Tertiary mental health education: Perspectives of people with lived and living experiences

Abstract

Objective:

The purpose of this study was to explore elements of high-quality mental health education from the perspective of individuals with mental health lived and living experience, and to initiate dialogue about how this could be better achieved in contemporary higher-education curricula.

Methods:

Six semi-structured interviews and one focus group were conducted between June and August of 2024. Reflexive thematic analysis was used to analyse the data.

Results:

Three themes were created from the data analysis: (a) embracing holistic, values-based approaches; (b) the need to socially embed students in safe learning environments; and (c) the impact and burden of shared living experiences. Findings of this study highlight the critical importance of integrating lived and living experience into tertiary mental health education to challenge traditional diagnosis-focused models in the curriculum. In addition, they advocate for the inclusion of mental health knowledge as a core component of education across health disciplines.

Conclusion:

This research contributes to the evidence base, urging the development of transformative, inclusive, and socially responsive mental health education that reflects the realities of service provision and includes the perspectives of people with lived and living experience.

Keywords

mental health education lived experience collaboration curriculum

Background

All over the world, people experience mental health challenges that negatively impact aspects of their life, with those who are already experiencing disadvantage among the most vulnerable. Health professions education and training remain largely biomedically focused, perpetuating a skills gap upon graduation in which often deeply ingrained assumptions, generalisations, or values have not been challenged. This creates a context in which person-centred care is often compromised, health professionals’ preparation is insufficient, and poorer health outcomes are perpetuated (Cheung et al., 2024; Furnham and Swami, 2018; McInnis and Merajver, 2011; World Health Organization, 2023).

Knowledge related to mental health is an integral foundation of all health profession training and does not solely fall within the remit of those who will go on to work in mental health specialities (Brunero et al., 2012). Recent research demonstrates that mental health education is most efficacious when it is integrated across curricula and embedded in multiple subjects and years, rather than confined to a single unit or semester (McCormack et al., 2025). This approach allows students to build and apply knowledge progressively, reinforcing concepts through clinical practice and interdisciplinary learning (McCormack et al., 2025).

Despite the importance of mental health education as a key component of health professions curricula, there are challenges to integrating this content widely. Some of these challenges have been identified as ongoing stigma surrounding mental illness, limited faculty training in mental health pedagogy, and curriculum crowding, making integration difficult without sacrificing other content (Brunero et al., 2012; Chukwuere et al., 2025). There are also challenges associated with content selection, considering the breadth of information that could be included in mental health education and the number of professions that need to apply this knowledge across the diversity of their practice (Caulfield et al., 2019; McCormack et al., 2025).

One potential way of achieving the integration of mental health content into diverse health professional curricula lies in positioning mental health education as a strengths-based, humanistic, recovery-oriented, values-driven worldview so as to replace the diagnosis-oriented approach to mental illness. A broad approach to mental health education, grounded in core values rather than biomedical approaches, could encourage greater integration with other health education topics while avoiding the limitations of diagnosis-specific content. This type of approach would contribute to the fundamental skills that underpin all health delivery and better align healthcare with integrated people-centred approaches (World Health Organisation, 2025). To achieve this, it is imperative that people with lived and living experience are involved in the design of mental health education provision.

Collaboration with people who have lived and living experience of mental health in curriculum design has been advocated in recent literature (McGarry et al., 2022; Parnell et al., 2023; Whitaker et al., 2025; Yousiph et al., 2023). Higher-education providers agree that connection with those who have lived experience of mental health can establish sound foundations for students learning and aligning with humanistic models of care (Brand et al., 2021). The involvement of people with lived and living experience of mental health in delivering or designing mental health education has also been shown to have a positive impact on stereotypes and stigma in students and can contribute to impactful teaching and learning from their experience (Stanyon et al., 2024). However, methodologically, much of the work undertaken thus far has been tethered to a particular intervention or educational offering, rather than focusing on worldviews and broad humanistic values.

