Starting out: take good care of yourself

Challenges that physio students might face and some sources of advice and support

Take good care of yourself (Photos: Ed Maynard)

Getting a place to study physiotherapy at university is just the start of it. Student life can be exciting and exhilarating: the opportunity for in depth learning, to widen your horizons and contacts, sometimes to live independently for the first time and explore new places. But these opportunities are equally likely to be overwhelming, causing stress and anxiety and contributing to what the media periodically refers to as the crisis in student mental health. 

There’s no disputing that UK students’ levels of mental illness are increasing. An IPPR report on improving university students’ mental health suggests that, between 2007 and 2017, the numbers of students reporting a mental health condition went up fivefold. The effects of poor mental wellbeing can be damaging and debilitating, both to academic performance and to general wellbeing, and there is wide acknowledgement that this is a huge challenge that both the sector and the government should be prioritising and addressing.

Enrolling on a physiotherapy course can bring added pressures for new students. Finance can be confusing and tricky to navigate for any student. And the requirement to complete 1,000 hours of clinical practice in order to consolidate your knowledge, skills and behaviours can make regular part-time work trickier to plan.

The requirement to complete 1,000 hours of clinical practice can make regular part-time work tricky

Undertaking practice-based learning has always been a challenging part of the path to becoming a qualified physiotherapist. CSP student officer Ciara Younge includes guidance on managing placements as part of her advice to physiotherapy students, reminding them of the importance of monitoring their own wellbeing. She says: ‘Physiotherapy is concerned with identifying and maximising quality of life, which encompasses physical, psychological, emotional and social wellbeing. Your own wellbeing and mental health is central to delivering this for your patients, as you cannot pour from an empty cup.’

Under pressure

The CSP Student Reference Group is exploring how it can forge closer links with university physiotherapy societies to share good practice on activities that promote student mental health and resilience. Its chair, Charlotte Perry, has spoken to students about their experiences while on placement, and reports some as feeling ‘overwhelmed’, ‘fragile’, ‘isolated’, ‘a lack of control’ and ‘a loss of sense of self’.

She says, ‘I know lots of people who have to work part-time while doing their placements, plus assignments and other commitments,’ putting them under pressure to work to support themselves alongside a high intensity course.

Ms Perry also believes that growing demands on the health services can blur the boundaries of students’ roles while on placement. ‘Clinical educators are under a lot of pressure. I think they sometimes need reminding that a student isn’t an extra helper, but is there to learn too, it is about finding the balance. As students we don’t only feel pressure from the judgement of our clinical abilities, but also fear of being judged on who we are as individuals.’

Physiotherapist Brendon Stubbs, a part-time practice educator, acknowledges the difficulties some students may experience on placement. He says, ‘Being in a clinical environment for the first time can be very stressful, so it’s important that students are nurtured and encouraged as they are the future of our profession.’ 

Mr Stubbs says when students come on placement at the trust where he works, they are encouraged to talk about their feelings if they wish: ‘Working in mental health is often a stressful environment and they should feel welcome to talk about how they’re feeling just as any member of staff can. 

‘We want them to feel equal,’ he says. ‘If a student is struggling on placement, I’d talk to the student, suggest they take time out and look after themselves and go and seek professional help.’ 

And he is clear in his view on where responsibility for support lies: ‘If a student is in a clinical environment and being supported by a clinical educator and they are experiencing mental health difficulties, it is the clinical educator’s responsibility to ensure the student is getting support; whether that support is delivered by the trust or the university, it doesn’t really matter.’

Encouragingly, there is lots of positive activity taking place in UK universities with many physiotherapy educators and students raising awareness and providing innovative ways to address different mental health challenges. One such example is the physiotherapy society at Robert Gordon University (RGUPS) which, in March, ran an ‘Active Listening Seminar’ with the university’s mental health service, Nightline, which is run by students from 8pm to 8am. 

Learning new skills

Stephanie Cullen of RGUPS explains: ‘The purpose of the seminar was to learn skills that we could use in patient assessments. We decided that as AHP students we didn’t have enough experience to deal with people we encounter with mental health problems.’

Nightline volunteers shared their active listening skills, including being attentive, how to ask open-ended and probing questions, reflecting and summarising patients’ feelings. 

‘It’s really structured my thinking and opened up my thought processes a bit more,’ says Victoria Saint, RGUPS president. ‘It makes you feel more confident on placement, you might be able to pick up on a peer’s mental health, even if you’re not directly thinking about your own mental health, active listening is a life skill and you can apply it for all situations.’

