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Hearing voices: Qualitative research with postsecondary students experiencing mental illness ANNIE V ENVILLE Department of Social Work & Policy, La Trobe University, Melbourne, VIC, Australia A NNETTE F S TREET Adjunct Professor of Palliative Care, La Trobe University, Melbourne, VIC, Australia ABSTRACT Vocational Education and Training (VET) students experiencing mental illness have been described as one of the most vulnerable student groups in the Australian post-secondary sector. This vulnerability can be attributed to the impacts of illness, the oft-reported experiences of stigma and discrimination, and low educational outcomes. There is increased pressure for researchers and policy-makers to listen to the voices of the most disadvantaged learners to aid design and delivery of the Australian VET system, yet little knowledge exists in the sector about how this could and should occur. This paper critically reflects on some of the ethical issues and methodological challenges recently encountered in our research with VET students experiencing mental illness. Through rich description of our strategies for student recruitment and managing participant vulnerability, we aim to contribute to the literature informing qualitative research with VET students experiencing mental health issues. This is a timely contribution to the current debate on strategies designed to listen to the voice of the disadvantaged learner in order to inform teaching and learning and achieve better student outcomes. Keywords: mental illness, post-secondary education, qualitative research, ethics

I NTRODUCTION Qualitative research methods produce ethical dilemmas that concern specific people, located in a particular time, place, and culture. (Haverkamp, 2005, p. 155)

T

he Australian Vocational Education and Training (VET) sector is a major provider of post-secondary education offering a valuable stepping-stone towards participation in the community and the labour market (Hargreaves,

2011; Productivity Commission, 2011). International comparisons indicate that Australians have a high participation rate in VET (Field, Hoeckel, Kis, and Kuczera, 2009); however, students with disabilities are often under-represented in course completion statistics (Karmel & Nguyen, 2008). Further, students experiencing mental illness are less likely than any other student group to complete the course in which they are enrolled (Cavallaro, Foley, Saunders & Bowman, 2005). This raises concerns about the

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Annie Venville and Annette F Street

capacity of the sector to respond to students experiencing mental illness. Data on the participation in and outcomes of vocational education and training for students with a disability are collected by the National Centre for Vocational Education Research (NCVER) through the National VET Provider Collection, the National Apprentice and Trainee Collection, and the Student Outcomes Survey. These data show that, while overall the numbers of students with a disability have increased over time, since 2005 the percentage of VET students disclosing a disability has remained at around 6% of the total student population in Australian VET institutions. Of this proportion, students disclosing a mental illness occupy just 13.3% (NCVER, 2013). Evidence pointing towards high rates of non-disclosure of mental illness (Griffin & Beddie, 2011) suggests that the quantitative data routinely collected by NCVER cannot provide an accurate profile of students within the VET sector who experience mental health issues. The qualitative portrayal can give greater attention to nuance, complexity and context (Patton, 2002). Two early Australian studies investigating the support needs of post-secondary students sought to hear from those experiencing mental illness. McLean and Andrews (1999) examined 115 survey responses from students self-identifying as having a psychiatric disability. They report developing the survey questions after consultation with key stakeholders, including students; however, the precise methods of these student consultations are not fully described. Bathurst and Grove (2002) reported student experiences of disclosing a mental health issue through analysis of the written narratives submitted by 17 students. In a more recent study exploring the lived experience of learning for VET students reporting a diagnosed mental illness, five students participated in semi-structured interviews (Venville, 2010). The afore-mentioned studies have yielded rich data and added to our understanding of the VET student perspective; however, they provide limited methodological description and guidance 46

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for the qualitative researcher in VET. This paper attempts to address this gap. We aim to contribute to the literature informing qualitative research with VET students experiencing mental illness through rich description of our methodological decision-making, strategies for student recruitment, and managing participant vulnerability. This commentary is timely in the context of increased pressure for researchers and policy-makers to listen to the voices of the most disadvantaged learners to aid design and delivery of the VET system (NVEAC, 2011). A brief description of the substantive study provides context for this reflection on our research, part of which privileged the voice of the VET student experiencing mental health issues.