There are however some notable examples of studies that have taken a broader approach to exploring skills important in mental health practice. An international study undertaken by Horgan et al. (2021) examined what “experts by experience” saw as important skills for mental health nurses to have in practice from a sample of five countries (Horgan et al., 2021). Results indicated that greater respect, dignity, compassion, and effective communication were valued. The implications of this study indicate the importance of nurturing these qualities before qualifying for practice. Similar findings emerged in a recent study by Hall et al. (2024) who explored the knowledge, skills, and attitudes of enrolled nurses in Australia. In their study, consumers of mental health services identified critical thinking, communication, mental health knowledge, and awareness of local services and support were important inclusions in the education of enrolled nurses. These two studies demonstrate that mental health education can go well beyond diagnosis-orientated approaches.

Recent studies undertaken in Australia have also shown that despite ongoing awareness of the importance of lived experience in education (Happell et al., 2022), this remains an area for ongoing development across the health care disciplines (Lakeman et al., 2024). Against this background, the current study aimed to explore the knowledge that people with lived or living experience of mental illness have in relation to current and future mental health education offered to undergraduate health students. The purpose of the research was to holistically consider what mental health education should entail, from the perspective of those with lived and living experience of mental health challenges, and to initiate a dialogue about how this could be achieved in higher-education curricula. The study adopted an exploratory approach, focusing broadly on current perceptions of mental health education from the perspective of individuals with lived and living experience, and investigating what high-quality mental health education could entail from the perspective of those who are experts by experience.

Research aims

The study was guided by the following research questions:

What are the perceptions of people with lived experience of mental illness on the current mental health education of health students?

What do people with lived experience of mental illness think health students should learn about mental health and illness?

Methodology

This study was conducted from within a social constructionist paradigm. Ontologically, the study took a relativist approach, meaning we viewed everything as a form of information. We aimed to review different perspectives and appreciate the unique aspects of experiences relating to mental health education (Rassokha, 2022). Epistemologically, the study favoured the view that multiple realities exist, that knowledge can be co-created with shared or varying experiences of place and time, and that knowledge and social action go together (Hyde, 2020). This approach supported the study to remain focused on the individual experiences and perspectives that provide a unique window into the impact of mental health education to people who receive mental health services. Fundamental to the research was the critical stance we took towards what has been adopted as the norm in relation to how mental health education should be undertaken (Hyde, 2020).

To support methodological clarity, we used the Reflexive Thematic Analysis Reporting Guidelines (Braun and Clarke, 2024) when writing this paper. In recognition of the importance of ethical research that incorporates people’s lived experiences, the research focused on the knowledge people gain from their experiences interacting with students and recent graduates, and how this could inform current and future mental health education. Given this focus, the research team did not seek to collect details on diagnosis, treatment, or current mental and physical health. For example, questions were posed to explore participants’ perceptions of what knowledge and approaches to learning are valuable in undergraduate student education. Examples of the questions asked were:

What would you want health students to learn about mental health? What would it [such learning] look like? (probes: how do they learn, what content, topics, skills, or abilities)

Recall a time or interaction with a student that was positive. What features of that experience made it a positive one? (probes: if they haven’t or can’t think of one, what are the risks and benefits of students interacting with current consumers?)

Participant recruitment

Participants were recruited using an opt-in process via email to a lived-experience network coordinated by a health network covering parts of southern and central western New South Wales, Australia. At the time of the study, the network has approximately 60 active members, all of whom identified as having lived or living experience of mental illness, and some who also worked as peer workers within the health sector. An email was sent to all members of the network via the coordinator, providing information about the study research and requesting that interested individuals contact the research team. Participation in the research took place via an interview or as part of a focus group, depending on the individual participant’s preference. In appreciation for their contribution to the research, participants received financial remuneration in line with Australian recommendations (National Health and Medical Research Council, 2024).

