Table 3.

Student attitudes about working with people with severe mental illness

Theme	Codes	Categories	Supporting Quotes
Pre-SL
Uncertainty and fear	Fear and concerns for safety	Negative Perceptions	“I didn’t know if people would be freaking out sometimes, like if we’d ask them to do things, and maybe it might be dangerous at times, or like I don’t know, I just don’t even know what that would be.”
	Concern about ability to participate	Uncertainty	“I figured there would be more challenges for sure whether it’s communication or physically. I thought there would be more challenges. For example, I thought they’re sedentary or they have difficulty with activities of daily living.”
	Lack of knowledge and ambiguity, unpreparedness, and lack of awareness of needs	Lack of preparedness	“[Individuals with a serious mental illness] are definitely a population I hadn’t really thought about specifically. It’s not something that we really learn a lot about in physical therapy.”
Post-SL
Personal and professional growth	Expanded abilities; working in a new environment; in vivo application of skills, inter-professional practice; and flexibility in practice and adaptation to population needs	Problem solving	“We came up with how we thought we would approach the physical activity portion and within the first week quickly realized that what we had planned was not going to work …[we] had to change our approach. I think that was very helpful. Going in with this plan and then reading your patients, and then getting an idea of what works for them and having to change [the plan] to meet their needs.”
	Attain new skills and challenge to improve clinical services	Expanded abilities	“I think the really biggest thing was getting outside the comfort zone…it was just this really positive and challenging experience that probably made us all grow.”
	Providing PT services in the context of other disciplines; teamwork	Interprofessional practice	“It was the first time I saw multiple disciplines [e.g. physical therapy, mental health, peers, dietitians] together working with one population and saw how that teamwork and the multidisciplinary approach was really important.”
	Identifying deficits in focus and attention; managing time	Working through challenging behaviors	“I would say one challenge was having everybody staying on task. A lot of times they get distracted easily…something’s going on in the room. So I think that the biggest challenge was grabbing the attention of everybody.”
Benefits for People with SMI	Physical strength, emotional well-being	Improved health and fitness levels	“It shows you the benefits of exercise and even if you start on a low level the overall benefits, reducing anxiety, increasing endurance, wellbeing.”
Positive Experience	Includes students/graduates and participants. Reflective of process and outcomes.	Mutually enjoyable	“The most important thing I took away…[it] was just a joyful experience. I really enjoyed it. I thought that it was something that was interesting. I really enjoyed participating in it. It was beneficial to me as a student to prepare me for my career and I thought that it was beneficial to them just to get [the people with SMI] up and moving…[with] an hour of something fun to do.”
	Reflective practice, highlighting motivation, and adaptation of practice {positive exp. -engagement	Engagement	“I remember there was a situation where one of the men who was participating in the program was having difficulties getting motivated. I recall one of my colleagues … working very closely next to him, reiterating everything that we were going through and doing the movements in front of him. I found that once we got to the more active stuff he got excited and kind of lit up and stood up and started participating ….and it was really nice to see.

SL=Service-learning, SMI=Severe mental illness, PT=Physical therapy