controls) tookp a rt in the study. Collaborative education sessions

of 90 minutes were held weekly for 14 w e e k s .Consumers undertook assessed work on a volun-t a ry basis. Those who completed the assignmentsreceived credit in a course of their choice at QUT.The assignments were compulsory for under-g r a d u a t e s .

METHODOLOGY

A quasi-experimental method was used to collectpre- and post-test data from the 70 participantsand 32 controls. Community students and under-graduate students were allocated at random toone of five collaborative education gro u p s .Random allocation took place separately toensure an equal number of community studentsand undergraduates in each group. Two groupswere later combined.

MeasuresThere is insufficient space to describe all themeasures used in the study (preparation of a com-prehensive report is in progress). The measurerelevant to this article is the Social ResponseQ u e s t i o n n a i re (SRQ) developed by Beiser,Wa x l e r- M o rrison, Iacono, Lin, Fleming, andHusted (1987). The SRQ is a 17-item scale thatrequires respondents to use a three-point scaleto rate a set of adjectives as descriptors of peoplewith a psychiatric disability. The scale has areported test–retest reliability of 0.89 in a sampleof people with schizophrenia; 0.93 in a sample ofpeople with affective psychosis; and 0.83 in acommunity sample (Beiser et al., 1987). As thephilosophy of collaborative education requiresstatus equalisation, a modified version of theSRQ developed by the author was used to collectinformation on the attitudes of the participantstowards university students.

RESULTS

The mean scores on the SRQ were significantlyhigher for the community students than for theundergraduates (Table 1: F = 5.50; d.f. = 60,1;P < 0.05). This indicates that the communitystudents held more stereotypical views aboutpeople with a mental illness than the undergrad-

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uate students. However, the scores of the partici-pants in the treatment group decreased signifi-cantly during the collaborative educationp rogramme (Ta b l e 2: F = 27.53; d.f. = 6 0 , 1 , 1 ;P < 0.01), indicating an easing of stereotypicalthinking about the characteristics of people witha mental illness. Less stereotyped thinking atpost-test was confirmed separately for both thecommunity students (t = 2.09; d.f. = 2 3 ;P = 0.05) and the undergraduate students(t = – 6.09; d.f. = 37; P < 0.001). Furthermore,the improvement in SRQ scores for undergrad-uates in the treatment group was greater thanthat for undergraduate controls (Ta b l e 3 :F = 26.6; d.f. = 64,1,1; P < 0.05). Members of thec o n t rol group began with and maintained ag reater tendency to stigmatise (F = 9 . 0 9 ;d.f. = 64,1; P < 0.01).

At pre-test the community students weremore likely to think of themselves as weak, dif-ferent, non-productive, bad, not OK, worthless,not normal and unstable. Undergraduates mademore positive attributions. By the end of the col-laborative education sessions, the participantswere more likely to think of people with a mentalillness as having positive characteristics.H o w e v e r, the community students were lesslikely than the undergraduates to describe peoplewith a mental illness as relaxed and well adjusted.

The participants’ scores for stere o t y p i c a lthinking about undergraduate studentsimproved during the programme for the groupas a whole (F = 11.06; d.f. = 59,1,1; P < 0.01) andfor the community students (t = 2.51; d.f. = 23;P < 0.05) and undergraduates (t = 2 . 3 2 ;d.f. = 36; P < 0.05) considered separately.

102 M. CLINTON

TABLE 1: Means and standard deviations for Social Response Questionnaire (mental illness) scores as a function of partici-pant status

Community students (n=24) Undergraduate students (n=38) Undergraduate controls (n=28)

Time 1 35.64 (6.50) 33.79 (4.95) 35.70 (6.12)Time 2 32.32 (8.02) 28.01 (5.24) 33.79 (7.61)

TABLE 2: Stereotyped perceptions of people with a mental illness, and significant changes in individual attributions as afunction of participation in the collaborative education programme

Attribution Level Change at post-test Differential change

Weak CS>UGs**ReliableRelaxed P1>P2** UGs>UGCs**Different CS>UGs** P1>P2**CooperativeSelf-reliant P1>P2**Non-productive CS>UGs**Bad CS>UGs* P1>P2*PredictableHealthy P1>P2**Not OK CS>UGs** P1>P2**Worthless CS>UGs**Normal CS>UGs* P1>P2**Safe P1>P2**Well adjusted P1>P2** UGs>UGCs*Unreliable CS> UGs P1>P2**Strong P1>P2*

Higher scores = greater stereotypical thinking.CS = community students; UGs = undergraduates; UGCs = undergraduate controls; P = participants (i.e. CS+UGs).*P<0.05, **P<0.01.