Data collection

Once prospective participants contacted the research team, they could ask any additional questions about the research and nominate a time and modality for the interview or for attending a focus group. Interviews were conducted over the phone, face-to-face, or via video link, according to the participant’s preference, and were audio-recorded and transcribed for analysis. An interview guide was used during the semi-structured interviews, and the interviewers took notes during the interviews. The guide was developed to assist the discussion to identify current expectations of undergraduate health student knowledge, particular topics, and approaches they have experienced or perceive as highly valuable. Interviews were conducted over the phone, face-to-face, or via video link, according to the participant’s preference. The focus group was held in person with two participants at their request. All interviews and focus groups were audio-recorded and transcribed for analysis. The interviewers explained the purpose and process of the interview and confirmed that participants had received a participant information sheet and consent form. Participants were informed that the study aimed to explore perceptions of current mental health education for undergraduate health students in a broad sense. It was explained that participants had been invited because of their lived and expertise. Once consent had been obtained, none of the participants dropped out of the study. Interviewees were offered the opportunity to review their transcripts, and those who did so provided no requested amendments.

Research team

All data collection was conducted by EG and LC. Both interviewers were employed at a regional university delivering a rural mental health education programme. EG identifies as female and is a researcher and an experienced intensive care nurse. None of the participants were previously known to EG. LC identifies as female and is an experienced researcher and registered nurse. None of the participants were previously known to LC. During the interview, only the interviewer and interviewee were present. The single focus group was attended by two participants and researcher LC. LK was involved in the design of the study and rejoined the team during the analysis, interpretation, and write-up. LK identifies as female and is an experienced occupational therapist with additional qualifications in psychology. None of the participants were previously known to LK. The authors approached the study from academic, clinical, and lived-experience standpoints, respectively, using their personal experiences of mental ill-health and as carers of persons experiencing mental ill-health, which informed their analyses and interpretations.

Data analysis

Reflexive thematic analysis was used in this study, as the research team was interested in what participants perceived mental health education would currently look like, and what it could become in the future in relation to undergraduate health students. With a diverse range of experiences in mental health, service delivery, and education, we sought to incorporate our subjectivity into the design and interpretation of the research. Reflexivity was integral to the approach taken in designing and conducting the research, and we met frequently to discuss, question, re-interpret, and critically examine our own understanding of mental health education as the study progressed. Broadly, we used the six steps of reflexive thematic analysis and undertook an inductive approach to analysis at the semantic level, as outlined in Braun et al. (2022). In practice, this involved:

Reading each interview transcript and re-listening the recordings, meeting to discuss reflections, ideas, and provocations.

Closely reading the data and coded excerpts that were deemed important, interesting, or confronting or required discussion.

Referring back to the research questions and reflecting on interpretations of the data, including initial draft themes.

Taking time to think about the participants’ stories, discuss the dataset, and review and re-develop the themes.

Writing up the research results and, through this process, further refining the themes, their definitions, and how participants’ quotes fitted within the story told by each theme.

Finalised the research results by reviewing and revising the content included in each theme and reflecting once again on the theme meanings.

Following stage 6, a summary of the key themes was compiled and emailed to each participant in the study for their review, requesting any modifications or additional information. None of the participants wished to alter the themes or findings.

Ethics approval and consent to participate

This study protocol was reviewed and approved by the Greater Western Human Research Ethics Committee (Reference: 2024/ETH00131). All participants provided informed, written consent.

Results

Six semi-structured interviews and one focus group (with two participants) were conducted between June and August of 2024 and ranged from 38 to 51 minutes in duration. Demographic information about the participants is not provided to protect confidentiality. Three main themes were developed and are detailed below, with excerpts from the interviews used to exemplify the type of data within each theme.

Embracing a holistic, values-based approach

When reflecting on the mental health knowledge required for health professionals, participants spoke about the importance of developing holistic and humanistic understandings of mental illness. They stressed the importance of valuing individuals as a whole before examining their diagnosis, behaviour, or any presenting issues. They urged both emerging and practising health professionals to take a moment to reflect on their personal mind-set and prepare mentally before engaging with a client. This preparation should involve considering the person’s life journey and experiences while approaching them with compassion and respect for their human experience.