THE

STUDY

The study was designed to investigate both the problem of low course completion rates for VET students experiencing mental illness, and student and staff perspectives of student disclosure of mental illness in VET. To address the research problems, it was necessary to adopt a methodology that questioned and problematised ‘the social processes of knowledge production’ (Day, 2012, p. 65), and that most closely aligned the study with a social constructionist epistemology (Burr, 1995). Social constructionism places an emphasis on how meanings of phenomena develop through interaction in a social context (Conrad & Barker, 2010). As a theoretical frame it allowed for an examination of the social structures and processes that influence course outcomes and perspectives of student disclosure of mental health issues in VET – notably, the language participants that used and the sense they made of what they did. A collective case study design (Stake, 1995) was used to inform the recruitment of 20 enrolled students experiencing mental health issues and 20 teaching and specialist support staff, across four sites providing vocational education and training. Selected sites were characteristic of the diverse locations in which VET delivery occurs across Australia: inner city, outer metropolitan, a

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Hearing voices: Qualitative research with postsecondary students

regional centre and a large rural town. In an attempt to identify similarities and differences across sectors, three large government-funded and one large private provider were recruited. Data were collected through the use of semi-structured interviews and examination of the policies and practices related to equity, counselling and disability management at these institutions. All data were analysed thematically. The key findings from this study are reported elsewhere (Venville & Street, 2012; Venville, Street & Fossey, 2014a; Venville, Street & Fossey, 2014b). Here we report on methodological issues related to student recruitment and participation. Problem definition shapes how, or if, society responds to a problem, and how this definition and response impacts upon the individual experience (Conrad & Barker, 2010). In the context of this study, mental illness refers to clinically diagnosed mental disorders as defined by the DSMIV (American Psychiatric Association, 4th edn. 2000) and ICD-10 (WHO, 10th edn. 2008) classification systems. We adopted the term mental illness as it reflects the dominant language used in VET sector policies and practices related to enrolment, access and equity, counselling, disability and student support. These institutional processes are informed by the Disability Discrimination Act (Commonwealth of Australia, 1992) which uses a definition of disability based on the medical rather than the social model of disability (Kiuhara & Huefner, 2008; Thomas, 2007). We acknowledge that the use of the term mental illness and this definition is contested in the literature (Reeve, 2002).

Ethical considerations Ethical protocols demanded a research design that would allow for both the collection of participant stories yet safeguard participant vulnerability. Gaining approval to proceed with the research from the La Trobe University Human Ethics Committee required careful and considered responses to a range of ‘what if ’ scenarios posed by the committee. The committee required re-

assurance of researcher capacity to recognise and respond to participant distress. Response strategies were developed and built into the research procedures prior to the study being approved and the commencement of recruitment at each VET site. A brief discussion of our methodological decision-making is followed by an examination of the research methods specifically related to the student participants.

Methodological decision-making Although meaning may be studied using quantitative means, qualitative methods are particularly suited to examining individuals within their social frameworks (Morrow, 2005). The need to address the research problem from a range of positions and perspectives, as well as account for the researchers’ own subjective experiences and impact on the setting, informed the choice of a qualitative framework for this study (Flick, 2009). Qualitative research is, however, a broad term and there exist multiple internal debates and tensions in relation to the approach (Morrow, 2005; Schwandt, 2000). As a set of interpretive practices, qualitative research is characterised by complexity and the precise methodology of studies is not always clearly articulated (Denzin & Lincoln, 2000). Recruitment is frequently described as the most challenging part of a research study and often not adequately reported in the literature (Patel, Doku & Tennakoon, 2003). Increased understanding of the student perspective of successful course completion and disclosure of mental illness required gaining access to those students who could speak firsthand of the experience of being enrolled in a VET program of study. This reflected our commitment to recruiting participants who could discuss the research questions from an informed position (Grbich, 2007; Charmaz, 2006). A purposive sampling frame (Patton, 2002) was adopted and we deliberately sought to recruit students who had, and students who had not, disclosed their mental illness to their VET provider.


