A Pint Sized Conversation
Scarlett Parr-Reid, Science Print Editor, interviews Medical Imaging lecturer Julie Mills, the organiser of the latest A Pint Sized Conversation performance at Exeter, as well as Dylan Frankland, director and actor and Ferdinand Boucher, medicine student at Exeter who attended the performance.
A Pint Sized Conversation is a theatre piece on mental health in an unlikely setting – the pub. I spoke to one of the lead actors, Dylan Frankland. He performs the show with Rosa Day-Jones and Tobias Grace. It is currently touring the UK. Dylan Frankland, Rosa Day-Jones, Tobias Grace and Katherine Lea are touring A Pint Sized Conversation – an innovative theatre approach to engaging conversation about mental health. Through drama, lights, sounds and gestures, the group depict examples of what it can be like to look after those with a mental health condition, such as depression. The group recently performed at the Exeter Medical School for first year medical students.
Pubs are one of the last places you might expect to go to for a conversation about mental health. When the Salvation Army used to visit pubs to sell their Christian newspaper, The War Cry, heads would turn if only to indicate that the charity had no place in a pub. Yet, there are people who have shooed them away who are now grateful for the Salvation Army for providing rooms to use at little rent for Alcoholics Anonymous support group meetings.
Interview with Julie Mills, Senior Lecturer in Medical Imaging and Best Employability Skills Support nominee for the Students’ Guild
Why did you decide to organise ‘A Pint Sized Conversation’ event at the Exeter Medical School, bringing it to an educational institution?
I’ve noticed, being a personal tutor for both Medicine and Medical Imaging over the years that there’s been a rise in student mental health concerns and our structures are sometimes quite overburdened by the amount of people that are going to access them. So, we need to give students much clearer signposting during induction week. Students coming to the campus, particularly the College of Medicine and Health where they are dealing with clinical environments and clinical patients, will sometimes see quite distressing things and we need to ensure that they are properly supported in that. Even coming to university, it’s a really difficult transition, so we want to make it a conversation that they feel comfortable with in that it’s okay to not be okay from very early on. And also that it’s okay to feel a bit disgruntled, worried or tired if you’re supporting someone with their mental health, as it’s difficult.
I think the good thing about this drama production is that it’s young people and it’s like a conversation, as if they’re talking to their friends and the students are listening to that. It’s not highbrow. It’s not on a stage, but it’s very immersive; the students can probably relate to the Pint Sized Conversation performers more.
Our induction process is being looked at. I’ve been to several conferences over the last couple of years in my role and they were saying that the inductions are the key thing. We do amazing open days, but induction doesn’t quite match that initial excitement. So, this year, there’s been a lot of work around getting students to know what is there early on in a fun and different way than the usual PowerPoint presentation format. It was told to me through an email from the drama department that this event was made available to the University of Exeter. I had to push quite a lot to get the North Cloisters lecture theatre at St.Luke’s free and set-up. As student feedback comes through, which is already really positive, we will know the impact of events like these and it will be easier to organise them in future.
Drama is really powerful anyway. But with mental health, because you can’t see it in the same way as physical health, it’s a lot less clear. But here the emotions were being brought alive instead of being internalised.
Yes. They used a range of methods, such as turning the lights up and down. This puts you in a state of unease, immersing you in what it might be like for someone. They held up some torches from the iPhones to show where some people might self-harm. We were a little bit worried about immersing the students in that, due to triggering them. We looked into that in detail and did a risk-assessment before we held the event. There were three case workers for the session and I was given mental health first aid training.
Students who were triggered were able to leave at any point. We were then able to signpost the students to further support. The Director of Education saw it as a positive thing that we could then identify any students who needed help when before they might not have been able to speak out about it. So, the idea of using drama to portray mental health worked really well, but it needs to be managed well. The full risk assessment was signed off by the Director of College Operations, all the Directors of Education, all of the health care workers and Mark Sawyer, the Head of Wellbeing at the University of Exeter. We also made it optional for students to go to the event, which had consequences, as if students see something new on their induction timetables, they might not know about it and might choose not to go.
Is mental health taught on the Medical Sciences, Medicine, Neuroscience and Medical Imaging curriculum?
For most of the programmes, mental health is not something that is taught explicitly. Our Nursing programme, however, did not attend the Pint Sized Conversation, because one of the six pillars of their course is no health without mental health. For them, it was a strand that runs through their programme anyway. So, most of them are very comfortable with talking about mental health. It’s a new course, with a great example of mental health running right the way through. They didn’t want it to be a stand-alone thing. I can see the ethos behind that. But I do think that there does need to be more mental health first aid trained staff working on all of the colleges across the university. There does need to be some explicit discussion about mental health at every stage of the students’ courses, not just the induction. You might be fine in the first year, but then in second year when it starts to count towards your classification as well as in your final year, the pressures might become overwhelming.