Yeah, I think accepting other people’s world view, being respectful, that just because someone’s going through a hard time doesn’t make them a bad person. (Participant 1)

Participants described the importance of adopting a mind-set that starts with listening to people’s stories and connecting with individuals on a personal level.

. . . come to learning about mental health with an open mind and without any preconceived – I mean, everyone has preconceived ideas, I guess. But [coming] with a non-judgemental mind than is open to learning about what trauma-informed practice is and learning about mental health. (Focus Group 2)

When communicating with those experiencing mental illness, participants emphasised the importance of avoiding jargon and labels and having the cognitive flexibility to remember the person’s journey before they sought support. Language is powerful and can impact the way support is received.

It’s knowing that feeling using simple language like having – because I work with a lot of social workers and psychologists and counsellors. Sometimes they forget to use everyday language, and they’ll get very clinical with their language. And they forget that people who are unwell don’t want to be treated like a number, they want to be treated with a bit of empathy and compassion. And when you use simple everyday language, they feel it. (Participant 2)

Participants described the impact that health professionals have on recovery when they create safe and supportive spaces that result in honest and open connection.

The trust . . . really being able to communicate and be honest and open and that’s obviously a two-way street. But when you feel comfortable with a clinician, a social worker, whoever the person is, and you’re able to talk about honestly what’s going on and you know that they’ve got your back. (Focus Group 1)

Many participants had witnessed situations where health profession students lacked the interpersonal skills to connect or communicate effectively with someone at an individual level, and they believed the absence of these skills could establish and reinforce fear.

. . . in our talks with students a lot of them have said that they are initially quite scared to go on their mental health placements because they haven’t had conversations and chats with people with lived experience before, and they don’t want to say the wrong thing and that comes back to the stigma around the topic. (Participant 5)

Embracing holistic and values-based approaches to mental health education should permeate throughout health professions education so as to have a positive impact more broadly.

We are talking about a field, like, you know, health field that works with people, they’re going to see people at their greatest and at their most vulnerable anyway, that whether you’re working specifically in mental health or say working, you know, I don’t know, in paediatrics or whatever, you’re still going to be working with people who might not be at their greatest . . . so it just sort of underpins everything really. (Participant 3)

The need for improved relational skills among healthcare students was acknowledged throughout this theme in order to provide effective mental healthcare. This was voiced as vital to the wellbeing of students, their ability to engage fully in mental health placements, and to maximise health outcomes for those they care for into the future.

The need to socially embed students in safe learning environments

The second focus was on where and how mental health education should take place. Connecting students with those who have lived and living experience was viewed as deeply important by participants, particularly the notion of meeting people who were not acutely unwell, which was considered important in challenging stereotypes.

But a lot of people will never meet a person, or they’ll never know that they’re meeting a person who has a diagnosis of bipolar, when they’re well. They’re only meeting people, particularly in the acute environment, who are unwell, and I think it’s very easy to get those kinds of ideas around what that constitutes. (Participant 6)

Learning the foundations of connection, language, and building trust was the gateway to establishing effective learning that could then be undertaken in settings where people were experiencing mental illness. Many participants acknowledged that not shielding students from the reality of everyday practice was important, but preparing them appropriately to address fear and promote self-regulation was key.

In acute settings, people can be very unwell, which can be expressed loudly as yelling, pushing, swearing (physically and verbal abuse) – get used to it! Be ok with it. Understand and sit with that – it is painful for the person inside and behind that. However, we should consider people across their lifespan as a person not just a moment of acute illness. (Participant 4)

Participants acknowledged that student preparation for placement is important when it includes exposure to the realities of practice. This can often include negative workplace practices in which critical reflection is required.

A mental health placement is only really as useful as the culture of service that you’re going to be doing that placement in. The idea that you would be learning how to provide best practice service to consumers with mental health issues in an environment where best practice has not been established is just setting people up to perpetuate the same systemic issues that keep going [on]. (Participant 6)

To achieve high-quality mental health education, students needed to be guided by those with diverse skills, including faculty and individuals with lived experience. All learning should be intentional and not assumed.