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E n t r y t o re s e a rc h s i t e s Institute Directors at each of the four research sites nominated specialist equity and access staff, or counsellors, to act as our contacts for the duration of the project. Contact staff assumed a key role in arranging site visits and approving recruitment strategies; they determined our access to students. In nominating the specialist staff, Institute Directors sent a clear, if unintended message, that research with students experiencing mental illness belonged in the specialist domain. Methodological texts devote complete chapters to gaining access to research sites and sometimes conflate site access with cooperation (Wanat, 2008). We found that official permission from the Institute Directors to conduct research at a site did not guarantee cooperation or participation from their nominated contacts once we were on site. Unexpected resistance to student recruitment came from some counselling and specialist disability staff couching their reluctance to promote the study in the language of duty of care (Venville, Street & Fossey, 2013). These staff constructed their resistance as a risk management strategy, an obligation to avoid potential harm to students. Further evidence of staff resistance was seen in their limited participation in the study (Venville et al., 2013). In an effort to reduce our dependence on these staff for access to students, we deliberately created multiple opportunities for students to optin to the study.


access to the majority of classes in operation during site visits. During the in-class presentations students were given a snapshot of the issues under investigation. The lived experience of mental illness was described as central to increasing understanding and students were cast in the role of expert. The voluntary nature of participation in the project, strategies for participant protection, and researcher background were described. All inclass presentations were delivered by the same researcher, a former VET disability teacher consultant and counsellor. This strategy was supplemented by other site specific recruitment activities including email invitations to participate from the Institute Director to all students, the use of student websites and intranet sites, hard copy posters, and direct email contact to students registered with disability services. All recruitment information specifically stated the desire to speak with students who had or had not disclosed their mental illness to their VET provider. Table 1 displays the student recruitment strategies used at each site. Nine students opted in as a result of in-class presentations; three as a result of contact from disability staff; email and intranet promotion resulted in a total of nine student participants; and one student joined in response to a hard copy poster displayed in a lift.

The student par ticipants Recr u i t m e n t s t r a t e g i e s Recruitment success in earlier research with VET students experiencing mental illness (Venville, 2010) prompted us to seek permission to enter mainstream classes to speak of the study. As mentioned earlier, researcher access to classes was at the discretion of the key site contact and in-class presentations were agreed to in three of the four sites. The two governmentfunded sites limited access to arts, retail, information technology, nursing and welfare oriented classes. In contrast, the private site allowed 48

Twenty VET students, 15 females and five males, opted into the study. All were enrolled full-time or part-time in a course of study of at least 12months’ duration and above the minimum qualification level. Participants ranged in age from 21 to 57 years. Fifteen of the students were diagnosed with depressive and/or anxiety disorders, and five with a psychotic illness (see Table 2 for student details). At the time of their first interview, 15 of the 20 students had not disclosed their mental illness to their educational provider. Only five students had disclosed.




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R E C R U I T M E N T S T R AT E G I E S F O R E A C H S I T E

Site 1 Private inner city

Strategies

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Site 2 Public outback

Site 3 P u b l i c re g i o n a l

Site 4 Public outer-metro

Email recruitment

General email to all students and staff from Director, March 2010 Poster emailed, February 2010

General email to all campus heads and head teachers, April 2010

In-class presentation

March 2010, 21 classes August 2010 6 classes

March 2010 4 classes May 2010 3 classes

Student websites/ Intranets

Recruitment poster on student website, March–October 2010

Contact through disability service

Counsellor displaying poster and information sheet

Counsellor displaying poster and information sheet

Poster/ information sheet displays

March–October 2010 All public areas

March–October 2010 March–October 2010 Counsellor displaying poster and Library, student Library, student information sheet, notice boards notice boards April–October 2010

