Developing a student-led community health and wellbeing clinic in an under-served community: collaborative learning, health outcomes and cost savings
The University of New England (UNE), Australia decided to develop innovative placement opportunities for its increasing numbers of nursing students. Extensive community and stakeholder consultation determined that a community centre in rural New South Wales was the welcomed site of the student-led clinic because it fit the goals of the project-to increase access to health care services in an underserved area while providing service learning for students. 'Methods': Supported by a grant from Health Workforce Australia and in partnership with several community organisations, UNE established a student-led clinic in a disadvantaged community using an engaged scholarship approach which joins academic service learning with community based action research. The clinic was managed and run by the students, who were supervised by university staff and worked in collaboration with residents and local health and community services. 'Results': Local families, many of whom were Indigenous Australians, received increased access to culturally appropriate health services. In the first year, the clinic increased from a one day per week to a three day per week service and offered over 1000 occasions of care and involved 1500 additional community members in health promotion activities. This has led to improved health outcomes for the community and cost savings to the health service estimated to be $430,000. The students learned from members of the community and community members learned from the students, in a collaborative process. Community members benefited from access to drop in help that was self-determined. 'Conclusions': The model of developing student-led community health and wellbeing clinics in underserved communities not only fulfils the local, State Government, Federal Government and international health reform agenda but it also represents good value for money. It offers free health services in a disadvantaged community, thereby improving overall health and wellbeing. The student-led clinic is an invaluable and sustainable link between students, health care professionals, community based organisations, the university, and the community. The community benefits from the clinic by learning to self-manage health and wellbeing issues. The benefits for students are that they gain practical experience in an interdisciplinary setting and through exposure to a community with unique and severe needs.
Health, Disorder, and the Psychiatric Enterprise: Reclaiming Lost Connections
In this chapter, I describe why Benner's insights on human experience are important for understanding psychiatric phenomena. Her stance critiques narrow decontextualized views of what constitutes illness and honors the experiences of individuals and communities who confront and live through challenges. In psychiatry such experiences that become problematic are most often reduced to a list of symptoms, disorders, and technical terms and can obscure personal and collective coping possibilities. In this chapter, diagnoses of Post-Traumatic Stress Disorder (PTSD), Seasonal Affective Disorder (SAD), and schizophrenia are used to illustrate the dangers of classification systems generally - and why the interpretive approach developed by Benner and colleagues paves the way to restoring human connections that can preserve dignity and worth that is necessary for health and healing. The research excerpts spotlighted in this chapter point to the iatrogenic nature and trend of the diagnostic culture of psychiatry. Undoubtedly, diagnoses can bring meaning to experiences and join individuals in suffering. However, they can also serve to disconnect individuals and communities when the meanings are based on the deficit view of the person or persons. This view undermines personal and collective strength and cultural resilience and coping practices.