I think that the Pint Sized Conversation is a good starting point, but we need to think of other initiatives throughout the students’ journey at university that are similar but maybe more embedded in the curriculum. A multi-faceted approach is needed including sessions that are spaced out across the years of study.
How do you think that the use of creative arts to express aspects of mental health conditions such as anxiety and depression can help the public to better understand the nature of such conditions?
I think that it’s about getting it out there in the public domain and whatever form you use to do that is great. Using creativity and immersion, if done well, can do a good job at highlighting mental health for people, especially those that don’t go on social media or don’t go to the theatre. The resources that we have here – welfare support and counselling etc – are very much mainstream methods. They have their place, absolutely, but as the conversation about mental health develops, that’s when arts and drama come in. That’s human and it’s expressive.
There has been increasing discussion about mental health in recent years, particularly destigmatising mental health conditions. From a medical standpoint, how much impact do you think events like this can have on encouraging students to seek help for their mental health or better help their friends and loved ones?
I think there is a big national problem with junior doctors in the NHS and indeed actually any graduate from nursing, medical imaging etc, that they’re sent off into the world and encounter many mental health and physical health concerns in patients, but also have their own mental health concerns. There are huge staff shortages, putting the NHS under pressure. The NHS long-term plan talks about supporting staff and their well-being; it’s the first NHS document that puts focus on the mental health of staff themselves. But I think a lot more needs to be done to support this. You have to have your own self-care before you can help others. This is a big factor in retention of doctors and nurses. That’s what the Pint Sized Conversation talked about as well. Dylan Frankland, one of the performers, articulated this really well and I hadn’t really thought of that before. They have a triage system in mental health and this event would be the initial step of getting people to speak out and feel okay with that.
Does the ‘A Pint Sized Conversation’ performance depict mental health conditions from a diverse range of perspectives, including different mental health pressures facing those from Black and Minority Ethnic (BAME) individuals or LGBTQ+ individuals? If not, how can the event be more inclusive?
It didn’t cover that, as it was about the position of someone supporting someone with mental health. It was about someone’s stepfather who’d had depression and the stepson hadn’t realised that it was depression, but it was too far down the journey. So, they talked more generally about depression, anxiety and self-harm. There are some other areas that they could extend into. And those performing were White British representatives. So, that might be something we could feed back to the Pint Sized Conversation team – that in terms of inclusivity the representation wasn’t really there.
As an international student at university, there are different pressures that you face, perhaps culturally compared with home and EU students.
That could be improved, but you’ve got to do it really carefully. You can’t just use tokenism and get a BAME actor. That’s not the same thing. So, it needs to be more discursive.
How would you describe the ‘Pint Sized Conversation’ event at Exeter Medical School in three words?
Powerful. Immersive. Thought-provoking.
Interview with Ferdinand Boucher, Medicine student at the University of Exeter
Is mental health taught on the Medical Sciences and Medicine curricula?
No. There should be training for students. You have to get it separately, e.g. from the Guild.
How do you think that the use of creative arts to express aspects of mental health conditions such as anxiety and depression can help the public to better understand the nature of such conditions?
Students stayed behind if they were triggered or needed help. The show sparked conversation with the audience. It represented a real-life situation. It was conducive of openly speaking and empathy-building. It was a performance, not just death by PowerPoint, so was more engaging. But, there’s still stigma regarding talking to people who may not know as much about mental health. People are more likely speak with others within audience who know more, rather than outside of the audience. I think the talk should be for all years not just first-year students.
Do you think the mental health services at the University of Exeter are adequate?
Seeking support from the university is difficult. There are problems getting help when you need it, such as waiting times, lack of mental health funding and training. Also, the Exeter medical school gets less emphasis than Streatham does in terms mental health resources.
The Peer-Assisted Learning Scheme (PALS) could expand to include more mental health support rather than predominantly academic support. I believe there should some form of mental health training for academic tutors, so they can help students directly rather than signpost them to long waiting lists. The Students’ Guild is creating eight new roles for equality panellists, based on the Equality, Diversity and Inclusivity Act (EDI) 2014.
Students will represent each role, with each student promised to receive mental health support training to offer to the student cohort.
How would you describe the ‘Pint Sized Conversation’ event at Exeter Medical School in three words?
Invigorating, emotional & crucial.
Interview with Dylan Frankland, director and actor from the show
Why did you decide to perform this piece in the pub?
