If you are lucky enough to experience leading a group on a psychiatric intensive care unit, you are in for a treat. You will most likely be challenged, entertained, delighted, and educated yourself all at the same time. The patients on a psych unit are going through crisis, and they have mental illnesses which make education challenging. The education, however, is all that much more important to them. Psychiatric patients are in the hospital because they need stabilization from their crisis, and if you have the opportunity to educate them you at least one key to unlock a higher quality of life.

Some frequent issues challenge the learning environment of the inpatient psychiatric educational group. These challenges can totally ruin any possibility of patients learning anything from the group you lead. These challenges are sure to present themselves, because the people have problems. Keep this in mind. And note that some resistance from students is good because is indicates engagement.

• Wide variation in developmental levels
• Overactive and under-active participation
• Short attention span
• Total disrespect for the leader

The success of the group should be measured by learning. More specifically, whether the patients learned what you designed for them to learn. You can "wing it" and have a great group, but you can also have an awful group. When leaders are winging it you get a wide variation across different leaders. Of course, some topics are going to naturally be better for some leaders, but structure in the planning process can minimize the factor of chance.

Ask yourself what it is that you would like your patients to learn from your group. These can be deep understandings to simpler ideas and concepts. You are the designer of the learning, and the best way to design anything whether it be a car or a lesson plan is by starting with the goal in mind. Do you want your students to learn that when they go off meds and pass up sleep they end up in crisis and earn a trip to the hospital? Start there for yourself, but work backwards to plan the learning activities of the group. This idea comes from a popular education book Understanding By Design (or UBD). It is a backwards planning concept. This is much better than simply finding resources and making them fit. Backwards planning starts with understandings in mind which choose which resources will fit.

• Tip: Make a concept map with your large understanding in the middle of the page. Spider web to smaller ideas and concepts. Use this as your crude lesson plan.

Depending on where you are working, you will probably have certain topics you are to teach clients, ranging from life skills to medication education. You will be responsible for teaching clients on these topics. Think about what order you should present each concept. The education field uses something called "scaffolding" in order to allow students to understand concepts by building on what they know. Start with where your patients are. Then give them the next step of education. If your patients need a group on personal hygiene and wellness more than communication skills, then start there. Even better yet let your hygiene group lead into communication skills noting the fact that hygiene communicates something to others as well as other non-verbal communication. Now you are scaffolding and prioritizing for the needs of your students.

• Tip: Stay Flexible and Scaffold Learning Experiences. Ensure that your lesson is appropriate to the clients you are serving. Survey your students to learn more about them. Just asking can really help.

Now that you have an idea of the "what" and "when" you will teach things, lets examine the "how." Keep in mind that you may have some clients who have more education than you while others in the group are developmentally disabled. "Dumbing Down" is not acceptable as you will quickly notice the higher functioning people losing interest. "Talking over their heads" is not a good idea either as you will find the same thing in the lower functioning patients. The way educators deal with this dilemma is by using differentiation. Differentiation is a term for strategies that allow all students on varying levels to learn from a single lesson. Veteran educators incorporate these strategies without thinking about it. Your job is to choose appropriate strategies at appropriate times.

• Choice. This sounds simple, but it is easily overlooked and one of the easiest to incorporate. You can give your students choice about what they learn, thus making them feel included in their own learning. This is like including them in their treatment plan. Cut down on engagement issues right away with this strategy. I suggest asking for feedback individually or in written form to gain good feedback without starting a riot.
• Group Work. This allows those at higher levels of functioning to help those at lower functioning levels. Be careful when designing your group work. Larger groups are more difficult to control. Make sure you have a clear explanation of expectations of each group member; assign roles. It is a good idea to choose who you want to work with who. This keeps people from choosing friends and socializing too much, and making others feel left out.
• Utilize Multiple Learning Styles. There are different types of intelligence types and different learning styles. Many people say they are visual learners. Survey your clients to find out what works best. I have found most learn the best from visual media and by doing. Professional educators use graphic organizers to make difficult information easier to understand. This cuts down on engagement problems. Use variety to keep your lessons interesting. Ideas include having patients listen to a song, write their own reaction, and then watch the video that the artists made. Then have the patients write their own song either collectively, in groups, or individually. And this could be just the intro to your topic.

We have investigated tools to ensure learning in our mental health groups. Depending on what challenges you are currently having or foresee in the future, you can use tactics to address each. Another unmentioned thing to think about is making your groups relevant to your clients. Aim material at their demographics. Keep in mind their age, interests, socioeconomic status, etc. Let's revisit the common challenges and list possible remedies.

• Differentiation (including: group work, using multiple learning styles, student choice)
• Scaffolding (building on what patients already know/learned)
  

• Set ground rules and expectations (examples: Respect others, No putting down others, Listen to others, No sharing of personal stories for this group)
• Differentiation (including: group work, using multiple learning styles, student choice)
• Scaffolding (building on what patients already know/learned)

• Differentiation (including: group work, using multiple learning styles, student choice)
  
• Scaffolding (building on what patients already know/learned)
• Ask yourself what would allow you to pay attention through the group.
  

• Differentiation (including: group work, using multiple learning styles, student choice)
• Set ground rules and expectations (examples: Respect others, No putting down others, Listen to others, No sharing of personal stories for this group)
• Examine your own attitude
• Avoid offensive statements
• Use Love and Logic language