Coping mechanisms

In October the RGUPS will also be running a mental health first aid course, a nationally recognised training programme run by Mental Health First Aid England The course teaches skills in becoming a designated mental health first aider, recognising when colleagues are struggling with work or personal stress. 

Earlier this year, Leicester University introduced a mental health support programme to teach students how to look after their own wellbeing and how to support patients with acute or long-term mental illness. It was adapted from the Essence of Health programme run by mindfulness guru Craig Hassed of Monash University in Australia.

‘The aim,’ explains Leicester physiotherapy lecturer Nicola Clague-Baker, ‘is to train students in coping mechanisms they can use throughout their careers.’ 

Over five weeks students learn different aspects of health and wellbeing, including sessions in mindfulness, diet, exercise, social connectivity and environment, as well as mental health first aid.

‘We have long recognised the need to do more on the psycho-social aspects of training because as a profession we generally spend much time with patients and develop connections with them,’ says Ms Clague-Baker. ‘While we learn support skills as we go along, these are not taught formally. We felt these skills need to be learned from the beginning before students go out on placements.’

Brighton University provides physiotherapy students with sessions to discuss the mental health and wellbeing of service users.

‘We link this to their own mental health and wellbeing as physiotherapy students and in future practice’, says physiotherapy course leader Patricia Fordham. ‘We cover issues such as resilience, managing their own expectations of their performance, ie not being perfect. And suggest management strategies and apps that may support them. We also do regular debrief sessions with students after placement.’

‘It is easy to get caught up in the pressures of placement and to bury yourself in work and study to get through,’ says Ciara Younge. ‘But it is important to remain connected socially and have time for those small conversations – and a cup of tea. As you would check in with a patient, you should also check in with yourself and with other students on placement with you.’

Students tell us

Amber Roberts, MSc student, was on placement in an elderly care service

‘I had a bit of a wobble when a patient passed away, and felt very sad, on top of this I was struggling financially, and felt the pressure of trying to prove myself, the patient dying was a trigger. I went to my clinical educators and said I was struggling, they asked me what I needed and if I’d like them to speak to my university. They gave me a couple of easier days, and checked on how I was feeling for the rest of my placement, they were really supportive. Now I’ve built my resilience and feel I can better deal with situations like this on my next placements.’

Carys Williams on placement on a respiratory ward

‘I had to take two days off because my anxiety flared up to such an extent that I couldn’t get out of bed without having panic attacks. I told my educator that I had a past medical history of anxiety and that I was struggling with my placement but she didn’t really give me any support or seem to understand about anxiety. Every day I was going home and felt like I couldn’t go back in. I couldn’t get access to counselling at university because the welfare services weren’t open by the time I got back after my commute. At my university there’s a buddy system with someone from the year above, those things are good, but they don’t always work out at the time you need them. I think that clinical educators should be given the support and resources to identify and support students who are struggling  with stress and anxiety while on placements, in order to minimise the loss of clinical hours.’

Nina Paterson, CSP head of learning and development says:

‘This Frontline article is timely, universities themselves are focusing their energies on supporting their students’ wellbeing much more explicitly. What is good to know – from a physiotherapy perspective – is that this ethos underpins all of the pre-registration programmes already. As you can see from the examples here, programmes have well-established support mechanisms for students to tap into. Personal tutors, open-door policies, link tutors, debriefs and time for reflection as well as all of the central university support are there for students should they need it. My advice is always – don’t be afraid to make use of that support, it’s all there to help you develop your resilience.’

Student Minds, the UK’s student mental health charity, has a range of useful information and resources to guide you through your time as a student.

  • With thanks to the students of University of Lincoln, and to Student Minds for permission to use their stress busting tool.

Additional reporting by Louise Hunt.

University can be a busy time, which can make it harder for you to take the time to look after your mental wellbeing. When you’re busy, stresses can mount up and really take their toll – so it’s important to take the time to prioritise your own mental wellbeing

If you have 5 minutes

  • Make a cup of tea and enjoy it undistracted
  • Cuddle a pet or soft toy
  • Write a to-do list
  • Text a friend

If you have 10 minutes

  • Do a guided meditation
  • Take a walk
  • Do a quick tidy and clean of your room/workspace 
  • Listen to your favourite songs

If you have 30 minutes

  • Take exercise – yoga, a run, a brisk walk
  • Call a friend or family member for a catch-up
  • Have a nap

If you have 60 minutes

  • Watch an episode of your favourite TV show
  • Go for coffee with a friend
  • Cook or bake something tasty

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