We started out with the performance in pubs mainly in the South West. In pubs people can chat about anything, but they generally won’t discuss mental health. So, it’s about getting it out there and normalising the conversation. It’s not just something you talk about in a theatre space only when the lights are focussed down on the performers; it’s something that everyone is equally part of. In communal spaces it can get heated. It can be loud. It can be messy. It can be ugly. This environment allows the audience to tap into aspects of mental health more easily.
Pubs also invite members of the public who might not normally frequent the theatre, particularly older men. They wouldn’t necessarily engage with it, one because it’s mental health and two because it’s theatre. We’ve had men that have stood at the bar before we’ve announced our show and they’ve been reluctant to watch because it wasn’t really their thing. And then when we start, they’re the ones who look. Sometimes they’ve even come to us for an open conversation at the end. I think men find it harder to open up about mental health because stereotypically “men don’t talk about emotions”.
What sort of mental health stories do you tell which support performances in pubs?
As a piece, we are the performance. We are all acting as ourselves conveying encounters that happened to us. What we say is not gospel. This is a snapshot of our experiences. In the performance we explore our perception of loved ones living with depression. I refer to my younger sister; Rosa talks about her cousin and Toby speaks about his stepdad. Although we are quite used to having a conversation about it now, there is a moment in the performance where Toby checks in on the audience. It demonstrates to the audience that mental health is real and lets them know that it is okay to check in about it. I delve a lot into guilt and about not supporting my sister in the best way.
Through the rehearsal period, we looked at how to make content as accessible as possible. We have a content warning and ensure that people in the audience can leave at any time they want to. We have all been mental health first aid trained. This involves an overview of depression, anxiety, eating disorders and psychosis and how best to support someone living with them. You’re not being trained to help someone in the long term through counselling, but instead you’re being trained to be there for someone who’s in crisis. One thing that our trainer said was “we can all go home in half an hour if I just tell you to be kind”. You can’t really make it any worse by talking about it. You don’t have to solve everything in that conversation, but it’s just providing someone with signposting to other services such as GPs or counselling and then letting them know that they can come back to you.
I liked a phrase on the A Pint Sized Conversation website about “not getting it right all the time, but trying”. What is your advice for a person who knows someone struggling with mental health but isn’t sure how to help?
I think it is just about speaking to them and letting them know that you’re there for them. It’s about listening non-judgmentally. It’s remembering that you also need to look after your own mental health. There’s a really good video on the difference between sympathy and empathy by Dr. Brené Brown. It elaborates on the importance of connection in being there for others. There will be times where you don’t fully understand an aspect of mental health and that’s okay. You can say that you don’t fully understand what it’s like to go through that, but you’re there for them.
There are services in place specifically for carers of those with mental health difficulties such as the Mind charity’s website and the Rethink website. Whilst it’s important that you are there for someone, it’s also about remembering that it’s okay not to be okay. There are support systems that can be put in place to help deal with others mental health. For example, in my experience with my sister, if she suddenly phones me, my family will know and give me space. So, they know I’m not being rude by taking the phone call. Therefore, I can support my sister more and I don’t resent that support I’m giving her when I’m spending time with family. I think that being very open with people is really useful.
A Pint Sized Conversation features coloured lights, gestures and song to depict mental health and the emotional effects of depression and self-harm. Why did you choose to appeal to many of the senses rather than just speaking in the performance?
When we first started out with the performance, we were just going to be talking through the microphones to amplify the emotions we were conveying in a hushed environment. But the visual part was another way for the audience to take information in. With the few resources we had, we realised we could improvise and play music, turn the lights down and play with sound.
It’s really the strongest part of theatre making: using different ways to put theatrical techniques across. It’s about bringing these methods into unconventional spaces. There are loads of amazing mental health professionals and speakers who give really inspiring presentations. And that’s not our skillset; our skillset is about tapping into emotion in a visual and creative way. It’s about ensuring that this is maintained throughout a performance. We thought about how we could show the neurons and pathways inside the brain within our performance. Consequently, the idea of lines became a recurring theme through our performance. This became a metaphor for family lines and connections as well as connections in the brain. That worked effectively.
Could you describe A Pint Sized Conversation as you know it in three words?
Honest. Caring. Uplifting.
For more information on the performance and where you can watch it, visit: https://apintsizedconversation.weebly.com/.
If you are affected by any of the issues discussed in this interview, there are a range of resources to support you:
Mind mental health charity: https://www.mind.org.uk , tel. 020 8519 2122
Time To Change campaign: https://www.time-to-change.org.uk/
Rethink: https://www.rethink.org, tel. 0121 5227007
Samaritans: https://www.samaritans.org/, tel. 116 123
Dylan also has a show on at 7.30pm in Westbury-on-Trym in Bristol on Dec 5th, raising money for the Off The Record mental health charity.