TA B L E 2 : S T U D E N T Pseudonym Natalia Suzannah Cathy Julie Eve Alain Carmel Sue Jane David Maureen Michael Belinda Anne Bruce Keith Mara Karen Felicity Veronica Jill

General email to all campus heads and head teachers, April 2010

March 2010 4 classes May 2010 2 classes

Not permitted

Recruitment poster on student website, March–October 2010 Counsellor displaying poster and information sheet

Disability liaison staff emailing all students registered

PA R T I C I PA N T S : G E N D E R , A G E , D I A G N O S I S A N D C O U R S E

Gender-Age (years) F-21 F-24 F-29 F-34 F-22 M-29 F-24 F-27 M-29 F-57 M-55 F-52 F-55 M-26 M-36 F-45 F-22 F-35 F-24 F-27

Diagnosis

Course

Depression Schizoaffective disorder Depression Depression Anxiety Depression and anxiety Depression, PTSD Depression and anxiety Asperger’s disorder, anxiety Depression, PTSD, anxiety Psychotic depression Anxiety and depression Depression Anxiety, substance use disorder Schizophrenia Depression Depression and anxiety Bi-polar disorder Psychotic depression, PTSD Depression

Hospitality management Information technology Natural therapies Welfare Natural therapies Communication Hospitality management Natural therapies Information technology Retail Welfare Retail Visual arts Retail Information technology Welfare Disability studies Information technology Visual arts Veterinary studies


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The ro l e o f t r u s t i n t h e recr u i t m e n t p rocess It takes me a long time to trust …I’m not very trusting; it’s hard for me to be quite open. Like now my heart’s still pounding a hundred miles an hour and I’m…not freaking out, I’m nervous…it’s just because of... I have to talk and…I don’t mind talking but it’s…it’s hard in a lot of other ways. (Student, site 4) Mechanic and Meyer (2000, p. 658) state that ‘there are circumstances where people are required to put trust in persons they may not know or only know casually and where misplaced trust can have great consequences’. Much attention is devoted in the literature to the critical role of trust in effective human relationships, and engendering trust in both the researcher and the research processes was pivotal to recruitment. The in-class presentation was one deliberate strategy designed to ‘humanise’ the research. Demonstrating our ability to ensure anonymity and safeguard student identity and role was paramount to all students’ decisions regarding participation. Students who had not disclosed their mental illness required more reassurance that their enrolment would not be affected than those who had formally disclosed to their provider. As researchers, we entered into a covenant with these students to protect their confidentiality and anonymity. In essence, we asked those students to afford us a level of trust they had not granted to those within the organisation. While this is true for the majority of research participants, this commitment to anonymity posed some ethical challenges in terms of researcher responses to the more vulnerable students.


National Statement on Ethical Conduct in Research jointly authored in 2007 by the National Health and Medical Research Council, the Australian Research Council and the Australian Vice-Chancellors’ Committee issued a clear directive to researchers working with people experiencing mental illness. It states clearly that consent should be sought from that person if he or she has the capacity to consent, and where the illness is episodic, ‘an attempt should be made to seek consent at a time when the condition does not interfere with the person’s capacity to give consent’ (NHMRC, 2009). In the present study, capacity to give informed consent was determined in a number of ways. Active enrolment in a VET program of at least 12-months’ duration and above the minimum qualification level indicated that mental health issues were not significantly interfering with student attendance and assessment requirements. The email and phone contact with the researcher prior to interview provided further evidence of each student’s capacity to understand the research procedures and strategies for participant protection. At the time of the initial interview, the researcher again reviewed both the participant information and informed consent procedures with students, and demographic data including date of birth (to confirm students met the age criteria), preferred means of contact, course of study and reported mental illness diagnosis was confirmed. As part of this process, students were asked when their diagnosis was given and by whom. In the interests of establishing the level of rapport and trust needed to conduct sensitive interviews, independent verification of a mental illness diagnosis was not sought. Student accounts were considered sufficient.