DISCUSSION

Underlying the use of the SRQ is the theoreticalperspective of social labelling theory, whichproposes that stereotyped social perceptions areassociated with the sick role and contribute tostigmatisation. As the SRQ was developed as ameasure of stigmatisation among people withschizophrenia and affective psychosis, it elicitsinformation about the internalisation of societalattitudes as well as about the propensity to stig-matise. To the extent that the study has demon-strated that the attitudes of the communitystudents towards people with a mental illnessimproved, collaborative education has the poten-tial to reverse the internalisation of negative per-ceptions and related social stereotyping. In thatit has demonstrated a significant attitudinal shiftin the same direction among underg r a d u a t estudents, it has shown that collaborative educa-tion has the potential to reverse common socialprejudices. The finding that attitudes towardsundergraduates improved strengthens supportfor this hypothesis.

However, it should be kept in mind that thereis a social acceptability aspect to self-report data.As it is more socially acceptable to refrain fromexpressing stereotyped opinions, it is possiblethat the SRQ is unable to discriminate betweendeep attitudinal change and any tendency toreport ‘politically correct’ attitudes. On the otherhand, if the SRQ measures ‘political correctness’rather than the propensity to stigmatise, it is nec-essary to explain why less stereotyped attitudesw e re not expressed in the pretest data.Therefore, it seems reasonable to conclude thatcollaborative education is effective in reducingthe stigmatisation of people with a mental illness.Furthermore, the finding that stereotypical per-ceptions of undergraduates declined, impliesthat collaborative education is an effective meansof reducing social stereotypes in small groups ofinteracting participants. However, the process islikely to be effective only in those situations inwhich stereotypes are not so strongly held thatthey inhibit cooperative learning.

These findings are encouraging. A decrease ins t e reotypical attitudes toward people with a

mental illness among consumers may build self-esteem and promote belief in personal self-efficacy. If this is the case, collaborative educationhas the potential to play an important role as anearly step in psychiatric rehabilitation. However,it is equally possible that changes in stereotypedattitudes are driven by prior changes in stereo-typical thinking.

Collaborative education also seems effectivein assisting undergraduates to develop morepositive attitudes towards people with a psychi-atric disability. It is hoped that these attitudes willencourage more nursing graduates to pursuecareers in mental health nursing.

CONCLUSION

Collaborative education has the potential to con-tribute simultaneously to psychiatric rehabilita-tion and undergraduate education. The findingsreported suggest that collaborative education canbe an effective means for breaking down stereo-types about people with a psychiatric disability.However, whether this is due to a perceivedchange in interpersonal self-efficacy or whetherincreased feelings of interpersonal self-efficacyfollow a weakening in stereotypical attitudesremains to be determined. In either case, col-laborative education is a fertile field for furtherresearch.

REFERENCES

Beiser, M., Waxler-Morrison, N., Iacono, W. G., Lin,T., Fleming, A. E., & Husted, J. (1987). A measureof the ‘sick’ label in psychiatric disorder andphysical illness. Social Science and Medicine, 25,251–261.

Rosenhotz, S. J. (1985). Modifying status expectationsin the traditional classroom. In J. Berger & M.Zeldtich (Eds), Status, Rewards and Influence:How Expectations Organize Behavior ( p p .445–470). San Francisco: Jossey-Bass.

Stein, C. H., Cislo, D. A., &. Wa rd, M. (1992).Collaboration in the classroom: Evaluation of asocial network and social skills programme forundergraduates and people with a serious mentalillness. Psychosocial Rehabilitation Journ a l, 1 8,13–32.

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