Abigail Moss, H Valerie Curran, Michael A P Bloomﬁeld, Sunjeev K Kamboj, Simon E Blackwell, *Tom P Freeman Clinical Psychopharmacology Unit, University College London, WC1E 6BT, UK (AM, HVC, SKK, TPF); Division of Psychiatry, University College London, UK (MAPB); Psychiatric Imaging Group, MRC Clinical Sciences Centre, London, UK (MAPB); MRC Cognition & Brain Sciences Unit, Cambridge, UK (SEB); and Mental Health Research and Treatment Centre, Department of Psychology, Ruhr-Universität Bochum, Germany (SEB) [email protected]
We declare no competing interests.
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Browning M, Grol M, Ly V, Goodwin GM, Holmes EA, Harmer CJ. Using an experimental medicine model to explore combination eﬀects of pharmacological and cognitive interventions for depression and anxiety. Neuropsychopharmacology 2011; 36: 2689–97. Roiser JP, Elliott R, Sahakian BJ. Cognitive mechanisms of treatment in depression. Neuropsychopharmacology 2012; 37: 117–36. Das RK, Freeman TP, Kamboj SK. The eﬀects of N-methyl D-aspartate and B-adrenergic receptor antagonists on the reconsolidation of reward memory: a meta-analysis. Neurosc Biobehav Rev 2013; 37: 240–55. Soeter M, Kindt M. An abrupt transformation of phobic behavior after a post-retrieval amnesic agent. Biol Psychiatry 2015; 78: 880–86. Insel TR. Next-generation treatments for mental disorders. Sci Transl Med 2012; 4: 155ps19–ps19. Alexopoulos GS, Arean P. A model for streamlining psychotherapy in the RDoC era: the example of ‘Engage’. Mol Psychiatry 2014; 19: 14–19. Goldfried MR. On possible consequences of National Institute of Mental Health funding for psychotherapy research and training. Prof Psychol-Res Pr 2016; 47: 77–83. Holmes EA, Craske MG, Graybiel AM. A call for mental-health science. Nature 2014; 511: 287–89. McHugh RK, Whitton SW, Peckham AD, Welge JA, Otto MW. Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review. J Clin Psychiatry 2013; 74: 598–602.
Integrating mental health simulation into routine health-care education
Caia Images/Science Photo Library
Mental health simulation has an important role as an eﬀective and engaging training modality in bridging the gap between education and clinical practice to improve mental health care.1,2 It is the educational practice of recreating clinical scenarios in safe environments using trained actors and technology, followed by debrieﬁng to reinforce learning. Although simulation training has a rich history in medical education, its use in psychiatry and mental health disciplines remains in its infancy. Mental health simulation focuses on human factors and core skills required by health-care professionals, with the ultimate goal of improving quality of care for individuals with mental health needs. Professional actors are used rather than mannequins or equipment, and are given training in mental health conditions from service users and other experts. This allows for creation of carefully constructed, high-ﬁdelity scenarios, and a focus on human factors and non-technical skills in subsequent debriefs supported by trained facilitators. Debriefs address skills such as interprofessional and multi-disciplinary collaboration, communication, and reﬂection, because mental health simulation strives to replicate the realities of clinical care, including the involvement of a range of health-care professions. It allows health-care professionals to develop skills that 702
are typically developed “on the job” by creating realistic scenarios involving real people, in a safe learning environment, with the time and expertise of facilitators to debrief these experiences. The use of trained actors to play patients, service users, and families or carers encourages participants to enhance health-care skills such as communication and collaborative working.3,4 This is in contrast to training methods lacking human interaction; it gives the trainee the opportunity to practise and reﬂect on the development of a therapeutic alliance in contrast to learning about therapeutic models and techniques. What use in clinical practice is the latter without the former? Mental health simulation provides an opportunity to develop skills such as teamwork and interprofessional collaboration by maintaining the ﬂexibility to include interprofessional, multidisciplinary groups.3,5 Clinical scenarios allow participants to improve competencies in teamwork and interprofessional practice, such as interprofessional understanding, attitudes, and communication. These skills are essential in providing care for mental health needs, with issues around fragmented healthcare systems and poor collaborative practice highlighted in the literature.6–9 Mental health simulation meets the need for increased interprofessional, www.thelancet.com/psychiatry Vol 3 August 2016