You can’t expect people to just come with a commonsense kind of knowledge of how to deal with things of mental health. It’s something that needs to be learned, I guess; you can’t assume that people would’ve had experience or know anything about it. (Focus Group 1)

Through this theme, participants provided realistic insights into the mental health care system and emphasised the need for enhanced mental health education and preparation for placements. This was described as crucial for supporting improvements to care delivery in the future.

Impact and burden of sharing lived experiences

Drawing on their work advocating for the incorporation of experts by experience in mental health service delivery, participants reflected on the relatively new concept of people with lived and living experience being involved in health professions education.

I talk to the doctors and the nurses, and I say, has anyone with lived experience ever spoken to you, as part of your studies . . . the resounding answer is no. (Participant 6)

Participants felt bringing lived and living experience into mental health was important and could be used to negate some of the harm that can be caused when health professionals are not equipped to work with those who are experiencing mental illness.

Seen quite a lot of people mishandle situations, try to take control of a situation when all that they really needed to do is talk to someone, and yeah, it just makes someone who’s in a heightened state turned into someone that’s been locked up or sectioned. (Participant 1)

Despite the potential value of incorporating lived and living experiences in mental health education, doing so must be balanced with the safety of those sharing their stories, both in relation to those with lived experience providing input to health curricula and to the more significant burden of trying to educate health professionals over time.

. . . the hardest part is really that every time, whether it’s like a GP or a new psychologist or, you know, you do present to hospital, it’s – you have to share your story over and over and over . . .. (Participant 3)

Throughout this theme, participants provided insights into the cumulative effect that explaining mental illness can have on their wellbeing. While the learning for staff and students from hearing mental health lived experiences is highly valuable, having adequate structures and supports is essential to guide who, when, and what is shared.

I think having opportunities for people to come in and, and share their story . . . this is me as a whole person . . . somewhere along the line . . . sharing their experiences and giving students opportunities to ask questions is important. (Participant 3)

This theme highlighted how incorporating lived experience into mental health education was one way to humanise learning, challenge harmful practices, and prepare health professionals for compassionate practice – but in order to be successful, it should be done intentionally and safely to avoid burdening those who are sharing their stories.

Discussion

This study aimed to explore mental health education from the perspectives of people with lived and living mental health experiences in an Australian context. The results demonstrate that high-quality mental health education for health professionals should move beyond diagnosis-focused content to embrace holistic, humanistic, and relational approaches that prioritise empathy, respectful language, and trust-building. Participants in this study emphasised the importance of carefully prepared and supported learning experiences. This was described as enabling early, intentional opportunities to connect with people who have lived or living experience of mental health concerns as a way of developing relational skills and challenging stereotypes. Incorporating lived experience into health professions education was seen as a powerful tool to humanise care and reduce harm, but it should be structured to protect the wellbeing of those sharing their stories. Overall, the findings call for the use of values-driven, experiential, and collaborative models of mental health education that prepare health profession students for compassionate, person-centred practice.

The results of this study make several important contributions to the literature. First, they contribute to discussion that challenges the traditional biomedical, diagnosis-focused approach to mental health education and advocate for education grounded in humanistic, holistic, and relational principles. Doing so reframes mental health education in terms of the acquisition of a skill set that has relevance across a wide range of health disciplines. Reconceptualising core mental health education in terms of skills that promote student engagement with people and communities at a human level appears highly valuable to those who receive support for mental health concerns, as found within this study and among the broader literature (Bonnamy et al., 2025; Hansen et al., 2023; Happell et al., 2019; Khanna et al., 2021). It also provides a platform for approaching mental health education from a strengths-based and wellbeing-focused lens, regardless of discipline or speciality. Such an approach aligns with an interprofessional model of mental health education that promotes a shared understanding of health across disciplines, rather than narrowly focusing on diagnoses and definitions, which may be provisional and subject to change over time (Horgan et al., 2021; Kreps, 2025; Zeng et al., 2024). It also aligns with the current growth of work on mental health literacy and population-based approaches to the promotion of mental wellbeing (Zeng et al., 2025).

