How Does the Mental Health Lived Experience Workforce Describe and Enact Our Discipline? A Narrative Literature...

Worldwide, mental health systems continue to grapple with providing recovery-oriented services as part of broader reform efforts. Critical to the objective of transforming mental health services is the employment of a rights-based, non-clinical lived experience workforce. Vital to undertaking the roles, and supporting this workforce, is a comprehensive understanding of the knowledge and practices of the discipline, particularly in situations where rapid growth may see this workforce developing in an ad hoc way. The aim of this review was to determine how members of the mental health lived experience workforce describe and enact our discipline, by synthesising evidence and illustrations.

A narrative review methodology employed searches for international peer reviewed literature and policy documents related to lived experience work. Resources required at least one mental health lived experience author. We used a deductive approach to the categorisation of three designated mental health lived experience role types: service delivery (such as peer support); leadership; and Indigenous. An inductive approach was then taken to identify the knowledge and practices informing the three role types. Relevant texts were allocated amongst the research team, independently read, coded and themed, followed by team discussions to reach consensus where there were conflicts.

After full text reading, we identified 25 resources. There were many more resources about the knowledge and practices of lived experience direct service delivery than about leadership roles. Three themes emerged from the knowledge and practices for each role type. For direct service roles knowledge was: having been there; knowing helpful qualities of relationships; and knowing how to use your own lived experience intentionally. Practices for direct service roles were: working relationally, sharing lived experiences in a meaningful way and working in a values and rights-based way. Knowledge required for leadership was: ethical decision-making; being informed by collective/shared history and knowing how to create change. Required practices were: transforming services from within; embedding the lived experience workforce and championing justice. Themes describing Indigenous knowledge were: challenging exclusively Euro-centric modes of treatment, truth-telling and self-determination. Emerging themes on practices of designated Indigenous lived experience workforces were: relational and community approaches, trauma informed, and culturally sensitive and safe practices.

Articulation of the knowledge and practices underpinning the lived experience discipline is required for this workforce to be confident in the scope, purpose and history of their roles and for organisations to successfully establish them and provide effective supports. For Indigenous workers in designated lived experience roles, approaches to wellbeing and cultural practices cannot be separated from the way that the roles are carried out. Embedding Indigenous leadership, knowledge and practices would strengthen the human rights, justice-based and non-clinical nature of these roles, is a necessary response to colonial violence and would guide workforce development for other LE staff, mental health professionals, and mental health service development.