Inspired student helps young people open up about mental health
Nursing student Zoe Butler brought together groups of young people to discuss mental health issues, resulting in a DVD on personal stories that is now being used in schools
‘The Hot Potato project really helped me develop an insight into the many ways mental health issues can affect individuals. It also set me on the path towards seeking help with my own mental health problems,’ says a teenager.
She is talking about nursing student Zoe Butler’s tireless work to improve the mental health of young people and support them to build resilience.
Zoe’s collaboration with a writer and other young people to produce 40 monologues have resulted in the Hot Potato Project – a DVD distributed to every school in Cumbria in northwest England that is also used in awareness sessions for nursing students.
Zoe, a third-year student at the University of Cumbria in Carlisle, began working to address young people’s mental health problems and reduce stigma before starting her nursing degree.
Ways of coping
‘From a young age I became very aware about the stigmas surrounding mental health among my peers. Trying to break them became a passion. I did it by any means possible – and realised when I up took my nursing studies that I was portraying the therapeutic use of self, as every element of my life became about assisting those with mental illness to feel supported and accepted by their peers, family members and colleagues.’
This passion was noticed by her MP, Tim Farron, who asked her to co-author a review of Cumbria’s mental health provision for young people and make recommendations.
One of those recommendations was to help young people develop emotional resilience.
‘I made it my personal task,’ says Zoe. ‘My goal was to empower young people to talk about mental health without a feeling of stigma and equip them with coping mechanisms and abilities to recognise mental illness and to go for help when needed.’
Zoe, whose other passion apart from nursing is creative writing, was a volunteer writer with Brewery Arts Youth Theatre in Kendal.
During that time, a girl in the group took their own life. ‘The group was devastated,’ Zoe recalls. ‘It was something that I was not prepared to let them go through alone.
‘They revealed many concerns surrounding mental well-being. I wanted to help them find answers and closure at such a distressing time.’
At the same time Zoe was working with The Crew, a group of young people accessing tier 4 child and adolescent mental health services to improve acute services for young people.
She used creative writing workshops to help the young people find coping mechanisms to help them with feelings of depression.
‘My goal was to empower young people to talk about mental health without a feeling of stigma and equip them with coping mechanisms and abilities to recognise mental illness and to go for help when needed’
‘It became clear that they felt misunderstood and undervalued within their community and peer groups, but most of all wanted their voices heard,’ says Zoe.
‘In a light bulb moment I realised I had two groups that could help one another. The Brewery group was seeking understanding about mental illness. The Crew wanted to share their stories and raise awareness.’
After liaising with numerous organisations she combined the groups to form a series of workshops that explored mental health and what it means to maintain good mental health. With the young people’s consent, she documented their experiences and feelings.
‘In some instances, hearing The Crew share their stories inspired theatre group members to discuss their own fears around mental illness,’ Zoe says.
‘Later we were contacted by the Barrow Ashton Youth Group, who had similar concerns regarding mental health. They joined the project, adding more value and stories.’
Zoe felt the message from the workshops – that support is available if young people need it – should be taken to a wider audience.
Helped by Zoe and local author Ann Wilson, who had an interest in mental health, the group explored personal stories to create 40 powerful monologues, each exploring a different element of mental health (for a selection of transcripts see boxes).
‘Some discuss how to maintain good mental health while others describe how to recognise mental illness,’ Zoe explains.
Honest about issues
Successful funding bids with local charity The Sir John Fisher Foundation and Cumbria County Council allowed Zoe to recruit Signal Films, a group supporting aspiring young filmmakers to develop their skills, and the monologues were filmed over six months.
The DVD is used in schools in Cumbria by nurses and in personal development lessons. One school nurse reported: ‘Many more young people have been opening up to us and being honest about their issues as a result of using the DVD – this is helping us to develop more trusting and therapeutic relationships with the students.’
The Hot Potato Project is also being used during simulation sessions and theory days for healthcare students at the University of Cumbria and University Hospitals of Morecambe Bay Hospital Trust.
University of Cumbria nursing, health and professional practice senior lecturer Janet Kay praises her efforts to understand each individual’s perception of their condition and experience of care in order to improve clinical practice.
‘The judges were impressed by her ability to bring in her experience from outside nursing to address something that she saw was a problem, and the way she marshalled other people and drew them in’
‘Zoe wants to ensure we, as nurses, are aware of our patients’ needs and are able to adapt our care to meet their needs,’ she says. ‘She worked independently on her project, needing just a sounding board and encouragement. She developed leadership skills, but also negotiation skills to ensure her project was introduced to a wider audience to have the impact she desired.’