The study also adds to the body of existing literature by highlighting that meaningful education occurs when students engage with people with lived and living experience in a safe and structured environment. The findings highlight the role of lived experience in mental health education as a means of supporting the development of recovery-oriented practice. Participants in this study focused on the importance of students learning how to mentally prepare and be adaptable in face-to-face learning contexts without being personally activated, and to focus on the person with mental health problems as a human experiencing difficult circumstances. These findings demonstrate the importance of a humanistic and person-first approach (Horgan et al., 2021; Taghinezhad et al., 2022). Calls to incorporate lived experience into mental health education are not new and are reflected in the work of Ridley et al. (2017), Happell et al. (2019) Parnell et al. (2023), and Seetharaman et al. (2025). The findings from this paper align with previous literature, indicating that involving individuals with lived and living experience of mental health concerns leads to effective and meaningful improvements in higher education (Oliveira et al., 2024; Omland et al., 2025).

The paper also emphasises the importance of shifting student learning towards activities that enhance self-awareness and ways of entering and sustaining connection with others while maintaining professional standards (Happell et al., 2015; Rickwood et al., 2021; Seetharaman et al., 2025). There is a need for further work on how these goals can be achieved and sustained across healthcare-related degrees, beyond a single study.

Finally, the results of this study highlight the importance of learning experiences such as work-integrated learning and the contribution these make to the development of students’ interpersonal skills. Fundamental to this is the facilitation of these experiences by those who have already developed the skills that students are required to learn. The importance of learning about mental health through human interactions in a facilitated work-integrated learning setting has been established in previous research (Kernaghan et al., 2025; Leplaw et al., 2025; Moxham et al., 2025; Perlman et al., 2017; Scheyett and Kim, 2004; Thornicroft et al., 2016). Our study provides further evidence to encourage policy and government funding to support placement resources that enable carefully crafted mental health placements that move beyond traditional learning environments and into community spaces.

Limitations

The findings of this study have several limitations, namely the relatively small sample and its relative homogeneity given participants were recruited from a pre-existing local forum. In future research, a more diverse representation of experience and perspectives would be helpful to steer curriculum design and opportunities for undergraduate learning. Future research should also involve all stakeholders in the research process and the application of the findings back into clinical and academic spaces. Widening collaboration to include academics across multiple disciplines, peer workers, clinical staff, people with lived and living experience of mental health concerns, and family or carers is to be recommended.

Conclusion

This study highlights the importance of integrating lived and living experience into undergraduate mental health professional education. Participants in the study reflected on how higher-education providers could enhance current approaches to mental health education. Findings indicated that a greater focus on holistic, values-based, and recovery-oriented frameworks that prioritise empathy, trust, and human connection is required.

Their perspectives underscore the need for structured, psychologically safe environments in which students can engage meaningfully with the wisdom from those with lived and living experience of mental health concerns, supported by skilled facilitators. These findings challenge the traditional, diagnosis-focused mental health education structures that are evident in today’s curriculum. Study findings highlight the need to redesign mental health education to focus on self-awareness and relational skills that build trust, and to ensure student readiness for practice across health disciplines.

The research contributes to a growing body of evidence calling for transformative, inclusive, and socially responsive forms of mental health professional education that reflect the everyday realities of service delivery and the voices of those who access and use mental health services.

Footnotes

Acknowledgements

The authors thank the study participants who shared their experiences and insights into the research topic.

ORCID iDs

Elyce Green

Latitia Kernaghan

Lucinda Clarke

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this study was supported by Three Rivers University Department of Rural Health, funded by the Australian Government under the Rural Health Multidisciplinary Training Program.

Declaration of conflicting interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors are employees of Three Rivers Department of Rural Health. The authors derived no personal or institutional benefit from the study.

Data availability statement

The datasets analysed during the current study are not publicly available due to the small number of participants and the desire to protect their anonymity. Anonymised data may be made available by the corresponding author upon reasonable request.

AI declaration

AI technology was not used to create any content in this manuscript.

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