LAUSR

To the Editor: There is little evidence that knowledge and attitudes toward mental health are improving [1]. This is of particular concern in medical students who must treat patients who are mentally ill with compassion and respect. There is also little evidence for any interventions that are effective in reducing mental health stigma in medical students [2]. At Western Sydney University School of Medicine, mental health and student well-being are the focus of a tutorial in the first year of study as part of the Personal and Professional Development course. Students discuss written and multimedia resources related to mental health during the tutorial. We explored whether showing our students the artwork of peers from the year before would reduce the stigma associated with mental illness. In 2016, the 130 students enrolled in the first year of their medical degree at the School of Medicine were invited to participate in the study. Of these students, 126 (97%) enrolled in the study. The participants were assigned to two groups according to tutorial groupings of 10 to 12 students. All students watched short excerpts from the ABC documentary Felicity’s Mental Mission [3], which presents the experiences of young Australian celebrities diagnosed with mental illness. This documentary was accessed via Informit EduTV. The students also watched a video presentation developed by one of the authors (JG) detailing statistics on the mental health of medical students. Thirdly, the students were given access to a website from the Australian Office of Teaching and Learning [4] that explains how to support peers with mental health concerns. Finally, the tutorial groups discussed the benefits and barriers to discussing mental health concerns with peers at university. The 62 students in the intervention group also viewed online three pieces of visual art accompanied by a narrative of a student’s experience of mental distress. Permission was gained to show the artwork, but the identities of the students whose creative works were presented were not disclosed. The three artworks that were chosen to share were dramatic representations in visual form of sadness, agitation, and isolation. They were accompanied by unself-conscious and unapologetic descriptions of pain and the need for help. The control group had more female students (62%) than the intervention group had (50%). Most population studies of stigma have not found an association with gender [1]. Two weeks before the tutorial, all participants completed the Mental Illness: Clinician Attitudes Scales (medical student version)MICAv2 [5]. The 16-item scale has been devised and validated for use in medical students to demonstrate levels of stigma and responsiveness to interventions. A single overall score is created through the summation of responses on a sixpoint Likert scale; the higher the overall score is, the more negative or stigmatized the attitude. The possible range of scores is 16 to 96. The mean score in the standardization scale for medical students was 37.9. The MICA v2 scale was completed again immediately after the completion of the tutorial by 98 students (75%). To encourage participation in an inclass study, the data were collected anonymously as an online survey. The data were therefore unpaired. We used a Mann-Whitney U test to compare the overall MICA v2 scores of both groups before and after the tutorial and to compare the before and after scores on individual items. A p value less than or equal to 0.05 was considered statistically significant. The statistical analysis was undertaken using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. Ethics approval was granted by the Western Sydney University Human Research Ethics Committee (Human Research Ethics Committee Approval No. H9989). Table 1 shows the means and the wide range of total scores. We found differences in the pre-intervention MICA v2 * Jenny McDonald [email protected]