Zoe was recently named winner in the Andrew Parker Student Nurse category of the RCNi Nurse Awards, the profession’s top accolade. Judge Jane Denton, an RCN Fellow, says: ‘Zoe showed outstanding personal communication skills. Her work is fantastic and she is a very worthy winner.’
RCNi editorial advisory board chair Caroline Shuldham says: ‘The judges were impressed by her ability to bring in her experience from outside nursing to address something that she saw was a problem, and the way she marshalled other people and drew them in.’
Zoe plans to take her project even further. ‘I would love to develop a national school programme which utilises workshops and the DVD as guidance for encouraging young people to discuss mental health in a safe environment.’
In the meantime, she is working with educational colleagues and school nurses to develop workshops that can be incorporated into lesson plans to improve the DVD’s effectiveness.
She wants to do research related to the Hot Potato project looking at the impact of involving patients’ narratives and stories into therapeutic interventions and the barriers to allowing this.
But she is most proud of the impact the project has had on the young people involved, illustrated by their feedback.
One says: ‘Before Hot Potato I was unaware of some of the struggles my peers go through on a daily basis. This fabulous project was an eye-opener and acted as a catalyst for me to educate myself more on mental health issues, and now, several years later, I have delivered numerous talks on mental health provision from schools to conferences.’
Another reported that the project made the group open to discussing mental health. ‘We were all too aware of the stigma around it and were eager for that to change. Our conversations became a catalyst for that change, as we created a safe space to be creative and perform honestly and with meaning, in the hope that our work might benefit others in the future.’
Zoe says: ‘We explored their fears and allowed them to overcome them, but also made them realise their aspirations for the future. Many of them are now at university or have their dream careers – something they say wouldn't have happened without Hot Potato. The fact that I could be a role model for them I find greatly humbling.’
Personal stories 1: If the mirror had a voice
There has always been something to worry about. She’s seen the slight facial hair this time, and she’s distraught. No angle makes a difference. When she returned from travelling she tried different treatments to remove it, and it’s not bad. She was avoiding a look for weeks, which is understandable if her reaction was going to be like this.
But recently she’s been looking, again and again, changing her look, applying makeup, creams, even cutting her hair and still she gets upset. Her hair used to go down past her shoulders, now it’s just by her ears. She spent an hour and a half on it the other day, but still she couldn’t get what she wanted. That is if she actually knows what she wants, which I doubt very much these days, as she constantly seems to change her mind about things.
I suppose I’m the only one that gets a proper look, a real look at who she is. And she’s beautiful. Imperfections are in everyone. Real people are not perfect, and perfect people just aren’t real. What would you do?
Personal stories 2: Friend's perspective on anxiety
I’m worried about Dave. He used to be really outgoing, he’d go to the gym three or four times a week, play badminton with us, he’d be in his local every night, the barmaid would have a pint ready for him at nine on the dot and he’d walk in at about a minute past. She hasn’t seen him for so long she’s forgotten what he drinks. His gym card hasn’t been written on for three months, we haven’t seen him at badminton for so long, today they decided to take him out of the league team.
I’m worried because I’ve been phoning him but he hasn’t answered for weeks. Last time I spoke to him he said he felt the world was closing in on him. I thought he was just being melodramatic, he can be like that. I know where his mum lives, they don’t get on, which is why he lives in that hostel, maybe I should go round and see her. I don’t want to cause trouble. Maybe I should put a note through his door. What would you do?
Personal stories 3: Bullying leading to self-harm
I’ve got to be honest. I was dreading the day a young person disclosed some information to me that I’d have to act on. I followed our child protection policy to the letter. I was so paranoid about getting something wrong that I read it every week when I started this job, sometimes a couple of times. Anyway I reassured her that everything would be fine, I wrote down the problem and got her to read it through, and then we both signed and dated it and I notified my boss. I guess my boss will then decide whether to call just her parents or the police or CAMHS (child and adolescent mental health services) as well. I asked the girl if she could tell a friend. She did, and I spoke to them both. I asked her friend to look after her, that part was instinct, it seemed like the right thing to do. What would you do?
Elaine Cole is managing editor Nursing Standard
The Andrew Parker Student Nurse Award is sponsored by Guidelines for Nurses