I n f o r med consent The experience of mental illness may impact upon a person’s ability to fully comprehend the implications of participation in a research project and the research literature has devoted significant attention to the complex issue of informed consent (DuBois, 2007). A recent addendum to the 50

The inter v i e w s Researchers are aware that ‘interviews can be and often are interventions. They affect people.’ (Patton, 2002, p. 277). Although students were offered a choice of medium for the first interview, telephone or face-to-face, 15 students completed




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both interviews by telephone. Telephone interviews are recognised as a way of obtaining sensitive information from hard-to-reach participants (Pridemore, Damphousse & Moore, 2005) and the increased anonymity afforded by a telephone interview may have enabled recruitment into the study. While students were able to speak to the researcher of their experience, their identity remained partially hidden. Informed consent and tape recording protocols were observed on both occasions and all interviews were conducted by the same researcher, transcribed verbatim and deidentified. An opportunity to re-consent was offered at the end of each interview. This was a deliberate strategy as it was not possible for the researcher or participant to have advance knowledge of how the interviews would proceed (Kvale & Brinkmann, 2009) and there was potential that a participant may elect to withdraw consent upon completion of the interview. However, no one withdrew from the study.

Managing par ticipant vulnerability It was necessary to consider the case that, while some mental illnesses are episodic in nature, others can be continuously active and characterised by frequent crises (Hickie, 2002). As described earlier in this paper, strategies for responding to participant distress had to be developed prior to the commencement of data collection. It was determined that participant safety would at all times over-ride the research interview. Clear indicators of vulnerability and distress were obvious in research interviews with two students, neither of whom had formally disclosed their mental illness to their VET provider. In both cases the interview was terminated when the researcher determined that the need to ensure the safety of the student took precedence over the research interview. In the reporting below, S denotes student and R denotes researcher. S1 sometimes – probably just when I – I sometimes... I don’t have... I am out of my mind – I will hurt myself to punish myself.

R yes. S1 to let others... R yes, so that’s what the self-harm does – is it a way of you punishing yourself? S1 I feel like release – sometimes when I saw the blood come out, I feel relief. R yes... when people said to you, I think you should get some help, what did you do, who do you talk to? S1 I should get some help. R yes... S1 like the day before yesterday I harmed myself again – after that I cried – I feel guilty – I know if they know it must be painful because of me and I feel very, very guilty and ashamed and I try so I didn’t sleep the whole night. Sometimes, not all the time, I have difficulty to sleep at night – I’m getting excited at night and I want to smoke to relax so then in the morning we had a fight – I just had a fight with my boyfriend and I harm myself again so um, that’s pretty true to how – I don’t want my father to know – I don’t want him to know – I don’t want everybody knows – I just don’t know what to do after I feel very hurt – what to express so... R yes... is there... are there some supports here that you can... The interview was terminated and with the student’s permission the counsellor was contacted and able to provide immediate support. The student disclosed her mental illness to the counsellor who agreed to hold the information in confidence. No disclosure was made to the teaching section. At the follow-up interview, the student reported contact had been maintained with the counsellor, however she also stated she was at risk of failing most of her subjects. As an international student this potentially had serious consequences for her continued stay in Aus-


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tralia. She was still resisting formal disclosure of mental illness. In the second instance, the student reported a history of feeling unheard by those from whom she had sought help. These experiences had convinced her of the futility of disclosure in the VET environment. S2 you know, it’s like I’m trying to get the help but no-one wants to do that – noone wants to listen – no-one wants to know what I’m trying to tell them – it seems like there’s a wall there – there’s a wall there and it’s not getting through... R Have you told anyone at TAFE about your anxiety? S2 no, I’ve kept it all to myself. R can I ask you, what, how you make that decision. How do you decide who to tell and who not to tell? S2 well, I felt by telling that no-one’s going to take any notice and they think I’m just stupid – weird – going off me head...I’m not going off me head – it’s – I’m definitely not, definitely not. R Definitely not – so that’s – that has stopped you from telling at TAFE? S2 yes. R yes, and telling anyone? S2 telling anyone what I’m, what I’m facing. R yes – so the only thing... S2 it’s like I can’t – it’s like it’s if I did tell – if I can tell them...but I just feel if I tell anyone what’s it going to do for me. R yes, what’s the point.