multidisciplinary models of education and care, aligning it with scientiﬁc evidence, governmental policy, and educational strategies regarding health-care provision.7,8,9 The experiential and interactive nature of mental health simulation aﬀords an eﬀective and engaging teaching method, with the ﬂexibility to tailor scenarios to the learner’s needs.2,3,10 Learning objectives focus on interprofessional, multidisciplinary working at healthcare interfaces, achieving relevance for participants irrespective of experience and seniority. Simulation in mental health improves participants’ knowledge, conﬁdence, attitudes, and skills that are essential in health care, such as communication, reﬂective practice, leadership, and teamwork.1–3,10 Several obstacles exist to eﬀective deployment of mental health simulation to bridge the gap between education and practice and address care for mental health needs. Release time is challenging for all professions, as is the dearth of established curricula against which to match these important interventions. The funding and commissioning of education is a major barrier, as income streams follow individual professions, often with a signiﬁcant skew at postgraduate level to medical training. This situation must be tackled either by securing buy-in from key stakeholders, acknowledging the beneﬁts of creating courses for a wide array of professions, or acquiring sustainable funding for interprofessional training within our systems. Sustainability must be developed by integrating mental health simulation into educational curricula and programmes alongside complementary training in a blended learning approach. This goal would be greatly supported by the production of robust and meaningful research into the eﬀect of mental health simulation on clinical practice and patient outcomes, rather than solely the eﬀect on the learner. This is a signiﬁcant challenge for simulation training, especially the evaluation of impact on the workplace and care outcomes. Mental health simulation can be expensive, and certain participants might be uncomfortable with the technology-enhanced methods of mental health simulation, while others might struggle with the reﬂective debrief process. However, as technology-enhanced learning becomes increasingly routine in health-care education, such reservations might diminish. The ability of mental health simulation to bridge the gap between education and clinical practice, alongside www.thelancet.com/psychiatry Vol 3 August 2016
its potential for interprofessional education and initial evidence supporting its eﬀectiveness, merit its inclusion as a key educational tool in providing better care for mental health needs. Mental health simulation courses addressing mental health needs across healthcare professions and settings exist and have been well received with promising feedback,1 although access for the UK healthcare workforce is signiﬁcantly limited.2,3 Although further research is required to assess and improve the impact of mental health simulation on health-care systems and patient outcomes, its potential is outlined in the existing scientiﬁc literature.1-3 Evaluation should progress concurrently with the systematic integration of mental health simulation into health-care curricula and training plans to ensure its sustainability and expansion. This integration should span undergraduate and postgraduate education, and continuing professional development across health-care settings and professions. Mental health simulation is poised to have a positive eﬀect should the necessary support, funding, and progressive thinking be applied. Chris Attoe, Chris Kowalski, Asanga Fernando, *Sean Cross Maudsley Simulation, South London & Maudsley NHS Foundation Trust, London SW9 9NT, UK (CA, CK, AF, SC); Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK (SC) [email protected]
For more on Maudsley Simulation, the UK’s first mental health simulation training centre see https:// www.youtube.com/ watch?v=J4zsvJFhPxs
We declare no competing interests. We received no funding for this report. 1
2 3 4 5
6 7 8
Thomson AB, Cross S, Key S, Jaye P, Iversen AC. How we developed an emergency psychiatry training course for new residents using principles of high-ﬁdelity simulation. Med Teach 2013; 35: 797–800. McNaughton N, Ravitz P, Wadell A, Hodges BD. Psychiatric education and simulation: a review of the literature. Can J Psychiatry 2008; 53: 85–93. Dave, S. Simulation in psychiatric teaching. Advan Psychiatr Treat 2012; 18: 292–98. Brenner AM. Uses and limitations of simulated patients in psychiatric education. Acad Psychiatr 2009; 33: 112–19. Baker C, Pulling C, McGraw R, Dagnone JD, Hopkins-Rosseel D, Medves J. Simulation in interprofessional education for patient-centred collaborative care. J Adv Nurs 2008; 64: 372–79. Centre for the Advancement of Interprofessional Education. Introducing Interprofessional Education. CAIPE: Fareham, UK, 2013. World Health Organisation. Framework for action on interprofessional education and collaborative practice. WHO: Geneva, 2010. Reeves S, Zwarenstein M, Goldman J, et al. Interprofessional education: eﬀects of professional practice and health care outcomes. Cochrane Database Syst Rev 2008; 1: CD002213. Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376: 1923–58. Goldfarb E, Gorrindo T. Simulation in Psychiatry. In: Levine AI, DeMaria Jr S, Schwartz AD, Sim AJ, eds. The Comprehensive Textbook of Healthcare Simulation. Springer: New York, 2005. 511–23.