“My brother Harrison struggled with his mental health, and he took his own life,” says Isabella De George. “He was a PGCE student in Manchester and was on placement at the time, but he didn’t receive a huge amount of support from his university.
“When I was a student nurse I had my own placements, so I understand how challenging they can be and I’m aware of the support that students need but don’t necessarily get.”
Isabella now works as a paediatric nurse, but following the loss of her brother in December 2020, she set up Positive Changes in Placement, an organisation dedicated to improving mental health provision for students while they’re working off campus.
Room for improvement
Isabella works with universities to discuss what they can do for their placement students to make sure they have sufficient wellbeing support and have safeguarding policies in place.
“For example, if a student doesn’t turn up to placement, this could be better followed up, or if staff have concerns about their students’ mental health, they could direct them to care services,” says Isabella.
“I want universities to look at what they’re providing their placement students. Are they doing enough to make them feel like part of their university? What policies and procedures do they have in place to make sure that someone is keeping tabs on students? How do they make sure the right people are made aware when there are issues going on?”
Top tips
A few suggestions for things you can do to support the wellbeing of you and your peers while on placement.
- When you’re on your placement, make sure you give an emergency contact to your mentor, so they can get in touch with someone if you don’t show up one day and people are worried about you. This is an important safeguarding measure.
- Get in touch with your course leaders to encourage them to make sure all placements keep emergency contact details on file.
- Find out what your university might already have in place, such as handbooks with basic information about your placement that would detail support services available to you.
- Have conversations with your peers and see if anyone is interested in creating a forum, so you can create your own student support networks.
- If you’re struggling, or feeling overwhelmed, don’t be afraid to ask for extensions or extenuating circumstances for your assessments – that’s what they’re there for.
- Make sure you reach out to wellbeing and health services, and if you find gaps in care, flag it to your RCN Student Ambassador or contact the RCN for further advice.
- Reach out to my campaign and I can see what I can do to get your university motivated to improve student health care services – we are stronger with a united voice.
Feeling included
“It’s so important student nurses still feel like they’re part of their university,” says Isabella. “It’s something I noticed myself when I was a student, because being off campus can feel so isolating.”
Isabella has first-hand experience of needing mental health support, and unfortunately didn’t receive adequate help while on placement. When she applied for counselling in her first year, the service only offered her one slot a week during the working day.
“I didn’t want to go to my placement and ask for time off to attend it when I could miss out on valuable learning,” says Isabella. “There was no degree of flexibility to work around the unique way placement degrees are structured.
“The attitude was that it was the student’s responsibility to make the session, or you had to wait for another slot to become available.”
Reaching out is difficult, but it is worth it
Students are under a lot of pressure already while on placement, to attend lectures and meet placement hours, all while studying for assessments.
“On my first placement, I told my mentor I was taking antidepressants and applying for counselling, but I was told not to talk about it, because people might think of me differently,” she says.
“I was so nervous and it was only a few years later, when I was more experienced, that I realised how bad their reaction was.”
Breaking the taboo
By using her own experiences and sharing Harrison’s story, Isabella has found universities receptive to her campaign.
“When we all speak with one voice, we’re much more likely to be heard,” she says.
It's not acceptable for mental health concerns to be brushed off
“Reaching out is difficult, but it is worth it. Whether that’s raising concerns or coming forward with mental health problems to your GP or nurse.
“If you do feel brushed aside, escalate your concerns. That’s why escalation procedures exist.
“It’s not acceptable for mental health concerns to be brushed off in academia or on placement – or in any workplace.”
Success so far
“I want to make sure there’s always an element of quality improvement, to make sure universities are checking in with their placements and ensuring they are of an appropriate standard,” she says.
Some universities initially responded to her by saying they didn’t think this was an issue for their students. In response, Isabella carried out a survey, and the results painted a very different picture.
“Many people said they felt like their universities didn’t care about their mental health and because they felt a lot of pressure to achieve and meet the hours, there wasn’t any room to have a mental health issue.
“I’ve heard of students being brushed off, and of them struggling to get in touch with someone at the university while on placement, and that student support services aren’t always tailored to placement students.”
By providing universities with data, student survey results and her own story, Isabella has now successfully worked with 16 universities, as well as organisations Universities UK and the Office for Students.
Together with Universities UK, Isabella has released an insert to the Suicide-safer Universities guidance, which is specifically for placement students.
It includes a checklist for universities to follow when offering placements to ensure they’re supporting mental health and wellbeing. You can find it here.
More information
To keep up with Isabella’s campaigning work, take a look at her social media pages. The platforms have significantly helped her broaden the reach of her activism.
Find out about the RCN’s free, confidential counselling service and see more RCN advice for nursing students including on raising concerns.
We have endorsed a twenty-minute suicide awareness training video from Zero Suicide Alliance to help you gain skills and confidence to help someone who may be considering suicide.
The Department of Health and Social Care has guidance on sharing information to prevent suicide to help members feel more assured around issues of confidentiality if they have concerns about a peer/colleague.
Second image credit: Isabella De George