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S2 yep – I’m thinking about going back to my doctor and saying can I go away for Rehab for a little while. The research interview was terminated at this point and the focus shifted to the student’s experience of local support services. The student expressed a willingness to consider speaking with the VET counsellor (a service limited to one day per week) with a view to talking about study skills, not about her mental illness. She reported being unaware of the existence of the on-site counselling service. As part of our commitment to participant safety, service contact and access details were provided immediately. This student remained in the study and in the follow-up interview reported feeling unsupported by the VET counsellor; however, she advised that she had resumed contact with local mental health professionals. In each of these instances the tape recordings and notes made at the time of the interview were re-examined within hours of the interview being completed. This was in an attempt to determine if the level of support offered by the researcher was commensurate with the degree of distress and vulnerability exhibited by the student. It was also to determine if the researcher had maintained clarity of boundaries and research focus and avoided adopting a therapeutic stance (Padgett, 1999). There are difficulties associated with researching in the area of one’s professional practice and the management of this tension requires a degree of self-awareness and reflexivity beyond that demanded in either domain alone (Padgett, 1999). Field notes made at the conclusion of each interview and regular meetings provided the opportunity for the research team to engage in ongoing critical reflection (Rennie, 2004).

S2 what’s the point...

Active advice seeking

R yes… yes – you’ve been to a lot of places and nothing has helped so far, and you’ve been to a few counsellors and nothing has helped there so far, so it’s almost like...

It is generally accepted that participation in a research interview may leave people more aware of parts of themselves than they were prior to the interview (Patton, 2002). This could be a result




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of active help seeking or a result of the directed reflective process that typifies many research interviews. Direct bids for assistance were made in three of the research interviews and took the form of advice seeking. The following excerpts provide examples of researcher responses to direct requests for advice. In the first instance the student expressed concern with an unresolved conflict with a fellow student; in the second instance a direct appeal for increased understanding came after more indirect approaches for help; and the third example relates to career advice. S3 yes. So why am I letting this get me down? R well that’s, that’s an interesting question. isn’t it? At the moment... and um, and one that I, I think might be useful for you to talk about... I was wondering if you’d had a chat with [the counsellor] who comes each Wednesday. S3 I did have a chat with her on the phone but I felt that she wasn’t particularly helpful and hung up on me so ... A ok, so she hasn’t been useful for you? S3 no. S2 can I ask you something – what’s the ... what do you think about what’s going on with me? R oh well… I think that you’re trapped in a situation and you can’t find anyone who’ll listen to you… You’re going round and round in circles and until you can find someone, things are not going to get any better. S2 I know that. S4 I think if I wasn’t so strong I could have been one of those people that jumped off a bridge or I could have been this or a drug addict but god knows but there was something inside me strong enough to force me in the right direction. A lot slower path but I got there eventually.

R yes you got there, something, something helped you didn’t it? S4 yeah – so I think that might be an option for me – at one point and I don’t actually – maybe that’s where you could advise me because I don’t know a lot of the study options – you know, I don’t want to be at University till I’m 30 – I wouldn’t mind – after I finish in November studying parttime next year or the year after or whatever it is and exploring what options there are out there. R is um, is [the campus counsellor] good at that stuff? Course info? S4 yes she is. R yes. S4 very very very good. On each of these occasions the researcher attempted to acknowledge the bid for assistance yet not engage in a helping response. It was possible that the participants perceived the response as inadequate since it did not directly address the concern raised. This did not appear to detract from their commitment to participate in the study, however, as on each occasion the research interview continued without interruption. The capacity of the researcher to recognise and respond to participant distress is crucial. This is a key ethical issue that must be addressed in research design and procedures. While the ability for a research site to offer a counselling service was a key feature in site selection, it should be noted that access to the service was variable. It took considerable and persistent effort on our part to access the one day a week counselling service for the purposes of promoting the study. In reality, a student expressing ambivalence about the usefulness of a service is unlikely to be as persistent as we were. In future, we recommend investigating the ease of accessing supports, not merely the existence of supports, prior to the recruitment


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of participants. The presence of a service does not guarantee ready access.

