A cautionary tale

Megan Prowse presents her personal reflections on overseas placements.

Working towards a goal such as a career in psychology – as any graduate or on-the-ball undergrad knows – can be difficult and at times frustrating. Getting good work experience on your CV is one of the most suggested ways to start working towards that goal, but this can be a job in itself. As an undergrad, I wrote to many NHS departments offering shadowing and assistance within departments, but for the most part to no avail. I found it hard to get good-quality work experience and with the ever-growing competition for admission onto doctorate training I was naturally attracted to a UK-based organisation offering oversees psychology placements. With the promise of exposure to hospitals and working closely with patients, they understandably said it was an opportunity hard to come by in the UK.I understood all too well how challenging working towards being on a training course can be, but I now offer this cautionary tale.

Volunteering abroad may fill a gap in the CV, but it is paramount that placements are responsibly and ethically organised. I also wish to suggest to the psychology community ways that we as practitioners can assist those wanting to be in the field, so there is less temptation for graduates to resort to potentially unsafe placements.

The unique selling point of the placement overseas was the chance to be in direct contact with patients on wards. Psychological work experience, not easily available in the UK, all for less than £2000 for up to three months. It sounded great so I signed up along with many others. As I arrived and we became orientated to the placement and what would be involved, confusion set in quickly followed by a heart sinking feeling that I had been ill-informed and ultimately missold the experience. With the addition of being thousands of miles away from home, I felt utterly disappointed.

In reality, the organisation offered psychology placements that entailed a variety of volunteering projects working on rotation. Although having signed up for a psychology placement you can, in fact, find yourself doing many different voluntary projects completely unrelated to psychology. The amount of time spent in a psychologically related institution was once, maybe twice in the week with the rest of the time spent teaching children to swim (without the request of qualification from the organisation and no lifeguard), or watching children playing. When finally in an institution and on a ward, there was no information given about the service, no notes or information given about patients, and neither the staff nor patients were able to communicate in English. Volunteers often asked the organisation if they could implement more meaningful activities, but the feedback was consistent that volunteers shouldn’t question the organisation.The tagline quickly became clear: we ‘wouldn’t get this experience anywhere else’ and therefore needed to be grateful.

It quickly became apparent that there were safety issues on the placement. For example, alarm bells were raised as my questions around risk management for volunteers on forensic wards were met with the vague response that we ‘didn’t need to think about that’ as we were not in the UK. The safety concerns continued, as I observed the project’s organisational staff knowingly encouraging volunteers to enter unpredictable wards where nurses were absent. Incidents did occur, where volunteers were being grabbed, pulled and scratched. Volunteers felt that they were unable to report this to the project’s organisational staff, due to their ‘lucky to be here’ defensive attitude to the feedback from volunteers.

This apparent disregard for the safety of patients and volunteers alike left me questioning the awareness of the organisation’s staff, with regard to psychological institutions and the necessary ethical considerations for working with vulnerable adults. I was also saddened by the lack of consideration for ethical and psychological factors for patients. For example, the organisation were not concerned with the potential disruption caused to patients by a regular presence of new people who were not staying long, who didn’t speak their language and were not permitted to provide them with any real support. We were encouraged to walk onto the ward without any introduction or warning. Yes, there is value in basic contact for certain patients who may be left for long periods of time without visitors, but I wondered if sending us in to sit on the ward, simply looking at patients, was helpful for them and the best use of volunteers’ time and money.

The organisation may have started out with good intentions, but the obvious lack of awareness for a safe and ethical placement is deeply concerning. I felt the organisation had a huge responsibility to provide something meaningful for patients and volunteers but to me there was an exploitative feel to the placement. I made the decision to end the placement early and do my best to speak up so that others wouldn’t be in the same position. I do feel the organisation provided an experience: of another country, living with families and being immersed in a different culture. So why not sell it this way? Instead, the organisation promised a chance to work psychologically with patients for a fee, which turned out to be a promise left very much unfulfilled. At every turn the staff batted away constructive feedback and I couldn’t help but feel that the organisation exploited the censorship in the country to defend against their failings.

So what could and should be done?

Firstly, in terms of safety, offering some risk-awareness training, to enable staff to be more on board and aware when volunteers are around. Improvements in the placements could include activities that are more useful to patients and psychologically related for volunteers, properly liaising with the hospitals so that placements are integrated into the hospital services and that staff are aware of the volunteers’ presence. Observations of doctors and professionals working with patients could also be provided if the placement was more integrated into services. Ultimately, providing a psychological placement should include some psychological elements, and if this is not feasible then the experience should be sold as it really is: at best, a cultural one.

Volunteering in mental health should be rewarding for those doing the work but more importantly should be meaningful for patients. Why should volunteers sign up and pay for these projects that are unsafe and do not provide any real psychological work? I believe mental health providers here in the UK need to consider how to include volunteers in departments. Often confidentiality is the reason for not offering volunteers a placement. However, there are ways to respect confidentiality whilst offering psychological work. For example, I was lucky enough to be offered observations of clinical psychologists providing psychoeducational groups (where disclosure of information and confidentiality constraints are limited),

in exchange for providing administrative duties. Such an arrangement meant that I was contributing to the service and gaining meaningful experience. Departments can often overlook the contribution graduates with knowledge of IT and research skills can make. Offering up graduates, or eager undergrads, to help in departments is a key resource to be thought about, and in return a chance for eager psychologists in the making to be learning their profession.

I therefore urge professionals in the field to truly consider the value of volunteers. If we could offer more opportunities in the UK then perhaps these organisations will not have the chance to hold out the promise of things that they cannot deliver on. In sum, I write this cautionary tale, not to deter any good intentions of those trying to offer volunteers placements abroad, but as a warning to graduates to be aware of what is out there. Ethical and safety considerations aside, there can be a vast discrepancy between what is sold and what is provided in reality. Check what you’re paying for, and whether you should be paying at all.

Megan Prowse is a CBT therapist.

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