CONCLUDING

health issues. This is a timely contribution to the current debate on strategies designed to listen to the voice of the disadvantaged learner.

REMARKS

Interpretive research tackling sensitive, real-life concerns has inherent ethical and methodological challenges. Denzin and Lincoln’s (2000) articulation of the crisis of representation has led to a greater understanding of the complexities of fairly representing the experiences of participants, and the subjectivity of the researcher has become embedded in considerations of whose reality is represented in the research. This concern remains central to the work of interpretive/constructivist and constructionist scholars who employ a number of strategies in their drive to fairly represent participants’ realities (Morrow, 2005). The meaningful inclusion of the voice of the often hidden and perhaps disadvantaged learner is recognised as central to system-wide change and improvement in VET; however, more attention must be paid to the meaningful involvement of those with lived experience of mental illness in research and service development (Epstein, McDermott, Meadows & Olsen, 2001). All research confronts challenges and our study is no exception. Caution must be exercised when applying the lessons learned from one study to another. Despite the purposeful recruitment of participants able to provide rich data there were many voices our study did not hear. Challenges encountered in student recruitment may have been reduced had we developed an advisory committee of key stakeholders across research sites (Moll, Eakin, Franche and Strike, 2013) to assist in the navigation of local sensitivities in data collection and research dissemination. Adopting the use of participatory research processes (Fossey, Harvey, McDermott & Davidson, 2002) and affording an opportunity to involve the students and staff in the development of the research questions may also have influenced participation. Limitations notwithstanding, we have presented a critical reflection on some of the methodological processes and challenges we encountered in our research with VET students experiencing mental 54


A CKNOWLEDGEMENT This research was funded by the National Centre for Vocational Education Research.

R e f e rences American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revised). Washington, DC: American Psychiatric Association. Bathurst, L., & Grove, J. (2000). Damned if you do. Damned if you don’t. Students’ experiences of disclosing a mental health disorder. Paper presented at the Pathways IV, Canberra, ACT, 5–8 December. Burr, V. (1995). An introduction to social construction. London, England: Routledge. Cavallaro, T., Foley, P., Saunders, J., & Bowman, K. (2005). People with a disability in vocational education and training: A statistical compendium. Adelaide, SA: National Centre for Vocational Education Research. Charmaz, K. (2006). Constructing grounded theory. Los Angeles, CA: Sage. Commonwealth of Australia. (1992). Disability Discrimination Act, Canberra, ACT: Author. Conrad, P., & Barker, K. K. ( 2010). The social construction of illness: Key insights and policy implications. Journal of Health and Social Behavior, 51(S), S67–S79. doi: 10.1177/0022146510383495. Day, S. (2012). A reflexive lens: Exploring dilemmas of qualitative methodology through the concept of reflexivity. Qualitative Sociological Review, 8(1), 60-85. Denzin, N., & Lincoln, Y. (2000). Introduction: The discipline and practice of qualitative research. In N. Denzin & Y. Lincoln (Eds.), Handbook of qualitative research (2nd ed., pp. 130). Thousand Oaks, CA: Sage. Du Bois, J. (2007). Ethics in mental health research. Oxford, England: Oxford University Press. Epstein, M., McDermott, F., Meadows, G., & Olsen, A. (Ed.). (2001). Mental health in Australia: Collaborative community practice. Melbourne, VIC: Oxford University Press. Field, S., Hoeckel, K., Kis, V., & Kuczera, M. (2009). Learning for jobs: OECD policy review of vocational education and training, Initial Report. Paris, France: OECD.




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